AR&T: Recommendations for resistance training in patients with fibromyalgia

Editor's note:  Fibromyalgia is a presumptive condition for Gulf War veterans for VA service-connected disability claims.  Many Gulf War Illness researchers believe that the chronic widespread pain suffered by many Gulf War Illness patients is medically distinct from Fibromyalgia.  Nevertheless, the recommendations below regarding resistance muscle training.  

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SOURCE: Arthritis Research & Therapy, Sep. 17, 2015, written by Kim Jones.

http://www.arthritis-research.com/content/17/1/258



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Editorial

Recommendations for resistance training in patients with fibromyalgia

Kim Dupree Jones

• Correspondence: Kim D Jones joneskim@ohsu.edu

Author Affiliations

Oregon Health & Science University, School of Nursing, 3455 SW US Veterans Hospital Road, Portland 97239, OR, USA

Arthritis Research & Therapy 2015, 17:258  doi:10.1186/s13075-015-0782-3

See related research by Larsson et al., http://www.arthritis-research.com/content/17/1/161

The electronic version of this article is the complete one and can be found online at: http://arthritis-research.com/content/17/1/258

Published:

17 September 2015

© 2015 Jones. 

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Abstract

It may seem counter-intuitive to purposely stress muscle in patients who have muscle pain. However, a growing body of evidence challenges the assumption that resistance (strength) training worsens muscle pain in people with fibromyalgia (FM). In fact, the latest evidence indicates that when resistance training is tailored to individual needs, people with FM can obtain worthwhile improvements in FM severity. Clinicians need a deeper understanding of how resistance training helps people with FM, so as to prescribe more specific, personalized resistance training to their patients.

Editorial

Resistance training is a type of exercise in which progressive resistance is used to improve muscle strength, endurance, power, or a combination. Resistance can be manipulated with free or machine weights, bands, or elastic tubing, or even with one’s own body weight. Resistance training not only builds muscle strength and mass, it also produces improvements in balance, coordination, and agility.

In an article published recently in Arthritis Research & Therapy, Larsson et al. [1] report the results of a multicenter, parallel randomized controlled trial (RCT) in which they compared group-based progressive resistance (strength) training versus relaxation training in 130 Swedish women with fibromyalgia (FM). The study was based on a “person-centered” model of exercise. This model actively involves the patient in planning the treatment, and optimizes self-confidence for exercise. Small groups of five to seven women exercised together under the supervision of a physiotherapist at a local gymnasium, twice weekly for 15 weeks. Starting loads were low (40 % one repetition maximum (1RM), the heaviest weight a person can lift or move in one contraction) and slowly progressed to 80 % 1RM. However, patients could decline increasing loads if they were unsure they could manage the new load. Immediately post intervention, the resistance training group—compared with the relaxation training group—demonstrated significant improvements in isometric knee and elbow extension, 6-minute walk, and health status (Fibromyalgia Impact Questionnaire). At 13–18 months post intervention, differences were no longer found between the groups on any measure, underscoring the difficulty in adopting exercise outside of a formal program.

Additional support for the benefits of resistance training in FM can be found in a recent Cochrane Database review [2]. The authors concluded that resistance training improves multidimensional function, pain, tenderness, and muscle strength in women with FM. However, the level of evidence remains “low” owing to the small number of resistance training RCTs to date [3]–[7]. Moreover, men have yet to be studied and minority representation is small. The optimal training frequency, intensity, timing, and progression are not yet fully understood in FM. This gap is due, in part, to the heterogeneity of fitness levels and symptom burden in people with FM. There is good evidence for individualizing the prescription of exercise with the philosophy of “starting low and going slow” during progression. Realistically, most patients will have difficulty transferring these results into a long-term habit outside the support of a formal study. Beyond the results reported here, there is evidence for the benefits of resistance training in healthy individuals in terms of body composition, muscle strength, age-related muscle loss, and all-cause mortality [8], [9].

Having FM poses hurdles that need to be to overcome before reaping the rewards of resistance training. People with FM are less physically active compared with age-matched controls [10]. Deconditioned muscle is a potent pain generator owing to delayed-onset muscle soreness (DOMS). This is a result of an inflammatory response during the repair and adaption process of building muscle (e.g., microtrauma, repair, and growth) [11], [12]. Not surprisingly, sedentary persons may have difficulty in initiating or maintaining an exercise program because of both immediate pain and DOMS. Simply put, being inactive will eventually lead to more pain on exertion, and for many will result in a symptom flare.

Patients rarely have access to an academic RCT like that of Larsson et al. Clinicians therefore need to be able to give patients safe, evidence-based exercise advice. Here is some pragmatic guidance: do not expect resistance training to be a replacement for medications; instead think of exercise as a key part of the overall interdisciplinary management plan.

The following presents some general advice for patients. Have a well-defined training goal in mind and focus on training consistently rather than intensively. Minimize eccentric muscle loading (a major cause of DOMS) by limiting overhead arm work and exercises done with limbs farther away from the body’s midline. Do not attempt to do strength training during a symptom flare. Do not attempt high-intensity, power-based workouts (e.g., pylometrics, CrossFit, bootcamps). Limit pain-provoking postures by working within the natural joint lines; this reduces the risk of aggravating tendinopathies or overextending hypermobile joints. Avoid the urge to overtrain on days you feel better. Be proactive by providing FM-specific exercise advice to a fitness trainer [13]. Work out at home with DVDs especially formulated for FM patients [14]. Lastly, link an exercise with an activity you like or do regularly to increase the likelihood that exercise will become a life-long habit.

Abbreviations

1RM: One repetition maximum

DOMS: Delayed-onset muscle soreness

FM: Fibromyalgia

RCT: Randomized controlled trial

Competing interests

The author declares that she has no competing interests.

References

1. 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 Res Ther. 2015; 17:161. PubMed Abstract | BioMed Central Full Text 
2. Bidonde J, Busch AJ, Bath B, Milosavljevic S. Exercise for adults with fibromyalgia: an umbrella systematic review with synthesis of best evidence. Curr Rheumatol Rev. 2014; 10:45-79.  PubMed Abstract | Publisher Full Text 
3. Bircan C, Karasel SA, Akgun B, El O, Alper S. Effects of muscle strengthening versus aerobic exercise program in fibromyalgia. Rheumatol Int. 2008; 28:527-32. PubMed Abstract | Publisher Full Text 
4. 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; 60:21-6.  PubMed Abstract | Publisher Full Text 
5. Jones KD, Burckhardt CS, Clark SR, Bennett RM, Potempa KM. A randomized controlled trial of muscle strengthening versus flexibility training in fibromyalgia. J Rheumatol. 2002; 29:1041-8.  PubMed Abstract | Publisher Full Text 
6. Kayo AH, Peccin MS, Sanches CM, Trevisani VF. Effectiveness of physical activity in reducing pain in patients with fibromyalgia: a blinded randomized clinical trial. Rheumatol Int. 2012; 32:2285-92.  PubMed Abstract | Publisher Full Text 
7. 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 (Oxford). 2004; 43:225-8.  Publisher Full Text 
8. FitzGerald SJ, Barlow CE, Kampert JB, Morrow JT, Jackson AW, Blair SN. Musclar fitness and all-cause mortality: prospective observations. J Phys Activity Health. 2015; 1:7-18.  
9. Katzmarzyk PT, Janssen I, Ardern CI. Physical inactivity, excess adiposity and premature mortality. Obes Rev. 2003; 4:257-90.  PubMed Abstract | Publisher Full Text 
10. McLoughlin MJ, Colbert LH, Stegner AJ, Cook DB. Are women with fibromyalgia less physically active than healthy women? Med Sci Sports Exerc. 2011; 43:905-12. PubMed Abstract | Publisher Full Text 
11. Paddon-Jones D, Muthalib M, Jenkins D. The effects of a repeated bout of eccentric exercise on indices of muscle damage and delayed onset muscle soreness. J Sci Med Sport. 2000; 3:35-43.  PubMed Abstract | Publisher Full Text 
12. Armstrong RB. Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. Med Sci Sports Exerc. 1984; 16:529-38.  PubMed Abstract | Publisher Full Text 
13. Hoffman, J. Safe exercise for fibromyalgia. http://www.myalgiateam.com/exercise_protocols2.html. Accessed 18 Aug 2015.
14. Exercise DVDs. Fibromyalgia Information Foundation. http://myalgia.com/VIDEOS/Video_Introduction.html. Accessed 18 Aug 2015.

USNews: DNA Damage May Play a Role in Gulf War Syndrome

SOURCE:  US News & World Report - HealthDay.  Mary Elizabeth Dallas reporting.  9/23/2015.

http://health.usnews.com/health-news/articles/2015/09/23/dna-damage-may-play-a-role-in-gulf-war-syndrome

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DNA Damage May Play a Role in Gulf War Syndrome

HealthDaySept. 23, 2015 | 4:00 p.m. EDT+ More

By Mary Elizabeth Dallas, HealthDay Reporter

WEDNESDAY, Sept. 23, 2015 (HealthDay News) -- Unexplained chronic fatigue, muscle pain and problems with thinking are experienced by a quarter of Gulf War veterans, and new research suggests exposure to DNA-damaging chemicals may cause this condition, known as Gulf War Syndrome.

Previous studies have suggested that the symptoms stem from a malfunction of mitochondria, the site in cells where molecules that power the body are made. The mitochondria have their own DNA, separate from the cell's.

Increases in mitochondrial DNA damage the mitochondria's ability to produce energy, leaving the individual feeling slow and tired. And the new study found direct evidence of increased damage to this cell powerhouse among Gulf War vets.

Researchers analyzed blood samples to measure the amount of mitochondrial DNA and degree of damage to this DNA among veterans with Gulf War Illness (GWI).

The vets not only had more mitochondrial DNA, but also more mitochondrial DNA damage than otherwise healthy adults, the researchers found.

Study author Yang Chen, a doctoral researcher at Rutgers Biomedical and Health Sciences in New Jersey, presented the findings at a recent meeting of the American [Physiological] Association in Tampa, Fla.

"Future studies are necessary to confirm these findings and determine their association with mitochondrial function. Work in this area may guide new diagnostic testing and treatments for veterans suffering from GWI," the study's authors wrote.

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APS: For Veterans with Gulf War Illness, an Explanation for the Unexplainable Symptoms

SOURCE:  American Physiological Society, Sep. 11, 2015, Written by Staff Editor.

http://www.healthnewsdigest.com/news/veteran%20issues0/For-Veterans-with-Gulf-War-Illness-an-Explanation-for-the-Unexplainable-Symptoms.shtml


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For Veterans with Gulf War Illness, an Explanation for the Unexplainable Symptoms By Staff Editor Sep 11, 2015 - 10:34:25 AM

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(HealthNewsDigest.com) - Newswise - Tampa, Fla. )-One in four Gulf War veterans suffers from Gulf War Illness (GWI). The condition is characterized by unexplainable chronic fatigue, muscle pain and cognitive dysfunction and may be associated with exposure to chemicals, many identified as genotoxins, during deployment. Previous studies suggest that the symptoms of GWI are due to dysfunction of the mitochondria, the site in cells where molecules that power the body's processes are produced. Not producing enough energy slows down the body and leaves the individual feeling tired. New preliminary research to be presented atPhysiological Bionergetics: From Bench to Bedside shows for the first time direct evidence of greater mitochondrial damage in Gulf War veterans.

The mitochondrion has its own DNA, separate from the cell's, that encodes the proteins needed to produce the molecules that power the body's processes. Damage to the mitochondrial DNA (mtDNA) directly affects the mitochondria's ability to function and produce energy. Increases in the amount of mtDNA have been associated with disease. In this study, researchers measured the mtDNA amount and degree of mtDNA damage in blood cells from blood samples from veterans with GWI. 

Compared with healthy non-deployed controls, Gulf War veterans had more mtDNA content and greater mtDNA damage. According to the researchers, these findings further support that mitochondrial dysfunction may be involved in GWI. "Future studies are necessary to confirm these findings and determine their association with mitochondrial function. Work in this area may guide new diagnostic testing and treatments for veterans suffering from GWI," the researchers wrote.

Yang Chen, MS, doctoral researcher at Rutgers Biomedical and Health Sciences, will present "Mitochondrial DNA is damaged in military veterans with fatiguing conditions" as part of the symposium "Translational Bioenergetics" on Thursday, Sept. 10, at 5:05 PM EDT in the Harbour Island Ballroom of the Westin Tampa Harbour Island.

This work was conducted with funding from Veteran Affairs (VA) Clinical Science Research & Development Service awarded to Michael J. Falvo, PhD, at the War Related Illness and Injury Study Center at VA-New Jersey Health Care System in East Orange, N.J.

NOTE TO JOURNALISTS: To read the full abstract or to schedule an interview with a member of the research team, please contact the APS Communications Office at communications@the-aps.org or 301-634-7209. Find more research highlights in the APS Press Room.

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About the American Physiological Society
Physiology is the study of how molecules, cells, tissues and organs function in health and disease. Established in 1887, the American Physiological Society (APS) was the first U.S. society in the biomedical sciences field. The Society represents more than 11,000 members and publishes 14 peer-reviewed journals with a worldwide readership.


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STARS AND STRIPES -- Study: Cell damage linked to Gulf War illness

SOURCE:  Stars and Stripes, Sep. 10, 2015

http://www.stripes.com/study-cell-damage-linked-to-gulf-war-illness-1.367439http://www.stripes.com/study-cell-damage-linked-to-gulf-war-illness-1.367439

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Study: Cell damage linked to Gulf War illness

By Heath Druzin

Stars and Stripes

Published: September 10, 2015

American servicemembers are silhouetted against the desert sun during the Gulf War.

ROB JAGODZINSKI/STARS AND STRIPES FILE PHOTO

WASHINGTON -- A new study could provide new clues for doctors struggling to treat a mysterious illness that has affected tens of thousands of Gulf War veterans for decades.

The study, done with Department of Veterans Affairs funding in conjunction with Rutgers University, found that veterans suffering from Gulf War illness have damaged mitochondria, which can lead to chronic fatigue, one of the main symptoms reported by Gulf War veterans.

“The more we know about the type of (damage) and the more we can characterize the mitochondrial damage in these veterans, the better we can treat them,” said Michael Falvo, the study’s senior researcher and a faculty member of the VA War Related Illness and Injury Study Center in Orange, N.J. “The symptoms are so diverse and vary so much person to person that that’s been a challenging piece.”

Gulf War illness (also known as Gulf War syndrome) is a multi-symptom disorder characterized by chronic fatigue, muscle pain and cognitive problems. While many believe that toxin exposure is to blame, and one study found a possible link to anti-nerve agent pills -- toxic chemicals can damage mitochondria -- the exact cause of the illness is still unknown. Falvo warned that while the study could help find better treatment, it was unlikely to uncover the root cause.

“If I was a veteran experiencing Gulf War illness, I would want to know, too,” he said. “This many years after, that’s going to be a really difficult, if not impossible, thing to figure out.”

The study, undertaken by Falvo and Rutgers Biomedical and Health Sciences doctoral researcher Yang Chen, was based on blood samples from more than 30 Gulf War Veterans including about two dozen who suffer from Gulf War illness. White blood cells were separated from the samples and researchers were able to study the mitochondrial DNA for evidence of damage.

These are preliminary findings and the study will continue through the summer, with researchers hoping to present a final paper by the end of the year, Falvo said. A larger study will be needed to confirm the study’s findings, he said.

Twenty-five years after the U.S. sent forces into Iraq after Saddam Hussein’s invasion of his oil rich neighbor, Kuwait, many veterans are frustrated with the pace of research on Gulf War illness. According to a 2008 government report, at least one quarter of all Gulf War veterans have experienced symptoms of the illness, and the Pentagon and VA were slow to publicly acknowledge it. Many vets are still fighting to get their illnesses recognized as related to their service in the Gulf War.

Ronald Brown, president of the National Gulf War Resource Center, said he welcomes new research but similar small studies into the causes of the illness have rarely received funding for wider research, leaving the findings to languish unproven.

“We have piles of studies that show promise that are sitting on shelves, collecting dust,” he said.

For more information: www.warrelatedillness.va.gov.

druzin.heath@stripes.com
Twitter: @Druzin_Stripes