Exercise and Fibromylagia

1. Exercise and Fibromylagia

2. Exercise in Fibromyalgia Kaisa Mannerkorpi Current Opinion in Rheumatology 2005, 17:190-194

3. Mannerkorpi, K. et al. Physical exercise in fibromyalgia and related syndromes. Best Pract Res Clin Rheumatol 2003; 17:629-647.

4. What is Fibromyalgia? A complex condition that causes persistent pain in muscles, ligaments, tendons, and joints (most commonly the neck, back shoulders, pelvic girdle and hands). It is usually accompanied by a primary or secondary chronic medical condition such as rheumatoid arthritis, hypothyroidism, and, most particularly, chronic fatigue syndrome

5. How prevalent is it? 1-3% of the population world wide. 3-6% in the US. 3.4% of all women; 0.5% of all men

6. What causes it? A disorder of central processing with neuroendocrine/neurotransmitter dysregulation which is amplified due to abnormal sensory processing in the CNS Some abnormalities found in FM patients Increased levels of substance P in the spinal cord Low levels of blood to the thalamus region HPA axis hypofunction Low levels of serotonin and tryptophan Abnormalities in cytokine function

7. What are symptoms of fibromyalgia Widespread pain with fatigue (reported by approximately 90% of people with FM), and disturbed sleep Irritable bowel and bladder, headaches, restless leg syndrome, impaired memory, skin sensitivity, dry eyes and mouth, anxiety, depression, dizziness, vision problems, etc. Symptoms can be made worse or triggered by anxiety, cold or drafty environments, depression, hormonal changes before menstrual periods or during menopause, physical overexertion, stress, and weather changes

8. Diagnosis No laboratory test available My take 5 years for some patients to be diagnosed Criteria: Widespread pain in all four quadrants of the body for a minimum of 3 months Tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied

10. Specified Tender Points

12. Treatment OTC pain medication Antidepressants (increase serotonin) Sleep management Psychological support Exercise

13. Exercise and FM Muscle deconditioning occurs with FM when exercise is neglect in order to avoid pain. Deconditioned muscles use excess energy to accomplish tasks. This may contribute to more fatigue and make the muscles more susceptible to microtrauma, thus aggravating pain even at low intensity exertion. This cyclical process leads to atrophy and greater effort performing various activities.

14. Exercise and FM Exercise can help to counteract this deconditioned state by improving oxygen delivery, increasing cellular metabolism, reducing muscle tightness, and eventually relieving pain to some degree. The main aims of exercise are to relieve and restore the effects of the prolonged deconditioning that may occur.

15. Exercise and FM Exercise for FM should include a comprehensive exercise program that incorporates designating individual goals, a slow start, pain management, and specific exercises for aerobic benefits, flexibility, and, where possible, increasing strength. There is no "One Size Fits All" when it comes to designing the appropriate exercise program for people with FM.

16. Exercise Benefits Increase in or prevention of a reduction in aerobic capacity Increase in or prevention of a reduction in muscular strength Relieving much, if not all, physical pain Reducing physical impairment and recovering function Improving flexibility Improving weight control Improving sleep Improving energy levels Reducing stress and depression Improving self-efficacy, some feeling of control over one's care, and overall feelings of well-being

17. Exercise Concerns Many people report experiencing exercise-induced pain 1 to 3 days following exertion. Some days may be worse than others but one “bad” day shouldn’t prevent future exercise

18. General Exercise Suggestions Avoid high intensity, high impact exercises The exercise program should start out slowly and gradually which will reduce the risk of muscle pain or trauma Alternate cycles of moderate activity with cycles of rest. Aerobic exercise and stretching are most helpful; strength training should be added later. Exercise is most helpful when done on a regular basis

19. General Exercise Many FM patients describe themselves as "exercise intolerant," that is, they report no noticeable improvement in symptoms following exercise Some find that exercise greatly reduces their pain Improvement in or prevention of a reduction in aerobic capacity Similar results with short or long bouts of exercise with the same total time Some studies show no improvement in aerobic capacity Differences due to the various training programs and baseline levels of FM in the patients Increase pain threshold Reduce their symptoms

20. Stretching Stretching can help remedy the general loss of flexibility inherent with FM Much of FM pain occurs in the muscles and tendons In most people tendons shorten with age and may become painful or discomforting when they are tight or when they are stretched--as they are in most exercise routines.

21. Aerobic Exercise People with FM may need to begin at the low end of this heart rate range or even much lower. Aerobic activity may lead to self-efficacy and increased psychological well-being, as well as pain relief, due to the release of hormone-like substances--endogenous endorphins. Pain may occur 1 to 3 days after exercise so any changes should be made gradually High-impact exercise has been known to worsen FM symptoms. At least 10-15 minutes but 20 to 30 minutes of aerobic exercise is recommended. Gradually increase up to 40 or even 60 minutes of exercise, 3 times a week.

22. Walking Results from walking are improved physical function, self-efficacy, tender point status, well-being, and quality of life with some lasting up to 7-11 months. As a minimum, start with 1 or 2 minutes and increase until walking for 30-60 minutes, 3-4 times a week

23. Jogging Recommended to be able to comfortably walk 3-4 times a week before starting a jogging program. May still need or want to alternate walking with jogging

24. Cycling Stationary bikes in an upright or recumbent position (not bent forward) may work best

25. Pool Exercise Recommended due to low impact and warm water (88-90 F) Benefits include reduced stiffness and pain and improvements in aerobic fitness. Studies using control groups show pool exercise improved FM symptoms including less depression, pain, fatigue, and stiffness.

26. Strength Training Not for all FM patients Muscular endurance program of low resistance and moderate reps Elastic bands may be a good option FM patients can increase or prevent a reduction in muscular strength through resistance exercise.

27. Qigong Movement Therapy Aimed at improving the quality of movement, concentration, and peacefulness. One study found it was effective but not more so than an educational program while another study found it to be more effective in “movement harmony” but not reducing symptoms.

28. Exercise Combined with Education Education helps with the ability to manage the disease and the difficulties encountered in daily life. Combining both are effective but no study has been conducted to determine if one is more effective than the other. FM patients who are informed about the risks and benefits of exercise are more likely to adhere to an exercise program.

29. Exercise and Symptoms Inconsistent results from research studies. Some studies found improvements in tender point status while others did not. Most patients chose to exercise at lower intensity levels.

30. Long-term Adherence Ability to deal with the increase in post-exercise pain (temporary)