Suelen Meira Góes

Functional capacity, muscle strength and falls in women with fibromyalgia ☆

BACKGROUND Patients with fibromyalgia have difficulty with activities of daily living, they exhibit reduced muscle strength and high incidence of reported falls. The objective of this study was to evaluate the functional performance and lower limb muscle strength in women with fibromyalgia and determine the relationship between muscle strength and falls. METHODS Sixteen females with fibromyalgia and 16 healthy women participated in the study. Pain intensity, fibromyalgia impact on quality of life, physical activity level and fall prevalence were assessed. The peak torque and the rate of torque development were determined in maximal voluntary isometric contraction (hip, knee and ankle joints) using a load cell. The 30s chair stand, 8 ft up and go, sit and reach, and functional reach tests were used to characterize functional performance. FINDINGS Women with fibromyalgia showed deficits in lower limb muscle strength, balance and agility and exhibited decreased knee extension peak torque and rate of torque development. In addition, they showed lower hip adduction and extension peak torque in comparison to the control group (P>0.05). Hip extension rate of torque development, duration of fibromyalgia symptoms, overall pain, knee pain, and fibromyalgia impact were strong predictors of the number of falls in patients with fibromyalgia (R2=0.86; P<0.05), when considered collectively. INTERPRETATION Women with fibromyalgia showed reduced functional performance and lower limb muscle strength, mostly explained by pain. There was a high prevalence of falls in this population, as explained by hip extensors rate of torque development, duration of fibromyalgia symptoms and pain.

Redução da capacidade funcional e exacerbação da dor durante o esforço do teste de caminhada de 6 minutos em mulheres com fibromialgia

BACKGROUND: Fibromyalgia has been association with physical performance limitations. Additionally, activities of daily living have been reported to be directly associated with the exacerbation of pain and perceived exertion in this patient population. OBJECTIVES: To compare the performance of a 6-minute walk (6MWT) test in patients with fibromyalgia and controls and to evaluate the relationship between test performance and quality of life, limitations of activities of daily living and physical activity level. METHODS: The study included 19 women with fibromyalgia (FM) and 20 healthy controls (CG). A 6MWT was conducted and pain intensity and perceived effort (PE) were assessed during the test. In addition, Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ) and International Physical Activity Questionnaire (IPAQ) were applied. RESULTS: The fibromyalgia group walked significantly shorter distances when compared to the control group (FM: 473.52±77.84 m vs. CG: 541.75±85.62 m; p=0.02). In the fibromyalgia group, there was a negative correlation between distance in 6MWT and FIQ (r=-0.46; p=0.05), HAQ (r=-0.49; p=0.03) and oxygen consumption (r=0.78; p<0.01). There was also a correlation between HAQ and oxygen consumption (r=0.52; p=0.02). Participants with fibromyalgia had higher pain intensity and perceived effort during the test when compared to the control group. CONCLUSIONS: Women with fibromyalgia had greater impaired of functional capacity, exacerbation of pain and exertion during the 6MWT when compared to healthy women.

Percepção de estresse e sintomas depressivos: funcionalidade e impacto na qualidade de vida em mulheres com fibromialgia

INTRODUCTION Depression is one of the most frequent psychiatric comorbidities in patients with fibromyalgia (FM), and chronic stress might be one of the triggering events of the characteristic FM symptoms. OBJECTIVES To compare depressive symptoms and stress perception between women with and without FM, in addition to investigate the relationship between those characteristics and the functionality and the impact on the quality of life of those patients. METHODS The study included 20 women with FM (FM group) and 20 healthy women (control group). The following instruments were used: Beck Depression Inventory, Perceived Stress Scale-10, Health Assessment Questionnaire, Fibromyalgia Impact Questionnaire, and Visual Analogue Scale for pain (0-10 cm). RESULTS The FM group showed higher severity of the depressive symptoms (24.10 ± 11.68) and greater perception of stress (25.10 ± 4.82) as compared with those of the control group (10.20 ± 12.78, P < 0.01;and 15.45 ± 7.29, P < 0.01;respectively). A higher incidence of depressive symptoms was observed in the FM group (75%) than in the control group (25%) (χ² = 10.00, P < 0.01). In the FM group, a positive correlation was observed between the depressive symptoms and perceived stress (r = 0.54, P < 0.05), pain (r = 0.58, P < 0.01), impaired functionality (r = 0.56, P < 0.01), and impact on the quality of life (r = 0.46, P < 0.05). In this group there was also correlation between perceived stress and impaired functionality (r = 0.50;P < 0.05). Pain showed no relationship with perceived stress. CONCLUSION The relationship between stress, depression and functionality seems to be part of a complex mechanism, which might affect the quality of life of patients with FM.

Physical activity level and physical performance in the 6-minute walk test in women with fibromyalgia

INTRODUCTION Fibromyalgia (FM) is a chronic pain condition that causes impaired functional capacity, possibly through the adoption of sedentary behaviour. However, little is known regarding physical activity level and its relationship with physical performance in women with FM. OBJECTIVES To compare physical activity level, assessed using the International Physical Activity Questionnaire (IPAQ), and physical performance, measured using the six-minute walk test (6MWT), in women with and without FM, and to examine the possible relationships between physical activity level and physical performance in both groups. METHODS The study included 30 women diagnosed with FM (patients) and 28 healthy women (controls) who answered the IPAQ and performed the 6MWT. RESULTS Patients and controls self-reported similar physical activity level, considering both the total score and all IPAC subcomponents (P > 0.05). However, the FM patients had worse physical performance in the 6MWT (patients, 441.8 ± 84.1 m vs. controls, 523.9 ± 80.3 m; P < 0.01). There were no relationships between the distance walked in the 6MWT and the IPAQ variables for the control group. However, the distance walked by patients in the test showed a significant correlation (P < 0.05) with the total score and the subcomponents transport, household activities, and physical activities of moderate intensity in the IPAQ. CONCLUSIONS Women with FM had physical activity levels similar to women without FM but exhibited worse physical performance. This functional impairment may be related to lifestyle adopted because there was a relationship between physical activity level and physical performance in those patients.

Nível de atividade física e desempenho físico no teste de caminhada de 6 minutos em mulheres com fibromialgia

INTRODUCTION: Fibromyalgia (FM) is a chronic pain condition that causes impaired functional capacity, possibly through the adoption of sedentary behaviour. However, little is known regarding physical activity level and its relationship with physical performance in women with FM. OBJECTIVES: To compare physical activity level, assessed using the International Physical Activity Questionnaire (IPAQ), and physical performance, measured using the six-minute walk test (6MWT), in women with and without FM, and to examine the possible relationships between physical activity level and physical performance in both groups. METHODS: The study included 30 women diagnosed with FM (patients) and 28 healthy women (controls) who answered the IPAQ and performed the 6MWT. RESULTS: Patients and controls self-reported similar physical activity level, considering both the total score and all IPAC subcomponents (P > 0.05). However, the FM patients had worse physical performance in the 6MWT (patients, 441.8 ± 84.1 m vs. controls, 523.9 ± 80.3 m; P < 0.01). There were no relationships between the distance walked in the 6MWT and the IPAQ variables for the control group. However, the distance walked by patients in the test showed a significant correlation (P < 0.05) with the total score and the subcomponents transport, household activities, and physical activities of moderate intensity in the IPAQ. CONCLUSIONS: Women with FM had physical activity levels similar to women without FM but exhibited worse physical performance. This functional impairment may be related to lifestyle adopted because there was a relationship between physical activity level and physical performance in those patients.

Acylated ghrelin: A potential marker for fibromyalgia?

Fibromyalgia is characterized by chronic widespread pain and sleep disturbances. Overweight and obesity, which lead to metabolic changes, are additional comorbidities that are rarely explored, although they are highly prevalent in patients with fibromyalgia.

Características da marcha de mulheres com fibromialgia: um padrão prematuro de envelhecimento

BACKGROUND Fibromyalgia is a condition which involves chronic pain. Middle-aged individuals with fibromyalgia seem to exhibit changes in gait pattern, which may prematurely expose them to a gait pattern which resembles that found in the elderly population. OBJECTIVE To determine the 3D spatial (linear and angular) gait parameters of middle-aged women with fibromyalgia and compare to elderly women without this condition. METHODS 25 women (10 in the fibromyalgia group and 15 in the elderly group) volunteered to participate in the study. Kinematics was performed using an optoelectronic system, and linear and angular kinematic variables were determined. RESULTS There was no difference in walking speed, stride length, cadence, hip, knee and ankle joints range of motion between groups, except the pelvic rotation, in which the fibromyalgia group showed greater rotation (P<0.05) compared to the elderly group. Also, there was a negative correlation with pelvic rotation and gluteus pain (r = -0.69; P<0.05), and between pelvic obliquity and greater trochanter pain (r = -0.69; P<0.05) in the fibromyalgia group. CONCLUSION Middle-aged women with fibromyalgia showed gait pattern resemblances to elderly, women, which is characterized by reduced lower limb ROM, stride length and walking speed.

Ankle dorsiflexion may play an important role in falls in women with fibromyalgia

BACKGROUND Fibromyalgia is a chronic pain condition, which involves reduced range of motion. This leads to gait changes and high incidence of falls. The understanding of the gait patterns in subjects with fibromyalgia and their relationship with falls may be useful when designing intervention programs. The purpose of this study was to evaluate the range of motion of the hip and ankle joints during gait in women with and without fibromyalgia. Further, we determined the relationship between joint range of motion and falls in this population. METHODS Middle-aged women (16 with fibromyalgia and 16 as control group) were recruited. Pain intensity, physical activity level, and fall prevalence were assessed. Three dimensional gait analysis provided temporal and joint kinematic variables. FINDINGS In general, hip and ankle range of motion were similar between groups, except that fibromyalgia group showed higher plantar flexion during toe-off (P<0.05) and reduced dorsiflexion during stance phase (P<0.05). Additionally, in the fibromyalgia group the higher number of falls was correlated to reduced dorsiflexion during stance phase. This limitation in dorsiflexion was related to longer length of time with fibromyalgia symptoms. INTERPRETATION Women with fibromyalgia showed a higher number of falls, reduced dorsiflexion during stance phase, and increased plantar flexion during toe-off. Also, the higher number of falls reported in the fibromyalgia group was related to reduced dorsiflexion during stance phase, which was correlated to a longer length of time living with fibromyalgia symptoms. These data suggest that improving ankle kinematics in patients with fibromyalgia may help prevent falls and improve mobility.

Torque and Muscle Activation Impairment Along With Insulin Resistance Are Associated With Falls in Women With Fibromyalgia.

Abstract Góes, SM, Stefanello, JMF, Homann, D, Lodovico, A, Hubley-Kozey, CL, and Rodacki, ALF. Torque and muscle activation impairment along with insulin resistance are associated with falls in women with fibromyalgia. J Strength Cond Res 30(11): 3155–3164, 2016—Fibromyalgia (FM) is a chronic pain condition associated with reduced muscle strength, which can lead to functional incapacity and higher risk of falls. The purpose of the study was to compare maximal ankle joint torque, muscle activation, and metabolic changes between women with and without FM. In addition, the relationship between those aspects and retrospectively reported falls in women with FM was determined. Twenty-nine middle-aged women with FM and 30 controls were recruited. Fall history, pain intensity, and pain threshold were assessed. Plasma glucose levels and insulin resistance (IR) were determined. Peak torque and rate of torque development (RTD) were calculated, and muscle activation was assessed from maximum isometric voluntary ankle dorsiflexion and plantar flexion contractions. In addition, voluntary muscle activation failure of the anterior tibialis muscle during maximal dorsiflexion was calculated. When compared to controls, women with FM reported higher number of retrospectively reported falls, exhibited higher IR, showed reduced plantar flexion and dorsiflexion RTD, had lower plantar flexion peak torque, and demonstrated more antagonist coactivation and higher muscle activation failure (p ⩽ 0.05). Higher muscle activation failure was explained by glucose level and pain intensity (adj R 2 = 0.28; p ⩽ 0.05). Reduced plantar flexion and dorsiflexion peak torque explained 80% of retrospectively reported falls variance; also, high antagonist coactivation (odds ratio [OR] = 1.6; p ⩽ 0.05) and high IR (OR = 1.8; p ⩽ 0.05) increased the chance of falls in the FM group. A combination of metabolic factors and muscle function increased the odds of retrospectively reporting a fall in FM. Both aspects may be considered in interventions designed for reducing falls in this population.

Efeitos de curto prazo de um programa de imaginação sobre o medo de queda de indivíduos pós acidente vascular encefálico

The fear of falling is one of the main problems with subjects after stroke. Imagery could be one succeed experience to decrease this issue. The aim of this study was to verify the effect of a short-time imagery intervention in fear of falling in subjects after stroke. Seven individuals affected by stroke participated in the study. The Falls Efficacy Scale International (FES-I-Brazil) were used before (PRE), after (POST) and seven days after intervention (RET). Four session of familiarization and six of imagery were performed. There were no difference in FES-I-Brazil score after intervention (p=0.46), except in up/down stairs task (PRE and POST, p=0.04; PRE and RET, p=0.01). Although, the improvement in up/down stairs task, no more changes were found in the scale items, which could represent a relatively reduced effect of short-time imagery intervention.