Search

Purpose: This study analysed the longitudinal associations of physical fitness and affect with depression, anxiety and life satisfaction at 2- and 5-year follow-up. Methods: In 312 adult women with fibromyalgia, physical fitness was measured by performance-based tests and affect, depression, anxiety and life satisfaction were self-reported using the Positive and Negative Affect Schedule (PANAS), Beck Depression Inventory-second edition (BDI-II), State Trait Anxiety Inventory-I (STAI) and Satisfaction with Life Scale (SWLS), respectively. We conducted sequential linear regression analyses adjusted for baseline levels of depression, anxiety, life satisfaction, age, body fat percentage and education. Results: At the 2-year follow-up, all the associations under study were significant. At the 5-year follow-up, a number of associations remained significant. First, lowering negative affect was independently associated with lower depression, anxiety and higher life satisfaction (β’s from 0.14 to 0.31). Second, favourable changes in positive affect were independently associated with lower anxiety (β = 0.21) and higher life satisfaction (β = 0.28). Third, enhancing physical fitness was related to higher life satisfaction (β = 0.16). Conclusion: Reductions in negative affect were associated with more favourable depression, anxiety and life satisfaction at the 2- and 5-year follow-up. Improvements in positive affect were associated with more favourable anxiety and life satisfaction and enhancements in physical fitness were associated with higher life satisfaction. If corroborated in clinical–experimental research, these findings may guide the development of interventions that are tailored to the levels of physical fitness, affect and the outcome of interest (i.e. depression, anxiety or life satisfaction) in women with fibromyalgia.

Introduction A variety of exercise programs are recognized to be effective for the management of hand osteoarthritis (HOA). It is important to report the essential elements of these exercise programs for clinicians to replicate properly and facilitate their implementation with individuals who suffers from HOA, especially if they are found to be effective programs. Purpose of the Study The objective of this article was to assess content reporting using three exercise reporting standardized assessment tools among exercise interventions randomized controlled trials (RCTs) involving individuals with HOA. Study Design A descriptive study was used. Methods Two pairs of trained assessors independently identified, selected, and scored the reporting quality of the exercise programs of RCTs on the management of HOA using three standardized assessment tools: the Consensus on Exercise Reporting Template (CERT) checklist, Consensus on Therapeutic Exercise Training (CONTENT) scale, and Template for Intervention Description and Replication (TIDieR) checklist to review the quality of reporting of 11 RCTs included in a recent Ottawa Panel guideline. Results Based on consensus reached by two different pairs of reviewers and an arbitrator, the mean total scores for the 11 included exercise programs were reported as follows: the mean total score for the CERT, CONTENT, and TIDieR was 10.58/19 ± 4.34, 3.27/9 ± 1.90, and 5.92/12 ± 2.54, respectively. The overall Pearson's Correlation (r) between the methodological quality and intervention reporting was 0.86, 0.71, and 0.54 for moderate-to-high RCTs and 0.47, 0.79, and 0.42 for fair-to-poor methodological quality for the CERT checklist, CONTENT scale, and TIDieR checklist, respectively. Conclusions The intervention reporting in the management of HOA is poor among low-, moderate-, and high-quality clinical trials. The least reported information was intervention parameters related to behavior change. Improving reporting is recommended to ensure replication of effective exercise programs to enhance quality of life of individuals with HOA.

This study aimed to examine the association between active commuting and sedentary time (ST) and physical activity (PA) in women with fibromyalgia.This cross-sectional study included 420 women with fibromyalgia (aged 30 to 74 years old) from Spain. The participants wore an accelerometer during seven days to record ST and PA. They also self-reported patterns of active commuting. Linear regression analyses were conducted to examine the relationships between commuting and accelerometer outcomes. Age, pressure pain threshold, and accelerometer wear time were used as confounders.There was a negative association between active commuting and ST whereas active commuting was positively associated with moderate PA, moderate-to-vigorous PA, total PA, and step count (allYounger women with fibromyalgia who were active commuters spent less ST and were involved in greater PA than passive commuters. This study highlights the importance of promoting active commuting to increase PA among young women with fibromyalgia, while other sources of PA might be recommended for older patients if levels of active commuting are not increased.Implications for rehabilitationActive commuting is a source to increase PA in women with fibromyalgia.Active commuting alone does not seem to be enough to increase PA levels in older women with fibromyalgia and additional PA strategies should be implemented.Promotion of active commuting in young women with fibromyalgia is recommended.

Purpose: To examine the association of physical activity (PA) intensity levels and sedentary time with health-related quality of life (HRQoL) in women with fibromyalgia and whether patients meeting the current PA guidelines present better HRQoL. Methods: This cross-sectional study included 407 women with fibromyalgia aged 51.4 § 7.6 years. The time spent (min/day) in different PA intensity levels (light, moderate, and moderate-to-vigorous physical activity (MVPA) and sedentary time were measured with triaxial accelerometry. The proportion of women meeting the American PA recommendations (>150 min/week of MVPA in bouts >10 min) was also calculated. HRQoL domains (physical function, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health), as well as physical and mental components, were assessed using the 36-item Short-Form Health Survey. Results: All PA intensity levels were positively correlated with different HRQoL dimensions (rpartial between 0.10 and 0.23, all p < 0.05). MVPA was independently associated with social functioning (p < 0.05). Sedentary time was independently associated with physical function, physical role, bodily pain, vitality, social functioning, and both the physical and mental component summary score (all p < 0.05). Patients meeting the PA recommendations presented better scores for bodily pain (mean = 24.2 (95%CI: 21.3-27.2) vs. mean = 20.4 (95%CI: 18.9-21.9), p = 0.023) and better scores for social functioning (mean = 48.7 (95%CI: 43.9-44.8) vs. mean = 42.3 (95%CI: 39.8-44.8), p = 0.024). Conclusion: MVPA (positively) and sedentary time (negatively) are independently associated with HRQoL in women with fibromyalgia. Meeting the current PA recommendations is significantly associated with better scores for bodily pain and social functioning. These results highlight the importance of being physically active and avoiding sedentary behaviors in this population., This study was supported by the Spanish Ministries of Economy and Competitiveness (I+D+i DEP2010-15639; I+D+I DEP2013-40908-R, BES-2014- 067612) and the Spanish Ministry of Education (FPU 13/ 01088; FPU 15/00002).

ObjectiveTo analyze 1) the independent association of physical fitness, positive affect, and negative affect with the different dimensions of fatigue (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue) and 2) whether the interactions of physical fitness, positive affect, and negative affect were associated with fatigue over and above the independent association.DesignCross-sectional study in 420 women with fibromyalgia.SettingFibromyalgia associations from southern Spain.MethodsPhysical fitness was measured by performance-based tests, and questionnaires were used to measure positive affect, negative affect, and different dimensions of fatigue (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue). Age, body mass index, and current pain level were included as potential confounders in all analyses.ResultsPhysical fitness was independently associated with general fatigue, physical fatigue, and reduced activity (all P ≤ 0.02). Positive affect was independently associated with all fatigue dimensions (all P ConclusionsIn women with fibromyalgia, positive affect was independently and consistently associated with all dimensions of fatigue. The combination of higher levels of overall physical fitness and positive affect might serve as a buffer against general and physical fatigue in women with fibromyalgia.

Supported by the Health and Social Care Public Health Agency, Northern Ireland (STL/5268/16 to C.H. and J.G.M.). F.E.-L. received funding from the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant (agreement no. 707404). The funders of the present study did not have any role in the study design, data collection and analyses, decision to publish, or preparation of the manuscript. F.E.-L. is the guarantor of the review., Objectives: To determine the effects of exercise on fatigue and sleep quality in fibromyalgia (primary aim) and to identify which type of exercise is the most effective in achieving these outcomes (secondary aim). Data Sources: PubMed and Web of Science were searched from inception until October 18, 2018. Study Selection: Eligible studies contained information on population (fibromyalgia), intervention (exercise), and outcomes (fatigue or sleep). Randomized controlled trials (RCT) testing the effectiveness of exercise compared with usual care and randomized trials (RT) comparing the effectiveness of 2 different exercise interventions were included for the primary and secondary aims of the present review, respectively. Two independent researchers performed the search, screening, and final eligibility of the articles. Of 696 studies identified, 17 RCTs (n=1003) were included for fatigue and 12 RCTs (n=731) for sleep. Furthermore, 21 RTs compared the effectiveness of different exercise interventions (n=1254). Data Extraction: Two independent researchers extracted the key information from each eligible study. Data Synthesis: Separate random-effect meta-analyses were performed to examine the effects from RCTs and from RTs (primary and secondary aims). Standardized mean differences (SMD) effect sizes were calculated using Hedges' adjusted g. Effect sizes of 0.2, 0.4, and 0.8 were considered small, moderate, and large. Compared with usual care, exercise had moderate effects on fatigue and a small effect on sleep quality (SMD, -0.47; 95% confidence interval [CI], -0.67 to -0.27; P, Health and Social Care Public Health Agency, Northern Ireland STL/5268/16, European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant 707404

Objectives: To identify effective aerobic exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. Methods: A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, or D-) was used, based on statistical significance ( P < 0.5) and clinical importance (⩾15% improvement). Results: The five high-quality studies included demonstrated that various aerobic training exercises are generally effective for improving knee osteoarthritis within a 12-week period. An aerobic exercise program demonstrated significant improvement for pain relief (Grade B), physical function (Grade B) and quality of life (Grade C+). Aerobic exercise in combination with strengthening exercises showed significant improvement for pain relief (3 Grade A) and physical function (2 Grade A, 2 Grade B). Conclusion: A short-term aerobic exercise program with/without muscle strengthening exercises is promising for reducing pain, improving physical function and quality of life for individuals with knee osteoarthritis.

Objective: To identify effective mind-body exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning non-traditional land-based exercises for knee osteoarthritis. Methods: A systematic search and adapted selection criteria included comparative controlled trials with mind-body exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, D-) was used, based on statistical significance ( P < 0.5) and clinical importance (⩾15% improvement). Results: The four high-quality studies identified demonstrated that various mind-body exercise programs are promising for improving the management of knee osteoarthritis. Hatha Yoga demonstrated significant improvement for pain relief (Grade B) and physical function (Grade C+). Tai Chi Qigong demonstrated significant improvement for quality of life (Grade B), pain relief (Grade C+) and physical function (Grade C+). Sun style Tai Chi gave significant improvement for pain relief (Grade B) and physical function (Grade B). Conclusion: Mind-body exercises are promising approaches to reduce pain, as well as to improve physical function and quality of life for individuals with knee osteoarthritis.

Objective: To identify effective strengthening exercise programs and provide rehabilitation teams and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. Methods: A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+ or D-) was based on statistical significance ( p Results: The 26 high-quality studies identified demonstrated that various strengthening exercise programs with/without other types of therapeutic exercises are generally effective for improving knee osteoarthritis management within a six-month period. Strengthening exercise programs demonstrated a significant improvement for pain relief (four Grade A, ten Grade B, two Grade C+), physical function (four Grade A, eight Grade B) and quality of life (three Grade B). Strengthening in combination with other types of exercises (coordination, balance, functional) showed a significant improvement in pain relief (three Grade A, 11 Grade B, eight Grade C+), physical function (two Grade A, four Grade B, three Grade C+) and quality of life (one Grade A, one Grade C+). Conclusion: There are a variety of choices for strengthening exercise programs with positive recommendations for healthcare professionals and knee osteoarthritis patients. There is a need to develop combined behavioral and muscle-strengthening strategies to improve long-term maintenance of regular strengthening exercise programs.

Background: The Fibromyalgia Impact Questionnaire (FIQ) is the most used questionnaire worldwide to measure the health status of patients with fibromyalgia. The questionnaire has been subjected to several studies to analyze psychometric properties. However, norm scores and cultural differences have not been presented. Objectives: To obtain and present norm scores for the FIQ in patients with fibromyalgia in different cultures, namely Southern, Central, and Northern areas of Europe. Study Design: This observational study consisted of women with fibromyalgia from 4 countries (Spain, Belgium, the Netherlands, and Sweden) classified in 3 areas (Southern, Central, and Northern) in Europe. Setting: Women with fibromyalgia from Spain, Belgium, the Netherlands, and Sweden. Methods: The impact of fibromyalgia was assessed by the FIQ. A total of 1,478 women with fibromyalgia were asked to fill out the FIQ in the Spanish (n = 531), Dutch and Belgian (n = 629), or Swedish (n = 318) versions. Results: The norm scores and percentiles score of the FIQ are presented. Norm scores differed between European areas (Southern area = 64.8 ± 15.9; Central area = 60.9 ± 15.7; Northern area = 62.8 ± 16.7). Perceived physical impairment, overall well-being (all, P < 0.001), FIQ total (P < 0.01), and morning tiredness (P < 0.05) in women with fibromyalgia from the Central area of Europe reported lower impact than Southern and Northern areas. The Northern area of Europe showed the lowest score of job difficulty, anxiety, depression (all, P < 0.001), and pain (P < 0.01), whereas the Southern area of Europe showed the lowest score of work missed subscale (P < 0.001) with regard to the rest of the areas studied. Limitations: The selection of patients was conducted with just women because of the scarce prevalence of fibromyalgia among men. Moreover, sociodemographic status, socioeconomic status, and clinical characteristics were not measured. Similar research should be conducted with adequate representation of populations from other parts of the world. Conclusions: Pairwise comparisons showed significant differences mainly between the Southern area versus Northern and Central areas of Europe. The impact of fibromyalgia showed mainly higher scores in women with fibromyalgia from the Southern area of Europe. Key words: Symptom, psychometric, norm scores, European comparison

Background Non-pharmacological interventions are the mainstay of treatment for fibromyalgia, however, current evidence-based guidelines report that the only therapy supported by ‘strong for’ evidence is exercise intervention for pain in fibromyalgia [1]. While increased fatigue and poor sleep quality are among the most burdensome symptoms in fibromyalgia, there remains limited evidence for the effectiveness of exercise in the management of these symptoms [2,3] Objectives To determine the effectiveness of exercise in the management of fatigue and sleep quality in fibromyalgia. Methods A systematic search was conducted using PubMed and Web of Science in October 2018 (Prospero Registration No. CRD42018118005). Eligible studies were randomised controlled trials (RCT) including adults with fibromyalgia (population), who received exercise (intervention) compared to usual care (comparator). Outcomes of interest were fatigue and/or sleep quality. No restrictions were applied for language nor for publication date. Random effects meta-analyses were conducted. The Cochrane Collaboration’s tool was used for assessing risk of bias in the included studies. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results Twenty RCTs were included, 17 included measures of fatigue (n=1003) and 12 measures of sleep quality (n=731). In comparison to usual care, exercise had beneficial effects on fatigue (Figure 1, P Conclusion According to the GRADE framework, this review provides low-to-moderate quality evidence that exercise is moderately effective for improving fatigue, and moderate evidence of no/meaningless effects of exercise to improve sleep quality. Further high quality RCTs are required to determine the effectiveness of exercise on fatigue, and in particular, sleep quality in fibromyalgia References [1] Macfarlane GJ, et al. Ann Rheum Dis2017;76:318–28. Doi:10.1136/annrheumdis-2016-209724 [2] Bidonde J, et al. Cochrane Database Syst Rev 2017;2017. Jun 21;6:CD012700 doi:10.1002/14651858.CD012700 [3] Busch AJ, et al. Cochrane database Syst Rev 2013;:CD010884. doi:10.1002/14651858.CD010884 Analyses were conducted using a random effects model. CI, Confidence Interval; df, degrees of freedom; Std, Standardised; SD, Standard Deviation; IV, Inverse Variance; Co-, Co-intervention (Photo, phototherapy; edu, education); C, Cardiorespiratory exercise; F, flexibility exercise; S, Strength training; TC, Tai Chi; QG, Quigong; Y, Yoga; L- and W-B, land- and water-based exercise, respectively. Acknowledgement This study was funded by the Health and Social Care Public Health Agency, Northern Ireland (STL/5268/16) and the Spanish Ministry of Economy and Competitiveness (BES-2014-067612) Disclosure of Interests None declared

Background Non-pharmacological approaches are the mainstay of treatment in fibromyalgia. The current recommendations of the European League Against Rheumatism (EULAR) for the management of fibromyalgia highlight that exercise is the only therapy with a ‘strong’ evidence [1]. Exercise has been typically implemented on either land- or water-based settings. However, it is unclear whether to perform exercise in different settings has different effects on pain; this knowledge might help to maximise the beneficial effects that exercise has in fibromyalgia [2] Objectives To compare the effects of two exercise interventions (land- and water-based training) on pain in people with fibromyalgia. Methods From 272 initially randomized, a total of 151 participants (50.6±7.6 years old, 98% women) completed all the assessments and attended to at least 70% of the programme; 48, 42 and 61 participants pertained to the land-based exercise, water-based exercise, and usual care (control) groups, respectively. The intervention groups trained 3 non-consecutive days/week (45-60 minutes per session) for 24 weeks. Each session included aerobic exercises, muscular strengthening and stretching for all the major muscle groups. Pain was measured by the 0-100 mm visual analogue scale (VAS) from the Fibromyalgia Impact Questionnaire (FIQ). Catastrophizing and self-efficacy pain-related cognitions were assessed by the Pain Catastrophizing Scale (PCS total score) and pain management subscale (PSE) of the Chronic Pain Self-efficacy Scale (CPSS), respectively. We calculated an algometer score based on the sum of pain thresholds (kg/cm2) of the 18 tender pints according to the 1990 American College of Rheumatology fibromyalgia diagnostic criteria. Participants were evaluated at baseline (pre-test), at the end of the 24-week intervention (post-test) and after a 12-week detraining period (re-test). The groups were comparable in sociodemographic and clinical characteristics; they only differ on age, which was included as a covariate along with baseline levels of pain. Results Adjusting for Bonferroni, most of the between-group comparisons of pain changes over time were not significant. As exceptions, in comparison to the control group, participants in the land-based exercise group lowered catastrophizing and improved algometer score at the post-tests; mean difference (95% interval confidence) [MD(95% CI)] = -4.0 (-7.5 to -0.5) and 6.2 (2.0 to 10.5), respectively. These differences became non-significant at the re-test. Conclusion These preliminary results suggest that a 24-week land-based exercise intervention had beneficial effects by reducing pain catastrophizing and increasing algometer score in people with fibromyalgia. However, these benefits were unsustained after the detraining period. In compassion to the control group, a water-based exercise intervention did not show any effect on pain. Although our finding suggest that a land-based exercise intervention may have short-term beneficial effects on pain, these findings must be considered as preliminary until more robust analyses are performed. References [1] Macfarlane GJ, et al. Ann Rheum Dis2017;76:318–28. Doi:10.1136/annrheumdis-2016-209724 [2] Carbonell-Baeza A, et al. BMC Musculoskelet Disord2012;13:18. Doi:10.1186/1471-2474-13-18 Acknowledgement This study was supported by the Spanish Ministry of Economy and Competitiveness (I+D+i DEP2010-15639; I+D+I DEP2013-40908-R; BES-2014-067612) and the Spanish Ministry of Education (FPU14/02518; FPU 15/00002) Disclosure of Interests None declared

Background Spending time seated has previously shown to be associated with worse symptomatology in fibromyalgia1. In addition, to accumulate sedentary time (ST) in prolonged, unbroken periods (bouts) has shown to be particularly harmful in the general population2. Objectives To examine the association of prolonged ST with the impact of the disease in women with fibromyalgia. Methods Four-hundred-and-seven (51.4±7.6 years old) fibromyalgia women participated in this cross-sectional study. Sedentary time accumulated in bouts of ≥10, ≥20, ≥30 and ≥60 minutes, and moderate-to-vigorous physical activity (MVPA) were measured with triaxial accelerometry (GT3X+). To control for total ST, the percentage of ST spent in different bout categories were calculated (e.g., (time spent in bouts ≥30 min/ total ST) ×100). We assessed different domains of fibromyalgia impact (function, overall, symptoms) and the global impact of fibromyalgia (total score) with the Revised Fibromyalgia Impact Questionnaire (FIQR). Separate linear regression models were built to assess the association of percentage of ST spent in different bout categories (independent variables) with the domains of fibromyalgia impact and the global impact of the disease (dependent variable) while controlling for age, fat percentage, medication for pain and depression, and total accelerometer wear time. Model 2 additionally included time spent in MVPA. Results Greater percentage of ST spent in bouts ≥10 min (β=0.171, p Conclusion The results seem to indicate that ST accumulated in bouts is negatively associated with the impact of the disease in women with fibromyalgia. Overall, these associations were independent of time spent in MVPA. It might be advisable to promote reducing prolonged ST in this population. References [1] Segura-Jimenez V, Borges-Cosic M, Soriano-Maldonado A, et al. Scand. J. Med. Sci. Sports. 2017;27:83–92. [2] Benatti FB, Ried-Larsen M. Med. Sci. Sports Exerc. 2015;47:2053–61. Acknowledgement We thank all the study participants for their collaboration. Funding: This study was supported by the Spanish Ministry of Economy and Competitiveness (I+D+i DEP2010-15639; I+D+I DEP2013-40908-R; BES-2014-067612) and the Spanish Ministry of Education (FPU 15/00002) Disclosure of Interests None declared

Background People with fibromyalgia identify fatigue as one of the main symptoms of the disease [1]. It is hypothesised that the pathogenesis of fibromyalgia involves a genetic susceptibility that is modulated by environmental factors [2] Objectives To examine the possible role of genetic susceptibility for fatigue in southern Spanish women with fibromyalgia, by looking at the possible associations of fatigue and single nucleotide polymorphisms in 34 fibromyalgia candidate-genes, at the interactions between genes, and at the associations between gene-physical activity. Methods In this cross-sectional study participated 276 women with fibromyalgia. We extracted DNA from saliva in order to analyse gene-polymorphisms related to fibromyalgia susceptibility, symptoms, or potential mechanisms. Accelerometers registered the participants’ physical activity and sedentary time. Five dimensions of fatigue were assessed with the Multidimensional Fatigue Inventory. Age, body fat (%), and analgesics and antidepressants consumption were considered as confounders in all analyses. Based on the Bonferroni’s and False Discovery Rate (FDR) values, the statistical significance was interpreted. Results AT carriers of the rs4453709 polymorphism (sodium channel protein type 9 subunit alpha, SCN9A, gene) showed the highest scores on fatigue. Carriers of the heterozygous genotype of the rs1801133 (methylene tetrahydrofolate reductase, MTHFR, gene) or rs4597545 (SCN9A gene) polymorphisms who were physically active reported lower fatigue compared to their inactive counterparts. Highly sedentary carriers of the homozygous genotype of the rs7607967 polymorphism (AA/GG genotype; SCN9A gene) presented higher fatigue than those with lower levels of sedentary time. Conclusion Physical (in)activity behaviours and the SCN9A and MTHFR genes were jointly related to fatigue. Thereby, the potential benefits of following an active lifestyle might be observed more clearly in women with fibromyalgia genetically predispose to higher levels of fatigue. References [1] Bennett RM, et al. BMC Musculoskelet Disord 2010;11:134. doi:10.1186/1471-2474-11-134 [2] McBeth J, Mulvey MR. Nat Rev Rheumatol 2012;8:108–16. doi:10.1038/nrrheum.2011.216 Acknowledgement This work was supported by the Spanish Ministry of Economy and Competitiveness [I+D+i DEP2010-15639, I+D+i DEP2013-40908-R to M.D.-F.; BES-2014-067612 to F.E.-L.]; the Spanish Ministry of Education [FPU13/03410 to D.S.-T.; FPU 15/00002 to B.G.C]; the Consejeria de Turismo, Comercio y Deporte, Junta de Andalucia [CTCD-201000019242-TRA to MD-F]; and the University of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES). Disclosure of Interests None declared

Background: In fibromyalgia, the main aim of therapy is to reduce the severity or impact of the disease [1]. The effectiveness of the most commonly used therapies is modest in fibromyalgia. Therefore, identifying modifiable factors associated with lower fibromyalgia severity is a priority as these modifiable factors may be possible therapeutic targets [2-4]. Objectives: This study examined the determinants of fibromyalgia severity. Methods: In this observational, population-based cross-sectional study, 569 people with fibromyalgia were assessed on resilience, catastrophizing, active lifestyle, declarative memory, subjective fitness, objective fitness, psychological distress, physical fatigue and disease severity. Structural equation modelling estimation was used to analyse the following hypotheses: (i) resilience, catastrophizing and active lifestyle through subjective fitness, objective fitness, psychological distress, and physical fatigue determine fibromyalgia severity; and (ii) these factors are distributed in two core pathways (one physical and one psychological) that interplay between each other. Results: We confirmed the above-mentioned hypotheses. Our model explained 83% of fibromyalgia severity, which is a considerably large proportion. Conclusion: Our findings not only corroborate the importance of the two core (i.e., physical and psychological) pathways but also their interaction in their association with fibromyalgia severity. The understanding of these interconnections between alleged predisposing and perpetuating factors may optimise current approaches for treating fibromyalgia. Although the present research is the most comprehensive model of fibromyalgia severity to date, its cross-sectional design impedes to determine causal relationships. Longitudinal research is warranted. References [1] Macfarlane GJ, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2017;76:318–28. doi:10.1136/annrheumdis-2016-209724. [2] Estevez-Lopez F, et al. Adaptation profiles comprising objective and subjective measures in fibromyalgia: the al-Andalus project. Rheumatology (Oxford)2017;56:2015–24. doi:10.1093/rheumatology/kex302 [3] Estevez-Lopez, F., Rodriguez-Ayllon, M., Soriano-Maldonado, A., Acosta-Manzano, P., Segura-Jimenez, V., Alvarez-Gallardo, IC., et al. Lower Fatigue in Fit and Positive Women with Fibromyalgia: The al-Andalus Project. Pain Med (In press). DOI: 10.1093/pm/pny304 [4] Estevez-Lopez, F., et al. The discordance between subjectively and objectively measured physical function in women with fibromyalgia: association with catastrophizing and self-efficacy cognitions. The al-Andalus project. Disabil Rehabil 2018;40: 329-337. All the coefficients were significant. Acknowledgement: This work was supported by the Spanish Ministry of Economy and Competitiveness [I+D+i DEP2010-15639, I+D+I DEP2013-40908, I+D+I PSI2015-65241-R, and BES-2014-067612]; the Spanish Ministry of Education [FPU15/00002], and the University of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES). University of Jaen, Plan de Apoyo a la Investigacion 2017-2019 [EI_SEJ07_2017]. Disclosure of Interests: None declared

Background: Physical fitness (PF) represents a marker of health and is associated with health-related quality of life (HRQoL). Different components of PF have shown to be consistently associated with lower symptomatology in people with fibromyalgia1,2. Identifying which PF components are associated with HRQoL in people with fibromyalgia may contribute to the development of more specific therapeutic strategies. Objectives: The aim was to examine the associations of different PF components with HRQoL in women with fibromyalgia. Methods: This population-based cross-sectional study included 466 women with fibromyalgia. The Senior Fitness Tests battery plus handgrip test were used to assess PF and the 36-item Short-Form Health Survey (SF-36) was used to assess HRQoL. Tender points, cognitive impairment, anthropometric measurements and medication usage were also measured and used as confounders. Firstly, multivariate linear regression assessed the individual relationship of each PF test with the eight dimensions of the SF-36. Secondly, a standardized composite score was computed for each component of PF (aerobic fitness, muscular strength, flexibility and motor agility). Forward stepwise regression was performed to analyse which components of PF were independently associated with the SF-36 physical and mental component scales. Results: Overall, higher performance on PF tests was associated with higher levels of HRQoL in all SF-36 dimensions and subscales (all p Conclusion: High PF is consistently associated with better HRQoL in women with fibromyalgia. Muscular strength, flexibility and cardiorespiratory fitness are independent indicators of HRQoL in this population. These results might have implications for future intervention studies because it could facilitate the selection of the most suitable exercise interventions according to the clinical profile of each patient. References [1] Soriano-Maldonado A, Ruiz JR, Aparicio VA, Estevez-Lopez F, Segura-Jimenez V, Alvarez-Gallardo IC, et al. Association of physical fitness with pain in women with fibromyalgia: The al-Andalus project. Arthritis Care Res 2015;67. [2] Estevez-Lopez F, Gray CM, Segura-Jimenez V, Soriano-Maldonado A, Alvarez-Gallardo IC, Arrayas-Grajera MJ, et al. Independent and combined association of overall physical fitness and subjective well-being with fibromyalgia severity: the al-Andalus project. Qual Life Res 2015;24. Acknowledgement: This work was supported by the Spanish Ministry of Economy and Competitiveness [I+D+i DEP2010-15639, I+D+i DEP2013-40908-R to M.D.-F.; BES-2014-067612 to F.E.-L.]; the Spanish Ministry of Education [FPU2014/02518 to MB-C; FPU 15/00002 to B.G.C]; the Consejeria de Turismo, Comercio y Deporte, Junta de Andalucia [CTCD-201000019242-TRA to MD-F]. Disclosure of Interests: None declared

Background: Fibromyalgia is characterised by chronic pain and a heterogeneous presentation of other symptoms (e.g., fatigue and depression) [1]. It is widely accepted that pain is promoted by both genetic susceptibility and environmental factors such as people’s behaviours [2]. In addition to genotype individual associations and gene-gene interactions, when considering complex phenotypes such as pain, gene-environmental interactions are likely present and can help to better understand the disease (i.e. by unravelling underlying mechanisms [3]). Objectives: To test the individual association of 64 polymorphisms (34 candidate-genes) and the gene-gene, gene-physical activity, and gene-sedentary behaviour interactions with pain and pain-related cognitions in fibromyalgia. Methods: In 274 women with fibromyalgia, saliva samples were collected for extracting DNA. We measured physical activity and sedentary behaviour by accelerometers for a week, pain with algometry and questionnaires, and pain cognitions with questionnaires. Age, body fat, and analgesics and antidepressants consumption were included as covariates. Significance was set at P-values lower than the Bonferroni’s correction or P- and false discovery rate values lower than 0.05. Results: The rs6311 and rs6313 polymorphisms were individually related to algometer scores. The interaction of rs4818 and rs1799971 polymorphisms was related to pain catastrophizing. Five gene-behaviour interactions were significant: the interactions of sedentary behaviour with rs1383914, rs6860, rs4680, rs165599, and rs12994338 polymorphisms were associated with the bodily pain subscale of the SF-36. Conclusion: The HTR2A gene (individually), COMT and OPRM1 gene-gene interaction, and the interactions of sedentary behaviour with ADRA1A, CHMP1A, COMT, and SCN9A genes were associated with pain-related outcomes in fibromyalgia females. Besides indicating the relevance of genetic background for pain and pain-catastrophizing, the observed genotype-behaviour interactions suggest that the effects of sedentary behaviour on pain may depend on the genotype of women with fibromyalgia. Future clinical experimental research should examine whether reducing sedentary behaviour is particularly beneficial for reducing pain in women with specific genotypes. References [1] Estevez-Lopez F, et al. Rheumatology (Oxford). 2017Nov;56(11):2015-2024 [2] Nielsen CS, et al. Pain. 2008May;136(1-2):21-9 [3] Hunter DJ. Nat Rev Genet. 2005Apr;6(4):287-98 Acknowledgement: This work was supported by the Spanish Ministry of Economy and Competitiveness [I+D+i DEP2010-15639, I+D+i DEP2013-40908-R to M.D.-F.; BES-2014-067612 to F.E.-L.], the Spanish Ministry of Education [FPU13/03410 to D.S.-T.; FPU15/0002 to B.G.-C.], the Consejeria de Turismo, Comercio y Deporte, Junta de Andalucia [CTCD-201000019242-TRA to MD-F], the Consejeria de Salud, Junta de Andalucia [PI-0520-2016 to M.D.-F.], and the University of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES). Disclosure of Interests: None declared

BACKGROUND Sedentary time (ST) has been associated with detrimental health outcomes in fibromyalgia. Previous evidence in the general population has shown that not only is the total amount of ST harmful but the pattern of accumulation of sedentary behaviors is also relevant to health, with prolonged unbroken periods (ie, bouts) being particularly harmful. OBJECTIVE To examine the association of the patterns of ST with health-related quality of life (HRQoL) in women with fibromyalgia and to test whether these associations are independent of moderate-to-vigorous physical activity (MVPA). METHODS A total of 407 women (mean 51.4 years of age [SD 7.6]) with fibromyalgia participated. ST and MVPA were measured with triaxial accelerometry. The percentage of ST accumulated in bouts and the frequency of sedentary bouts of different lengths (≥10 min, ≥20 min, ≥30 min, and ≥60 min) were obtained. Four groups combining total ST and sedentary bout duration (≥30 min) were created. We assessed HRQoL using the 36-item Short-Form Health Survey (SF-36). RESULTS A greater percentage of ST spent in all bout lengths was associated with worsened physical function, bodily pain, vitality, social function, and physical component summary (PCS) (all PP=.04). A higher frequency of bouts was negatively associated with physical function, social function, the PCS (≥30 min and ≥60 min), physical role (≥60 min), bodily pain (≥60 min), and vitality (≥20 min, ≥30 min, and ≥60 min) (all P CONCLUSIONS Greater ST in prolonged periods of any length and a higher frequency of ST bouts, especially in longer bout durations, are associated with worsened HRQoL in women with fibromyalgia. These associations were generally independent of MVPA.

BACKGROUND This study aimed to evaluate the therapeutic validity of exercise interventions included in a previous umbrella systematic review of high-quality randomized controlled trials (RCTs) in the management of fibromyalgia and to explore whether exercise interventions with high therapeutic validity and that meet the 2013 American College of Sports Medicine (ACSM) guidelines are positively associated with greater pain relief. METHODS Therapeutic validity was evaluated based on the CONsensus on Therapeutic Exercise and Training (CONTENT) Scale, in high methodological quality RCTs found in the nine systematic reviews of a previous umbrella review on exercise interventions in the management of fibromyalgia. Additionally, adherence to the 2013 ACSM exercise recommendations for fibromyalgia was analyzed. The effect size for pain relief after the exercise programs was also considered. RESULTS The CONTENT mean total score was 4.42 out of 9, demonstrating generally low therapeutic validity of the 28 included RCTs. There was poor concordance between therapeutic validity and pain relief (Kappa values ranging between -0.6 to 0.57). Kappa statistic results showed poor concordance (k=0.01) between statistically significant (P

Reproductive labour refers to activities and tasks directed at caregiving and domestic roles, such as cleaning, cooking, and childcare. Productive labour refers to activities that involve economic remuneration. The aim of the present study was to analyse physical activity, sedentary behaviour, physical fitness, and cognitive performance in women with fibromyalgia who engaged, or did not engage, in productive work.This cross-sectional study comprised 276 women with fibromyalgia from Andalusia (southern of Spain). Levels of physical activity (light, moderate, and vigorous) and sedentary behaviour were measured by an accelerometer. Physical fitness and cognitive performance were measured with a battery of performance-based tests.More hours/week of homemaker-related tasks were associated with higher time spend in light physical activity and lower sedentary behaviour (P 0.001 and P 0.05, respectively). Furthermore, in comparison with those who only engaged in reproductive labour, women with fibromyalgia who engaged in productive work showed lower levels of sedentary behaviour and higher levels of light and moderate physical activity, physical fitness (except muscular strength), and cognitive performance (all, P 0.05).Altogether, our findings suggest that productive work is consistently related to better physical and cognitive functioning in women with fibromyalgia. If future research corroborates causality of our findings, then, to maintain women with fibromyalgia engaging in productive work may be strived for not only because of societal or economic reasons but also for better health. However, we should keep in mind that people with fibromyalgia have a chronic condition, and therefore, adaptations at the workplace are imperative.Key Points• Women with fibromyalgia, who spend more time in reproductive labour, have higher levels of light physical activity and lower sedentary behaviour; however, it is associated with poorer general health (as lower physical fitness or cognitive performance).• Household tasks are often seen as a responsibility associated with the gender roles that women with fibromyalgia perform, despite the feelings of incapacity they cause. Policies focused on reducing reproductive labour demands for fibromyalgia patients (i.e. social help on housework or childcare) might facilitate the inclusion of daily active behaviours.• People with fibromyalgia who engage in productive work seem to have better health outcomes than those who have not; however, we cannot forget that adaptations and flexibility at the workplace are imperative.

Background Physical fitness is a marker of health and is associated with health-related quality of life (HRQoL). Identifying which components of physical fitness are associated with HRQoL in people with fibromyalgia may contribute to the development of more specific therapeutic strategies. Objective The 2 aims of this study were to examine the association of different components of physical fitness (ie, flexibility, muscle strength, speed and agility, and cardiorespiratory fitness) with HRQoL and to determine the extent to which any association between the components of physical fitness and HRQoL were of clinical relevance to women with fibromyalgia. Design A cross-sectional design was used. Methods This study included 466 women with fibromyalgia from southern Spain (Andalusia). The Senior Fitness Test battery and the handgrip test were used to assess physical fitness, and the 36-Item Short-Form Health Survey (SF-36) was used to assess HRQoL. Tender points, cognitive impairment, anthropometric measurements, and medication usage were also measured. First, multivariate linear regression was used to assess the individual relationship of each physical fitness test with the 8 dimensions of the SF-36. Second, a standardized composite score was computed for each component of physical fitness (flexibility, muscle strength, speed and agility, and cardiorespiratory fitness). A 1-way analysis of covariance to assess the differences in each of the 8 dimensions of the SF-36 across each physical fitness composite score was conducted. Forward stepwise regression was performed to analyze which components of physical fitness were independently associated with the SF-36 physical and mental component scales. Results Overall, higher levels of physical fitness were associated with higher levels of HRQoL (regardless of the SF-36 subscale evaluated). The effect sizes for HRQoL between participants with the lowest and the highest physical fitness levels ranged from moderate to large (Cohen d = 0.53–0.90). The muscle strength composite score was independently associated with the SF-36 physical component scale, whereas the flexibility composite score and cardiorespiratory fitness were independently associated with the SF-36 mental component scale. Limitations A limitation was that the cross-sectional design precluded the establishment of causality. Additionally, only women were included in the study, because fibromyalgia predominantly affects women. Conclusions High levels of physical fitness were consistently associated with better HRQoL in women with fibromyalgia; clinically relevant differences were demonstrated between those at extreme physical fitness levels. Muscle strength, flexibility, and cardiorespiratory fitness were independent indicators of HRQoL. These results warrant further prospective research on the potential of fitness to predict HRQoL in this population.

Rationale: Exercise programs for the management of fibromyalgia are well recognized as being effective. However, the incomplete descriptions of exercise programs make replication and implementation difficult. Also, existing reporting tools have not been validated in relation to pain relief as well as with each other. Objectives: This study aimed to evaluate the description of exercise programs in randomized control trials for the management of fibromyalgia using different assessment tools, and the correlations of each tool in relation to effectiveness of pain relief of fibromyalgia, and the correlations between each tool. Method/Results: Through a consensus made by two different pairs of reviewers and an arbitrator, the mean total scores for the exercise programs were reported: 10.61/19 for Consensus on Exercise Reporting Template; 4.17/12 for Template for Intervention Description and Replication; 7.05/12 for the Consensus on Therapeutic Exercise Training; and 2.50/4 (aerobic) and 2.36/5 (flexibility and resistance) for the 2016 American College of Sports Medicine guidelines. This demonstrates generally low reporting scores (less than 60% out of the total number of items were reported). Overall, low correlations (Cohen’s kappa value, ranging from −0.47 (poor) to 0.313 (fair)) were found between all tools and pain relief. Good to excellent correlations (0.680–0.908) among the reporting tools were shown. Conclusion: Incomplete descriptions of exercise programs were consistently shown among the randomized clinical trials assessed in this study. The overall weak correlations demonstrated that the reporting tools have the limited ability to determine whether exercise programs were or were not effective for pain relief among individuals with fibromyalgia.

Background:Optimizing the highly deteriorated quality of life (QoL) of patients with fibromyalgia is one of the main goals in the management of the disease1. Physical fitness has been identified as a powerful marker of health that is positively related to QoL in this population2, although previous evidence is mainly based on cross-sectional data.Objectives:This study aimed to examine the longitudinal associations (2- and 5-year follow-up) between physical fitness and QoL in women with fibromyalgia.Methods:In this prospective cohort study, women diagnosed with fibromyalgia (age: 51.3±7.6 years) with completed data were included at baseline (n=441), at 2-year follow-up (n=220) and at 5-year follow-up (n=227). The Senior Fitness Tests battery was used to assess physical fitness components and a standardized global fitness index was calculated. The eight dimensions plus the two physical and mental component summaries of the Short-Form health survey-36 questionnaire were used to assess QoL. To examine whether changes in fitness predicted QoL at follow-up, multiple linear regression models were built. The bidirectionallity of the associations (whether changes in QoL predicted fitness at follow-up) was also tested. Outcome values at baseline and age, fat percentage, analgesic consumption, educational level, and occupational status at follow-up were entered as potential confounders in all analyses.Results:Changes in fitness were associated with physical function (β=0.160), physical role (β=0.275), bodily pain (β=0.271), general health (β=0.144), and physical component summary (β=0.276) at 2-year follow-up (all,PPPPConclusion:Increasing levels of physical fitness over time predicts future QoL in women with fibromyalgia, especially for physical domains at 2-year follow-up. In addition, increasing QoL across all domains over time predicts future global fitness at 2- and, specially, 5-year follow-up. Future research is warranted to determine the clinical relevance of the bidirectional association between physical fitness and QoL in fibromyalgia.References:[1]Macfarlane GJ, et al. Ann Rheum Dis, 2018; 76(2), 318-328.[2]Álvarez-Gallardo IC, et al. 2019;99:1481–1494.Acknowledgments:This study was supported by the Spanish Ministry of Economy and Competitiveness (I+D+i DEP2010-15639; I+D+I DEP2013-40908-R; BES-2014-067612) and the Spanish Ministry of Education (FPU14/FPU 15/00002)Disclosure of Interests: :None declared

Background:Previous evidence has shown physical function (PF) improvements after physical exercise programs in fibromyalgia1. However, research comparing the efficacy of land vs. water-based programs is scarce.Objectives:This study aimed at comparing the effects of two exercise interventions (land- and water-based) on PF in patients with fibromyalgia.Methods:A total of 262 women were initially randomized and 152 (age:50.6 ±7.7 years) completed all the assessments with an attendance ≥70% (control n=62, land-based n=48, water-based n=42). The intervention groups trained three non-consecutive days/week (60 min/session) during 24 weeks. Every session consisted of exercises focused on improving cardiorespiratory fitness, muscle strength, and flexibility. Physical function components were assessed with the Functional Senior Fitness Test battery, and a standardized global PF index was calculated. Pre-, post- and re-test (12-week detraining) assessments were conducted. Groups did not differ in sex, sociodemographic characteristics, disease duration, drugs intake, and body mass index. Analysis of covariance was used to test the differences in changes from baseline (post-test vs. pre-test and re-test vs. pre-test) between groups using age, pain sensitivity, and baseline outcomes values as covariates.Results:Land- and water-based exercise groups improved lower body strength (mean difference; 95% confidence interval=2.8; 1.8, 3.8 and 1.7; 0.6, 2.8, respectively), upper body strength (4.8; 2.8, 6.8 and 3.5; 1.4, 5.6, respectively), and agility (-0.8; -1.2, -0.4 and -0.4; -0.8, -0.0, respectively) compared to the control group (all, P≤0.033). Additionally, land-based exercise group improved lower body flexibility and cardiorespiratory fitness compared to both the control (6.4; 2.8, 9.9 and 55.0; 31.0, 79.2, respectively) and water-based (5.4; 1.7, 9.2 and 37.5; 11.4, 63.6, respectively) groups (all, P≤0.002). Global PF improved in the land-based compared to the control group (0.4; 0.2, 0.5, PConclusion:Land- and water-based exercise interventions are overall effective to improve PF in patients with fibromyalgia. However, the land-based exercise intervention presented greater effectiveness compared to the water-based exercise intervention. Improvements were overall sustained in the land-based group after a 12-week detraining period.References:[1]Macfarlane, G.J.; Kronisch, C.; Dean, L.E.; Atzeni, F.; Häuser, W.; Fluß, E.; Choy, E.; Kosek, E.; Amris, K.; Branco, J.; et al. EULAR revised recommendations for the management of fibromyalgia. Ann. Rheum. Dis. 2017, 76, 318–328.Acknowledgments:This study was supported by the Spanish Ministry of Economy and Competitiveness (I+D+i DEP2010-15639; I+D+I DEP2013-40908-R) and the Spanish Ministry of Education, Culture and Sport (FPU15/00002).Disclosure of Interests: :None declared

Background: Sedentary time (ST) has been associated with detrimental health outcomes in fibromyalgia. Previous evidence in the general population has shown that not only is the total amount of ST harmful but the pattern of accumulation of sedentary behaviors is also relevant to health, with prolonged unbroken periods (ie, bouts) being particularly harmful. Results: A greater percentage of ST spent in all bout lengths was associated with worsened physical function, bodily pain, vitality, social function, and physical component summary (PCS) (all P, This study was supported by the Spanish Ministries of Economy and Competitiveness (I+D+i DEP2010-15639; I+D+i DEP2013-40908-R, BES-2014-067612) and the Spanish Ministry of Education (FPU 15/00002). This study was also partially funded by the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES), by the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades and European Regional Development Fund (ERDF), ref SOMM17/6107/UGR, and by the University of Cádiz (Research and Transfer Activity Promotion Program).

Background Family aggregation suggests genetic susceptibility to fibromyalgia.1 Candidate-gene studies on fibromyalgia susceptibility often include a small number of SNPs,2,3 which is a limitation.4 Additionally, there is a paucity of evidence in Europe. Objectives To compare genotype frequencies of candidate single nucleotide polymorphisms (SNPs) in a well-characterised sample of Spanish women with fibromyalgia and healthy non-fibromyalgia women. Methods Three hundred and fourteen women with a diagnosis of fibromyalgia (cases) and 112 non-fibromyalgia healthy (controls) women participated in the present candidate-gene study. Buccal swabs were collected for DNA extraction. Using TaqMan OpenArray, we analysed 63 single nucleotide polymorphisms (SNPs) of 33 genes related to fibromyalgia susceptibility, symptoms, or potential mechanisms. Results The rs841 and rs1799971 GG genotype was more frequently observed in fibromyalgia than in controls (p=0.04 and p=0.02, respectively). The rs2097903 AT/TT genotypes were also more often present in the fibromyalgia participants than in their control peers (p=0.04). Conclusions We identified, for the first time, associations of the rs841 (guanosine triphosphate cyclohydrolase 1 gene) and rs2097903 (catechol-O-methyltransferase gene) SNPs with higher risk of fibromyalgia susceptibility. We also confirmed that the rs1799971 SNP (opioid receptor μ1 gene) might confer genetic risk of fibromyalgia. Further studies are needed to confirm or refute the present findings. References [1] Arnold LM, et al. Arthritis Rheum2004;50(3):944–52. [2] Lee YH, et al. Rheumatol Int2012;32(2):417–26. [3] Estevez-Lopez F, et al. Rheumatol Int (in press). doi:10.1007/s00296-017-3896-x [4] Klepstad P. Scand J Pain2014;5:8–9. Acknowledgements The authors report no conflicts of interest. This work was supported by the Spanish Ministry of Economy and Competitiveness [I+D+ i DEP2010–15639, I+D+ i DEP2013–40908 R, BES-2014–0 67 612]; the Spanish Ministry of Education [FPU2014/02518] Disclosure of Interest None declared

Background There is an awareness of detrimental health effects of sedentary time (ST) in fibromyalgia. 1 2 However, data are limited on how replacing ST with physical activities of different intensities may be related to the typically reduced quality of life of these patients. Increasing time in one behaviour requires decreasing time in another but classic regression models are not able to directly target these substitutions. Hence, the isotemporal substitution paradigm (a novel model to study the estimated effects of one activity for another 3 ), might allow us to better understand the relationship between ST, physical activity and perceived health status in fibromyalgia. Objectives To investigate the association of replacing ST with light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) with quality of life and disease impact in women with fibromyalgia. Methods In total, 407 women with fibromyalgia (51.4±7.6 years old) were included in this cross-sectional study. The time spent in ST and PA intensity levels was objectively measured with triaxial accelerometry. Quality of life and disease impact were assessed using the 36-item Short-Form Health Survey (SF-36) and the Revised Fibromyalgia Impact Questionnaire (FIQR), respectively. An isotemporal substitution approach was used to estimate the associations between the substitution of 30 min of ST with an equivalent time of LPA or MVPA and the outcomes. Analyses were controlled for age, current occupational status, fat percentage, and antidepressant consumption. Results Substituting 30 min of ST with LPA in the isotemporal model was associated with better bodily pain ( B =0.55), vitality ( B =0.74) and social functioning ( B =1.45) of SF-36 and better scores at all of the domains of FIQR (function, overall impact, symptoms severity, and total impact) ( B ranging from −0.95 to −0.27), all p B =2.30) and social functioning ( B =4.11) of the SF-36 and function of FIQR ( B =-0.73) were observed (all p Conclusions Allocating time of sedentary behaviour to either LPA or MVPA was generally associated with better quality of life and lower disease impact in women with fibromyalgia. The isotemporal models suggest that LPA may be beneficial for a larger number of domains, while MVPA may establish greater changes in the outcomes. These results reinforce the importance of moving towards less sedentary lifestyle in fibromyalgia, although these findings should be investigated in longitudinal, experimental research. References [1] Ellingson LD, et al. J Pain2012Feb;13(2):195–206. [2] Segura-Jimenez V, et al. Scand J Med Sci 2017Jan;27(1):83–92. [3] Mekary RA, et al. Am J Epidemiol2009May;170(4):519–27. Acknowledgements This study was supported by the Spanish Ministries of Economy and Competitiviness (I+D+ i DEP2010–15639; I+D+I DEP2013–40908 R, BES-2011–047133; BES-2014–067612) and the Spanish Ministry of Education (FPU14/02518; FPU15/00002) Disclosure of Interest None declared

Purpose: People with fibromyalgia experience a disagreement between patient-reported (i.e., subjective) and performance-based (i.e., objective) status. This study aimed to (i) corroborate the discordance between subjectively and objectively measured physical function and (ii) examine whether catastrophizing (worrying, pain magnifying, and helpless cognitions) and self-efficacy (believing capable to manage pain) are independently associated with this discordance. Methods: This population-based cross-sectional study included 405 women with fibromyalgia and 193 age-matched female controls. Participants completed the Pain Catastrophizing Scale, Chronic Pain Self-efficacy Scale, and physical functioning subscales of the Revised Fibromyalgia Impact Questionnaire and Short Form-36 (SF-36) health survey. Objective physical function was measured with the Senior Fitness Test battery. Subjective and objective physical functions were expressed as deviation from the general population in standard deviation (SD) units using means and SD of the control group. Results: In fibromyalgia, subjective physical function was worse than objective physical function (p < 0.001). Higher catastrophizing was consistently associated with greater discordance between subjective and objective physical function, while self-efficacy was only significantly associated with this discordance when subjective physical function was assessed by means of the SF-36. Conclusions: Subjective physical function is more impaired than objective physical function in fibromyalgia, yet both are markedly impaired. Catastrophizing cognitions are associated with this discordance. In particular, high catastrophizing may promote a feeling of reduced ability to do meaningful activities of daily living (i.e., restrictions) that people with fibromyalgia are actually able to. Therefore, catastrophizing should be assessed and potentially targeted when focusing on improving physical function in fibromyalgia.Implications for rehabilitation Rehabilitation should focus on physical exercise programs to help women with fibromyalgia to improve their reduced physical function. In rehabilitation settings, physical function of people with fibromyalgia should be evaluated by both subjective and objective assessments to fully understand physical functioning and to test the existence of discordance between both assessments. In case of a large discordance between subjective and objective physical function, a physical exercise program might be better complemented with cognitive management techniques to reduce catastrophizing and subjective physical dysfunction. When people with fibromyalgia experience high levels of catastrophizing, subjective assessments seem to be poor indicators of physical function.

OBJECTIVE: To characterize the levels of objectively measured time spent in sedentary activities (sedentary time) and physical activities in female patients with fibromyalgia and compare them with the levels in age-matched healthy control women. METHODS: The study comprised 413 female patients with fibromyalgia (mean ± SD age 51.9 ± 7.4 years) and 188 female control subjects (age 50.9 ± 7.5 years). Sedentary time, the amount of time spent engaged in physical activity, and step counts were measured using triaxial accelerometry. The amounts of time (minutes/day) during which the participants were engaged in sedentary behaviors as well as in physical activity of different intensities (light, moderate, and moderate-to-vigorous) and the step counts were calculated. RESULTS: The amount of time spent in sedentary behavior was longer in patients with fibromyalgia compared with controls (estimated mean ± SEM difference 39 ± 8 minutes/day; P < 0.001). The patients with fibromyalgia spent less time than controls engaged in light physical activity (mean ± SEM difference -21 ± 7 minutes/day; P = 0.005), moderate physical activity (mean ± SEM difference -17 ± 3 minutes/day; P

OBJECTIVE: This population-based cross-sectional study aimed to characterize the association of different components of physical fitness with pain levels, pain-related catastrophizing, and chronic pain self-efficacy in women with fibromyalgia (FM). METHODS: A total of 468 women with FM participated. The experience of pain was assessed with different tools (algometry, a numeric rating scale [revised FM impact questionnaire], a visual analog scale, and the bodily pain subscale on the Short Form 36 health survey). We also assessed pain-related catastrophizing and chronic pain self-efficacy. Physical fitness was assessed with performance-based tests (Senior Fitness Test battery and handgrip dynamometry). A standardized composite score was computed for each component of physical fitness (aerobic fitness, muscle strength, flexibility, and motor agility), and their average comprised a clustered global fitness profile. RESULTS: Overall, higher physical fitness was consistently associated with lower levels of pain, lower pain-related catastrophizing, and higher chronic pain self-efficacy (regardless of the pain assessment method and the fitness test evaluated). Muscle strength and flexibility were independently associated with pain (P < 0.005 for both), and participants with high muscle strength plus high flexibility (combined effect) had the lowest levels of pain in this population. Aerobic fitness and flexibility were independently associated with pain-related catastrophizing (P < 0.001 for both) and chronic pain self-efficacy (P < 0.001 for both), and participants with high flexibility plus high aerobic fitness (combined effect) had the best catastrophizing and self-efficacy profiles. CONCLUSION: Our results suggest that higher physical fitness is associated with lower levels of pain, lower pain-related catastrophizing, and higher chronic pain self-efficacy in women with FM. These results might have implications for future intervention studies in this population.

This study aimed to determine the ability of a set of physical fitness tests to discriminate presence or absence of fibromyalgia in women.The sample comprised 487 women with fibromyalgia (52.1 ± 8 yr) and 250 control women (49.3 ± 9 yr). We assessed physical fitness using the arm curl, 30-s chair stand, handgrip strength, 8-ft up and go, 6-min walk, chair sit and reach, and the back scratch tests. The revised fibromyalgia impact questionnaire was used to assess fibromyalgia severity and symptomatology.Patients with fibromyalgia performed worse than control women in all the fitness tests studied (all, P0.001). The receiver operating characteristic analysis showed that all the fitness tests were able to discriminate between presence and absence of fibromyalgia (all, P0.001). The area under the curve ranged from 0.708 to 0.910 (all, P0.001). Among the fitness tests studied, the arm curl test, followed by the 30-s chair-stand and handgrip strength tests, showed the highest capacity discriminating between the presence and absence of fibromyalgia. An arm curl test score of20 repetitions was associated with increased odds of having fibromyalgia (odds ratio (OR), 35.6; 95% confidence interval, 12.6-101) in women age 35-44 yr. An arm curl test score of16 repetitions was associated with increased odds of having fibromyalgia (OR, 23.7; 95% confidence interval, 10.3-54.0) in women age 35-44 yr. In the group of women age 55-65 yr, the highest OR was observed for the handgrip strength test and the odds of having fibromyalgia was 17 times greater than that in patients who performed less than 19 kg.The arm curl, 30-s chair stand, and handgrip strength tests powerfully discriminated women with fibromyalgia from healthy women. Identification of women who fail to meet the suggested standards can help to easily, quickly, and cheaply rule out the presence of the disease, especially in primary care settings.

PURPOSE: This study examined the associations of different levels of depression with pain, sleep quality, fatigue, functional exercise capacity, overall fibromyalgia (FM) severity, and health-related quality of life (HRQoL) in women with FM. METHODS: A total of 451 women with FM participated in this cross-sectional study. Depressive symptoms (Beck Depression Inventory; BDI-II), pain intensity (numerical rating scale; NRS), pain sensitivity (algometry), sleep quality (Pittsburgh Sleep Quality Index), fatigue (Multidimensional Fatigue Inventory), functional exercise capacity (6-min walk test), FM severity (revised Fibromyalgia Impact Questionnaire), and HRQoL (SF-36) were assessed. RESULTS: Participants with severe depressive symptoms had significantly higher pain intensity (NRS = 1.1; 95 % CI 0.3-1.8), fatigue (12.6-units; 95 % CI 8.2-17.1) and overall FM severity (12.6-units; 95 % CI 11.4-23.7), as well as poorer sleep quality (3.2-units; 95 % CI 1.7-4.7) and mental component of HRQoL (-17.0-units; 95 % CI -21.0 to -12.9) than participants with minimal signs of depression. There was no association of signs of depression with pain sensitivity, exercise capacity, or the physical component of HRQoL (P > 0.05). CONCLUSIONS: These results extend current knowledge on the association of signs of depression with FM severity and quality of life in women with FM, and suggest that severity of depressive symptoms could potentially be a prognostic factor to be considered in future prospective intervention studies.

The present study aimed (1) to assess the validity and reliability of the Borg category-ratio (CR-10) scale for monitoring exercise intensity in women with fibromyalgia (FM) and (2) to examine whether women with FM can discriminate between perceived exertion and exercise-induced pain. Thirty-three women with FM performed two incremental treadmill tests (1 week separated). Heart rate, oxygen uptake, minute ventilation and respiratory quotient were measured. The ratings of perceived exertion (RPE: CR-10 scale) and exercise-induced pain were obtained at each workload. The Spearman's correlation of RPE with the physiological responses ranged from 0.69 to 0.79. The regression models explained ~50% of the variability of the studied physiological responses. We found "perfect acceptable" agreement in 69% of the observations. Weighted Kappa was 0.66 (95% confidence interval [CI]: 0.59-0.72). There were differences between RPE and pain at workloads 3 (1.50; 95% CI: 0.85-2.16), 4 (2.10; 95% CI: 1.23-2.96), 5 (3.40; 95% CI: 1.29-5.51) and 6 (3.97; 95% CI: 1.61-6.33). The main findings of the present study suggest that the Borg CR-10 scale is valid and moderately reliable for monitoring exercise intensity in women with FM, and these patients were able to discriminate between exertion and exercise-induced pain.

The aim of the present study was to determine the reliability and feasibility of physical fitness tests in female fibromyalgia patients. 100 female fibromyalgia patients (aged 50.6±8.6 years) performed the following tests twice (7 days interval test–retest): chair sit and reach, back scratch, handgrip strength, arm curl, chair stand, 8 feet up and go, and 6-min walk. Significant differences between test and retest were found in the arm curl (mean difference: 1.25±2.16 repetitions, Cohen d =0.251), chair stand (0.99±1.7 repetitions, Cohen d =0.254) and 8 feet up and go (−0.38±1.09 s, Cohen d =0.111) tests. Intraclass correlation coefficients (ICC) range from 0.92 in the arm curl test to 0.96 in the back scratch test. The feasibility of the tests (patients able to complete the test) ranged from 89% in the arm curl test to 100% in the handgrip strength test. Therefore, the reliability and feasibility of the physical fitness tests examined is acceptable for female fibromyalgia patients.

Objective. The aim of this study was to validate the modified 2010 ACR preliminary criteria for FM in a Spanish population. Methods. Five hundred and seventy-nine (550 women) FM and 294 (240 women) control participants were enrolled in the study. FM patients were previously diagnosed by a rheumatologist. All participants underwent both the 1990 ACR criteria (1990c) and the modified 2010 ACR criteria (m-2010c). Results. The tender points count showed correlations of 0.69, 0.65 and 0.71 with the widespread pain index (WPI), symptoms severity (SS) and polysymptomatic distress (PSD) scales, respectively (all P < 0.001). The WPI, SS and PSD showed greater correlations with impact of FM health-related quality of life, general fatigue and depression than the tender points count. The 1990c showed sensitivity and specificity values of 84.1 and 97.6, respectively, whereas the m-2010c showed values of 88.3 and 91.8, respectively. Both criteria showed the same overall accuracy, with a value of 0.89. When the 1990c and m-2010c were combined and patients had to satisfy one of two criteria to be diagnosed with FM, the sensitivity, specificity and accuracy of questionnaires were 96.7, 89.8 and 0.94, respectively. The original cut-off points (WPI5 7, SS5 5 and PSD5 12) showed the best test characteristics in the present study. Conclusion. The m-2010c, with the same cut-off points as the original version, are a valid tool for the diagnosis of FM in our population. Whenever possible, the combination of the 1990c and m-2010c is recommended (patients have to meet one of the two criteria to be diagnosed), since this approach showed the best diagnostic characteristics.

To analyse the cardiovascular disease risk profile of women with fibromyalgia and compare it with control women; and to test whether physical activity is associated with the cardiovascular disease risk profile in this population.This cross-sectional study comprised 436 women with fibromyalgia (51.4±7.5 years old) and 217 controls (48.4±9.6 years old) from Andalusia, Spain. Clinical data, waist circumference, body fat percentage, resting heart rate, blood pressure and cardiorespiratory fitness were assessed. Moderate-to-vigorous physical activity was objectively assessed with accelerometry. A clustering of individual cardiovascular disease risk factors was represented by the number of cigarettes/day, adiposity, mean arterial pressure, resting heart rate and cardiorespiratory fitness.Women with fibromyalgia presented higher waist circumference and body fat percentage, greater number of cigarettes/day consumption and lower levels of cardiorespiratory fitness after controlling for age, marital status, educational level, occupational status, medication for cholesterol and monthly regular menstruation (all, p.05). Women with fibromyalgia showed higher clustered cardiovascular disease risk than control women after controlling for the potential confounders described above (p.001). Women with fibromyalgia who did not meet moderate-to-vigorous physical activity recommendations showed increased clustered cardiovascular disease risk after adjusting for the potential confounders described above (p.001).Women with fibromyalgia may present higher risk of cardiovascular disease than controls. Inadequate levels of moderate-to-vigorous physical activity may play a significant role as an additional predisposing factor for cardiovascular disease risk in this population.

Objectives To examine the associations of non-bouted moderate-to-vigorous physical activity (MVPA) and patterns of MVPA in bouts ≥10 minutes with pain, physical fatigue, and disease severity in women with fibromyalgia, and test whether these associations are independent of sedentary time (ST) and physical fitness (PF). Design Cross-sectional study carried out from November 2011 to January 2013. Setting University facilities and fibromyalgia associations. Participants Women with fibromyalgia (N=439; 51.3±7.6y). Interventions Not applicable. Main Outcome Measures ST and MVPA were measured with triaxial accelerometry, and PF with the Senior Fitness test battery. We assessed pain, physical fatigue and disease severity with diverse questionnaires. Results Total time in non-bouted MVPA only was independently associated with lower physical fatigue (B=-0.012; P=.010) and disease severity (B=-0.068; P=.007) in women with fibromyalgia, regardless of PF but not of ST. Patterns of bouted MVPA were overall associated with symptoms independently of ST or PF. The strongest regressor was the maximum time in MVPA bout (min/bout), which was consistently and independently associated with pain, physical fatigue and disease severity after controlling for ST or PF (all, P≤.002). Patients meeting bouted physical activity guidelines displayed lower disease severity than those not meeting guidelines (bouted or non-bouted) and those meeting non-bouted physical activity guidelines (all, P≤.008). Conclusions Patterns of MVPA performed in bouts ≥10 minutes were overall consistently and independently associated with core symptoms (pain and fatigue) in fibromyalgia and the overall disease severity, regardless of ST or PF. The results suggest that longer bouts of continuous MVPA are associated with better symptoms profile in this population, which needs to be corroborated in longitudinal research.

OBJECTIVES: The aim of this study was to identify subgroups in terms of adaptation to FM and to test differences in FM severity between these subgroups. METHODS: The al-Ándalus project made it possible to perform a comprehensive population-based cross-sectional study in 486 FM patients including multiple assessments of modifiable (could be targeted in therapy) resilience and vulnerability factors, measured by objective and subjective assessments, related to psychological and physical function. FM severity was assessed by means of FM impact (total score of the Revised Fibromyalgia Impact Questionnaire) and distress (Polysymptomatic Distress Scale of the modified 2011 preliminary criteria for FM). Exploratory factor analysis, cluster analysis and analysis of variance were conducted. RESULTS: Factor analysis yielded eight factors: three included objective measures (declarative memory, active lifestyle and objective physical fitness) and five included subjective measures (fatigue, psychological distress, catastrophizing, resilience and subjective physical fitness). Cluster analysis based on these eight factors identified five profiles: Adapted (16%), Fit (18%), Poor performer (20%), Positive (20%) and Maladapted (26%). Most profile comparisons revealed different levels of FM severity varying from Adapted (the most favourable profile) to Maladapted (the most unfavourable profile) with Fit, Poor performer and Positive obtaining intermediate positions. CONCLUSIONS: Heterogeneity of FM was shown by five clinically meaningful profiles of modifiable factors that were associated with FM severity. It is of clinical interest to examine whether these profiles are associated with FM prognosis and the effectiveness of interventions, which would enhance the development of customized interventions based on adaptation profiles in FM. KEYWORDS: accelerometry; chronic pain; cognitive performance; coping; epidemiology; functional capacity; patient subgroups; quality of life; resilience (psychological); vulnerability (psychological)

Objective . The aim of this study was to examine the association between physical fitness and depressive symptoms in women with fibromyalgia (FM). We also assessed whether different fitness components present independent relationships with depressive symptoms. Design . Cross-sectional study. Setting . University facilities and FM associations. Subjects . Four hundred and forty-four patients with FM according to the 1990 American College of Rheumatology criteria. Methods . Depressive symptoms were assessed using the Beck Depression Inventory (BDI-II). Physical fitness (aerobic fitness, muscle strength, flexibility, and motor agility) was assessed using the standardized Senior Fitness Test battery and the handgrip strength test. A standardized composite score for fitness was computed and divided into quintiles. Results . Overall, the fitness tests presented inverse associations with the total BDI-II score ( P

We aimed (1) to report age-specific physical fitness levels in people with fibromyalgia of a representative sample from Andalusia; and (2) to compare the fitness levels of people with fibromyalgia with non-fibromyalgia controls. This cross-sectional study included 468 (21 men) patients with fibromyalgia and 360 (55 men) controls. The fibromyalgia sample was geographically representative from southern Spain. Physical fitness was assessed with the Senior Fitness Test battery plus the handgrip test. We applied the Generalized Additive Model for Location, Scale and Shape to calculate percentile curves for women and fitted mean curves using a linear regression for men. Our results show that people with fibromyalgia reached worse performance in all fitness tests than controls (P

This study assessed the association of fitness and fatness with cognitive function in women with fibromyalgia, and the independent influence of their single components on cognitive tasks. A total of 468 women with fibromyalgia were included. Speed of information processing and working memory (Paced Auditory Serial Addition Task), as well as immediate and delayed recall, verbal learning and delayed recognition (Rey Auditory Verbal Learning Test) were assessed. Aerobic fitness, muscle strength, flexibility and motor agility were assessed with the Senior Fitness Test battery. Body mass index, percent body fat, fat-mass index and waist circumference were measured. Aerobic fitness was associated with attention and working memory (all, p 0.05). All fitness components were generally associated with delayed recall, verbal learning and delayed recognition (all, p 0.05). Aerobic fitness showed the most powerful association with attention, working memory, delayed recall and verbal learning, while motor agility was the most powerful indicator of delayed recognition. None of the fatness parameters were associated with any of the outcomes (all, p 0.05). Our results suggest that fitness, but not fatness, is associated with cognitive function in women with fibromyalgia. Aerobic fitness appears to be the most powerful fitness component regarding the cognitive tasks evaluated.

Objective To create guidelines focused on the use of structured physical activity (PA) in the management of juvenile idiopathic arthritis (JIA). Data Sources A systematic literature search was conducted using the electronic databases Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), EMBASE (Ovid), and Physiotherapy Evidence Database for all studies related to PA programs for JIA from January 1966 until December 2014, and was updated in May 2015. Study Selection Study selection was completed independently by 2 reviewers. Studies were included if they involved individuals aged ≤21 years diagnosed with JIA who were taking part in therapeutic exercise or other PA interventions for which effects of various disease-related outcomes were compared with a control group (eg, no PA program or activity of lower intensity). Data Extraction Two reviewers independently extracted information on interventions, comparators, outcomes, time period, and study design. The statistical analysis was reported using the Cochrane Collaboration methods. The quality of the included studies was assessed according to the Physiotherapy Evidence Database Scale. Data Synthesis Five randomized controlled trials (RCTs) fit the selection criteria; of these, 4 were high-quality RCTs. The following recommendations were developed: (1) Pilates for improving quality of life, pain, functional ability, and range of motion (ROM) (grade A); (2) home exercise program for improving quality of life and functional ability (grade A); (3) aquatic aerobic fitness for decreasing the number of active joints (grade A); and (4) and cardio-karate aerobic exercise for improving ROM and number of active joints (grade C+). Conclusions The Ottawa Panel recommends the following structured exercises and physical activities for the management of JIA: Pilates, cardio-karate, home and aquatic exercises. Pilates showed improvement in a higher number of outcomes.

Objective. To test the gender differences in tenderness, impact of fibromyalgia, health-related quality of life, fatigue, sleep quality, mental health, cognitive performance, pain-cognition, and positive health in Spanish fibromyalgia patients and in age-matched nonfibromyalgia individuals from the same region. To test the optimal cut-off score of the different tender points for women and men.Methods. A total of 405 (384 women) fibromyalgia versus 247 (195 women) nonfibromyalgia control participants from southern Spain (Andalusia) took part in this cross-sectional study. The outcomes studied were assessed by means of several tests.Results. In the fibromyalgia group, men showed better working memory than women (all,P<0.01), whereas sleep latency was lower in women compared to men (P=0.013). In the nonfibromyalgia group, men showed higher pain threshold in all the tender points (all,P<0.01), except in right and left lateral epicondyle. Furthermore, men showed better working memory than women (all,P<0.01), whereas memory performance was better in women compared to men (all,P≤0.01).Conclusion. The results of the present study do not support consistent evidence of gender differences in fibromyalgia-related symptoms. However, it seems that detriment of some symptoms (especially pain) in fibromyalgia men compared with their nonfibromyalgia counterparts is greater than those of fibromyalgia women compared with their nonfibromyalgia peers.