Physical fitness reference standards in fibromyalgia: The al-Ándalus project.

We aimed (1) to report age-specific physical fitness levels in people with fibromyalgia of a representative sample from Andalusia; and (2) to compare the fitness levels of people with fibromyalgia with non-fibromyalgia controls. This cross-sectional study included 468 (21 men) patients with fibromyalgia and 360 (55 men) controls. The fibromyalgia sample was geographically representative from southern Spain. Physical fitness was assessed with the Senior Fitness Test battery plus the handgrip test. We applied the Generalized Additive Model for Location, Scale and Shape to calculate percentile curves for women and fitted mean curves using a linear regression for men. Our results show that people with fibromyalgia reached worse performance in all fitness tests than controls (P < 0.001) in all age ranges (P < 0.001). This study provides a comprehensive description of age-specific physical fitness levels among patients with fibromyalgia and controls in a large sample of patients with fibromyalgia from southern of Spain. Physical fitness levels of people with fibromyalgia from Andalusia are very low in comparison with age-matched healthy controls. This information could be useful to correctly interpret physical fitness assessments and helping health care providers to identify individuals at risk for losing physical independence.

The association of total and central body fat with pain, fatigue and the impact of fibromyalgia in women; role of physical fitness.

BACKGROUND: The relationship between estimates of total and central body fat with fibromyalgia pain, fatigue and overall impact has not been fully described. We aimed to assess the individual and combined association of body fat (total and central) with pain, fatigue and the overall impact in fibromyalgia women; and to study the possible mediation role of physical fitness in these associations. METHODS: A total of 486 fibromyalgia women with a mean (standard deviation) age of 52.2 (8.0) years participated. Pain was measured with self-reported measures and algometry, whereas fatigue with the Multidimensional Fatigue Inventory. The impact of fibromyalgia was measured with the Revised Fibromyalgia Impact Questionnaire (FIQR) total score. Total and central body fat were assessed by means of bioelectrical impedance and waist circumference, respectively. The Functional Senior Fitness Test battery and the handgrip strength test were used to assess physical fitness. RESULTS: Total and central body fat were positively associated with pain- and fatigue-related measures and the FIQR total score (ß from 0.10 to 0.25; all, p < 0.05). A combined effect of total and central body fat was observed on pain (FIQR and 36-item Short-Form Health Survey), general and physical-related fatigue and FIQR total score (all, overall p < 0.05), so that the group with no total and central obesity had more favourable results than those with total and central obesity. Cardiorespiratory fitness partially mediated (between 22-40% of the total effect) the associations between total and central body fat with pain, general fatigue, physical fatigue and reduced activity, and largely mediated (80%) the association of central body fat with the FIQR total score. CONCLUSIONS: Physical fitness might potentially explain the association between obesity and fibromyalgia symptoms.

Reliability and feasibility of physical fitness tests in female fibromyalgia patients.

The aim of the present study was to determine the reliability and feasibility of physical fitness tests in female fibromyalgia patients. 100 female fibromyalgia patients (aged 50.6±8.6 years) performed the following tests twice (7 days interval test-retest): chair sit and reach, back scratch, handgrip strength, arm curl, chair stand, 8 feet up and go, and 6-min walk. Significant differences between test and retest were found in the arm curl (mean difference: 1.25±2.16 repetitions, Cohen d=0.251), chair stand (0.99±1.7 repetitions, Cohen d=0.254) and 8 feet up and go (-0.38±1.09 s, Cohen d=0.111) tests. Intraclass correlation coefficients (ICC) range from 0.92 in the arm curl test to 0.96 in the back scratch test. The feasibility of the tests (patients able to complete the test) ranged from 89% in the arm curl test to 100% in the handgrip strength test. Therefore, the reliability and feasibility of the physical fitness tests examined is acceptable for female fibromyalgia patients.

Efectos de los programas de intervención enfocados al tratamiento del sobrepeso/obesidad infantil y adolescente / Effects of intervention programs focused on the treatment of overweight/obese children and adolescents

El objetivo del presente estudio fue realizar una revisión sistemática de la efectividad de los programas de intervención basados en actividad física (AF) y control dietético sobre el sobrepeso y/u obesidad en población infantil y adolescente. La búsqueda bibliográfica fue realizada en bases de datos electrónicas abarcando el período comprendido entre el 1 de julio de 2006 y el 30 de abril de 2012. Del total de 1.696 estudios encontrados inicialmente, se incluyeron 28 artículos que describieron 23 programas de AF y orientación alimentaria destinados a niños y adolescentes con sobrepeso/obesidad. Diecisiete programas fueron dirigidos a niños y adolescentes y 6 fueron diseñados específicamente para adolescentes. En 10 de los estudios, la condición física (CF) fue adicionalmente valorada. Los resultados parecen señalar que la AF asociada con orientación nutricional produce efectos positivos en la reducción del peso e índice de masa corporal (IMC). Resaltamos la necesidad de diseñar programas específicos para adolescentes, así como valorar objetivamente la eficacia de dichos programas a largo plazo en poblaciones de niños y adolescentes con sobrepeso/ obesidad (AU)

The aim of this study was to realize one systemic review the effectiveness of intervention programs which were based on physical activity (PA) and dietary control of overweight and/or obese children and adolescents. The literature search was conducted in electronic databases covering the time period between July 1th, 2006 to April 30th, 2012. From 1,696 studies initially reviewed, 28 articles describing 23 programs were included. We have included studies with exercise programs and nutritional counseling for overweight and/or obese children and adolescents. Interventions which were excluded were those which involved the use of drugs, studies conducted in adolescents with hormonal disorders and eating disorders, book chapters, conference proceedings and dissertations. Seventeen programs were targeted towards children and adolescents and six were designed specifically for adolescents. In ten studies, the physical fitness (PF) was further assessed. Due the methodological heterogeneity found, these results are insufficient to determine the effectiveness of intervention programs regarding PA and diet. The results seem to indicate that AF associated with nutrition counseling has positive effects on reducing weight and body mass index (BMI). We emphasize the need to design specific programs for adolescents, as well as the as well assess the effectiveness of long term programs in populations of children and adolescents with overweight and obesity (AU)

Effectiveness of Tai-Chi for decreasing acute pain in fibromyalgia patients.

Tai-Chi has shown benefits in physical and psychological outcomes in diverse populations. We aimed to determine the changes elicited by a Tai-Chi program (12 and 24 weeks) in acute pain (before vs. after session) in fibromyalgia patients. We also assessed the cumulative changes in pain brought about by a Tai-Chi program. Thirty-six patients (29 women) with fibromyalgia participated in a low-moderate intensity Tai-Chi program for 12 weeks (3 sessions/week). Twenty-eight patients (27 women) continued the program for an additional 12 weeks (i. e., 24 weeks). We assessed pain by means of a Visual Analogue Scale (VAS) before and after each single session (i. e., 72 sessions). We observed significant immediate changes (P-values from 0.037 to 0.0001) with an approximately 12% mean decrease of acute pain in the comparison of VAS-values before and after each session (72 sessions in total), with the exception of 4 sessions. We observed significant changes in cumulative pain pre-session (95% CI=-0.019; -0.014; P<0.001) and cumulative pain post-session (95% CI=-0.021; -0.015; P<0.001) along the 24-week intervention only. In conclusion, a low-moderate intensity Tai-Chi program for 12 weeks (3 times/week) decreased levels of acute pain in fibromyalgia patients. A longer period is necessary (e. g. 24 weeks) for observing cumulative changes in pain.

Are there differences in quality of life, symptomatology and functional capacity among different obesity classes in women with fibromyalgia? The al-Ándalus project.

Obesity may influence fibromyalgia severity. The present study aimed to examine fibromyalgia (FM) symptomatology, quality of life (QoL), and functional capacity across obesity class categories. A total sample of 208 obese FM patients and 108 obese control women were included in the study. The sample was further categorized following the international criteria for obesity classes: obesity I (BMI 30.0-34.99 kg/m(2)), obesity II (BMI 35.0-39.99 kg/m(2)), and obesity III (BMI ≥40.0 kg/m(2)). QoL was assessed by means of the Short-Form-36 Health Survey (SF-36) and FM symptomatology with the Fibromyalgia Impact Questionnaire (FIQ). Standardized field-based fitness tests were used to assess cardiorespiratory fitness, muscular strength, flexibility, agility, and balance. All the dimensions of QoL, as measured by SF-36, were worse in obese FM patients compared to the obese control group (all p < 0.001). Obese FM patients also scored worse in the entire functional capacity tests studied (all p < 0.001). Except for the higher FIQ-depression across obesity status categories (p < 0.05), no differences between obesity status groups were found in QoL and FM impact. However, upper-body muscular strength and cardiorespiratory fitness were worse across obesity class categories and pairwise comparisons showed differences mainly between obesity I and II (p < 0.05, and p < 0.01, respectively). The absence of clear differences in QoL and FM symptomatology among obesity classes suggests that just avoiding any obese status may be a useful advice for a better management of the disease. Nevertheless, upper-body muscular strength and cardiorespiratory fitness, which are important health indicators highly related to the mortality risk, were worse across obesity categories.

Fibromyalgia's key symptoms in normal-weight, overweight, and obese female patients.

Factors affecting the symptomatology of fibromyalgia (FM) are not fully understood. The aim of the present study was to analyze the relationship of weight status with pain, fatigue, and stiffness in Spanish female FM patients, with special focus on the differences between overweight and obese patients. The sample comprised 177 Spanish women with FM (51.3 ± 7.3 years old). We assessed tenderness (using pressure algometry), pain and vitality using the General Health Short-Form Survey (SF36), and pain, fatigue, morning tiredness, and stiffness using the Fibromyalgia Impact Questionnaire (FIQ). The international criteria for body mass index was used to classify the patients as normal weight, overweight, or obese. Thirty-two percent were normal-weight, 35% overweight, and 32% obese. Both overweight and obese patients had higher levels of pain than normal-weight patients, as assessed by FIQ and SF36 questionnaires and tender point count (p < .01). The same pattern was observed for algometer score, yet the differences were not significant. Both overweight and obese patients had higher levels of fatigue, and morning tiredness, and stiffness (p < .05) and less vitality than normal-weight patients. No significant differences were observed in any of the variables studied between overweight and obese patients. In conclusion, FM symptomatology in obese patients did not differ from overweight patients, whereas normal-weight patients significantly differed from overweight and obese patients in the studied symptoms. These findings suggest that keeping a healthy (normal) weight is not only associated with decreased risk for developing FM but might also be a relevant and useful way of improving FM symptomatology in women.

A warm water pool-based exercise program decreases immediate pain in female fibromyalgia patients: uncontrolled clinical trial.

Fibromyalgia is characterized by chronic and extended musculoskeletal pain. The combination of exercise therapy with the warm water may be an appropriate treatment. However, studies focusing on the analysis of immediate pain during and after an exercise session are rare. This study aimed to determine the immediate changes of a warm water pool-based exercise program (12 weeks) on pain (before vs. after session) in female fibromyalgia patients. 33 Spanish women with fibromyalgia were selected to participate in a 12 weeks (2 sessions/week) low-moderate intensity warm water pool-based program. We assessed pain by means of a Visual Analogue Scale before and after each single session (i. e., 24 sessions). We observed immediate benefits on pain with a mean decrease ~15% in all sessions, except in the fourth one. There was an association of pain difference (pre-post) session with pain pre session (p=0.005; ß=0.097±0.034) and with age (p<0.001; ß=0.032±0.008). There were no significant accumulative differences on pain, pre session, post session, and pre-post changes (all p>0.05). Therefore this study showed that a warm water pool-based exercise program for 12 weeks (2 times/week) led to a positive immediate decrease in level of pain in female patients with fibromyalgia. Improvements were higher in older women and in those with more intense pain.

Fitness testing as a discriminative tool for the diagnosis and monitoring of fibromyalgia.

We aimed to determine the ability of a set of physical fitness tests to discriminate between presence/absence of fibromyalgia (FM) and moderate/severe FM. The sample comprised 94 female FM patients (52 ± 8 years) and 66 healthy women (54 ± 6 years). We assessed physical fitness by means of the 30-s chair stand, handgrip strength, chair sit and reach, back scratch, blind flamingo, 8-feet up and go, and 6-min walking tests. Patients were classified as having moderate FM if the score in the Fibromyalgia Impact Questionnaire (FIQ) was <70 and as having severe FM if the FIQ was ≥70. FM patients and patients with severe FM performed worse in most of the fitness tests studied (P < 0.001). Except the back scratch test, all the tests were able to discriminate between presence and absence of FM [area under the curve (AUC) = 0.66 to 0.92; P ≤ 0.001], and four tests also discriminated FM severity (AUC = 0.62 to 0.66; P ≤ 0.05). The 30-s chair stand test showed the highest ability to discriminate FM presence and severity (AUC = 0.92, P < 0.001; and AUC = 0.66, P = 0.008, respectively), being the corresponding discriminating cutoffs 9 and 6 repetitions, respectively. Physical fitness in general, and particularly the 30-s chair stand test, is able to discriminate between women with FM from those without FM, as well as between those with moderate FM from their peers with severe FM.

Fitness, fatness and cardiovascular profile in South Spanish and North Moroccan women.

INTRODUCTION: We studied the differences on physical fitness, fatness and cardiovascular profile in Spanish and Moroccan women. MATERIAL AND METHODS: The study comprised 63 and 58 women aged 45-65 years from South of Spain and North of Morocco, respectively. We assessed fitness and body composition using standard procedures. We also assessed resting heart rate (RHR), blood pressure, fasting glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides. RESULTS AND DISCUSSION: Moroccan women had a better performance in the main health-related physical fitness components, i.e. higher levels of cardiorespiratory fitness (P = 0.01) and (lower-body) muscular strength (P < 0.001). Diastolic blood pressure (P = 0.004), RHR and total cholesterol (both P = 0.04) were lower in Moroccan women. No differences were observed in the prevalence of metabolic syndrome. CONCLUSIONS: The women from Morocco had a healthier fitness and cardiovascular profile than the women from Spain. Further research on physical fitness and other health indicators in understudied populations is needed.

Fitness, fatness and cardiovascular profile in South Spanish and North Moroccan women / Condición física, grasa corporal y perfil cardiovascular en mujeres del sur de España y del norte de Marruecos

Introduction: We studied the differences on physical fitness, fatness and cardiovascular profile in Spanish and Moroccan women. Material and methods: The study comprised 63 and 58 women aged 45-65 years from South of Spain and North of Morocco, respectively. We assessed fitness and body composition using standard procedures. We also assessed resting heart rate (RHR), blood pressure, fasting glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides. Results and discussion: Moroccan women had a better performance in the main health-related physical fitness components, i.e. higher levels of cardiorespiratory fitness (P = 0.01) and (lower-body) muscular strength (P < 0.001). Diastolic blood pressure (P = 0.004), RHR and total cholesterol (both P = 0.04) were lower in Moroccan women. No differences were observed in the prevalence of metabolic syndrome. Conclusions: The women from Morocco had a healthier fitness and cardiovascular profile than the women from Spain. Further research on physical fitness and other health indicators in understudied populations is needed (AU)

Introducción: Estudiamos las diferencias en la forma física, grasa corporal y perfil cardiovascular de mujeres españolas y marroquíes. Materiales y métodos: El estudio comprendió 63 mujeres del sur de España y 58 del norte de Marruecos con un rango de edad de 45-65 años. Evaluamos la forma física y la composición corporal utilizando procedimientos estándar. También evaluamos la frecuencia cardíaca en reposo (FCR), la presión sanguínea, la glucosa en ayunas, el colesterol total, el colesterol LDL, HDL y los triglicéridos. Resultado y discusión: las mujeres marroquíes obtuvieron mejores resultados en los principales componentes de la salud relacionada con la forma física, como son mejores niveles de capacidad cardiorrespiratoria (P = 0,01) y fuerza muscular del tren inferior (P < 0,001). La presión sanguínea diastólica (P = 0,004), FCR y colesterol total (ambos P = 0,04) fueron menores en las mujeres marroquíes. No se observaron diferencias en la prevalencia de síndrome metabólico. Conclusiones: Las mujeres marroquíes presentaron unos niveles de forma física y perfil cardiovascular más saludables que las españolas. Se requieren investigaciones adicionales sobre la forma física y otros indicadores de salud en poblaciones poco estudiadas (AU)

Fitness, fatness and cardiovascular profile in South Spanish and North Moroccan women.

INTRODUCTION: We studied the differences on physical fitness, fatness and cardiovascular profile in Spanish and Moroccan women. MATERIAL AND METHODS: The study comprised 63 and 58 women aged 45-65 years from South of Spain and North of Morocco, respectively. We assessed fitness and body composition using standard procedures. We also assessed resting heart rate (RHR), blood pressure, fasting glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides. RESULTS AND DISCUSSION: Moroccan women had a better performance in the main health-related physical fitness components, i.e. higher levels of cardiorespiratory fitness (P=0.01) and (lower-body) muscular strength (P<0.001). Diastolic blood pressure (P=0.004), RHR and total cholesterol (both P=0.04) were lower in Moroccan women. No differences were observed in the prevalence of metabolic syndrome. CONCLUSIONS: The women from Morocco had a healthier fitness and cardiovascular profile than the women from Spain. Further research on physical fitness and other health indicators in understudied populations is needed.

Fitness, fatness and cardiovascular profile in South Spanish and North Moroccan women / Condición física, grasa corporal y perfil cardiovascular en mujeres del sur de España y del norte de Marruecos

Introduction: We studied the differences on physical fitness, fatness and cardiovascular profile in Spanish and Moroccan women. Material and methods: The study comprised 63 and 58 women aged 45-65 years from South of Spain and North of Morocco, respectively. We assessed fitness and body composition using standard procedures. We also assessed resting heart rate (RHR), blood pressure, fasting glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides. Results and discussion: Moroccan women had a better performance in the main health-related physical fitness components, i.e. higher levels of cardiorespiratory fitness (P = 0.01) and (lower-body) muscular strength (P < 0.001). Diastolic blood pressure (P = 0.004), RHR and total cholesterol (both P = 0.04) were lower in Moroccan women. No differences were observed in the prevalence of metabolic syndrome. Conclusions: The women from Morocco had a healthier fitness and cardiovascular profile than the women from Spain. Further research on physical fitness and other health indicators in understudied populations is needed (AU)

Introducción: Estudiamos las diferencias en la condición física, grasa corporal y perfil cardiovascular en mujeres españolas y marroquís. Material y métodos: El estudio comprendió 63 mujeres del sur de España y 58 del norte de Marruecos con un rango de edad de 45-65 años. Evaluamos la condición física y la composición corporal empleando procedimientos estándar. También evaluamos la frecuencia cardíaca en reposo (FCR), la presión sanguínea, la glucosa en ayunas, el colesterol total, el colesterol LDL, HDL y los triglicéridos. Resultados y discusión: Las mujeres marroquíes obtuvieron mejores resultados en los principales componentes de salud relacionada con la condición física, como son los mayores niveles de capacidad cardiorrespiratoria (P = 0,01) y fuerza muscular (del tren inferior) (P < 0,001). La presión sanguínea diastólica (P = 0,004), la FCR y el colesterol total (ambos P = 0,04) fueron menores en las mujeres marroquíes. No se observaron diferencias en la prevalencia de síndrome metabólico. Conclusiones: Las mujeres marroquíes tenían una condición física y un perfil cardiovascular más saludables que las españolas. Se necesita investigación adicional sobre la condición física y otros indicadores de salud en poblaciones infra estudiadas (AU)

Usefulness of tenderness to characterise fibromyalgia severity in women.

OBJECTIVES: To investigate the usefulness of tenderness (tender points count (TPC) and algometer score) to characterise fibromyalgia (FM) severity and symptomatology in women. METHODS: The study sample comprised 174 women aged 51±7 years. We ossesse tenderness using pressure algometry; quality of life by means of the Short-Form 36 Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). We used the FM impact questionnaire (FIQ) to assess FM severity and symptomatology. Patients were categorised according to three FIQ-derived categories: FIQ<70 vs. ≥70; FIQ<59 vs. ≥59; and FM-type I and II. RESULTS: TPC was significantly higher in the group of patients with FIQ≥59 (16.9±2 vs. 15.6±4, p=0.02), whereas no differences between groups were observed according to FIQ≥70 (17.0±2 vs. 16.2±3, p=0.12) or FM type (16.8±3 for type II vs. 15.9±4 for type I, p=0.13). We observed a significant association between TPC and FIQ-job difficulty, pain, morning tiredness and stiffness dimensions (all p<0.05), yet it was not correlated with total score of FIQ, FIQ-anxiety, fatigue and depression dimensions (all p>0.05). Algometer score was lower in the FIQ≥70 (45.7±12 vs. 51.1±14, p=0.05) and FIQ≥59 (46.7±13 vs. 52.7±14, p=0.05) groups, and there were no difference between FM types (48.7±13 vs. 49.5±14 for type II and I respectively, p=0.81). Algometer score was not associated with total score of FIQ or FIQ dimensions (all p≥0.1). CONCLUSIONS: Widespread pain and pain hypersensitivity, as measured by TPC and algometer score, do not seem to be useful to characterise FM severity and symptomatology (measured by FIQ) in women.

Effectiveness of multidisciplinary therapy on symptomatology and quality of life in women with fibromyalgia.

OBJECTIVES: To study the effects of a 3-month multidisciplinary intervention based on exercise and psychological therapy on symptomatology and quality of life in women with fibromyalgia. METHODS: Seventy-five women with fibromyalgia volunteered to participate and were allocated to a 3-month (3-times/week) multidisciplinary (pool, land-based and psychological session based on the Acceptance and Commitment Therapy) intervention (n=41), or to a usual care group (n=34). Sixty-five women with fibromyalgia completed the study protocol (n=33 multidisciplinary intervention, aged 51.4±7.4 years and n=32 usual care group, aged 50.0±7.3 years). The outcomes variables were Fibromyalgia Impact Questionnaire (FIQ), Short Form Health Survey 36 (SF-36), Hospital Anxiety and Depression Scale, Vanderbilt Pain Management Inventory and Rosenberg Self-Esteem Scale. RESULTS: We observed a significant interaction effect (group*time) for the FIQ total score, the subscales fatigue, stiffness, anxiety and depression, and the subscales of SF-36 physical role, bodily pain, vitality and social functioning. Post-hoc analysis revealed significant improvements in total score of FIQ (p<0.001), fatigue (p=0.001), stiffness (p<0.001), anxiety (p=0.011), depression (p=0.008), physical role (p=0.002), bodily pain (p<0.001), vitality (p<0.001) and social functioning (p<0.001) in the intervention group, whereas in the control group, there was a significant worsening in the subscale depression (p=0.006) and social functioning (p=0.019). CONCLUSIONS: A 3-month low-moderate intensity multidisciplinary intervention improved fibromyalgia symptomatology and quality of life in women with fibromyalgia.

Handgrip strength in men with fibromyalgia.

OBJECTIVES: To examine the association of muscular strength, as measured by handgrip strength test (HGs), with the presence/absence of fibromyalgia (FM) and FM severity in men. METHODS: A total of 20 men (age, (mean age±standard deviation) of 48.0±8.0 years) with FM and 60 healthy subjects (age, 49.5±7.3 years) participated in the study. The HGs was measured by a maximal isometric test using a dynamometer with adjustable grip in both hands, and the average score was used in the analysis. All FM patients completed the Spanish version of the Fibromyalgia Impact Questionnaire (FIQ). Patients were classified as having moderate FM if the FIQ was <70 and as having severe FM if the FIQ was ≥70. RESULTS: HGs was ~17% lower in FM patients compared to healthy men (p=0.005) and ~27% lower in men with severe FM compared to those with moderate FM (p=0.03). Age-adjusted logistic regression models showed that 1 kilogram increment in HGs was associated with an 8% reduced risk of having FM (OR=0.92, 95% CI: 0.86-0.97, p=0.002). In the FM group, 1 kilogram increment in HGs was associated with a 13% reduced risk for having severe FM (OR=0.87, 95% CI: 0.76-0.99, p=0.04). HGs was negatively associated with pain, fatigue, stiffness and with the total score from the FIQ (all p<0.05). CONCLUSIONS: HGs is reduced in male FM patients and is inversely related to FM severity and symptomatology. HGs testing could be used as a complementary tool in the assessment and monitoring of FM. Further research on male FM patients is needed to confirm or contrast these findings.