1. F IBROMYALGIA EXS 486 Rachel Glick

2. Q UICK FACTS ABOUT FIBROMYALGIA Fibromyalgia only affects 2-4% of people, women more commonly than men There is no cure, but medication helps reduce symptoms There is no test to detect the disease Proper self-care is needed to treat it, including enough sleep and exercise A person is at higher risk if they have rheumatic disease- such as osteoarthritis, lupus, rheumatoid arthritis, or spondylitis

3. WHAT IS FIBROMYALGIA ? Fibromyalgia is a disorder characterized by widespread musculoskeletal pain It is accompanied by fatigue, mood issues, sleep deprivation, cognitive difficulties Symptoms can come from physical trauma, psychological stress, infection Symptoms are gradual over time with NO single triggering event

5. PATHOPHYSIOLOGY Pain from fibromyalgia comes from a generalized decrease in the pain perception threshold Fibromyalgia abnormalities in pain processing include: Excess excitatory neurotransmitters Low levels of inhibitory neurotransmitters Dopamine dysregulation Leads to whole-body sensitivity to pain and suggests that it may be a condition of central processing of pain input BUT– we still don’t know!!

6. D IAGNOSIS There is no blood test or diagnostic test for fibromyalgia– but they are used to rule out other health problems Doctors make diagnoses based on if the patient has had widespread pain for 3+ months An 18 tender point exam is used as well

7. T REATMENT There are a few approved drugs to treat Fibromyalgia – Lyrica, Cymbalta, and Savella Lyrica was previously approved to treat seizures and pain from damaged nerves. Side effects are dizziness, sleepiness, blurry vision, weight gain Cymbalta was previously approved for depression, anxiety, and peripheral neuropathy. Side effects can include nausea, constipation, decreased appetite, increased sweating Savella is the first drug approved primarily for fibromyalgia. Side effects include depression, constipation, nausea, high heart rate, high blood pressure, insomnia

8. L IVING WITH FIBROMYALGIA Patient self-care is vital for day-to-day life Deep breathing, meditation, relaxation Adequate sleep, limiting caffeine and naps Staying active is crucial

9. N ATURAL REMEDIES There are many reported natural remedies—but not enough sufficient evidence for long-term relief: Massage therapy Chiropractic care/spinal manipulation Melatonin Acupuncture Vitamin D Natural pain relievers Biofeedback

10. H OW EXERCISE CAN HELP FIBROMYALGIA A 2007 study from the Archives of Internal Medicine reported that women suffering from fibromyalgia on a four-month exercise program reported significant improvements in mood, depression, muscle function, and fatigue. It reportedly takes a week or two to see any improvement before patients notice less fatigue, better sleep, and easier movement It’s a conundrum – muscles hurt  work the muscles  muscles feel better Light/moderate intensity, low-impact exercise is considered best Walking, swimming, water aerobics

11. C ASE STUDY Susan is a 56-year old who has been diagnosed with fibromyalgia. Her BMI is 25 kg/m 2. Her total cholesterol is 210 mg/dL and her HDL is 65 mg/dL. Her fasting plasma glucose is 100 mg/dL. Her blood pressure is 138/86. She has trouble sleeping, is previously sedentary, and is depressed. Along with prescribing Cymbalta and Savella, her doctor has suggested she begins exercising and making lifestyle changes to help with her fibromyalgia and depression.

12. R ISK STRATIFICATION Age: Woman over 55 yrs – YES Family history: No family history of heart disease – NO Cigarette smoking: NO Sedentary lifestyle: YES Obesity: BMI <30 – NO Blood pressure: <140/90 – NO Dyslipidemia: Cholesterol >200 – YES Pre-diabetes: Glucose >100 – YES Negative risk factor: HDL >60 – YES Total risk factors: 4 – 1 negative risk factor = 3 MODERATE RISK!

13. E XERCISE TESTING & PRESCRIPTION Submaximal test = medical exam/supervision not necessary Maximal test = medical exam/supervision IS recommended Aerobic exercise, light to moderate intensity, 50- 60% VO 2 max, 30-45 minutes, 3-5 days/week – walking/jogging, water aerobics, elliptical, swimming Strength training, 2-3 days/week, 2-4 sets per exercise, 6-10 reps, free weights and machines Flexibility training, yoga, static stretching, 2-3 days/week. 10-30 seconds per muscle group, repeated 3 times

14. E XERCISE CONSIDERATIONS Fibromyalgia patients demonstrate 30-50% of aerobic capacity, range of motion, and some reduction in muscular strength They may not tolerate normal progressions in exercise programs START SLOW – educate them about being more active, taking the stairs, walking the dog, etc. Muscle soreness from training is okay—but the muscles should not be pushed to fatigue during the training sessions Flexibility training is very important for muscle stiffness– yoga may be helpful in this

15. PRECAUTIONS This client is depressed and previously sedentary. She is starting very slowly and probably lacking motivation. Keep the motivation high and be there emotionally for the client. Always remind them to be patient because when the results come they will be worth it. Be aware of drugs being taken and their side effects, and how they may affect exercise Fatigue, dizziness, increased sweating, heart rate, and blood pressure (important when exercise testing!)

16. W ORKS CITED Black-Brown, C. (2002, March 20). Exercise Prescription for Fibromyalgia: A Plan for Patients From Beginner to Advanced. Retrieved April 04, 2016, from http://www.prohealth.com/library/showarticle.cfm?libid=8305 http://www.prohealth.com/library/showarticle.cfm?libid=8305 Crofford, L. (2015, May). Fibromyalgia. Retrieved April 04, 2016, from http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases- Conditions/Fibromyalgia http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases- Conditions/Fibromyalgia Fibromyalgia. (2015, October 01). Retrieved April 04, 2016, from http://www.mayoclinic.org/diseases- conditions/fibromyalgia/basics/definition/con-20019243 http://www.mayoclinic.org/diseases- Shaw, G. (n.d.). Relieving Fibromyalgia Pain With Exercise (Low-Impact). Retrieved April 04, 2016, from http://www.webmd.com/fibromyalgia/features/exercise-can-ease- fibromyalgia-pain?page=2 http://www.webmd.com/fibromyalgia/features/exercise-can-ease- fibromyalgia-pain?page=2 Thompson, D. L. (2007). Fitness Focus Copy-and-Share. ACSM's Health & Fitness Journal, 11 (3), 4. Retrieved April 4, 2016, from http://journals.lww.com/acsm- healthfitness/Fulltext/2007/11000/Fitness_Focus_Copy_and_Share__Fib romyalgia_and.4.aspx http://journals.lww.com/acsm-