Exercise Prescription for Fibromyalgia
The clinical efficacy of exercise prescription to treat Fibromyalgia (FM) can be vague given that patients report increased pain with exercise. Since the exact pathophysiology of FM is under constant scrutiny, an analysis of predominating theories can help to elucidate this topic.
Multiple studies suggest that FM arises from heightened resting sympathetic activity and impaired parasympathetic modulation, causing increased total peripheral resistance, hypoperfusion and ischemic muscle pain (Kulshreshtha & Deepak, 2013). An autonomic imbalance at rest decreases stress-induced analgesia, which explains why FM pain worsens in response to physical and mental stress (Martinez-Lavin and Solano, 2009). In a more recent study, FM patients experienced relief from vasodilators administered at localized pain sites, indicating impaired endothelial-mediated vasodilation (Kulshreshtha et al., 2012). This suggests that FM may stem from a vascular end organ dysfunction versus central autonomic impairment.
FM patients battle a vicious cycle since exercise-induced pain leads to physical inactivity and deconditioning, which further disrupts vascular homeostasis by increasing arterial wall stiffness, exacerbating endothelial dysfunction and increasing sympathetic tone. (Kulshreshtha & Deepak, 2013)
Fortunately, various studies have been able to distinguish between therapeutic and pain-producing exercises, as listed below:
- FM patients display improved parasympathetic modulation following resistance exercise training (Figueroa et al., 2008).
- Aerobic exercise training promotes dilatation of peripheral vasculature by metabolic and mechanical factors, improving sympathetic regulation (Vierck, 2012).
- FM patients display chronotropic incompetence and a blunted rise in peripheral blood flow during graded aerobic exercise protocols (da Cunha Ribeiro et al., 2011).
- Continuous and/or high intensity aerobic and repetitive isometric exercises increase FM-pain, while brief rests alleviate pain (Kulshreshtha and Deepak, 2013).
In summary, short bouts of moderate resistance and aerobic exercises, with heart rate restrictions should be prescribed to disrupt the cycle of inactivity/deconditioning and promote improved vascular homeostasis.
References
da Cunha Ribeiro, R. P., Roschel, H., Artioli, G. G., Dassouki, T., Perandini, L. A., Calich, A. L., de Sá Pinto, A. L., Lima, F. R.,Bonfá, E. and Gualano, B. (2011) Cardiac Autonomic Impairment and Chronotropic Incompetence in Fibromyalgia. Arthritis Research and Therapy. 13:R190
Figueroa, A., Kingsley, J.D., McMillan, D., Panton, L. B., (2008) Exercise Training Improves Heart Rate Variability in Women with Fibromyalgia. Clinical Physiology and Functional Imaging. 28. pp 49-54.
Kulshreshtha, P. and Deepak, K. K. (2012) Autonomic Nervous System Profile in Fibromyalgia Patients and its Modulation by Exercise: A Mini Review. Clinical Physiology and Functional Imaging, 33(2), pp 83-91.
Kulshreshta, P., Gupta, R., Yadav R. K., Bijlani, R.L., Deepak, K. K. (2012) A Comprehensive Study of Autonomic Dysfunction in the Fibromyalgia Patients. Clinical Autonomic Research. 22(3) pp. 117-122.
Martinez-Lavin, M. and Solano, C. (2009) Dorsal Root Ganglia, Sodium Channels and Fibromyalgia Sympathetic Pain. Medical Hypothesis. 72(1), pp 64-66.
Vierck, C. J. (2012) A Mechanism-based Approach to Prevention of and Therapy for Fibromyalgia. Pain Research and Treatment. 951254