INTRODUÇÃO: A fibromialgia (FM) foi definida pelo American College of Rheumatology (ACR) em 1990 como a presença de dor crônica e difusa de origem musculoesquelética nos quatro quadrantes e esqueleto axial associada à presença de pelo menos 11 de 18 tender points. Em 2010 uma revisão dos critérios diagnósticos apontou para outros sintomas, como o sono não reparador, dor de cabeça e depressão. A prevalência dos distúrbios do assoalho pélvico é alta e causa impacto negativo na qualidade de vida das mulheres, entretanto existem poucos estudos com esse enfoque em fibromiálgicas. OBJETIVO: Avaliar a força do assoalho pélvico, perda urinária e desempenho sexual em mulheres com fibromialgia e verificar se existe associação entre a FM e a incontinência urinária (IU). MÉTODO: Foram avaliadas 128 mulheres com idade entre 19 e 65 anos distribuídas em dois grupos, sendo um com diagnóstico médico de fibromialgia (GFM) e outro sem fibromialgia (GS). A avaliação foi realizada em um único encontro e com o mesmo avaliador, na qual foram obtidos dados pessoais e ginecológicos, características da incontinência urinária, avaliação do assoalho pélvico segundo o Esquema PERFECT e perineometria, aplicação do King Health Questionnaire (KHQ) para mulheres incontinentes e do questionário Quociente Sexual - Versão Feminina (QS-F). RESULTADOS: As mulheres GFM apresentaram menor grau de força muscular no esquema PERFECT (p < 0,001) e na perineometria (p=0,04). A IU foi frequente nas fibromiálgicas (p < 0,001). As mulheres do GFM tiveram pior desempenho no KHQ nos domínios Saúde Geral (p < 0,001) e sono/ energia (p < 0,003) e quanto ao escore total do QS-F (p<0,001). CONCLUSÃO: A incontinência urinária é frequente nas mulheres com fibromialgia, e está relacionada com o grau de força dos músculos do assoalho pélvico, afetando negativamente sua qualidade de vida, principalmente no que diz respeito a saúde geral e sono/ energia, afetando ainda seu desempenho sexual. / INTRODUCTION: In 1990, fibromyalgia (FM) was defined by the American College of Rheumatology as chronic and widespread pain of musculoskeletal origin in the four quadrants and axial skeleton associated with the presence of 11 of the 18 tender points. The fibromyalgia studies were focused on pain, but a 2010 review of the diagnostic criteria pointed to other symptoms such as non-repairing sleep, headache and depression. The prevalence of pelvic floor disorders is high and has a negative impact on women\'s quality of life, however there are few studies with this focus on women with fibromyalgia. OBJECTIVE: To assess the strength of the pelvic floor, urinary loss and sexual performance in women with fibromyalgia and to verify if there is an association between FM and urinary incontinence (UI). METHOD: A total of 128 women aged 19 to 65 years old were distributed in two groups, one group of 62 that were diagnosed with fibromyalgia (GFM) and one group of 64 that were not (GS). Data were collected in a single meeting with the same evaluator and included personal data, clinical data, and information about urinary tract symptoms, pelvic floor assessment was according to the PERFECT Scheme and perineometry. The King\'s Health Questionnaire was given to women who reported urinary leakage and Sexual Quotient - Female Version questionnaire (QS-F) for sexually active women. RESULTS: GFM women presented lower muscle strength in the PERFECT scheme (p < 0.001) and in perineometry (p=0.04). UI was frequent in GFM (p < 0.001). GFM women had poorer KHQ performance in the General Health (p < 0.001) and Sleep/Energy domains (p < 0.003) and QS-F final score (p < 0.001). CONCLUSION: UI is frequent in women with fibromyalgia and is related to pelvic floor muscle strenght, negatively affecting their quality of life, especially regarding general health and sleep/ energy, also affecting their sexual performance

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-06-15T13:45:40Z No. of bitstreams: 1 Mariana Moreira da Silva.pdf: 2627073 bytes, checksum: 8b556a25b3da990d9fcef2fc095004ad (MD5) / Made available in DSpace on 2018-06-15T13:45:40Z (GMT). No. of bitstreams: 1 Mariana Moreira da Silva.pdf: 2627073 bytes, checksum: 8b556a25b3da990d9fcef2fc095004ad (MD5) Previous issue date: 2015-06-29 / Introduction: Fibromyalgia (FM) is a syndrome characterized by chronic widespread pain, with prevalence in women. An important issue is that many patients with FM also have the diagnosis of temporomandibular disorders (TMD) and the coexistence of these conditions generates a clinical result of high complexity. Exercise and phototherapy (low level laser therapy / LED) are two areas used for the treatment of chronic pain and may be promising in the rehabilitation of these comorbidities. In a protocol (1) the objective was to verify if the phototherapy and exercise program in a single application can increase or decrease the sensitivity of pain in patients with FM associated with TMD. Objective of the protocol two (2) was to evaluate the potential of physical exercise program and phototherapy on condition of chronic pain in women with FM associated with TMD. Methods / Study Design: Randomized clinical trial, double-blind and controlled. Protocol 1 was conducted involving 80 women aged ≥ 35 years old with a diagnosis of FM TMD. Patients were randomly allocated to one of four groups: CON (have not undergone any operation); PHO group (intervention with phototherapy); EXT group (intervention with exercise); PHO + EXT group (more intervention exercise phototherapy). One session of the treatments and the revaluation was carried out was after thirty (30) minutes of application, with analysis of algometry. In Protocol 2 used the same methodology to protocol 1, but the revaluation was after ten (10) weeks of treatment, with addition of other evaluative tools algometry. Statistical analysis was performed using Student's t-test, one-tailed and paired and was held Gaussian distribution: Shapiro-Wilk and Kruskal Wallis test (Dunnes post-test), and even the use of the Wilcoxon test and the significance of statistical analysis 0.05 for all tests. The study protocol is registered with the World Health Organization under protocol number NCT02279225. Results: Groups with active intervention, had a good response on the group without intervention and even the combination of therapeutic resources was more effective in the two periods evaluated, there was a significant improvement from the point corresponding to DTM in the intervention groups. Discussion: This is the first randomized controlled trial to evaluate the role of phototherapy, a physical exercise program and the combination of these interventions for pain in fibromyalgia patients with TMD in assessment baseline and after longitudinal treatment. The results provide valuable clinical evidence for objective assessment of the potential benefits and risks of the procedures. Conclusion: The therapy associated with specific exercise program improves the painful condition FM patient with TMD. Perspectives: Check the role of phototherapy, the exercise program and these therapies in combination in the hormone changes that may be related to quality of life of patients. / Introdução: A Fibromialgia (FM) é uma síndrome caracterizada pela dor crônica generalizada, com prevalência em mulheres. Uma questão importante é que vários pacientes com FM também apresentam o diagnóstico de disfunção temporomandibular (DTM) e a coexistência dessas patologias gera um resultado clínico de alta complexidade. O exercício físico e a fototerapia (laserterapia de baixa potência/ diodo emissor de luz) são duas áreas utilizadas para o tratamento da dor crônica, podendo ser promissores na reabilitação dessas comorbidades. No protocolo um (1) o objetivo foi verificar se a fototerapia e o programa de exercício físico em uma única aplicação pode aumentar ou diminuir a sensibilidade da dor no paciente com FM associado a DTM. Objetivo do protocolo dois (2) foi avaliar o potencial do programa de exercício físico e da fototerapia na condição de dor crônica em mulheres com FM associado a DTM. Métodos / Desenho do estudo: Ensaio clínico randomizado, duplo-cego e controlado. O protocolo 1 foi realizado envolvendo 80 mulheres com ≥ 35 anos de idade com diagnóstico de FM com DTM. Os pacientes foram alocados aleatoriamente para um dos quatro grupos: Grupo CON (não foram submetidas a qualquer intervenção); Grupo PHO (intervenção com a fototerapia); Grupo EXT (intervenção com exercícios físicos); Grupo PHO + EXT (fototerapia mais intervenção do exercício). Foi realizado uma única sessão dos tratamentos e a reavaliação foi após trinta (30) minutos da aplicação, com analise da algometria. No Protocolo 2 usou a mesma metodologia que o protocolo 1, mas as reavaliações foram após dez (10) semanas de tratamento, com outras ferramentas avaliativas além da algometria. Para análise estatística foi utilizado o teste t-Student, unicaudal e pareado e foi realizada a distribuição Gaussiana: Shapiro-Wilk e teste Kruskall Wallis (pós-teste de Dunnes), e ainda a utilização do teste Wilcoxon, sendo a analise estatística de significância 0,05 para todos os testes. O protocolo deste estudo está registrado com a Organização Mundial de Saúde sob protocolo número NCT02279225. Resultados: Os grupos com intervenção ativa, tiveram uma boa resposta sobre o grupo sem intervenção e ainda a combinação de recursos terapêuticos mostrou ser mais eficaz nos dois momentos avaliados, houve uma melhora significante quanto ao ponto correspondente a DTM nos grupos de intervenção. Discussão: Este é o primeiro estudo controlado randomizado avaliando o papel da fototerapia, de um programa de exercício físico e a combinação dessas intervenções para a dor em pacientes fibromiálgicos com DTM, em avaliação em linha de base e após tratamento longitudinal. Os resultados oferecem evidências clínicas valiosas para avaliação objetiva dos potenciais benefícios e riscos dos procedimentos. Conclusão: A fototerapia associada ao programa de exercício físico específico melhora a condição dolorosa do paciente de FM com DTM. Perspectivas: Verificar o papel da fototerapia, do programa de exercícios e essas terapias de forma combinada na alteração de hormônios que podem estar relacionados a qualidade de vida destes pacientes.

Among persons living with, or recovering from, chronic illness, poor physical health-related quality of life is a concern, as current and residual illness symptoms and treatment side effects may deleteriously impact physical functioning and fulfillment of daily roles. Numerous cognitive, emotional, and behavioral factors may impact perceptions of health status. Optimism, for example, is conceptualized as belief in the occurrence of positive future outcomes, and is beneficially associated with physical health-related quality of life. Further, optimism may contribute to enhanced perceptions of control and efficacy over disease symptoms and general health, manifesting as proactive health behaviors (e.g., wellness behaviors; treatment adherence) and, in turn, improved health-related quality of life. Across independent samples of persons living with remitted cancer (N = 164) or fibromyalgia (N = 508), we examined the serial mediating effects of health-related self-efficacy and proactive health behaviors in the relation between dispositional optimism and physical health-related quality of life. Participants completed online self-report measures, including the Life Orientation Test – Revised, Control Beliefs Inventory, Multidimensional Health Profile – Health Functioning Index, Wellness Behaviors Inventory, Medical Outcomes Study General Treatment Adherence Scale, and the Short-Form Health Survey. Significant serial mediation was observed across samples; higher dispositional optimism was associated with greater health-related self-efficacy and, in turn, greater engagement in proactive health behaviors and better physical health-related quality of life. For persons with remitted cancer, absence of other specific indirect effects indicates a need to consider the potential impact of unique aspects of disease, such as late effects of treatment or fear of recurrence, that may limit the beneficial effects of optimism exclusively through health-related self-efficacy or wellness behaviors. For persons with fibromyalgia, we found specific indirect effects through each mediating variable, lending support for the decoupling of cognitive and behavioral factors, consistent with pathophysiological and psychosomatic explanations of illness symptoms and approaches to treatment. Interventions designed to enhance optimism (e.g., cognitive-behavioral therapy; best possible self exercise) or self-efficacy (e.g., exercise skills training) may have positive downstream effects on health behavior engagement and perceptions of physical health-related quality of life among individuals living with remitted cancer or fibromyalgia.

Relationship between Adverse Childhood Experiences and Illness Perceptions among Individuals with Fibromyalgia by Susan D. Fay MS, Drexel University, 1994 BS, Metropolitan State University of Denver, 1983 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Psychology Walden University February 2015 Adverse childhood experiences (ACEs), including abuse and neglect, are a significant social health problem. Exposure to ACEs can place a child at a high risk for developing different diseases or illnesses in adulthood, including fibromyalgia. The purpose of this study was to determine if exposure to ACEs, moderated by perceived social support and/or social undermining, would result in more negative illness perceptions of personal control and/or treatment control. A survey research design was used in this quantitative study. Purposive convenience sampling methods were used to solicit 231 participants to complete an online survey. Moderated multiple regression analysis was used to assess the moderating roles of perceived social support and social undermining on the relationship between ACEs with personal control and treatment control facets of illness perceptions among individuals with fibromyalgia. Developmental traumatology, allostatic load, social support, social undermining, and illness perceptions served as the theoretical and empirical foundation for this study. Social undermining was found to be a significant moderator of the relationship between sexual abuse, perceived social support, and personal control perceptions, F(7, 174) = 1.28, p <.001, but only when levels of social undermining were moderate to high. The relationship was not significant for treatment control perceptions as the criterion variable, or for physical or emotional abuse as predictor variables. Positive social change implications include an expanded knowledge of important social and psychological factors that influence the health of fibromyalgia patients, especially those exposed to sexual abuse. Such information can assist health care providers develop more effective therapies, treatments, and screening protocols.

Fibromyalgia syndrome (FMS) is a debilitating and chronic condition with an array of symptoms, the most distinguishable being widespread pain. FMS patients experience a marked decrease in quality of life related to intensity of symptoms. Current treatment options and pharmaceuticals do not provide adequate relief. This thesis examines integrative and complementary therapy options for symptom management and improvement of quality of life for FMS patients. A literature review was conducted of English current research using multiple databases. Findings indicate mindful movement therapies (MMT) such as yoga and tai chi, mindfulness, sensory-related relaxation techniques with guided imagery, and cognitive behavioral therapy (CBT) provided some relief and increased in perceived quality of life (QoL).

Bakgrund: Fibromyalgi är ett primärt smärttillstånd, vilket innebär att smärtan utgör själva sjukdomen. Individer med fibromyalgi drabbas ofta av fördomar och ifrågasättande då sjukdomen inte går att bevisa med blodprov eller röntgen samt frågetecken kring etiologin. Behandling riktad mot sjukdomens orsak finns ännu inte, den behandling som erbjuds är endast symtomlindrande. Sjuksköterskan har en viktig roll i att hjälpa patienten att hitta strategier för minskad smärta, stötta patienten i att identifiera och ägna sig åt hälsofrämjande åtgärder, dela med sig av kunskap och information gällande smärttillståndet samt enligt ordination genomföra farmakologisk och icke-farmakologisk behandling.  Syfte: Syftet var att beskriva personers upplevelser av att leva med fibromyalgi.  Metod: En litteraturöversikt genomfördes baserad på tio kvalitativa vetenskapliga artiklar. Databaserna Pubmed och Cinahl Complete användes till datainsamlingen och resultatet analyserades enligt Fribergs metod.  Resultat: Utifrån dataanalysen framkom fyra huvudteman: kroppen som ett fängelse, en ny identitet, att anpassa sitt liv till sjukdomen och erfarenheter av bemötande. Resultatet visade att fibromyalgi innebar stora förändringar i privatliv, arbetsliv, i relation till andra och i relationen till sig själv.  Slutsats: Bristande bemötande inom vården och begränsningar i vardagen hade störst inverkan på livskvaliteten och skapade isolering, lidande och psykisk ohälsa. Resultatet kan kopplas till bristande kunskap och forskning kring sjukdomen vilket resulterar i en ifrågasättande attityd, stigmatisering och ineffektiva behandlingar. Genom att öka medvetenhet och kunskap inom ämnet kan vården förbättras avsevärt, vilket i sin tur kan leda till en förbättrad livskvalitet för dem som lever med fibromyalgi. / Background: Fibromyalgia is a primary pain condition, meaning the pain constitutes the illness itself. Individuals with fibromyalgia often suffer from prejudice and questioning as the disease cannot be proven by blood tests or X-rays and lack of knowledge regarding etiology. There is yet no treatment for the illness, only symptom relief. The nurse has an important role in helping the patient find strategies for reduced pain, supporting the patient in identifying and engaging in health-promoting measures, sharing knowledge and information regarding the illness and, according to prescription, implement pharmacological and non- pharmacological treatment.  Aim: The aim was to describe people’s experiences of living with fibromyalgia.  Method: A literature review based on ten qualitative scientific articles was conducted. Databases Pubmed and Cinahl Complete were used for data collection and the results were analyzed according to Friberg’s method.  Results: Based on the data analysis, four themes emerged: the body as a prison, a new identity, adapting life to the disease and experiences of social interactions. The results showed that fibromyalgia led to big changes in private life, work life, in relation to others and in relation to oneself.  Conclusions: Inadequate approach in healthcare and limitations in everyday life had the biggest impact on the quality of life and created isolation, suffering and mental illness. The result can be linked to a lack of knowledge and research about the illness, which results in a questioning attitude, stigmatization and ineffective treatments. By increasing awareness and knowledge on the subject, healthcare can be significantly improved, which can lead to an improved quality of life for those living with fibromyalgia.

Proporção significativa dos doentes que preenchem os critérios atuais que caracterizam a síndrome fibromiálgica apresenta dor assimétrica e alterações do exame da sensibilidade distintas dos doentes com a apresentação clássica, \"simétrica\", de fibromialgia (SFM). Denomina-se esta entidade clínica como Síndrome Dolorosa Disfuncional com Sensibilidade Exteroceptiva Assimétrica (SFM-SDDSEA). Este grupo de doentes apresenta particularidades quanto ao resultado do tratamento e impactos negativos na qualidade de vida significativamente distintos daqueles com o quadro de fibromialgia \"clássica\". O presente estudo objetivou analisar aspectos clínicos, psicofísicos e neurofisiológicos de amostra de doentes que preenchem os novos critérios diagnósticos da SFM e que apresentam SFM-SDDSEA comparando-os aos dos doentes com SFM \"clássica\" e aos voluntários saudáveis. Método. Foram incluídas 32 doentes (45,9±8,5 anos) do sexo feminino que preencheram os Critérios para o Diagnóstico de Fibromialgia do Colégio Americano de Reumatologia (CAR) de 2010 e 31 voluntárias saudáveis (43±2 anos). Dezenove doentes apresentavam quadro clínico \"clássica\" da SFM e 13, SFM-SDDSEA (dor assimétrica e definida como EVA com diferença maior que 40% entre os dois dimídios). Foram utilizados para a avaliação: a Escala Visual Analógica (EVA), a Versão Resumida do Questionário de Dor McGill, a Escala Hospitalar de Ansiedade e Depressão (HAD), o Questionário de Impacto de Fibromialgia (QIF), o Inventário Breve de Dor (IBD), os valores dos limiares de dor à pressão nos pontos dolorosos mensurados com o algiômetro de Fischer (PD), o teste quantitativo de sensibilidade (TQS) e a excitabilidade cortical aferida com estimulação magnética transcraniana (EMT). Resultados. Os doentes com SFM-SDDSEA apresentaram maior escores de interferência da dor nas atividades diárias em relação aos com SFM (54,7±8,9 e 37,6±13,5; respectivamente, p < 0,0001) e maior impacto da dor na qualidade de vida em relação a SFM de acordo com o QIF (73,6±13,9 e 58,3±13,9; respectivamente, p < 0,004). Doentes com SFM-SDDSEA apresentaram limiares de dor à pressão assimétrica, sendo mais baixos no hemicorpo onde a dor era mais intensa (27,74±7,90 e 35,86±8,37; respectivamente, p=0,007). Nos doentes do grupo SFM-SDDSEA, os limiares de dor à pressão do lado mais doloroso foram semelhantes aos dos doentes com SFM (27,77±1,25 e 27,74±2,20; respectivamente, p=0,472), ao passo que os limiares no hemicorpo menos doloroso foram significativamente mais elevados do que os de doentes com SFM (35,86±2,32 e 27,77±1,25; respectivamente, p<0,031). Os doentes com SFM-SDDSEA apresentaram valores maiores de facilitação intracortical no hemisfério contralateral ao hemicorpo em que a dor era mais intensa (1,64±1,06 e 3,35±2,31; respectivamente, p=0,008) e maior amplitude de potencial evocado motor (PEM) à 140% do limiar motor (827±996 e 2134±1495; respectivamente, p=0,005). Conclusões. Doentes com SFM-SDDSEA apresentaram maior impacto dos sintomas dolorosos na qualidade de vida e maior interferência nas atividades diárias, alterações da excitabilidade cortical e limiares de evocação de dor frente aos estímulos pressóricos diferentes daqueles com SFM. Estes resultados indicam que a SFM-SDDSEA constitui entidade clínica à parte, com mecanismos de ocorrência de doença, resposta ao tratamento e prognósticos diferentes da SFM \"clássica\" / Aim of Investigation: A significant proportion of patients fulfilling the diagnostic criteria of fibromyalgia syndrome (FMS) present asymmetrical ongoing pain and abnormalities on the physical examination that are not present in patients with \"classical\" symmetric FMS. From the clinical perspective, this condition has been named FMS-Dysfunctional Pain Syndrome with Asymmetrical Exteroceptive Sensibility (DPSAES). Patients with DPSAES usually present higher negative impact in quality of life when compared to the more \"classic\" FMS patients. The present study aimed at characterizing the clinical, psychophysical and neurophysiological aspects of the FMS-DPSAES patients and compared them to those of \"classic\" FMS patients and healthy controls. Methods: Thirty-two patients (45.9±8.5yo) fulfilling the 2010 American College of Rheumatology FMS Diagnostic Criteria and 31 age-matched healthy controls (HC) (43.0±2.1 yo) were included. Nineteen patients had \"classical\" FMS and 13 had FMS-DPSAES (defined as asymmetrical pain with a more than 40% pain intensity difference between body sides). The following tools were used: The Visual Analogic Scale (VAS), the Short Version of the McGill Pain Questionnaire (MPQ), the Fibromyalgia Impact Questionnaire (FIQ), and the Brief Pain Inventory (BPI). The quantitative sensory test battery was performed and included pressure, thermal and mechanical detection and pain thresholds in both hands and suprathreshold stimulations. Cortical excitability measurements were performed in all participants with the transcranial magnetic stimulation. Results: When compared to patients with \"classical\" FMS patients with DPSAES presented higher scores in pain interference in daily activities (54.73±8.90 and 37.66±13.56; respectively; p < 0.0001); higher negative impact in quality of life (73.67±13.90 and 58.38±13.97; respectively, p < 0.004), and lower pressure pain thresholds on the most painful body side (27.74±7.96 and 35.86±8.37; respectively, p=0.007). Cortical excitability parameters were asymmetrical in FMS-DPSAES patients and showed higher intracortical facilitation (3.35±2.31 and 1.64±1.06; respectively, p=0.008) and higher amplitude of motor evoked potentials in the brain hemisphere contralateral to the more painful body side in FMS-DPSAES (2134±1495 and 827±996; respectively; p=0.005). Conclusions: Patients with FMS-DPSAES had higher negative impact in quality of life, distinct cortical excitability profile changes and different pressure pain thresholds compared to patients with \"classical\" FMS. The current evidence suggests that FMS-DPSAES may be a clinical entitiy distinct from FMS with its own mechanisms, response to treatment and prognosis

Introdução: A fibromialgia é uma desordem reumatológica comum que compromete significativamente a qualidade de vida. Caracteriza-se por dor crônica generalizada e limiar de dor diminuído, associados normalmente a sintomas e comorbidades, como sono não reparador, distúrbios de equilíbrio e ansiedade. Dentre as modalidades de tratamento, vem crescendo o uso das terapias alternativas e complementares, porém mais evidências são necessárias. O objetivo principal deste estudo foi avaliar o efeito do Shiatsu na dor, qualidade de sono, ansiedade, nível de confiança no equilíbrio e qualidade de vida relacionada à saúde de indivíduos com fibromialgia. Método: participaram do estudo 34 sujeitos na faixa etária de 33 a 62 anos, divididos em: Grupo Shiatsu (GS; n=17), que realizou 16 sessões de Shiatsu corporal com duração de 50 minutos, duas vezes por semana, e Grupo Controle (GC; n=17), que recebeu orientações educativas através de uma cartilha. Os grupos foram avaliados na linha de base, após 4 e 8 semanas, quanto a: intensidade da dor pela Escala Visual Analógica (EVA), limiar de dor pela dolorimetria, qualidade de sono pelo Índice de Qualidade de Sono de Pittsburgh (IQSP), ansiedade pelo Inventário de Ansiedade Traço-Estado, confiança no equilíbrio pela Escala de Confiança no Equilíbrio em Atividades Específicas (Escala ABC) e qualidade de vida pelo Questionário de Impacto da Fibromialgia (QIF). Resultados: por regressão logística, verificou-se que o tratamento de oito semanas com Shiatsu está associado à melhora na EVA (p=0,043), limiar de dor (p=0,014), IQSP (p=0,006), Escala ABC (p=0,026) e QIF (p=0,016). Todas essas variáveis também apresentaram ganho percentual relativo clinicamente importante (EVA: 40,6%; limiar de dor: 76,4%; IQSP: 34,4%; Escala ABC: 44,2%; QIF: 22,3%). Não foram observadas melhoras estatisticamente significantes ou clinicamente relevantes para a ansiedade. Conclusão: o Shiatsu foi eficaz para melhorar a dor, qualidade de sono, confiança no equilíbrio e qualidade de vida de sujeitos com fibromialgia. / Introduction: Fibromyalgia is a common rheumatological disorder that greatly impairs quality of life. It is characterized by chronic widespread pain and decreased pain threshold, normally associated with symptoms and comorbidities, such as non-restorative sleep, balance disorders and anxiety. Among treatment modalities, the use of complementary and alternative therapies is increasing, but more evidence is needed. The main objective of this study was to evaluate the effect of Shiatsu in pain, sleep quality, anxiety, balance confidence level and health-related quality of life of individuals with fibromyalgia. Methods: 34 subjects aged 33 to 62 years participated in this study and were divided into: Shiatsu Group (SG; n=17), which received 16 sessions of full-body Shiatsu lasting 50 minutes, twice a week, and Control Group (CG; n=17), which received educational guidance through a booklet. Groups were assessed at baseline, after 4 and 8 weeks, regarding: pain intensity by Visual Analogue Scale (VAS), pain threshold by dolorimetry, sleep quality by Pittsburgh Sleep Quality Index (PSQI), anxiety by State-Trait Anxiety Inventory, balance confidence level by Activities-specific Balance Confidence Scale (ABC Scale) and quality of life by the Fibromyalgia Impact Questionnaire (FIQ). Results: by logistic regression, it was found that the eight-week treatment with Shiatsu was associated with improvements in VAS (p=0.043), pain threshold (p=0.014), PSQI (p=0.006), ABC Scale (p=0.026) and FIQ (p=0.016). All these variables also presented clinically important relative percentage changes (VAS: 40.6%; pain threshold: 76.4%; PSQI: 34.4%; ABC Scale: 44.2%; FIQ: 22.3%). There were no statistically significant or clinically relevant improvements for anxiety. Conclusion: Shiatsu was effective for improving pain, sleep quality, balance confidence and quality of life of subjects with fibromyalgia.

Os objetivos deste projeto foram avaliar o comportamento da modulação autonômica cardíaca em resposta ao exercício e logo após o mesmo e verificar a prevalência de insuficiência cronotrópica (IC) na coorte de pacientes com fibromialgia. Métodos: Quatorze mulheres com FM [idade 46 ± 3 anos; índice de massa corpórea (IMC) 26,6 ± 1,4 kg/ m2] e quatorze indivíduos saudáveis (controle) pareados por gênero, IMC (25,4 ± 1,3 kg/m2) e idade (41 ± 4 anos) fizeram parte desse estudo de corte transversal. As participantes foram submetidas a um teste ergoespirométrico em esteira onde foram avaliados o comportamento da frequência cardíaca (FC) durante o teste e logo após o término do mesmo. A reserva cronotrópica (RC) e a FC de recuperação no primeiro (deltaFCR1) e segundo (deltaFCR2) minutos após o teste foram calculadas para verificar a presença de disautonomia e de IC. Resultado: Pacientes com FM apresentaram menor consumo de oxigênio máximo (VO2max) quando comparadas com os sujeitos saudáveis (22 ± 1 versus controle: 32 ± 2 ml/kg/minuto, respectivamente, P < 0,001). Adicionalmente, as pacientes com FM apresentaram menor reserva cronotrópica (72,5 ± 5% versus controle: 106,1 ± 6%, P < 0,001), deltaFCR1 ( 24,5 ± 3bpm versus controle: 32,6 ± 2bpm, P = 0,059) e deltaFRC2 (34,3 ± 4bpm versus controle: 50,8 ± 3bpm, P = 0,002) do que seus pares saudáveis. A prevalência de IC foi de 57,1% entre as pacientes com FM. Conclusões: Pacientes com FM apresentaram disautonomia tanto durante o exercício quanto na recuperação do mesmo, e ainda, essa coorte de pacientes apresentou uma alta prevalência de IC. / We aimed to gather knowledge on the cardiac autonomic modulation in patients with fibromyalgia (FM) in response to exercise and to investigate whether this population suffers from chronotropic incompetence (CI). Methods: Fourteen women with FM (age: 46 ± 3 years; body mass index (BMI): 26.6 ± 1.4 kg/m2) and 14 gender-, BMI- (25.4 ± 1.3 kg/m2), and agematched (age: 41 ± 4 years) healthy individuals (CTRL) took part in this crosssectional study. A treadmill cardiorespiratory test was performed and heart-rate (HR) response during exercise was evaluated by the chronotropic reserve. HR recovery (deltaHRR) was defined as the difference between HR at peak exercise and at both first (deltaHRR1) and second (deltaHRR2) minutes after the exercise test. Results: FM patients presented lower maximal oxygen consumption (VO2 max) when compared with healthy subjects (22 ± 1 versus CTRL: 32 ± 2 mL/kg/minute, respectively; P < 0.001). Additionally, FM patients presented lower chronotropic reserve (72.5 ± 5%versus CTRL: 106.1 ± 6%, P < 0.001), deltaHRR1 (24.5 ± 3hpm versus CTRL: 32.6 ± 2hpm, P = 0.059) and deltaHRR2 (34.3 ± 4hpm versus CTRL: 50.8 ± 3hpm, P = 0.002) than their healthy peers. The prevalence of CI was 57.1% among patients with FM. Conclusions: Patients with FM who undertook a graded exercise test may present CI and delayed HR recovery, both being indicative of cardiac autonomic impairment and higher risk of cardiovascular events and mortality.

Introdução: Exercícios físicos são descritos como uma das formas mais eficazes de controle da Fibromialgia (FM). No entanto, os exercícios de fortalecimento e alongamento muscular ainda permanecem pouco avaliados. Objetivos: Avaliar e comparar a eficácia dos exercícios de alongamento e fortalecimento muscular, isolados, na melhora da força muscular, flexibilidade, dor, sintomas e qualidade de vida de pacientes com FM, comparando com um grupo controle. Casuística e métodos: A amostra foi composta por 79 mulheres elegíveis das quais 16 foram excluídas e 63 iniciam o estudo, sendo alocadas aleatoriamente em três grupos: alongamento (GA), fortalecimento (GF) e controle (GC). Ao final, 14 finalizaram o tratamento no GA, 16 no GF e 14 no GC. Todos os sujeitos foram avaliados antes e após 12 semanas, da seguinte forma: força muscular de flexores e extensores de joelho pela contração isométrica voluntária máxima (CIVM) com célula de carga (EMG System do Brasil); flexibilidade pelo teste do 3º dedo-solo (3DS); dor pela escala visual analógica (EVA); limiar de dor nos tender points (LD) e número de tender points positivos (TP+) com dolorímetro de Fischer; sintomas da FM pelo Questionário de Impacto da FM (QIF) e qualidade de vida pelo Medical Outcomes Study 36-item Short-Form Health Survey (SF- 36). O GA e o GF realizaram exercícios gerais, envolvendo a musculatura de membros superiores, inferiores e tronco, com freqüência de bissemanal. Os dados foram analisados pelos testes estatísticos: t-Student, Wilcoxon, Anova um fator e Kruskal- Wallis, com nível de significância de 5%. Resultados: O GA teve melhora estatisticamente significante nas variáveis: LD, 3DS; fadiga, sono e rigidez do QIF; capacidade funcional, Vitalidade, saúde mental, dor e total físico e emocional do SF-36 (p=0,05) e, o GF nos itens: LD, TP+, 3DS, CIVM flexão de joelho; fadiga, sono, rigidez, ansiedade, depressão e escore total do QIF; capacidade funcional, vitalidade, saúde mental e total emocional do SF-36 (p=0,05). O GC não apresentou melhora em nenhuma das variáveis (p=0,05). Na comparação entre os grupos, o GA foi estatisticamente diferente nos itens CF, Dor, e Total Físico do SF-36; o GF na Depressão do QIF (p=0,05) e o GC foi pior na capacidade funcional, sono e rigidez do QIF e vitalidade do SF-36 (p=0,05). Conclusões: Os exercícios de alongamento e fortalecimento muscular melhoram de forma significativa a dor, sintomas da FM e qualidade de vida podendo ser considerados complementares já que apresentam melhora em aspectos distintos / Background: Exercises have been reported as one of the most effective management of Fibromyalgia (FM), however stretching and strengthening training remain under evaluated. Objectives: To assess and compare the effects of stretching and strengthening exercises on muscle strength, flexibility, pain, symptoms and quality of life of FM patients, comparing to a control group. Methods: The sample was composed by 79 eligible women of whom 16 were excluded, and 63 entered the study and were randomly assign in to one of three groups: flexibility group (FG), strength group (SG) and control (CG). At the end, 14 finished the study on FG, 16 on ST and 14 on CG. All subjects were evaluated before and after 12 weeks according to the following procedures: maximum isometric muscle contraction for knee flexion and extension (MIMC) using the EMG System do Brasil dynamometer, flexibility by finger-to-tip floor test (FTF), pain by visual analogue scale (VAS), pain threshold (PT) and tender points count (TP+) by a Fischer dolorimeter, symptoms by Fibromyalgia Impact Questionnaire (FIQ) and quality of life by Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). FG and SG underwent in a stretching and strengthening program, respectively, including exercises for upper and lower body and trunk, twice a week. Data were statistically analyzed by: t-Student test, Wilcoxon test, Anova one-way and Kruskall- Wallis Anova, with significance level of 5%. Main Results: FG had statistically improvements after treatment in: PT, FTF, fatigue, sleep and stiffness of FIQ; functional capacity, vitality, mental health, pain and role physical of SF-36 (p=0,05). SG had statistically improvements after treatment in: PT, TP+, FTF, MIMC of knee flexion, fatigue, sleep, stiffness, anxiety, depression and total score of FIQ and functional capacity, vitality, mental health and role emotional (p=0,05). No significant difference was observed in CG after 12 weeks (p=0,05). Comparing three groups, the FG was statistically better after treatment for functional capacity, pain and role physical of SF-36. The SG was statistically better for depression of FIQ and CG was statistically worse for functional capacity, sleep and stiffness of FIQ and vitality of SF -36. Conclusions: Stretching and strengthening exercise had statistically improvements in pain, symptoms and quality of life of FM patients. Considering the positive effects on different aspects, they could be used as complementary exercises