Heterogeneity in fibromyalgia based upon cognitive and physical performance and psychological symptomology.

PURPOSE: This study sought to investigate the existence of subgroups within a fibromyalgia (FM) sample based on physical and cognitive performance measures, as well as self-report psychological measures. A multisystem disorder characterized by widespread musculoskeletal pain and co-morbid conditions, FM can lead to declines in cognitive functioning and difficulty with psychological health. DATA SOURCES: Community participants (n = 57 women) recruited from support groups and university center databases provided documentation of having met the criteria for diagnosis of FM. Measures included validated performance and self-report instruments. Analysis was completed using hierarchical cluster analysis; a four cluster solution was chosen for its level of interpretability. The resulting model identified four distinct subgroups based upon patterns of performance and symptomology. Significant group differences were found on pain, fatigue, stiffness, and level of physical activity. CONCLUSIONS: Study results support the existence of subgroups among the FM population based on levels of cognitive and physical performance and psychological symptoms. IMPLICATIONS FOR PRACTICE: Nurse practitioners aware of potential subgroups within FM should be better prepared to recommend treatment options for patients that target subgroup characteristics (e.g., high vs. low levels of psychological symptoms).

A comparison of women with fibromyalgia syndrome to criterion fitness standards: a pilot study.

PURPOSE: To compare fitness of women with fibromyalgia syndrome (FMS) aged 50+ with performance standards associated with functional independence in late life. METHODS: Data came from a longitudinal study tracking physical and cognitive function of 93 women with FMS and included the most recent symptoms, activity levels, and fitness assessments. RESULTS: Most women performed below criterion-referenced fitness standards for all measures. Nearly 90% percent of those < 70 years scored below the standard for lower body strength. Only ~20% of respondents < 70 years old met the criteria for aerobic endurance. A third of those aged over 70 met the standard in agility and dynamic balance. Physical activity was positively associated with fitness performance, while pain and depression symptoms were negatively associated. DISCUSSION: High proportions of women with FMS do not meet fitness standards recommended for maintaining physical independence in late life, indicating a risk for disability. Regular fitness assessments and targeted exercise interventions are warranted.

Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years.

PURPOSE: To develop and validate criterion-referenced fitness standards for older adults that predict the level of capacity needed for maintaining physical independence into later life. The proposed standards were developed for use with a previously validated test battery for older adults-the Senior Fitness Test (Rikli, R. E., & Jones, C. J. (2001). Development and validation of a functional fitness test for community--residing older adults. Journal of Aging and Physical Activity, 6, 127-159; Rikli, R. E., & Jones, C. J. (1999a). Senior fitness test manual. Champaign, IL: Human Kinetics.). METHODS: A criterion measure to assess physical independence was identified. Next, scores from a subset of 2,140 "moderate-functioning" older adults from a larger cross-sectional database, together with findings from longitudinal research on physical capacity and aging, were used as the basis for proposing fitness standards (performance cut points) associated with having the ability to function independently. Validity and reliability analyses were conducted to test the standards for their accuracy and consistency as predictors of physical independence. RESULTS: Performance standards are presented for men and women ages 60-94 indicating the level of fitness associated with remaining physically independent until late in life. Reliability and validity indicators for the standards ranged between .79 and .97. IMPLICATIONS: The proposed standards provide easy-to-use, previously unavailable methods for evaluating physical capacity in older adults relative to that associated with physical independence. Most importantly, the standards can be used in planning interventions that target specific areas of weakness, thus reducing risk for premature loss of mobility and independence.

Positive associations between physical and cognitive performance measures in fibromyalgia.

OBJECTIVE: To investigate the associations between perceived physical function (self-report) and physical and cognitive performance (objective assessments) in persons with fibromyalgia (FM). DESIGN: Correlational study. SETTING: Exercise testing laboratory in Southern California. PARTICIPANTS: Community-residing ambulatory adults meeting the American College of Rheumatology 1990 criteria for FM (N=68; mean age, 59.5y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Composite Physical Function scale, Senior Fitness Test (3 items), Fullerton Advanced Balance scale, 30-foot walk, Trail Making Test parts A and B, Digit Symbol Substitution Test, a composite score of these 3 cognitive measures, attention/executive function composite, processing speed composite, problem solving, inhibition, and episodic memory composite. RESULTS: Hierarchical regression analyses showed that after controlling for age and FM symptoms, better physical performance (based on assessments, not self-report) was associated with higher cognitive function in attention/executive function, processing speed, problem solving, and inhibition. CONCLUSIONS: Researchers should continue to investigate the relationship between physical and cognitive function in both clinical and nonclinical populations, as well as explore changes across time. Because physical activity has been associated with neural improvements, further research may identify whether particular mechanisms, such as neurogenesis, synaptogenesis, or changes in inflammatory marker levels, are involved.

Typology of chronic pain among overweight Mexican Americans.

Having a better understanding of the intersection between chronic pain and obesity in the Mexican American community can be valuable for pain management specialists in determining treatment, service, and prevention strategies. The objectives of this study were (1) to describe the type and severity of chronic pain among overweight/obese Hispanic adults aged 40 years and older, and (2) to determine the association between chronic pain indices and key demographic variables, including excessive weight. Hispanic adults (N=101) were interviewed using validated questionnaires and measured for BMI and waist circumference. Data analyses revealed that most participants had widespread pain; 60% were suffering severe pain (including back, knee, and shoulder pain); the most common pain location was head (headache, 80%), followed by knee and upper back (75-76%), shoulder (73%) and lower back (73%). Greater obesity was associated with some negative pain outcomes. Results are relevant for pain management with this at-risk population.

Predictors of physical performance and functional ability in people 50+ with and without fibromyalgia.

The purposes of this study were to determine whether people with and without fibromyalgia (FM) age 50 yr and above showed differences in physical performance and perceived functional ability and to determine whether age, gender, depression, and physical activity level altered the impact of FM status on these factors. Dependent variables included perceived function and 6 performance measures (multidimensional balance, aerobic endurance, overall functional mobility, lower body strength, and gait velocity-normal or fast). Independent (predictor) variables were FM status, age, gender, depression, and physical activity level. Results indicated significant differences between adults with and without FM on all physical-performance measures and perceived function. Linear-regression models showed that the contribution of significant predictors was in expected directions. All regression models were significant, accounting for 16-65% of variance in the dependent variables.

Do fall predictors in middle aged and older adults predict fall status in persons 50+ with fibromyalgia? An exploratory study.

We explored potential predictors of fall status in 70 community-dwelling persons > or =50 years of age with fibromyalgia (FM). Over 40% of the sample reported one or more falls in the year prior to the study. A logistic regression model using 10 variables known to predict falls in middle aged and older persons predicted 45% of the variance in fall status. Three variables offered significant independent contributions to the overall model predicting fall status: perception of postural instability, balance performance, and executive function processing speed. The results support prior work in both nonclinical and clinical populations of middle aged and older adults indicating that falls are associated with multiple risk factors. Prospective designs with larger samples are needed to (a) validate and extend these findings, and (b) identify risk factors related to fall status that are unique to persons with FM.

Physical performance as a predictor of attention and processing speed in fibromyalgia.

UNLABELLED: Cherry BJ, Weiss J, Barakat BK, Rutledge DN, Jones CJ. Physical performance as a predictor of attention and processing speed in fibromyalgia. OBJECTIVE: To explore the associations between physical (both self-report and objective measures) and cognitive function for persons with fibromyalgia (FM). DESIGN: Correlational study. SETTING: An exercise testing laboratory in southern California. PARTICIPANTS: Community-residing and functionally independent (not wheelchair-bound) adults meeting the American College of Rheumatology 1990 criteria for FM (N=51) with a mean age of 54 years and no history of stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Composite Physical Function Scale, Fibromyalgia Impact Questionnaire, adapted Trail Making Test parts A (TMT-A) and B (TMT-B), Digit Symbol Substitution Test, a composite index of TMT-A, TMT-B, and Digit Symbol Substitution Test combined, and physical performance assessments. RESULTS: Hierarchical regression analyses indicated that better objective physical performance predicted increased cognitive function for TMT-A and the composite cognitive score after controlling for age and symptom burden. That is, as the physical performance level decreased, cognitive performance levels decreased. CONCLUSIONS: Findings suggest that research is needed to determine whether patterns of physical activity participation, through their effects on physical fitness and performance, can enhance cognitive performance in persons with FM. Physiologic changes in specific brain regions in FM (eg, hippocampus, neural pain regions) suggest that further research is also warranted in determining specific relationships between biomarkers and cognitive performance in persons with FM.

Predicting high physical function in people with fibromyalgia.

PURPOSE: The purpose of this study was to investigate predictors of high physical function in people with fibromyalgia (FM). DESIGN: Cross-sectional descriptive, correlational study of 2,580 persons with FM who responded to an online survey during fall 2005. METHODS: The survey indicated self-reported physical activity levels, functional abilities, symptoms, health care costs, employment status, work productivity, self management strategies. It had adequate validity and reliability. A significant binary logistic regression model of predictors of physical function (individual factors, symptoms, self management strategies) was validated using backwards logistic regression. FINDINGS: Significant explanatory variables of high physical function were: men, greater education, younger age, lower intensity fatigue, spasticity, and balance problems, not using prescription pain medications, using aerobic or strength training exercise, and not using relaxation methods. CONCLUSIONS: People with FM suffer from multiple symptoms and use many modalities to control symptoms to remain functional. Given knowledge of predictors of physical function in FM, health care providers might be able to develop strategies to promote better functioning. Prospective trials are needed to track the natural course of study variables, measuring their effect on function, and to test effects of interventions to maximize function.

Effects of topical essential oil on exercise volume after a 12-week exercise program for women with fibromyalgia: a pilot study.

OBJECTIVES: We determined--in women with fibromyalgia (FM)--effects of essential oils used with a 12-week exercise program on exercise volume, pain, physical performance, and physical function. DESIGN: This was a randomized clinical trial comparing 024 essential oil with sham oil combined with exercise. SETTINGS: SETTINGS included community sites in southern California. SUBJECTS: The study included 20 women randomized to 024 oil, 23 to sham oil. INTERVENTIONS: Women were trained in oil application before exercise, at bedtime on exercise days; the 12-week program included weekly group sessions with trained leaders guided by a prerecorded regimen (allowing choice of program level) plus 2 days of home exercise with the recorded regimen. OUTCOME MEASURES: Primary: Exercise volume (number of days exercised multiplied by exercise level--intensity and duration). Secondary: Pain (Brief Pain Inventory), measures of physical performance (30-second chair stands, 6-minute walk, multidimensional balance), and self-reported physical function (Composite Physical Function scale). RESULTS: The average participant was 54 years old, had some college education, was married, Caucasian, and minimally/mildly depressed. There was no significant difference in exercise volume between women using 024 as compared with those using sham oil after 12 weeks (depression as covariate). There were no significant group nor pre- to postexercise changes in pain intensity or interference. There were greater positive changes in 30-second chair stands, 6-minute walk distance, and multidimensional balance scores in the 024 group than in the sham group, but these were not significant. The counterirritant 024 oil was not different from the sham oil in its effect on exercise volume (frequency, exercise level--intensity and duration) for women with FM. It is unknown whether 024 actually decreases local pain when used with exercise. CONCLUSIONS: Increases in physical function found, while not significant, may be attributable to the exercise regimen or to the interaction of the oils and exercise regimen.