Sharon R. Clark

Prescribing exercise for people with fibromyalgia.

Fibromyalgia (FM) is a costly and debilitating pain syndrome which is commonly encountered by advanced practice nurses working in acute care settings. Fibromyalgia affects nearly 6 million people in the United States, approximately 80% to 90% of whom are women. Symptoms of FM include widespread and localized pain, disrupted sleep, fatigue, visceral pain and other pain syndromes, neurological symptoms (eg, dizziness, numbness, tingling, impaired cognition), and exercise-induced pain. Difficulties remaining active with FM may lead to extreme deconditioning, inability to remain employed, and eventually even impaired ability in complete activities of daily living. Exercise that combats deconditioning without triggering pain is, therefore, a key component in treating FM. Clinicians who understand FM pain and associated symptoms can minimize the negative impact of deconditioning by prescribing disease-specific exercise for people with FM.

Factors affecting blood pressure responses to diet: The vanguard study

To study physiologic factors affecting the blood pressure (BP) response to nonpharmacologic maneuvers, fasting blood glucose, insulin, lipid and mineral levels, urinary mineral excretion, and the calcium regulating hormones parathyroid hormone (PTH) and 1,25 dihydroxyvitamin D (1,25 (OH)2D) were measured in 71 unmedicated hypertensive (26 hypertensive only [HT], 45 hypertensive hyperlipidemic [HTHL]), and 87 normotensive hyperlipidemic (NTHL) control subjects before and during a 10-week multicenter, randomized controlled trial comparing a prepared meal plan (CCNW) with a self-selected diet (SSD) based on nutritionist counseling. Blood pressure fell to a greater extent in hypertensive versus normotensive subjects (-8+/-1/-5+/-1 v -2+/-1/-2+/-1 mm Hg, P < .0001/P < .0001), and on CCNW versus SSD diets (delta systolic BP [SBP]/delta diastolic BP [DBP], P = .033/P = .002). Diet-induced weight change was the strongest correlate of changes in BP (SBP: r = 0.360, P < .0001; DBP: r = 0.414, P < .0001), which, on multivariate analysis for deltaSBP, could partly be accounted for by diet-induced changes in fasting glucose (r = 0.215, P = .009) and cholesterol (r = 0.219, P = .006) levels. Independently of weight, diet-induced changes in SBP also were significantly related to concomitant changes in urinary excretion of potassium (r = -0.285, P = .001), magnesium (r = -0.254, P = .003), and calcium relative to sodium (r = -0.200, P = .021), but not to sodium per se; and to changes in serum potassium (r = -0.249, P = .002), phosphorus (r = -0.279, P = .001), PTH (r = 0.288, P = .0006), and 1,25 D (r = 0.202, P = .017). We conclude that the ability of diet to lower BP successfully may result from the additive contributions of multiple components. Independently of weight loss and the associated changes in circulating glucose and cholesterol, BP is influenced by the increasing provision of minerals such as potassium, magnesium, and calcium, perhaps by virtue of their suppressive effects on circulating vasoactive calcium regulating hormones.

Pain Coping Strategies and Quality of Life in Women with Fibromyalgia: Does Age Make a Difference?

Objectives: To characterize and compare the demographics, symptom profiles, pain coping strategies, and quality of life in three age groups of women with fibromyalgia [FMS]. Methods: Self-report questionnaires, including the Fibromyalgia Impact Questionnaire [FIQ], Beck Depression Inventory, Coping Strategies Questionnaire, and Quality of Life Scale, were filled out by 343 consecutive women who were participating in FMS treatment programs. Patients were divided into three age groups for purposes of data analysis. Results: The youngest age group had their symptoms for a significantly shorter period of time than the middle age and older age groups. Tender point pain score, the FIQ physical functioning and well-being items, and perceived ability to decrease pain were significantly worse for the youngest age group when compared to the other two groups. The youngest group had significantly higher catastrophizing scores and lower quality of life than the oldest age group. Discriminant function analysis between the youngest and oldest groups revealed that a combination of six variables: length of symptoms, quality of life, tender point pain score, morning tiredness, behavioral activity strategies, and a pain control/rational thinking factor were 84% accurate in classifying these patients into their original groups. When length of symptoms was excluded, the remaining five variables were 79% accurate in classifying the patients. Conclusions: Young women with FMS perceive the severity of FMS to be higher and respond with more distress than older women with FMS. This finding is largely independent of symptom length.

Long-Term Follow-Up of Fibromyalgia Patients Who Completed a Structured Treatment Program versus Patients in Routine Treatment

Objective: To determine whether patients with fibromyalgia [FMS], treated in a tertiary care setting, got worse over time, remained the same, or got better. Methods: Validated self-report questionnaires and checklists were sent at two-year intervals to patients who were screened for entry into a six-month FMS treatment program. Patients were divided into subgroups based on whether they finished the program or did not enter or finish. They were followed for up to nine years. Results: The subgroup that finished the six-month program had lower Fibromyalgia Impact Questionnaire and Beck Depression Inventory and higher Quality of Life Scale scores over time than the subgroup that did not enter the program or finish. The Fibromyalgia Impact Questionnaire scores of program finishers were significantly lower at three to four years [P =. 031] and seven to nine years [P =. 001]. Beck Depression Inventory scores were significantly lower at three to four years [P =. 047]. The Quality of Life Scale scores were not significantly different at any measurement. Over the survey period, a majority of the total group rated their FMS symptoms and physical abilities as better than when they were pretested for the program. Up to 35 percent had periods of time without symptoms and nearly 50 percent rated their general health as good or excellent. A majority of patients whether they finished the program or not took medications for sleep, exercised, and used relaxation and self-talk coping strategies. Use of both pain medications and anti-depressants increased over the course of the study. Conclusions: Patients treated in a comprehensive program had consistently lower FMS impact, depression, pain, and fatigue scores over time. Patients who did not enter or complete the program were as likely take sleep medication, exercise or use self-management techniques over time but did not perceive themselves to be doing as well as those who completed the program.

Comprehensive Nutrition Plan Improves Cardiovascular Risk Factors in Essential Hypertension

Increased arterial pressure is known to be influenced by a variety of nutrients. Compliance with dietary recommendations for risk reduction is often limited by the complexity of their implementation. In addition, how improvements in total diet, rather than single nutrients, influence concomitant cardiovascular risk factors has not been thoroughly explored. We assessed the effects of a nutritionally complete prepared meal program, the Campbells Center for Nutrition and Wellness plan (CCNW), compared with dietary therapy in which participants received a structured nutritional assessment and prescription and selected their own foods, in 101 women and men with mild-to-moderate hypertension. Outcome measures included blood pressure (BP), lipids and lipoproteins, glucose, glycosylated hemoglobin (HbA1c), insulin, homocysteine, nutrient intake, compliance, and quality of life. Both dietary interventions significantly lowered BP (P < .0001), while simultaneously improving the overall cardiovascular risk profile. Significantly greater benefits were observed with the CCNW plan as compared with the participant selected diet in cholesterol and LDL levels (both P < .0001), LDL:HDL (P < .001), HbA1c (P < .05), homocysteine (P < .001), total nutrient intake (P < .0001), compliance (P < .0001), and quality of life (P < .001). This study demonstrates that improving the total diet to include the full array of recommended dietary guidelines, rather than focusing on single nutrients, has significant benefits for the cardiovascular risk profile of hypertensive persons beyond BP control. Compared with typical dietary therapy, the comprehensive CCNW meal plan has significantly greater effects on multiple cardiovascular risk factors while yielding greater compliance and improved quality of life.