1. FIBROMYALGIA Sabrina Murphy

2. FIBROMYALGIA: WHAT IS IT?  Chronic widespread pain and stiffness in the muscles and joints.  Related symptoms include  Unusual tiredness  Poor sleep quality  Impaired cognitive abilities  Irritable Bowl Syndrome (IBS)

3. DIAGNOSIS  American College of Rheumatology created the criteria for Fibromyalgia (1990)  History of widespread pain  At least 11 of 18 tender points present

4. WHO DOES THIS EFFECT  More common in women than in males.  Seen most commonly in women of childbearing age and older.  Those who have a 1 st degree relative with fibromyalgia are at an 8 times greater risk for developing it themselves

5. PATHOPHYSIOLOGY  The cause of Fibromyalgia is unknown.  High rate of comorbidity  Depression  Anxiety  Individuals exhibit hyperalgesia and/or allodynia  High levels of substance P have been found in those with fibromyalgia.  Reduced serum levels of serotonin and L-tryptophan

6. TREATMENTS  Treatment of sleep disorders  Pharmacotherapy  Exercise  Psychotherapy (CBT)  Education  Medications  NSAID’s  Pregabalin  Gabapentin  Antidepressants

7. PRE-EXERCISE CONSIDERATIONS  Each program will vary depending on client symptoms.  Clients already experience muscle and joint pain and/or stiffness.  Most discontinue regimen once clinical guidance stops.  Severe symptom days may call for rest.

8. EXERCISE TESTING  Sub-max testing protocols.  Test should last between 8-12 minutes  Modified Bruce treadmill protocol, standard bicycle test.

9. AEROBIC EXERCISE  Frequency: 3-5x/wk  Intensity: Low to moderate intensity. 50-75% of HR max.  Type: Low impact activities. Water based activities, walking, cycling etc.  Time: 30 minutes/session

10. ANAEROBIC EXERCISE  Frequency: 3x/wk  Intensity: 2-3 sets of 6-8 reps 40-60% of 1RM max.  Type: resistance training; dumbbells, barbells machines, resistance bands.  Time:15-20 minutes  Flexibility routines should be included

11. CASE STUDY  Caucasian female, 34 y/o with one, 3 y/o child. She is a non-smoker. She is 64 inches and 140lbs with a BMI of 24. Her resting BP is 120/76 and HR is 68 BPM. Her father suffered a heart attack at the age of 53 y/o. Her total cholesterol level is 180, with an HDL reading of 50. She was going on walks 4 nights a week with her family, but reduced it to 2 due to her fibromyalgia pain. She is currently not taking any medicine for this condition.  Risk Factors: 1  Risk Stratification: Low  Goals: She would like to begin a workout program to help alleviate some of her fibromyalgia symptoms before she tries medications.

12. REFERENCES  Ang, D. (2010). Research to Encourage Exercise for Fibromyalgia (REEF): Use of motivational interviewing design and method. Contemporary Clinical Trials, 32(1), 59-68.  Clauw, D. (2009). Fibromyalgia: An Overview. The American Journal of Medicine, 122(12A), S3-S13.  Ehrman, J., Gordon, P., Visich, P., & Keteyian, S. (2013). Multiple Sclerosis. In Clinical Exercise Physiology (Third ed., pp. 511-524). Human Kinetics, 61-68.  Iverson, M., & Mannerkorpi, K. Physical Exercise in Fibromyalgia and Related Syndromes. Best - Practice and Research Clinical Rheumatology,629-647.  Fibromyalgia. (2013). In HarvardMedicalSchool, Harvard Medical School Health Topics A-Z. Boston, MA: Harvard Health Publications.  Mahan, M. (2015). Is Fibromyalgia a Real Pathology? World Neurosurgery News, 83(5), 717-717.  Skinner, J. S., & Skinner, J. S. (11/01/2005). ACSM's health & fitness journal: Get with the program American College of Sports Medicine.