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Exercise and movement are very important in controlling the severity of Fibromyalgia symptoms, this we all know, or have been told time and time again by our Doctors, therapists and friends, but.....how much exercise, what types of exercise? Can we exercise with Chronic Myofascial Pain Syndrome, RSD, Lupus or CFIDS? In an attempt to make some sense of it all, we are placing all of the research, tips and tricks we find on the subject here, where hopefully we can help you find some answers. As always, if you know of a site, a book or other resource that should be listed on this page to help others find some answers, please mail it to us so we can include it here. E-Mail
Studies and Articles Page last updated on February 16, 2008
Say you were injured playing your favorite sport and had to have surgery on your knee. Now think of the countless hours of painful rehabilitation you face just to get your knee working again. What if there was a way to rehabilitate your knee in less time and with less pain? Or maybe you suffer from fibromyalgia or some other disorder that makes even the lightest touch painful. What if there was a way to get your muscles back in working order without all the pain? Well, there is. It's water therapy. Using water to rehab injuries and ailments is both old and new. Greeks and Romans in ancient times used water to help them rehabilitate after sporting events, but it's only caught on recently in modern times. When NASA started doing research on weightlessness in water in the 1960s, people started realizing the scientific benefits of water therapy. "Water can really help most patients," says Jan Pratt, physical therapist and owner of Aquatic Fitness Inc. in Creve Coeur and O'Fallon, Mo. "Using water is faster and better and offers less pain for the patient. For years physical therapists were referred to as physical terrorists or physical torturists. Water isn't that way -- it's fun. And it has a powerful effect." Just ask Steve Rainey, 45, of O'Fallon, Mo. After his third, and most invasive, back surgery, his doctor recommended water therapy. "I just couldn't believe the difference it made," he says. "When I did regular land therapy it seemed like I hurt all the time." With water therapy, many patients are able to get back to movement earlier, and with less pain and without stressing the parts that are healing. You can start treatment one or two days after a sprain or strain and two to 10 days after surgery; compare this with five to seven days for a sprain or strain and two to four weeks after surgery for treatment on land, Pratt says. Of course, an open wound would prohibit immediate water therapy, though in some cases a special bandage can be used. Water therapy with a different twist also worked for Susan Staat, 51, of Arnold, Mo. Staat has suffered from fibromyalgia for years. Fibromyalgia, an arthritis-related condition characterized by generalized muscular pain and fatigue, affects different people in different ways; for Staat, the feeling was similar to flulike symptoms in her joints. "There were days I couldn't even put my feet on the floor, it hurt so bad." She was in so much pain that the slightest touch affected her, and a traditional land massage, though beneficial, was extremely painful. Her husband read about a form of water therapy called Watsu. Watsu is a sort of Shiatsu massage in the water, a sequence of gentle movements and stretches as you are held in warm water that relaxes your body, resulting in greater flexibility and freedom. Staat thought she'd give it a try, so she called Kathleen Christ, who has performed close to 6,000 Watsu treatments at her St. Louis Aquatic Healing Arts Center in Creve Coeur, Mo. "She puts me in a very relaxed state, and I'm just lifeless, and she gives me a deep, deep massage, the kind of massage I'm unable to do on a table," Staat says. "It would be just too painful. In the water, I don't feel the pressure." After four years of therapy, Staat says she's noticed a huge change. "I feel so good now. I was really in bad shape. I was in bed most of the time. Now, I'm very active. I cut the grass; I do a lot." In fact, she's been able to cut in half the number of pills she takes to control her fibromyalgia. Watsu works for several reasons, she says. First, the warm water is hypnotic. "It's essential for anyone, especially a super Type A personality, because it gets the mind to relax. The body can heal itself when it's left to its own devices, but the mind gets in the way." The warm water then allows Christ to stretch and move the body. "The greater freedom of movement it encourages creates a modality that can affect every level of our being," she says. Freeing the spine in a weightless environment is the cornerstone of a Watsu session. The therapist supports the client in water while gently rocking and stretching the back and limbs. The head stays above water in Watsu; for greater effect, patients can try Wassertanzen -- essentially the same thing, just with the head underwater. During traditional water therapy and Watsu, the water is heated to body temperature. The warm water, says Christ, allows for a soothing of the mind as well as greater muscle movement. Water is an ideal rehabilitation tool for several reasons, Pratt says. First is buoyancy. When you are immersed in water there is less gravity and less compression on the spine and other parts of the body. "Thus, someone just standing in water often has zero pain level without even having to move." Water's hydrostatic pressure is also a reason it's a great tool. The body feels compression from all sides. The physiological effects of this include a decrease in swelling. Finally, the ability to add movement adds a new dimension. Water is 12 times denser than air, Pratt says, so the resistance (if you move swiftly enough) is great for rebuilding muscles. Plus, you can use more functional movements, working specific muscles in the water. Source: Houston Chronicle (www.chron.com). Copyright
2004 St. Louis Post-Dispatch. For more than two years, Diane Schneier and her mother Joyce have been doing aquatic therapy three times a week, trying to alleviate the pain of fibromyalgia syndrome. Fibromyalgia is not fatal, disfiguring or crippling, and it doesn't get progressively worse. But it is often frustrating, because a person's pain, symptoms and energy levels can change every day. For Diane and Joyce, aquatic therapy relieves their condition and improves fitness and well being. "The pool is the only place I can work out that doesn't hurt me," says Diane, a film producer who often spends 16 hours a day on her feet. "When I can get two or three months in a row of steady therapy sessions, I start to feel strong and physically capable again." Fibromyalgia, the pain of fibrous tissue and muscles, isn't considered a disease, but rather a combination of symptoms that range from mild to severe. Up until 1990, this syndrome wasn't diagnosed directly. Instead, doctors ruled out other disorders that produced similar symptoms -- arthritis, lupus, rheumatism, connective-tissue disorders, thyroid disease or neurologic disorders. In 1990, however, the American College of Rheumatology stated that fibromyalgia could be diagnosed by a history of widespread pain that occurred for more than three months in combination with pain in 11 of 18 specific, bilateral points in muscle tissue. If tender spots appear in all four quadrants of the body, a patient is diagnosed with fibromyalgia. General symptoms include burning or stabbing pain deep in the muscles, sensitive skin, tingling or numbness of the hands and feet, headaches, bloating, dizziness and blurred vision. Approximately 15 percent to 20 percent of patients treated by rheumatologists have fibromyalgia. Fibromyalgia patients are notoriously deconditioned; they often can't walk, use a bicycle or go to the gym without incurring more pain. The water, however, helps improve fitness while simultaneously treating aches and pains. Water's buoyancy virtually eliminates painful tissues and joints and provides an ease of movement not possible on land. Water also provides a three-dimensional resistance to movement so that muscles develop strength equally in all directions. The water applies hydrostatic pressure to bodies immersed in it, and that reduces swelling and discomfort. The following water protocol for fibromyalgia focuses on total body fitness, as well as stretching and strengthening specific areas of the body. All of these exercises are explained in detail, with photos, in The Complete Waterpower Workout Book by Lynda Huey and Robert Forster, P.T. (Random House, 1993). Deep-water warm-up. By avoiding all impact, patients slowly perform general warm-up exercise with a sense of ease. Most patients have their heads above water, but people with severe neck pain do warm-ups submerged. This takes the weight of the head off the neck so they can exercise more comfortably. For safety, all patients are tethered to the side of the pool. Deep-water interval training. An interval training session is created by combining the three skills -- deep water running, deep water walking and flies (hip and shoulder ab/adduction) -- in the deep water warm-up and varying the speed to create alternate periods of work and rest. Fibromyalgia patients should work at low to medium intensity levels to gain maximum aerobic benefits without crossing over into anaerobic work, which can cause undue fatigue. Pacing is important to help these patients make it through the entire session. Again, patients with neck pain are submerged. Deep water-power exercises. The following nonweight-bearing exercises help strengthen the body gently and safely: sit kicks, heel lifts, bent-knee twists, quick scissors, v-kicks and deep back kicks. Kick training. All of the following kicks target the muscles of the hips, thighs and buttocks: front and back flutter kick, bicycle kick, straight-leg deep kick and slap kick. Therefore, the lower extremities are reconditioned without any impact or undue fatigue. Patient's shoulders are protected by doing these exercises in a corner or on a step. Stretching. The following stretches cover all the major muscle groups, but particular focus is on the shoulders and neck, where fibromyalgia patients report the most pain.
Upper extremity exercises. This series of range-of-motion exercises helps shoulders and arms gain strength, flexibility and function. On days when the pain level in the neck, shoulders and arms is minimal, we may ask a patient to use webbed gloves to create more resistance, thereby gaining strength. On days when pain is great, we may ask them to slowly perform the following pain-relieving exercises:
Swimming or assisted swimming. If a patient swims, she can use the stroke that causes the least pain and aggravation. For people with back or neck pain, we often add face masks, snorkels, flotation belts for the hips and cervical collars for the neck. Most patients, however, do either a combined stroke (breaststroke with flutter kick) or a modified backstroke. The backstroke modifications apply the least amount of pressure on the neck, upper back and shoulders. Watsu. This relaxation technique yields the greatest pain relief for fibromyalgia patients. The therapist cradles the patient in her arms, then gently rotates her own body from side to side, which causes the patient's limbs to sway. During a 15- to 20- minute treatment, the therapist moves from one side of the other side. During this motion, the patient floats with eyes closed and ears in the water, creating sensory deprivation, which relaxes and breaks the pain cycle. Watsu also has a cumulative effect on well being. For instance, if patients are pain-free for an hour or so after the first session, they may not have pain for up to four hours the next time. Waterpower Workout exercises. These low-impact jumping exercises are optional and used only on days when a patient has little pain and feels strong and energetic. Exercises such as lunges, crossovers, squat jumps, side straddles, leg swings, front kicks, back kicks and frog jumps give patients a sense of athleticism they don't normally possess.
Our success with these patients has inspired rheumatologists to send other fibromyalgia patients to us. Insurers, workers' comp and private, are reimbursing steadily for treatment as well. Several years ago, Fibromyalgia patients had few options, but with aquatic therapy, they have a valid treatment plan that provides what they need: pain relief and a fitness routine that won't exacerbate their condition. Lynda Huey, MS, who pioneered the use of aquatic therapy with Olympic and professional athletes, is co-author of The Complete Waterpower Workout Book (Random House, 1993) and Heal Your Hips (John Wiley & Sons, 1999). Since 1994, Pattie O'Leary has worked with Lynda Huey in Southern California and Florida. You may contact the authors at (310) 829-5622. Fibromyalgia Pain vs. Muscle Soreness: Monitoring Pain During Exercise by Colleen Black-Brown, M.S. The following information was developed as a guide for health care professionals to assist their FM patients in an exercise program, and contains useful information for patients. Presented with permission of the author. Exercise Prescription for Fibromyalgia: A Plan for Patients From Beginner to Advanced By Colleen Black-BrownWhy Water Exercise is Beneficial
Dangers of Repetitious Exercise with TrPs: By Devin Starlanyl What Your Physical Therapist Should Know about Fibromyalgia: By Devin Starlanyl Exercise: "Another very important component to my well-being." excerpt from My Regimen by Miryam Williamson An Exercise Program for Fibromyalgia by the American Academy of Family Physicians Scroll down about 3/4's of the page.
Stretching the legs. 5 examples, with photos, on the proper way to stretch your legs. Stretching Exercises. A great resource that contains animated images you can download and watch at your leisure. They show you the proper way to stretch each area. Tai chi: Tai chi is good for people with FM and CFS because of the slowness of the exercises, which take the body very, very gently through a whole range of motions without engaging strong muscle contraction, like weightlifting does. This type of exercise does not create adrenaline in the body. People who have FM know that if they engage in physical exercises that produce adrenaline, their bodies have a difficult time processing it. (Source: Alternative Treatments for Fibromyalgia & Chronic Fatigue Syndrome, by Mari Skelly and Andrea Helm.) Yaz Exercises for those who need to exercise to get better, but have difficulty because exercising induces symptoms. Qigong Association of America: Qigong is a self-healing art that combines movement and meditation. Visualizations are employed to enhance the mind/body connection and assist healing.
Exercise and Stretching. A video for fm'ers by Dr. Robert Bennett, Dr. Sharon Clark and the NFRA. Easy Does It. A series of video tapes for those who have injuries, knee problems, don't like to get on the floor, seniors, and those who just prefer to do the workout at a slower pace. "Pain Erasure The Bonnie Prudden Way" addresses MPS and a program for stretching and exercise "The Travell Stretch Program", by Dr. Janet Travell, developed especially for MPS, is available in Book-chart form as well as a three volume video Click on Books and Charts and also on Videos. "Fibromyalgia: Simple Relief Through Movement" by Stacie L.
Bigelow. You do have to register to get in to read this. The The Fibromyalgia Survivor: By Mark Pellegrino, MD. The Dr. describes how he manages to cope day to day with FM. He addresses the role of Chiropractic care, and it contains a section that an be useful to your Physical therapists and Occupational Therapists. Anadem Publishing, Columbus Ohio. Taking Charge of Fibromyalgia: A Self-Help Management Program: By Julie Kelly , MS RN and Rosalie Devonshire BA. A comprehensive book, covering all aspects of living with FM. Contains charts to monitor your progress, covers the psychological aspects of this disease and info on Nutrition, traditional medicine, posture and exercise. 170 page handbook for patient and health care provider. 612-473-6218 or Write Fibromyalgia Educational systems, Inc. 500 Bushaway Rd. Wayzata. MN 55391 Gentle Fitness, an exercise video geared to those with chronic conditions. Different activity levels and very mild, no impact, stretching, yoga and breathing techniques are stressed. Fibromyalgia Exercise Video, produced by Oakville-Trafalgar Memorial Hospital in Oakville, Ontario, Canada. It has been created by health care professionals working in the field of rehabilitation for FM Patients. It is a 28 min. video that explains each component of exercise and guides you through it in a practical way. To order: Send 20.00 + 4.50 S&H to OTMH charitable Corp. Exercise Video. 327 Reynolds Street Oakville, Ontario L67 3L7 Attn: Pauling Mihok, Physiotherapy Department. AHA exercise pamphlet: Low impact & stretching Call 1-800-AHA-USA1 Soft and Easy Exercises for Everyone: (Recommended for Fibromyalgia) By: Mary Bennett
Dr. Charles Lapp......The second step we talk about is activity and exercise. Of course, the first thing we point out is that this is an exertional illness. The more you exert, the sicker you get. If you overexert then you end up sick for a couple or three days in bed. On the other hand, if you don't do anything and you just lay around in the bed, you get deconditioned, and the muscles hurt, and the joints hurt more. So you have to get a narrow road. The thing that we really stress is that you have to avoid strict bed rest. That just does not do it, but balance light activity with rest, using common sense as a guideline. *For the complete transcript of a lecture given by Dr. Lapp, that contains this quote, go here. Dr. Rudin. There is no single ideal exercise program for patients with fibromyalgia syndrome, as each patient is unique. Some fibromyalgia patients have associated back, neck, or joint problems that require specific attention. Others have difficulty maintaining a high enough blood pressure when sitting or standing, and an exercise program must compensate for this. Still others are very flexible or "double-jointed" individuals who cannot perform certain exercises without risking injury. The best way to find your ideal exercise program is to work with a physician who has experience in the evaluation and treatment of fibromyalgia. Many rheumatologists and physiatrists (rehabilitation physicians) have particular expertise in this area. These physicians often work with specially trained physical therapists, exercise physiologists, and other health professionals who can help refine the details of your program. You mentioned a swimming pool. Aquatic exercise, for those who have access to it, provides an excellent workout for some individuals with fibromyalgia. However, for those who can't tolerate the water or don't have access to a pool, there are many other appropriate exercises. Your specialist can point you in the right direction. Dr. Rudin, is Assistant Professor in Physical Medicine and Rehabilitation (Physiatry) in the Johns Hopkins University School of Medicine. Dr. Rudin's interests focus on the assessment and treatment of pain disorders and musculoskeletal problems. Dr. David Nye: Low
levels of growth hormone, important in maintaining good muscle and other soft tissue
health, have been found in-patients with fibromyalgia. This hormone is produced almost
exclusively in deep sleep, and its Robert Bennett, M.D Understanding
the right approach to exercise is crucial. Robert Bennett, M.D., provided the
statements below as a rebuttal to the poorly written article on fibromyalgia which
appeared in an issue of Prevention Magazine.
The buoyancy of water decreases the effects of gravity so it takes less effort to move. And water provides resistance, which promotes strength and enhances balance. Immersion in water also reduces pain perception and aids in relaxation. An exercise done in water will be both easier to perform and more beneficial than the same exercise done on land. Getting Started:
Research Supporting Water ExerciseMultiple studies have shown that water exercise benefits fibromyalgia patients both physically and emotionally. This year (2006) a study in Brazil looked at the effectiveness of deep water running on FM symptoms, while in Spain researchers evaluated FM patients exercising in waist-high warm water. A 2001 Norway study compared the effects of land-based and pool-based aerobic exercise on women with FM. In these studies, fibromyalgia patients experienced reduced pain, improved functionality and better emotional health. The comparative study found that both forms of exercise resulted in physical improvements but in the pool-based group improvements were also found in the number of days of feeling good, self-reported physical impairment, pain, anxiety and depression. All of the studies also showed long-term benefits from water exercise. 23 weeks of aerobic
exercise for individuals with fibromyalgia. Usefulness of a
Readaption Program in Patients with Primary Fribromyalgia and CFS Patients with
Concomitant Fibromyalgia
Strength and physiological response to exercise in patients with chronic fatigue syndrome. OBJECTIVE: To measure strength, aerobic exercise capacity and efficiency, and functional incapacity in patients with chronic fatigue syndrome (CFS) who do not have a current psychiatric disorder. METHODS: Sixty six patients with CFS without a current psychiatric disorder, 30 healthy but sedentary controls, and 15 patients with a current major depressive disorder were recruited into the study. Exercise capacity and efficiency were assessed by monitoring peak and submaximal oxygen uptake, heart rate, blood lactate, duration of exercise, and perceived exertion during a treadmill walking test. Strength was measured using twitch interpolated voluntary isometric quadriceps contractions. Symptomatic measures included physical and mental fatigue, mood, sleep, somatic amplification, and functional incapacity. RESULTS: Compared with sedentary controls, patients with CFS were physically weaker, had a significantly reduced exercise capacity, and perceived greater effort during exercise, but were equally unfit. Compared with depressed controls, patients with CFS had significantly higher submaximal oxygen uptakes during exercise, were weaker, and perceived greater physical fatigue and incapacity. Multiple regression models suggested that exercise incapacity in CFS was related to quadriceps muscle weakness, increased cardiovascular response to exercise, and body mass index. The best model of the increased exercise capacity found after graded exercise therapy consisted of a reduction in submaximal heart rate response to exercise. CONCLUSIONS: Patients with CFS were weaker than sedentary and depressed controls and as unfit as sedentary controls. Low exercise capacity in patients with CFS was related to quadriceps muscle weakness, low physical fitness, and a high body mass ratio. Improved physical fitness after treatment was associated with increased exercise capacity. These data imply that physical deconditioning helps to maintain physical disability in CFS and that a treatment designed to reverse deconditioning helps to improve physical function. Originally published in: J Neurol Neurosurg Psychiatry 2000 Sep;69(3):302-307 LaManca JJ, Peckerman A, Sisto SA, DeLuca J, Cook S, Natelson BH. Chronic Fatigue Syndrome Cooperative Research Center, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey. OBJECTIVE: The purpose of this study was to compare the cardiovascular responses of patients with chronic fatigue syndrome (CFS) to healthy control subjects when performing stressful cognitive tasks before and after strenuous exercise. METHOD: Beat-by-beat blood pressure and electrocardiogram were recorded on 19 women with CFS and 20 healthy nonexercising (i.e., sedentary) women while they performed cognitive tests before, immediately after, and 24 hours after incremental exercise to exhaustion. RESULTS: Diminished heart rate (p <.01) and systolic (p <.01) and diastolic (p <.01) blood pressure responses to stressful cognitive testing were seen in patients with CFS when compared with healthy, sedentary controls. This diminished stress response was seen consistently in patients with CFS across three separate cognitive testing sessions. Also, significant negative correlations between self-ratings of CFS symptom severity and cardiovascular responses were seen (r = -0.62, p <.01). CONCLUSIONS: Women with CFS have a diminished cardiovascular response to cognitive stress; however, exercise did not magnify this effect. Also, the data showed that the patients with the lowest cardiovascular reactivity had the highest ratings of CFS symptom severity, which suggests that the individual response of the patient with CFS to stress plays a role in the common complaint of symptoms worsening after stress. PMID: 11573024 Should you exercise With CFIDS? CFIDS patients have always known among themselves that exercise makes their fatigue and pain worse. Especially early in the illness, exercise intolerance – activity intolerance, in fact – is a hallmark of the disease, ranking right up there with fatigue and cognitive difficulties as a fundamental symptom. It’s even listed as a minor criterion in the 1994 case definition. For most CFIDS patients, the exercise question usually doesn’t arise until months or years into the illness. The newly ill are often basically bedridden, getting up only to attend to daily necessities of life like going to the bathroom, getting food and maybe, if it’s a good day, taking a shower. A brisk 10-minute walk is completely out of the question. But if symptom severity improves, many try to begin or return to an exercise program, and many fail. Why? Further complicating the conundrum is the fact that some research into fibromyalgia (FM) shows that exercise can help improve overall health and lessen symptoms of that condition. Could the answer possibly be to exercise to capacity if you have FM and not at all if you have CFIDS? What bout the thousands of us who share symptoms of both – and the indications that CFIDS and FM are actually the same illness? And what do experts recommend for those of us who’ve tried several times to return to some higher level of physical health and failed? What kind of exercise is the best for us? A research puzzle The research done so far into exercise and its effect on CFIDS and fibromyalgia has led only to more questions and confusion. The website www.networx.com.au/mall/cfs/, kept up-to-date by Ted Saw, an advocate in Australia, contains references to 31 journal articles about CFIDS and exercise. But if you were to wade through all of them, you wouldn’t find a consensus. Some researchers say their studies show aerobic exercise is crucial. The British Medical Journal favors this view in research it publishes. SueAnn Sisto, PhD, and other researchers have shown that carefully limited or graded exercise helps some patients. And some studies, most notably those of Dr. Martin Lerner into viral infections affecting the heart, suggest that exercise can be harmful for some patients. The bottom line: Almost all researchers agree that finding the point at which exercise is a positive influence in a CFIDS patient’s overall health in problematic. And finding exactly how much exercise is good and for what subset of patients is the crux of the matter. They all agree more work needs to be done. The specialists’ opinion And if patients are confused about exactly what they should do, they’re not alone: none of the CFIDS specialists I talked with had a pat answer, either. Each believes that exercise and CFIDS are best handled on a patient-by-patient basis. Furthermore, most agreed that the research done so far on the subject of CFIDS and exercise is not conclusive. “I agree the literature on exercise in CFS/CFIDS is small and inconclusive,” said Dr. Anthony L. Komaraoff, a director of the American Association for CFS and a doctor at Brigham and Women’s Hospital in Boston. “I also think the literature demonstrates some patients respond well and others clearly do not respond well, suggesting that there are subsets of patients among those with CFS: a universal rule is unlikely to apply to all patients.” Dr. Komaroff said that based on his clinical experience, he urges patients to try limbering exercises daily and mild aerobics, starting off very gradually, three times each week. “In general, it’s my experience that people feel better with such a program, although there will be unpredictable times when they suddenly feel sicker the day after even light exercise,” he said. Leonard Jason, PhD, professor of clinical psychology at DePaul University, called the issue a complex one for persons with CFIDS (PWCs). “No question, some exercise is important. The key is how much and when. Pushing a person who is already exhausted is not generally helpful.” Dr. Jason wrote an interesting article in the Fall 1997 issue of the Chronicle detailing how CFDIS and fibromyalgia patients can help avoid relapse by relating their perceived amounts of energy, or in PWC vernacular, “not overdoing it.” “What is often not considered is the overall amount of energy that a person with CFS exerts in a day,” he said. “If they’re already beat due to doing some shopping and dealing with family crises, than to add on additional exercise might be rather counterproductive. However, trying to keep the expended and available energy somewhat similar can lead to increase in available energy, and the reserves to begin a gentle, steady exercise program.” Dr. Marsha Wallace, a general practitioner in Washington, D.C., considers exercise as just one of the many things in her arsenal to fight illness. “I think exercise for PWCs is like any other modality – it’s not for everyone and the ‘dose’ has to be adjusted,” she said. “I like to see my patients doing something, even if it’s just to start with some stretching and later some muscle toning. The key is to avoid doing anything for which there is significant ‘payback,’ even over the next several days.” Dr. Wallace suggested cutting back by at least 20% the activity that makes you crash and try again. “The idea is to find a level of activity that you can sustain,” she said. “I don’t believe in pushing when you feel bad. It also helps to break activities up when possible. So two 10-minute sessions on a treadmill, for those at that level, may be better than one 20-minute session. It’s also important for people with NMH (neurally mediated hypotension) to build up the tone in their legs.” Ongoing research effort Dr. Sisto, a research scientist and physical therapist at The New Jersey CFS Center, is heading up a study that is designed to find a level of exercise that CFIDS patients can safely tolerate. “It’s important to counteract the effects that severe physical inactivity, which is a significant part of CFS, can have on a person’s health,” said Dr. Sisto. Those effects can include cardiovascular disease and bone mineral loss. The center’s current project consists of a series of pre-tests, 10 weeks of an individualized treadmill walking program three times each week, and postj-testing. Only 15 people have completed the fitness trial. The patient’s point of view Despite what the research says, many CFIDS patients rely on their past personal experience to gauge their ability to exercise. The bottom line, say those with experience: Begin slowly, increase intensity and frequency even slower, and stop vefore your body is tired. “I do bed exercises every day,” says a woman who asked that her name not be used. “Sometimes, they’re not anything more than deep breathing exercises. I do stretches of some kind for flexibility and range of movement. I lift small, two-pound weights until I either break out in a sweat or start getting palpitations. My doctor told me to lift slowly while counting to seven, hold for a count of seven and then drop slowly. Exhale on the lift and inhale on the drop. Between lifts, breathe deeply three times, inhaling through your nose and exhaling through your mouth, counting to seven for each inhale and exhale. Afterward, cool down by breathing slowly and deeply. On good days I can do 40 reps. On medium days I might do 10. On bad days, I don’t even bother.” Sue Noble of Orcas Island, Washington, also believes in stretching. “After much painful trial and error, I find that my body really likes a 15-minute stretching regime very morning (if I don’t I’m achy all day), followed by a short, moderate walk.” “I found out the hard way that ‘forcing myself to exercise’ – especially aerobically – repeatedly led to terrible crashes,” says Cerryl Laird of New Mexico. “I keep reading that with CFIDS even a small amount of exercise leads to relapses, while in FM the articles usually suggest exercise. Since I have both, I just try to do some simple stretching.” Others point out that they feel better overall if they stick to any exercise program. “Most of the time I feel like Sisyphus, the guy rolling the rock up the hill,” admits Su Neuhauser of Chicago. “When I have a serious relapse, I just can’t exercise vigorously. But if I have the least bit of energy, I go for it. Yes, it hurts, both while I am exercising as well as afterward for days. But I also need to sweat and get an endorphin high during those good periods. If I am too weak and not ready to do it my body will let me know – rapid heartbeat, dizziness, faintness and nausea.” Neuhauser also points out that she avoids increasing the amount of exercise she does, instead concentrating on maintaining a consistent level of exercise over time. “I could swim 15 laps a year ago, and I can still only swim 15 laps,” she said. “Next year I’ll still be swimming 15 laps. That’s because of the crashes in between the relative good periods. So I set no goals other than: Get to the gym, do whatever to increase the aerobic capacity of the heart just a little, sweat a little, shower and go home.” One day at a time Others find that their ability to exercise varies widely, depending on their health at any given time. “About four years ago, I had some energy I hadn’t had before and I decided to take advantage of it. I began to take walks, short ones at first,” said Cathy Beedle, a 45-year-old former nurse who lives in Zimmerman, Minn. “Gradually, I was able to do more. I bought myself some nice walking tapes and by the end of that year, I was able to walk three miles a day at a bit less than three miles per hour. Then, I got the flu. Afterward, I tried to resume walking. I went down the driveway and nearly passed out. I tried and tried into June of the next year, trying at least once or twice a week. I’ve never gotten beyond the mailbox.” Others, burned once or twice, simply gave up. “When I exercise, I pay; any walking, like shopping, gets me in the end. I’m really happy for those of you who can exercise – and wistfully envious – but not dumb enough to try to emulate you again,” said Lyn Bjorkman. “I became so ill after exercise that I ended up in bed for a month at a time, not just fatigued, but with all the horrors this illness can bring and on short-term disability,” said Ellie Meehan. The 51-year-old former computer salesperson disabled since 1989. Still others, albeit a smaller group, say exercise has helped them a great deal, and perhaps even attributed to their partial recovery. “I never exercised prior to CFIDS. And when I did start, I didn’t push it,” said Helen Dopperpuhl of Shawano, Wis. “I worked in gradual increments over a two-year time span. For me, it was a major factor in my recovery. I don’t mean to lay a guilt trip on anybody saying I regularly jog two miles. But if I didn’t say anything about it, it would be like me withholding the name of a medication or supplement that had given me great improvement.” “I have to exercise,” said Angela Rawls of Smyrna, Texas. “My muscles were withering and hurting until I began doing so. While it’s very light exercise, it definitely helps me. I have yet to graduate past 10 minutes a day, but that 10 minutes is very important to me. It really does make me feel better.” Rawls stresses that PWCs should “do what you know you should do.” And that’s a good point. Most veteran PWCs find that listening to your body is the most important factor in making a decision as to whether you should exercise. “Finding the balance is the key,” said Dopperpuhl. “You need to find the right balance between activity, exercise and rest. It’s a very delicate balance, and everybody’s balance point is different. I realize that as with any other treatments for CFIDS, exercise only helps a subset of patients, just like sodium or melatonin or whatever.” Feldenkrais Intervention in
Fibromyalgia Patients: A Pilot Study ABSTRACT Objectives: To evaluate the effect of the Feldenkrais intervention in fibromyalgia patients. Methods: Twenty fibromyalgia patients started Feldenkrais intervention done as one individual and two group sessions weekly for 15 weeks. Nineteen started a group-based pain education program followed by a pool program. Test and self-report questionnaires were administered at the start, at six month follow up, and at the end of intervention. Results: After the Feldenkrais intervention improvement in balance and trends to better lower extremity muscle function were shown, but the improvements were not maintained. Conclusions: No sustained benefit of the Feldenkrais intervention compared to a pool program was seen. Methodological problems are discussed. INTRODUCTION The core symptoms of fibromyalgia [FMS] are chronic widespread muscle pain at rest and after muscular exertion, the feeling of muscular stiffness, sleep disturbances, and fatigue. Its cause[s] is unknown and several pain mechanisms may be present (1,2). A number of studies have shown benefit from nonpharmacological therapies (3) but further systematic evaluation of the effectiveness of nonpharmacological treatment approaches in FMS is needed (4). Pool training [hydrotherapy) is recommended in Sweden (5) and has nearly become standard therapy. Another intervention that has attracted considerable interest in Sweden is Feldenkrais therapy (6). The Feldenkrais method (7) is based on the theory of sensory awareness as a prerequisite for voluntary control of the pattern of movement. A central concept is self-image, viewed in terms of movement, sensation, feeling, and thought. The four components influence each other but changes [improvement] in actions and movement will only occur after changes in the brain and nervous system have taken place. Feldenkrais therapy aims to teach how to relearn the basic motor pattern used before the [painful] condition appeared and to give the student knowledge about how we move not merely experience that we move. Thus the external, physical changes towards which Feldenkrais therapy aims are the outward conscious manifestations of an internal change in the other components of self-image. The Feldenkrais intervention has not been studied systematically in FMS although a randomized, controlled trial in women with neck-shoulder complaints (6) showed a decrease in complaints and occupational disability. We hypothesized that the Feldenkrais therapy would be beneficial in FMS management. The aims of the present study were to analyze the effects of a Feldenkrais Intervention in FMS compared with pool training [hydrotherapy] and to examine stable personality traits measured by the Karolinska Personality Scale [KSP]. The effects of progressive
strength training and aerobic exercise on muscle strength and cardiovascular fitness in
women with fibromyalgia: A pilot study. OBJECTIVE: To determine the safety, feasibility and consequences of a program of progressive strength training and cardiovascular exercise in women with fibromyalgia syndrome (FMS). METHODS: Fifteen women with confirmed FMS were monitored for injury and exercise compliance, and assessed for muscle strength (1-repetition maximum technique), cardiovascular endurance (6-minute walk test), and functional status (Fibromyalgia Impact Questionnaire [FIQ]) before and after a 20-week exercise intervention. RESULTS: Zero injuries and an 81% compliance rate occurred during training. Improvement was seen in muscle strength of the lower (191 +/- 75 to 265 +/- 67 pounds; P < 0.001) and upper (61 +/- 18 to 76 +/- 18 pounds; P < 0.001) body, 6-minute walk distance (530 +/- 80 to 629 +/- 74 meters; P < 0.001), and in FIQ score (44 +/- 9 to 32 +/- 14; P < 0.01). CONCLUSION: A program of progressive strength training and cardiovascular exercise can be safe, well tolerated, and effective at improving muscle strength, cardiovascular endurance and functional status in women with FMS without exacerbating symptoms. This program may also contribute to a reduction in the severity of several symptoms. Maximal Oxygen Uptake and Lactate
Metabolism are Normal in Chronic Fatigue Syndrome Maximal oxygen uptake and lactate metabolism are normal in chronic fatigue syndrome. Med. Sci. Sports Exerc., Vol. 34, No. 1, 2002, pp. 51-56. PURPOSE: Previous studies in chronic fatigue syndrome (CFS) have reported reductions in maximal oxygen uptake (VO2max), yet often the testing procedures have not followed accepted guidelines, and gender data have been pooled. The present study was undertaken to reevaluate exercise capacity in CFS patients by using "gold standard" maximal exercise testing methodology and stratifying results on a gender basis. METHODS: Sixteen male and 17 female CFS patients and their gender-, age-, and mass-matched sedentary controls performed incremental exercise to volitional exhaustion on a stationary cycle ergometer while selected cardiorespiratory and metabolic variables were measured. RESULTS: VO2max in male CFS patients was not different from control values (CFS: 40.5 +/- 6.7; controls: 43.3 +/- 8.6; mL.kg-1.min-1) and was 96.3 +/- 17.9% of the age-predicted value, indicating no functional aerobic impairment (3.7 +/- 17.9%). In female CFS patients, VO2max was lower than control values (CFS: 30.0 +/- 4.7; controls: 34.2 +/- 5.6; mL.kg-1.min-1, P = 0.002), but controls were higher than the age-predicted value (112.6 +/- 15.4%, P = 0.008) whereas the CFS patients were 101.2 +/- 20.4%, indicating no functional aerobic impairment (-1.2 +/- 20.4%). Maximal heart rate (HRmax) in male CFS patients was lower than their matched controls (CFS: 184 +/- 10; controls: 192 +/- 12; beats.min-1; P = 0.016) but was 99.1 +/- 5.5% of their age-predicted value. In female CFS patients, HRmax was not different from controls (CFS: 183 +/- 11; controls: 186 +/- 10; beats.min-1) and was 98.9 +/- 5.1% of the age-predicted value. The VO2 at the lactate threshold (LT) in each gender group, whether expressed in mL.kg-1.min-1 or as a percentage of VO2max, was not different between CFS patients and controls. CONCLUSIONS: In contrast to most previous reports, the present study found that VO2max, HRmax, and the LT in CFS patients of both genders were not different from the values expected in healthy sedentary individuals of a similar age. PMID: 11782647 [PubMed - as supplied by publisher] Experimental Chewing in Myofascial
Pain Patients AIMS: To evaluate the potential capacity of a chewing exercise to differentiate chronic myofascial pain (MFP) patients from healthy controls and to test whether there are distinct pain response differences among MFP patients. METHODS: Eighty-nine subjects participated in the study; 49 were diagnosed as belonging to the MFP subgroup of temporomandibular disorders (TMD) and had suffered from MFP for at least 6 months, and 40 healthy age- and gender-matched subjects comprised the control group. After completion of a clinical examination, all subjects performed a chewing exercise. Subjects chewed on half a leaf of green casting wax for 9 minutes and then held their jaw at rest for another 9 minutes. They indicated the intensity of the pain experience on a visual analog scale (VAS) every 3 minutes from the beginning (P0) to the end (P18) of the chewing exercise. Only changes in pain report of more than 5 mm on the VAS were considered. Analysis of covariance with repeated measures was used to analyze fluctuations in pain levels during the test, with the pain level at baseline (P0) as a covariant. RESULTS: Statistical analysis revealed a significant main effect for group (MFP versus control); a significant main effect for activity (chewing versus rest); an interaction between activity and time; and an interaction between activity, time, and group. The latter revealed the significant effect of the chewing activity on pain levels in both groups along the axis of time and its recovery at rest. In the MFP patients, pain had increased by 32 mm at P9 in 84% of the patients and recovered to almost the initial pain levels by P18; 6% reported a decrease in pain sensation and 10% reported no change in pain. In the controls, pain had increased 4.9 mm by P9, a value within the recording error range of the scale. CONCLUSION: (1) A strenuous chewing exercise is a potentially beneficial tool in the diagnostic process of myofascial pain patients and, if validated, could be incorporated into clinical examinations. (2) The increase in pain intensity following the chewing exercise is typical of most of the MFP group. (3) The phenomenon of pain decrease in a small percentage of MFP patients should be further investigated. Women With Fibromyalgia Have
Impaired Growth Hormone Secretion Women with fibromyalgia have an impaired growth hormone response to exercise that is reversible with pyridostigmine. This impaired response exists even in fibromyalgia (FM) patients with normal levels of insulin-like growth factor-one (IGF-one), Eduardo S. Paiva and colleagues from Oregon Health Sciences University, Portland, Oregon, United States, have found. Because pyridostigmine reduces somatostatin tone, this defective growth hormone (GH) response may result from higher levels of somatostatin, a hypothalamic hormone that inhibits GH secretion, these authors surmise. The two-fold objective of this study was to determine the GH response to acute exercise stressor in female FM patients and to assess the importance of somatostatin tone in the generation of this response. Twenty women with FM and 10 healthy female controls, all of whom exercised on a treadmill to their own idea of exhaustion, were monitored for pulse, blood pressure, electrocardiography, oxygen uptake, carbon dioxide output, anaerobic threshold and maximal workload. Researchers drew blood for GH and cortisol measures one hour before exercise, and then again immediately before, immediately after and one hour after exercise. This entire procedure was precisely repeated one month later, except now all of the women received pyridostigmine bromide (Mestinon; 30 mg orally) one hour before exercise. Although FM patients versus controls showed no GH or cortisol response to exercise, their GH levels increased eight-fold after receiving the pyridostigmine to a value comparable with that of controls. In the FM patients, pyridostigmine did not increase the cortisol response to exercise and did not alone stimulate GH secretion, nor did it improve exercise-induced GH secretion in controls. FM patients with normal IGF-one levels were also found to have an impaired GH response to exercise. Arthritis & Rheumatism Volume 46, Issue 5, 2002. Pages: 1344-1350. STUDY ABSTRACT: Impaired growth hormone secretion in fibromyalgia patients: Evidence for augmented hypothalamic somatostatin tone Eduardo S. Paiva, Atul Deodhar, Kim D. Jones, Robert Bennett * Oregon Health Sciences University, Portland *Correspondence to Robert Bennett, Department of Medicine (OP09), Oregon Health Sciences University, Portland, OR 97201 Funded by: USPHS; Grant Number: 5-M01-RR-00334 Objective: To determine whether female fibromyalgia (FM) patients exhibit a normal growth hormone (GH) response to an acute exercise stressor, and to assess the importance of somatostatin tone in the generation of this GH response. Methods: Twenty female FM patients were compared with 10 healthy female controls. All subjects exercised to volitional exhaustion on a treadmill. A standard metabolic cart was used to monitor pulse, blood pressure, electrocardiography, oxygen uptake, carbon dioxide output, anaerobic threshold, and maximal workload. Blood was drawn for GH and cortisol measurements 1 hour before exercise, immediately before exercise, immediately after exercise, and 1 hour after exercise. One month later, testing that was exactly similar was performed, except all subjects were given pyridostigmine bromide (Mestinon; 30 mg orally) 1 hour before exercise. Results: Compared with controls, FM patients failed to exhibit a GH or cortisol response to acute exercise (P = 0.003). After administration of pyridostigmine, 1 hour before exercise, the GH levels of FM patients increased 8-fold (P = 0.001), to a value comparable with that of controls. Pyridostigmine did not increase the cortisol response to exercise in FM patients. Pyridostigmine alone did not stimulate GH secretion in FM patients, nor did it improve exercise-induced GH secretion in controls. FM patients with normal insulin-like growth factor 1 (IGF-1) levels had an impaired GH response to exercise. Conclusion: Three new findings are reported: 1) FM patients have a reduced GH response to exercise, 2) pyridostigmine reverses this impaired response, and 3) defective GH secretion in FM can occur in patients with normal IGF-1 levels. Because pyridostigmine is known to reduce somatostatin tone, it is surmised that the defective GH response to exercise in FM patients probably results from increased levels of somatostatin, a hypothalamic hormone that inhibits GH secretion. According to leading CFS physician Paul Cheney, M.D., "Golden Rule: Find the boundaries of what you can do and then stay within them. Both trying to do too much, or pulling back and doing too little are counter productive. Limit setting is probably the most important thing you can do. Patients are very susceptible to push-crash phenomena and you need to learn to stay within certain boundaries. To the extent you do that, you will tend to do better. To the extent you don't, you likely will not do well. Aerobic Training: Beyond certain limits this cannot be attempted until you are much improved. Be cautious about any aerobic exercise (any sustained activity, such as running, walking, or swimming, designed to raise the heart rate and increase oxygen flow throughout the body). The aerobic system is injured and reactive oxygen species (free radicals) generated in the mitochondria by excessive training may not be detoxified with resulting injury which can potentially be permanent (DNA damage). Walk, cycle or swim only as much as your body will allow, no more than 20 minutes, three times per week. Aerobic exercise past a certain point can dramatically worsen this disorder." (Source: Dr. Cheney's Basic Treatment Plan for Chronic Fatigue Syndrome. ImmuneSupport.com) Stretching: Intensifying
Aerobics Does Not Provide Big Improvement In Fibromyalgia Exercise in the
treatment of chronic pain. Predictors of Exercise Behaviors
among Fibromyalgia Patients Background. Exercise improves the physical and psychological well being of patients with fibromyalgia syndrome (FMS). However, exercise interventions for patients with FMS have suffered from poor adherence. The purpose of this study was to examine predictors of exercise for people with FMS. Methods. Participants were 444 patients with FMS who were part of a larger study. Hierarchical logistic regression analyses were conducted examining exercise behavior at multiple time points. Discriminant analyses were also used to identify predictor variables. Results. Engaging in regular exercise and having higher exercise self-efficacy significantly predicted continued engagement in exercise behavior in people with FMS. Age, employment status, depression, education level, self-efficacy for managing FMS, and the size of one's social network also demonstrated predictive qualities. Conclusion. Exercise self-efficacy and continued participation in regular exercise most strongly predicted present and future exercise behavior in patients with FMS. Interventions designed to train FMS patients in initiating exercise programs while addressing exercise self-efficacy, depression, and social support are warranted. PMID: 12453716 A randomized controlled trial of
group aerobic exercise in primary care patients with persistent, unexplained physical
symptoms BACKGROUND: The management of persistent, unexplained physical symptoms is challenging and often unsatisfactory for patients and doctors. Aerobic exercise training has benefited patients referred to secondary care with symptoms of chronic fatigue and fibromyalgia. It is not known if this approach is either possible or beneficial for patients with the broader range of persistent, unexplained symptoms found in primary care. OBJECTIVES: To examine the feasibility and effects of aerobic exercise training in primary care patients with unexplained physical symptoms persisting more than 12 months. METHODS: Randomized comparison (n = 228) of aerobic exercise with stretching as control among patients recruited from primary care. Training comprised 20, one-hour, sessions led by NHS physiotherapists. Adherence to training was recorded along with two groups of outcome measures: (i) documented symptoms and health care use, monitored from six months before to six months after training; and (ii) self-reported measures including emotional state and perceived disability, assessed before, during and six months after training. RESULTS: Exercise training proved feasible: more than 70% of referred patients attended for assessment and were randomized to aerobic or control exercise; 78% of eligible patients attended the first session; and median attendance was 11 sessions for both programmes. Primary care consultations and prescriptions were significantly reduced in the 6 months after training; extent of reduction was related to attendance at training sessions, irrespective of type. Whilst self-reported measures improved similarly during both training programmes, improvements were unrelated to level of attendance. CONCLUSION: For primary care patients with persistent, unexplained physical symptoms willing to be involved in exercise training, aerobic exercise offers no benefits over non-aerobic exercise. Whilst the observed reduction in primary health care use following exercise training is potentially of practical importance in a group of patients characterized by high consultation rates, improvement in patients' subjective state was not clearly attributable to exercise training. PMID: 12429672 [PubMed - in process] The role of fear of physical
movement and activity in chronic fatigue syndrome OBJECTIVE: To examine beliefs in relation to avoidance of activity in chronic fatigue syndrome (CFS) patients. METHODS: The first phase consisted of modifying an existing chronic pain measure of kinesiophobia-fear of physical movement and activity-and validating it on the CFS population [Tampa Scale of Kinesiophobia-Fatigue (TSK-F); n=129; test-retest: r=.89, P<.001; alpha=.68]. Subscales of Illness Beliefs (alpha=.78) and Beliefs about Activity (alpha=.70) were identified. The second phase consisted of evaluating whether behavioural persistence was predicted by the TSK-F (n=33). Participants were asked to ride an exercise bike for as long as they felt able. RESULTS: Analyses indicated that behavioural persistence did not correlate with maximal heart rate or resting heart rate, level of tiredness, symptom severity, illness identity or emotional distress. However, the TSK-F did correlate highly with distance travelled and added a significant 15% of the variance in distance after adjustments for gender and physical functioning (PF). The TSK-F Beliefs about Activity subscale appears to be the predictive factor, explaining 12% of the variance in excise performance or rather 12% of the avoidance of exercise. CONCLUSION: Beliefs about activity appear to be an important variable in predicting behaviour and avoidance of exercise. As avoidance has been suggested as a key to the maintenance of symptoms, disability and distress in CFS patients, this research has important theoretical, clinical and research implications. Source: Co-Cure Six- and 24-month follow-up of
pool exercise therapy and education for patients with fibromyalgia OBJECTIVE: To follow patients with fibromyalgia six and 24 months after they finished a six-month treatment programme. The programme comprised pool exercise therapy, adjusted to the patients' limitations, and education based on their health problems. METHODS: Twenty-six patients were examined six and 24 months after the completion of the treatment programme with the Fibromyalgia Impact Questionnaire (FIQ), SF-36, the 6-minute walk test, and the Grippit measure. The values obtained at the follow-up examinations were compared with the baseline and post-treatment values. RESULTS: As compared with baseline, symptom severity (FIQ, SF-36), physical function (FIQ, SF-36, 6-minute walk test) and quality of life (SF-36) still showed improvements six months after the completion of treatment (p <0.05). Pain (FIQ, SF-36), fatigue (FIQ, SF-36), walking ability, and social function (SF-36) still showed improvements 2 years after the completion of the programme as compared with the baseline values (p < 0.05). No significant changes were found for these variables, when the values obtained at the two follow-up examinations were compared with those of the post-treatment examination. CONCLUSIONS: Improvements in symptom severity, physical function and social function were still found six and 24 months after the completed treatment programme. PMID: 12455823 Activity rhythm
degrades after strenuous exercise in chronic fatigue syndrome.
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