Evaluación de los efectos de un programa de actividad física basado en el trabajo de fuerza en mujeres diagnosticadas de fibromialgia (fm)

Resumen

Introduction. Fibromyalgia (FM) is a disease characterized by a complex symptomatology with the presence of generalized chronic musculoskeletal pain the prevailing disabling symptoms. This pathology generates high expenses not only for patients but also for the health care system. The consequences of FM are exacerbated by sedentary lifestyle that leads to a decrease in physical fitness and as a results most of the patients affected by this condition have difficulties in carrying out the activities of daily living which triggers physical inactivity and increased risk of disability. The current treatment for FM is palliative, as there is no healing. Among the strategies to reduce physical and psychological symptoms and thus to improve quality of life is physical activity. Most studies show the effects of physical exercise through aerobic and aquatic training programs on this pathology. Despite this research, few studies assessed the effects of strength training and the adequate combination of intensity, volume and duration aimed at improving daily activities and relieving pain, sleep disorders, fatigue, and anxiety. Objective: In this context, the main aim of this doctoral thesis was to assess the effects of a gradual muscle strengthening program focused on daily activities in order to improve the symptomatology, physical functionality and impact of FM to achieve a better quality of life. Methods: A quasi-experimental study was developed. The sampling was intentional and it was carried out in the fibromyalgia association of the Community of Madrid (AFIBROM). A total of 41 participants met the inclusion criteria. All of them, were enrolled in the aforementioned muscle-based intervention program aimed at improving daily activities. This muscle-strengthening program started with self-loads exercise and it was gradually progressing to strength work by using elastic bands and ending with free weights. A graduate student in Sports Science developed training sessions. The frequency of sessions was two days a week (not consecutive) with a total of 60 minutes/session. Adherence to the program was 90%. The intervention lasted 24 weeks and participants were evaluated in three occasions: one week prior (pre), in the middle (week 12) and one week after finishing the intervention program (week 25). The variables analysed were: pain intensity and pain interference using the Brief Pain Questionnaire (BPQ), FM impact, physical function and symptomatology using the Revised Fibromyalgia Impact Questionnaire (FIQR) and anxiety with the Anxiety Questionnaire Inventory (STAI). The internal load of the sessions was controlled and standardized by the use of OMNI-GSE visual scale specific for adult population in strength training. Results: Significant differences and high clinical effects were obtained in all strength tests (p<0.002) and quality of life dimensions (physical function; p<0.002, overall impact; p<0.002, and symptomatology, p<0.003) at week 12 and 25 (intervention ended) (study I). The training program improved physical fitness (p<0.001) in both age groups (less than or equal to 55 and greater than or equal to 56 years). In addition, the first group significantly improved pain dimensions (pain intensity; p<0.020 and pain interference p<0.03). In contrast, the second group, not only improved pain dimensions (pain intensity; p<0.002 and pain interference p<0.001), but also achieved significant differences in in domains that value quality of life, that is, symptomatology, physical function and overall impact, all p<0.001. Moreover, aerobic fitness (assessed with the 2-minute step test) only reached significant inverse association with pain intensity (p=0.04), pain interference (p=0.02) and FM impact (p=0.02) in younger women (study II). Regarding the specific symptoms of FM, at the end of 24 weeks intervention, participants reached significant differences in sleep quality (p<0.05), a fact that did not occur for anxiety and fatigue, both p>0.05 (study III). Conclusions: i) The gradual muscle-strengthening program was effective in improving physical function, symptomatology and FM impact at 12 and 24 weeks in women diagnosed with FM (study I); ii): This program produced improvements in physical fitness (both at the level of muscle strength and at the aerobic level) and pain regardless of age group. However, quality of life (physical function, impact and symptoms) only improved only in the group of women over 56 years of age. Moreover, improvements in aerobic fitness are only associated with increased quality of life (physical function, impact and symptoms) and pain in the group of women under the age of 55. (study II); iii) In addition, this program was effective in improving physical fitness (upper and lower limb strength, lower limb flexibility, and aerobic fitness), pain, and sleep quality. Despite improvement levels of anxiety and fatigue at 12 weeks and at the end of the muscle strengthening program (week 25). This was not effective in achieving significant differences in either phase (study III).