Diego Munguía-Izquierdo

Assessment of the Effects of Aquatic Therapy on Global Symptomatology in Patients With Fibromyalgia Syndrome: A Randomized Controlled Trial

OBJECTIVES To evaluate the effects of a 16-week exercise therapy in a chest-high pool of warm water through applicable tests in the clinical practice on the global symptomatology of women with fibromyalgia (FM) and to determine exercise adherence levels. DESIGN A randomized controlled trial. SETTING Testing and training were completed at the university. PARTICIPANTS Middle-aged women with FM (n=60) and healthy women (n=25). INTERVENTION A 16-week aquatic training program, including strength training, aerobic training, and relaxation exercises. MAIN OUTCOME MEASURES Tender point count (syringe calibrated), health status (Fibromyalgia Impact Questionnaire); sleep quality (Pittsburgh Sleep Quality Index); physical (endurance strength to low loads tests), psychologic (State Anxiety Inventory), and cognitive function (Paced Auditory Serial Addition Task); and adherence 12 months after the completion of the study. RESULTS For all the measurements, the patients showed significant deficiencies compared with the healthy subjects. Efficacy analysis (n=29) and intent-to-treat analysis (n=34) of the exercise therapy was effective in decreasing the tender point count and improving sleep quality, cognitive function, and physical function. Anxiety remained unchanged during the follow-up. The exercise group had a significant improvement of health status, not associated exclusively with the exercise intervention. There were no changes in the control group. Twenty-three patients in the exercise group were exercising regularly 12 months after completing the program. CONCLUSIONS An exercise therapy 3 times a week for 16 weeks in a warm pool could improve most of the symptoms of FM and cause a high adherence to exercise in unfit women with heightened FM symptomatology. The therapeutic interventions effects can be assessed through applicable tests in the clinical practice.

Association of objectively assessed physical activity with total and central body fat in Spanish adolescents; the HELENA Study.

Objectives:To examine the association of objectively assessed physical activity (PA) with markers of total and central body fat in adolescents, and to determine whether meeting the current PA recommendations (⩾60 min day−1 of at least moderate intensity PA) is associated with reduced levels of total and central body fat.Subjects/Methods:A total of 365 Spanish adolescents aged 12.5–17.5 years participated in this cross-sectional study. PA was assessed by accelerometry and expressed as average PA (counts per minute), and min day−1 of light, moderate, moderate to vigorous (MVPA) and vigorous PA. MVPA was dichotomized into <60 min day−1 and ⩾60. Total body fat was measured by DXA, BodPod and the sum of six skinfolds. Central body fat was measured by DXA at three regions (R1, R2 and R3), and waist circumference.Results:All markers of central body fat were negatively associated with vigorous PA (P<0.01) after controlling for sex, age and pubertal status. Abdominal adiposity measured at R1, R2 and R3 was also negatively associated with MVPA (P⩽0.001), and with average PA (P<0.01). All markers of total body fat were negatively associated with vigorous PA (P<0.01), MVPA (P<0.01) and average PA (P<0.05). Adolescents engaged on at least 60 min day−1 MVPA presented lower levels of total (P<0.05) and central body fat (P⩽0.01).Conclusions:The results suggest that vigorous PA may have a greater effect on preventing obesity in adolescents than does PA of lower intensity, whereas both average PA and at least moderate PA may have an impact on total and central body fat in youth.

Determinants of sleep quality in middle-aged women with fibromyalgia syndrome

The objectives of this study were: (i) to compare the sleep quality at home of patients with fibromyalgia with that of healthy controls; and (ii) to examine the factors associated with sleep quality in patients with fibromyalgia. In addition to anthropometric measures, 75 women with fibromyalgia and 48 healthy controls completed standardized questionnaires that assessed sleep quality, functional impairment (Fibromyalgia Impact Questionnaire), depression, anxiety and physical activity level. Comparisons between groups, correlation coefficients and a series of hierarchical multiple regressions were performed. The global Pittsburgh Sleep Quality Index scores were worse in patients with fibromyalgia than in the controls. This result was partly explained by the Fibromyalgia Impact Questionnaire score. For the patients with fibromyalgia, the results of the first model that tested the importance of demographic factors were not statistically significant. In the disease‐related model, the duration of symptoms and symptom severity contributed to poor sleep quality. A measurement of physical activity participation and the sum of the skinfold thickness were added to the demographic factors. In the psychological model, the level of anxiety contributed to poor sleep quality. When all variables were entered simultaneously, the level of physical activity, duration of symptoms and symptom severity remained significant determinants of sleep quality. In conclusion, our results showed that the symptoms associated with fibromyalgia contributed to poor overall sleep quality in patients compared with healthy subjects. The findings also suggest that the duration of symptoms, symptom severity and especially a sedentary lifestyle contributed to decreased sleep quality in patients with fibromyalgia.

Objectively measured sedentary time and physical activity in women with fibromyalgia: a cross-sectional study.

Objectives To characterise levels of objectively measured sedentary time and physical activity in women with fibromyalgia. Design Cross-sectional study. Setting Local Association of Fibromyalgia (Granada, Spain). Participants The study comprised 94 women with diagnosed fibromyalgia who did not have other severe somatic or psychiatric disorders, or other diseases that prevent physical loading, able to ambulate and to communicate and capable and willing to provide informed consent. Primary outcome measures Sedentary time and physical activity were measured by accelerometry and expressed as time spent in sedentary behaviours, average physical activity intensity (counts/minute) and amount of time (minutes/day) spent in moderate intensity and in moderate-to-vigorous-intensity physical activity (MVPA). Results The proportion of women meeting the physical activity recommendations of 30 min/day of MVPA on 5 or more days a week was 60.6%. Women spent, on average, 71% of their waking time (approximately 10 h/day) in sedentary behaviours. Both sedentary behaviour and physical activity levels were similar across age groups, waist circumference and percentage body fat categories, years since clinical diagnosis, marital status, educational level and occupational status, regardless of the severity of the disease (all p>0.1). Time spent on moderate-intensity physical activity and MVPA was, however, lower in those with greater body mass index (BMI) (−6.6 min and −7 min, respectively, per BMI category increase, <25, 25–30, >30 kg/m2; p values for trend were 0.056 and 0.051, respectively). Women spent, on average, 10 min less on MVPA (p<0.001) and 22 min less on sedentary behaviours during weekends compared with weekdays (p=0.051). Conclusions These data provide an objective measure of the amount of time spent on sedentary activities and on physical activity in women with fibromyalgia.

Feasibility of resistance training in adult McArdle patients: clinical outcomes and muscle strength and mass benefits

We analyzed the effects of a 4-month resistance (weight lifting) training program followed by a 2-month detraining period in 7 adult McArdle patients (5 female) on: muscle mass (assessed by DXA), strength, serum creatine kinase (CK) activity and clinical severity. Adherence to training was ≥84% in all patients and no major contraindication or side effect was noted during the training or strength assessment sessions. The training program had a significant impact on total and lower extremities’ lean mass (P < 0.05 for the time effect), with mean values increasing with training by +855 g (95% confidence interval (CI): 30, 1679) and +547 g (95%CI: 116, 978), respectively, and significantly decreasing with detraining. Body fat showed no significant changes over the study period. Bench press and half-squat performance, expressed as the highest value of average muscle power (W) or force (N) in the concentric-repetition phase of both tests showed a consistent increase over the 4-month training period, and decreased with detraining. Yet muscle strength and power detraining values were significantly higher than pre-training values, indicating that a training effect was still present after detraining. Importantly, all the participants, with no exception, showed a clear gain in muscle strength after the 4-month training period, e.g., bench press: +52 W (95% CI: 13, 91); half-squat: +173 W (95% CI: 96, 251). No significant time effect (P > 0.05) was noted for baseline or post strength assessment values of serum CK activity, which remained essentially within the range reported in our laboratory for McArdle patients. All the patients changed to a lower severity class with training, such that none of them were in the highest disease severity class (3) after the intervention and, as such, they did not have fixed muscle weakness after training. Clinical improvements were retained, in all but one patient, after detraining, such that after detraining all patients were classed as class 1 for disease severity.

Cardiorespiratory fitness, physical activity, and quality of life in patients with McArdle disease

BACKGROUND This study sought to determine whether health-related quality of life (HRQoL) could be related to cardiorespiratory fitness (CRF) and/or physical activity (PA) in patients with McArdle disease and to compare the CRF and HRQoL data obtained with normative data for age- and sex-matched healthy subjects. METHODS Eighty-one adult patients with McArdle disease underwent aerobic capacity testing to determine peak oxygen uptake (V˙O2peak), among other variables. HRQoL (Short Form 36-Item Health Survey questionnaire version 2 (SF-36 version 2)) and PA (International Physical Activity Questionnaire) questionnaires were completed by 45 of the patients. HRQoL and V˙O2peak data were compared with published normative data. RESULTS Positive correlations were observed between V˙O2peak and leisure time PA versus the physical component summary score and scores for several domains of the SF-36 questionnaire after adjusting for age, body mass index, and disease severity (R values, 0.42-0.68; all P < 0.01). In a regression analysis, the physical component summary score was directly linked to V˙O2peak (B = 1.28; 95% confidence interval, 0.78-1.78; P < 0.001; R = 0.422). The mean V˙O2peak recorded for patients with McArdle disease was 57% lower than the normative value (17.1 ± 5.3 vs 40.0 ± 9.5 mL·kg·min, respectively; P < 0.001). All patients showed a CRF below their age-/sex-matched normality value and scored clinically lower in the physical component summary and in most SF-36 domains compared with the Spanish general population. CONCLUSIONS Patients showed a consistent link between higher physical HRQoL scores and higher CRF. Patients fulfilling leisure time PA recommendations showed higher CRF and physical HRQoL scores than those not meeting guideline recommendations. According to normative data for healthy subjects, CRF and physical HRQoL are severely impaired in adult patients with McArdle disease.

Transcultural Adaptation and Psychometric Properties of a Spanish-Language Version of Physical Activity Instruments for Patients With Fibromyalgia

OBJECTIVES To develop a transcultural adaptation of the Leisure Time Physical Activity Instrument (LTPAI) and the Physical Activity at Home and Work Instrument (PAHWI) in Spanish and to assess their psychometric properties in women with fibromyalgia syndrome (FS). DESIGN A cross-sectional transcultural adaptation and validation study. SETTING Testing was completed at the university. PARTICIPANTS Seventy-five (N=75) women with FS (median age=51y; 25th-75th percentiles, 45-55y) and a median symptom duration of 16 years (25th-75th percentiles, 10-25y) were recruited for the study. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Cognitive function (Paced Auditory Serial Addition Task), physical activity habits (LTPAI, PAHWI, International Physical Activity Questionnaire [IPAQ]), and active energy expenditure using a multiple-sensor body monitor were used for the evaluations. The differences between the readings (test 1 - test 2) and the SD of the differences, intraclass correlation coefficient (ICC), 95% confidence interval (CI) for the ICC, coefficient of repeatability, intrapatient SD, standard error of the mean, minimal detectable change, Wilcoxon signed-rank test, and Bland-Altman graphs were used to examine reliability. The magnitude of the associations between LTPAI-PAHWI and IPAQ, and between LTPAI-PAHWI and the body monitoring device, were used to examine the validity of the construct. RESULTS The median time that the study population spent performing physical activities during their leisure time was 5h/wk (25th-75th percentiles, 3-9h/wk). A satisfactory test-retest reliability was found for the total score of the LTPAI (ICC=.84; 95% CI, .76-.90) and for the workplace subscale of the PAHWI (ICC=.87; 95% CI, .81-.92). A significant association was observed between LTPAI and both the leisure time domain of the IPAQ (ρ=.61; P<.001) and the active energy expenditure of the body monitoring device (ρ=.27; P=.021). A significant association was found between the workplace subscale of the PAHWI and the work domain of the IPAQ (ρ=.58; P<.001) as well as between the subscale for housework of the PAHWI and the domestic domain of the IPAQ (ρ=.43; P<.001). However, no association was observed between PAHWI and the SenseWear Armband. CONCLUSIONS The Spanish version of the LTPAI and PAHWI is understandable, and its administration is feasible in patients with FS. LTPAI can be considered a fairly reliable and valid tool to assess leisure physical activities in Spanish women with FS. The PAHWI does not appear to be a reliable and valid tool to assess physical activities associated with work in Spanish women with FS. Although the PAHWI demonstrated acceptable test-retest reliability for the workplace subscale, a lower reliability was observed for the total score and for the housework subscale.

Evaluation of a Wearable Body Monitoring Device During Treadmill Walking and Jogging in Patients With Fibromyalgia Syndrome

OBJECTIVE To evaluate the reliability and validity of a body monitoring device against measures obtained from indirect calorimetry (IC) in patients with fibromyalgia syndrome (FMS) during various incremental exercise intensities. DESIGN Cross-sectional reliability and validity study. SETTING Testing was completed in a university exercise physiology laboratory. PARTICIPANTS Women (N=25) with FMS, with a mean age ± SD of 48.6±8.4 years and a median symptom duration of 15 years (25th-75th percentiles, 10-23y), were recruited to the study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patients walked and jogged on a treadmill at 4 intensities (50m·min(-1), 0% grade [n=25]; 83.3m·min(-1), 0% grade [n=25]; 116.7m·min(-1), 0% grade [n=21]; 116.7m·min(-1), 2.5% grade [n=13]) during 2 measurement conditions, while IC and a multiple-sensor body monitor measured energy expenditure (EE). The differences between the readings (test 1 - test 2) and the SD of the differences, intraclass correlation coefficient (ICC), 95% confidence interval (CI) for the ICC, coefficient of repeatability, intrapatient SD, standard error of mean (SEM), minimal detectable change, Wilcoxon signed-rank test, and Bland-Altman graphs were used to examine reliability. The magnitude of the associations between IC and the body monitoring device, ICC, 95% CI for the ICC, paired t tests, and Bland-Altman graphs were used to examine the validity of the body monitoring device versus the IC. RESULTS Moderate to excellent test-retest reliability was found for the 4 bouts of exercise (ICC=.73-.76). The SEM and minimal detectable change were satisfactory for the 4 bouts of exercise (.54-1.18kcal·min(-1) and 1.51-3.28kcal·min(-1), respectively). The differences mean between test and retest were lower than the SEM for the 4 bouts of exercise, varying from -.17 to .14kcal·min(-1). No significant differences were found between test and retest for any bout. The Bland-Altman plots and the coefficients of repeatability indicated that the differences between repeated tests would lie within 2 SDs in 95% of the cases for the 4 bouts of exercise. Significant associations were found between the body monitoring device and IC measurements of EE for the 4 bouts of exercise (r=.87-.99). The differences for all bouts between the 2 methods were nonsignificant, except for the second bout (P<.001). The ICCs and Bland-Altman plots of EE for the 4 bouts showed high agreement (ICCs=.84-.99) and sufficient accuracy for quantifying EE during exercise in patients with FMS. CONCLUSIONS The body monitoring device provided a valid and reliable estimate of EE in patients with FMS during walking on horizontal and inclined surfaces in a laboratory setting across various exercise intensities.

Match-play Activity Profile in Elite Women's Rugby Union Players

Abstract Suarez-Arrones, L, Portillo, J, Pareja-Blanco, F, Sáez de Villareal, E, Sánchez-Medina, L, and Munguía-Izquierdo, D. Match-play activity profile in elite womens rugby union players. J Strength Cond Res 28(2): 452–458, 2014—The aim of this study was to provide an objective description of the locomotive activities and exercise intensity undergone during the course of an international-level match of female rugby union. Eight players were analyzed using global positioning system tracking technology. The total distance covered by the players during the whole match was 5,820 ± 512 m. The backs covered significantly more distance than the forwards (6,356 ± 144 vs. 5,498 ± 412 m, respectively). Over this distance, 42.7% (2,487 ± 391 m) was spent standing or walking, 35% jogging (2,037 ± 315 m), 9.7% running at low intensity (566 ± 115 m), 9.5% at medium intensity (553 ± 190 m), 1.8% at high intensity (105 ± 74 m), and 1.2% sprinting (73 ± 107 m). There were significant differences in the distance covered by forwards and backs in certain speed zones. Analysis of the relative distance traveled over successive 10-minute period of match play revealed that the greatest distances were covered during the first (725 ± 53 m) and the last (702 ± 79 m) 10-minute period of the match. The average number of sprints, the average maximum distance of sprinting, the average minimum distance of sprinting, and the average sprint distance during the game were 4.7 ± 3.9 sprints, 20.6 ± 10.5 m, 5.8 ± 0.9 –m, and 12.0 ± 3.8 m, respectively. There were substantial differences between forwards and backs. Backs covered greater total distance, distance in certain speed zones, and sprinting performance. The players spent 46.9 ± 28.9% of match time between 91 and 100% of maximum heart rate and experienced a large number of impacts (accelerometer data and expressed as g forces) during the game. These findings offer important information to design better training strategies and physical fitness testing adapted to the specific demands of female rugby union.

Benefits of skeletal-muscle exercise training in pulmonary arterial hypertension: The WHOLEi + 12 trial

BACKGROUND Pulmonary arterial hypertension is often associated with skeletal-muscle weakness. The purpose of this randomized controlled trial was to determine the effects of an 8-week intervention combining muscle resistance, aerobic and inspiratory pressure-load exercises on upper/lower-body muscle power and other functional variables in patients with this disease. METHODS Participants were allocated to a control (standard care) or intervention (exercise) group (n=20 each, 45±12 and 46±11years, 60% women and 10% patients with chronic thromboembolic pulmonary hypertension per group). The intervention included five, three and six supervised (inhospital) sessions/week of aerobic, resistance and inspiratory muscle training, respectively. The primary endpoint was peak muscle power during bench/leg press; secondary outcomes included N-terminal pro-brain natriuretic peptide levels, 6-min walking distance, five-repetition sit-to-stand test, maximal inspiratory pressure, cardiopulmonary exercise testing variables (e.g., peak oxygen uptake), health-related quality of life, physical activity levels, and safety. RESULTS Adherence to training sessions averaged 94±0.5% (aerobic), 98±0.3% (resistance) and 91±1% (inspiratory training). Analysis of variance showed a significant interaction (group×time) effect for leg/bench press (P<0.001/P=0.002), with both tests showing an improvement in the exercise group (P<0.001) but not in controls (P>0.1). We found a significant interaction effect (P<0.001) for five-repetition sit-to-stand test, maximal inspiratory pressure and peak oxygen uptake (P<0.001), indicating a training-induced improvement. No major adverse event was noted due to exercise. CONCLUSIONS An 8-week exercise intervention including aerobic, resistance and specific inspiratory muscle training is safe for patients with pulmonary arterial hypertension and yields significant improvements in muscle power and other functional variables.