FIBROMYALGIA IMPROVES WITH STRENGTH TRAINING

Fibromyalgia (FM) is a chronic disease characterized by generalized skeletal muscle pain (1, 2), and other common symptoms include fatigue, sleep disorders, depression, and excessive anxiety (3–6). The pathogenesis of FM is still not well understood (7), and FM is considered by some researchers to be a neurobiological disease caused by abnormal processing of pain (8).

There is currently no cure for FM, but palliative treatments are available. One type of treatment is strength training (ST). The aim of this study was to analyze the effects of ST in the treatment of FM through a systematic review of experimental research. Twenty-two studies were included in the review. Women aged 18–65 years comprised the total sample and the main variables analyzed were pain, strength, muscular activity, functional capacity, fatigue, quality of life, and sleep. 

Information extracted from: (Andrade, A., de Azevedo Klumb Steffens, R., Sieczkowska, S. M., Peyré Tartaruga, L. A., & Torres Vilarino, G. (2018). A systematic review of the effects of strength training in patients with fibromyalgia: clinical outcomes and design considerations. Advances in Rheumatology, 58(1). doi:10.1186/s42358-018-0033-9). 

 

Results

 The analysis of the results revealed that ST reduced the symptoms of patients with FM, such as pain, fatigue, number of tender points, depression, and anxiety, with improved functional capacity and quality of life (9, 10, 11, 12, 13, 14, 15, 16), despite the different training protocols used.

 Pain

Pain was the most studied variable, showing a reduction after ST (11, 12, 17, 18, 19–21). No study reported increased pain after or during the intervention period

 Muscle Strength

With regard to muscle strength, increases between 33 and 63% were observed after 21 and 16 weeks (15, 22).

 Quality of life and Functionality

Studies analysing quality of life and functionality showed that ST is effective in improving these variables (23, 12, 24, 15, 16, 18).

 Depression

The most investigated psychological variable was depression. The studies of Jones et al. (18), Gavi et al. (12), and Assumpção et al. (25) showed that ST reduces depressive symptoms; however, the study of Ericsson et al. (10) did not find a significant difference after 15 weeks of intervention.

 Sleep Quality

We also analyzed the results related to sleep quality. Andrade et al. (9) found that sleep disorders were reduced after ST and that sleep correlated with pain. The results of Ericsson et al. (10) also disclosed that ST yielded better results than relaxation sessions in improving sleep quality. In addition, another important result is that patients with FM presented similar responses to those of healthy persons; thus, they recommended ST to assist in the treatment of patients.

  

Training Protocol

It was observed that there is no specific training protocol for patients with FM; thus, the researchers developed their own protocol.
 Intervention protocols should start at low intensity (40% of 1RM) and gradually increase the intensity. ST should be performed 2 or 3 times a week to exercise the main muscle groups.  The current studies showed that ST is a safe and effective method of improving the major symptoms of FM and can be used to treat patients with this condition.  

Example of Training Protocol, Rooks et al. (18)

The intervention was designed to gradually increase the volume and intensity of exercise a person performed, to involve all major muscle groups of the body, and to include all 3 aspects of fitness— cardiovascular endurance, muscle strength, and joint flexibility.
 The exercises began with a low volume of exercise performed at a low intensity, because of the expected lower levels of cardiovascular fitness and muscle strength reported in women with Fibromyalgia, and the lower threshold for postexercise muscle pain and fatigue seen in this population. Participants exercised for 60 minutes per session, 3 times per week for 20 weeks. The intervention was composed of 2 phases of exercise.

 The first phase (4 weeks) was performed in a pool, and focused on active range of motion of the body’s major joints. Movements were controlled single-joint motions.

 The second phase (16 weeks) involved land-based exercises for improving cardiovascular endurance, muscle strength, and joint range of motion. Each exercise session was divided into 3 sections—cardiovascular, strength training, and flexibility—and was always performed in the same order.

 - Cardiovascular exercises incorporated walking on a treadmill (Life Fitness), an elliptical device (Precor, Bothell, WA), and walking on a track.

 - Strength training exercises included static contractions for pelvic and lumbar spine stabilization, and dynamic movement of large muscles and multijoint actions: hip flexion/extension, knee extension/flexion, ankle plantar/dorsiflexion, shoulder flexion, extension, abduction and horizontal adduction and abduction, elbow flexion and extension, and trunk flexion and rotation.
Strength training exercises were performed using a combination of machines (Life Fitness), hand weights, and body weight. Subjects began with resistance levels they could do easily, and progressed in an 8-10-12-12 repetition format when appropriate.

 - Flexibility was developed using a complete range of motion during strength training movements, traditional stretches, and a flexibility device (Precor).

 The land-based exercise program was revised after 3 months to prevent boredom and reduce the chance of dropout.  

Conclusion

In conclusion, ST had positive effects on physical and psychological symptoms, in terms of reducing pain, the number of tender points, and depression, and improving muscle strength, sleep quality, functional capacity, and quality of life.  

Bibliography

1. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum. 1990;33(2):160–72. 

2. Wolfe F, Clauw DJ, Fitzcharles M-A, Goldenberg DL, Häuser W, Katz RL, et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Seminars in arthritis and rheumatism. 2016;46:319-29. 

3. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology Preliminary Diagnostic Criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62(5):600–10 PubMed PMID: WOS:000280979600004. 

4. Borchers AT, Gershwin ME. Fibromyalgia: a critical and comprehensive review. Clin Rev Allergy Immunol. 2015;49(2):100–51 PubMed PMID:WOS: 000362902500002.English. 

5. McDowell CP, Cook DB, Herring MP. The effects of exercise training on anxiety in fibromyalgia patients: a meta-analysis. Med Sci Sports Exerc. 2017; 49(9):1868–76 PubMed PMID: 28419024.Epub 2017/04/19.eng. 

6. Häuser W, Ablin J, Fitzcharles M-A, Littlejohn G, Luciano JV, Usui C, et al. Fibromyalgia. Nature reviews Disease primers. 2015;1:15022. 

7. Andrade A, Vilarino GT, Sieczkowska SM, Coimbra DR, Steffens RAK, Vietta GG. Acute effects of physical exercises on the inflammatory markers of patients with fibromyalgia syndrome: a systematic review. J Neuroimmunol. 2018;316:40–9. 

8. Sluka KA, Clauw DJ. Neurobiology of fibromyalgia and chronic widespread pain. 

9. Andrade A, Vilarino GT, Bevilacqua GG. What is the effect of strength training on pain and sleep in patients with fibromyalgia? Am J Phys Med Rehabil. 2017. 

10. Ericsson A, Palstam A, Larsson A, Lofgren M, Bileviciute-Ljungar I, Bjersing J, et al. Resistance exercise improves physical fatigue in women with fibromyalgia: a randomized controlled trial. Arthritis Res Ther. 2016;18:12 PubMed PMID: WOS:000381728500002. English. 

11. Kingsley JD, McMillan V, Figueroa A. The effects of 12 weeks of resistance exercise training on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia. Arch Phys Med Rehabil. 2010;91(10):1551–7 PubMed PMID: WOS:000282720300010. English. 

12. Gavi M, Vassalo DV, Amaral FT, DCF M, Gava PL, Dantas EM, et al. Strengthening exercises improve symptoms and quality of life but do not change autonomic modulation in fibromyalgia: a randomized clinical trial. PLoS One. 2014;9(3):–8 PubMed PMID: WOS:000333352800023. English.

13. Hakkinen A, Hakkinen K, Hannonen P, Alen M. Strength training induced adaptations in neuromuscular function of premenopausal women with fibromyalgia: comparison with healthy women. Ann Rheum Dis. 2001;60(1): 21–6 PubMed PMID: WOS:000166008100005. English. 

14. Martinsen S, Flodin P, Berrebi J, Lofgren M, Bileviciute-Ljungar I, Mannerkorpi K, et al. The role of long-term physical exercise on performance and brain activation during the Stroop colour word task in fibromyalgia patients. Clin Physiol Funct Imaging. 2017; PubMed PMID: 28627125. Epub 2017/06/20. eng. 

15. Valkeinen H, Alen M, Hannonen P, Hakkinen A, Airaksinen O, Hakkinen K. Changes in knee extension and flexion force, EMG and functional capacity during strength training in older females with fibromyalgia and healthy controls. Rheumatology. 2004;43(2):225–8 PubMed PMID: WOS:000188850000018. English. 

16. Bircan C, Karasel SA, Akgun B, El O, Alper S. Effects of muscle strengthening versus aerobic exercise program in fibromyalgia. Rheumatol Int. 2008;28(6): 527–32 PubMed PMID: WOS:000254206100004. English. 

17. Hooten WM, Qu WC, Townsend CO, Judd JW. Effects of strength vs aerobic exercise on pain severity in adults with fibromyalgia: A randomized equivalence trial. Pain. 2012;153(4):915–923. PubMed PMID: WOS: 000301877300027. English. 

18. Rooks DS, Silverman CB, Kantrowitz FG. The effects of progressive strength training and aerobic exercise on muscle strength and cardiovascular fitness in women with fibromyalgia: a pilot study. Arthritis Rheum-Arthritis Care Res. 2002;47(1):22–8 PubMed PMID: WOS:000173803700005. English. 

19. Valkeinen H, Hakkinen A, Hannonen P, Hakkinen K, Alen M. Acute heavyresistance exercise-induced pain and neuromuscular fatigue in elderly women with fibromyalgia and in healthy controls - effects of strength training. Arthritis Rheum. 2006;54(4):1334–9 PubMed PMID: WOS:000236830800035. English. 

20. Larsson A, Palstam A, Lofgren M, Ernberg M, Bjersing J, Bileviciute-Ljungar I, et al. Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia-a randomized controlled trial. Arthritis Research & Therapy. 2015;17:15 PubMed PMID: WOS:000357248900001. English. 

21. Palstam A, Larsson A, Lofgren M, Ernberg M, Bjersing J, Bileviciute-Ljungar I, et al. Decrease of fear avoidance beliefs following person-centered progressive resistance exercise contributes to reduced pain disability in women with fibromyalgia: secondary exploratory analyses from a randomized controlled trial. Arthritis Research & Therapy. 2016;18 PubMed PMID: WOS:000376372300006. 

22. Figueroa A, Kingsley JD, McMillan V, Panton LB. Resistance exercise training improves heart rate variability in women with fibromyalgia. Clin Physiol Funct Imaging. 2008;28(1):49–54 PubMed PMID: WOS:000251629100008.

23. Kingsley JD, Panton LB, Toole T, Sirithienthad P, Mathis R, McMillan V. The effects of a 12-week strength-training program on strength and functionality in women with fibromyalgia. Arch Phys Med Rehabil. 2005; 86(9):1713–21 PubMed PMID: WOS:000231747300001. 

24. Panton LB, Figueroa A, Kingsley JD, Hornbuckle L, Wilson J, St John N, et al. Effects of resistance training and chiropractic treatment in women with fibromyalgia. J Altern Complement Med. 2009;15(3):321–8 PubMed PMID: 19249999. Epub 2009/03/03. eng. 

25. Assumpção A ML, Yuan SL, Santos AS, Sauer J, Mango P, Marques AP. Muscle stretching exercises and resistance training in fibromyalgia: which is better? A three-arm randomized controlled trial. - PubMed - NCBI. 2017.

KINESIOTAPING and KNEE OSTEOARTHRITIS

 

Knee osteoarthritis (OA) is the most prevalent chronic joint disease. Cartilage is the central tissue affected by OA and causes subsequent symptoms, including joint pain, stiffness and joint swelling, which diminishes the range of motion (1,2).

Currently, no reliable treatment has been confirmed to prevent progression of knee OA. The aim this review was to evaluate the efficacy of Kinesio Taping (KT) in reducing pain and increasing knee function in patients with OA.
 

Knee osteoarthritis

(Information extracted from: Lu, Zhijun, et al. "Kinesio taping improves pain and function in patients with knee osteoarthritis: A meta-analysis of randomized controlled trials." International Journal of Surgery (2018))

 

Kinesio Taping Application

Five studies were included in this review. They compared an intervention group who received KT to a placebo group received sham Taping.

1. Cho et al. (3) an I-shaped KT starting at the origin of the rectus femoris and a Y-shaped KT proximal to the superior patellar boarder. While KT was applied, the quadriceps muscle was being stretched.
 

Cho et al.

 2. Wageck et al. (4) three KT elements applied simultaneously. 

A) Drainage element of the experimental application. B) Muscle strength element of the experimental application. C) Pain-relief element of the experimental application. D) Combined experimental application.
 

Wageck et al.

 3. Mutlu et al. (5) KT on their quadriceps femoris and hamstring muscle. First, patients were taped with a Y-shaped Kinesio type at the quadriceps femoris. The tape was applied a point 5 cm inferior to the anterior superior iliac spine to the knee cap (origin to insertion), with the patient in a supine position with 25% tension. Then, each patient flexed his or her knee, and the Y-shaped tape (the tails of the tape) was circled around the patella, ending at its inferior side with no tension.
 

Next, patients were taped with a Y-shaped Kinesio type at the hamstring muscle. The tape was applied from ischial tuberosity to the back of the knee, with the patients in a standing position with their trunk bent. Then, the Y-shaped tape (the tails of the tape) was applied around the lateral side of the knee and medial side of the knee.
 

Mutlu et al.

 4. Aydogdu et al. (6) KT on quadriceps and hamstring muscles was performed with Y-shaped technique. The subjects lay in the supine position with the hip flexed at 30◦ and the knee flexed at 60◦. In the supine position, taping was first applied to the quadriceps femoris. The tape was applied from a point 10 cm inferior to the anterior superior iliac spine, bisected at the junction between quadriceps femoris tendon and the patella, and circled around the patella, ending at its inferior side. The first 5 cm of the tape were not stretched. The portion between the first part of tape and superior patella was stretched to 50–70%. The remaining tape around the patella remained un-stretched. After that, in the prone position, hamstring was taped secondly with the same method.
  

Aydogdu et al.

5. Rahlf et al. (7) KT on their quadriceps femoris and hamstring muscle. A medial and a lateral “I” strap as well as 1 “I” strap over the patella were applied. “I” strap means the tape is not cut into different parts; The strap across the patella was applied in individual maximum knee flexion. The base of the tape was applied at the tibial tuberosity and pulled in maximum tension over the patella, ending at the lower third of the quadriceps femoris muscle. The medial and lateral straps were applied in 45° knee flexion along the collateral medial and lateral ligaments.
  

Rahlf et al.

Outcomes after place KT

Visual analog scale (VAS)

VAS scale was adopted to measure pain and it was considered a subjective method.

Taping was associated with a significantly reduction in VAS scale at rest, as well as at movement in patients with knee OA. This pain reduction can be attributed to neurological suppression, due to stimulation of cutaneous mechanoreceptors.

Anandkumar et al. (8) showed that there was a decreased pain in Kinesio Taping groups while climbing stairs. The present meta-analysis indicated that Kinesio Taping was associated with a significantly reduction in VAS scale at rest.

Range of motion and McMaster Universities Arthritis Index (WOMAC) scale
Articular cartilage can be damaged by normal wear and abnormal mechanical loading which may cause abnormal cellular activities in cartilage and synovium, resulting in stiffness, loss of range of motion (9).

Our review demonstrated that Kinesio Taping was associated with an improved WOMAC compared with sham Taping. So Kinesio Taping could significantly improve knee flexion range of motion.
 

Muscle strength

Quadriceps femoris muscle weakness is a common symptom in knee OA and this may affect joint function and accelerate progress of degeneration (10,11). There was no significant difference in quadriceps femoris muscle in patients with knee OA.
 

Conclusions

Kinesio Taping is effective in improving for pain and joint function in patients with knee OA.
 

Bibliography

 1. M. Hurley, K. Dickson, R. Hallett, R. Grant, H. Hauari, N. Walsh, C. Stansfield, S. Oliver, Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review, Cochrane Database Syst. Rev. 4 (2018) CD010842. 

2. S. Demehri, D. Shakoor, Structural Changes in Aging-knee versus Early-knee Osteoarthritis: Review of Current Evidence and Future Challenges, Osteoarthritis and cartilage, 2018. 

3. H.Y. Cho, E.H. Kim, J. Kim, Y.W. Yoon, Kinesio taping improves pain, range of motion, and proprioception in older patients with knee osteoarthritis: a randomized controlled trial, Am. J. Phys. Med. Rehabil. 94 (3) (2015) 192–200. 

4. B. Wageck, G.S. Nunes, N.B. Bohlen, G.M. Santos, M. de Noronha, Kinesio Taping does not improve the symptoms or function of older people with knee osteoarthritis: a randomised trial, J. Physiother. 62 (3) (2016) 153–158. 

5. E. Kaya Mutlu, R. Mustafaoglu, T. Birinci, A. Razak Ozdincler, Does kinesio taping of the knee improve pain and functionality in patients with knee osteoarthritis?: a randomized controlled clinical trial, Am. J. Phys. Med. Rehabil. 96 (1) (2017) 25–33. 

6. O. Aydogdu, Z. Sari, S.U. Yurdalan, M.G. Polat, Clinical outcomes of kinesio taping applied in patients with knee osteoarthritis: a randomized controlled trial, J. Back Musculoskelet. Rehabil. 30 (5) (2017) 1045–1051. 

7. A.L. Rahlf, K.M. Braumann, A. Zech, Kinesio taping improves perceptions of pain and function of patients with knee osteoarthritis. A randomized, controlled trial, J. Sport Rehabil. (2018) 1–21. 

8. S. Anandkumar, S. Sudarshan, P. Nagpal, Efficacy of kinesio taping on isokinetic quadriceps torque in knee osteoarthritis: a double blinded randomized controlled study, Physiother. Pract. 30 (6) (2014) 375–383. 

9. D. Chen, J. Shen, W. Zhao, T. Wang, L. Han, J.L. Hamilton, H.J. Im, Osteoarthritis: toward a comprehensive understanding of pathological mechanism, Bone Res. 5 (1) (2017) 1–13. 

10. C. Slemenda, D.K. Heilman, K.D. Brandt, B.P. Katz, S.A. Mazzuca, E.M. Braunstein, D. Byrd, Reduced quadriceps strength relative to body weight: a risk factor for knee osteoarthritis in women? Arthritis Rheum. 41 (11) (1998) 1951–1959. 

11. M.B. Conroy, C.K. Kwoh, E. Krishnan, M.C. Nevitt, R. Boudreau, L.D. Carbone, H. Chen, T.B. Harris, A.B. Newman, B.H. Goodpaster, Muscle strength, mass, and quality in older men and women with knee osteoarthritis, Arthritis Care Res. 64 (1) (2012) 15–21.