Fibromyalgia and Physical Fitness Status & Muscles

Fitness Status


Anthropometric measures, such as body mass index (height in meters divided by weight in kg'), can be derived in standard ways with elevations of this index, for instance, reflecting change in energy metabolism associated with unfitness.

Aerobic Fitness Assessment

Formal assessment in a Human Performance Laboratory or equivalent can provide a number of physiologic variables useful in further evaluation of the FMS subject. Exercising to volitional exhaustion on a treadmill, using a modified Balke protocol, 3.0 miles per hour with grade increased by 2.5'X, every 2 minutes, has been deemed an appropriate method for evaluation of women with FMS. 13, 14,24.

Endurance capacity can be measured using a Gould 9000 metabolic cart.18 During this test, each subject is encouraged to continue as long as they are able but may terminate the test at any time. This test thus represents a symptom-limited exercise test to tolerance. The maximum oxygen consumption (VO2 max) can be derived from the breath-to- breath analysis of oxygen consumption and C02 production and can be expressed as mL/kg/min. The ventilatory flexion point, also called the anaerobic threshold can be evaluated by determining the point at which the workload and ventilation rate become nonlinear. When this corresponds to the point at which C02/02 that is, the Respiratory Quotient (RQ), is greater than l.O, the latter calculation can be used. The subject's rating of perceived exertion18can be ascertained at the beginning and end of each work session. The reason for stopping the test and an exercise electrocardiogram can provide information about the patient's level of aerobic fitness, the overall physical and emotional response to exercise, and whether there is any concomitant ischaemic heart disease that might preclude the subject from a formal exercise program. In addition, failure to reach anaerobic threshold at a reasonable workload may be indicative of a metabolic muscular defect that would require independent evaluation.13 Furthermore, if the anaerobic threshold is reached at an extremely low workload, alternative muscle energy and muscle biopsy studies may be needed to seek the cause of these symptoms. Based on these tests, fitness categories can be expressed as levels of poor, fair, average, or excellent based on data from the American Heart Association. 6. The 12-point Borg rating of perceived exertion scale is simple to understand, commonly used, and shows correlations between perceived and physiologic exertion. 17

Exercise Capacity

A useful measure of the current exercise pattern can be determined using the Training lndex.48This is determined by estimating exercise intensity, duration, and frequency. Intensity is represented by the percent of the maximum heart rate achieved at the end of the exercise session. In general, the maximum heart rate is 220 minus the subject's age as long as there are no concurrent medical problems. The intensity statement is thus represented as a percentage (e.g., 50%, or 0.5'%,). The duration is expressed as minutes per exercise session. Intensity is multiplied by the duration (e.g., 0.5 x 10 minutes = 5), and this number is added to those obtained from other exercise sessions over a period of 1 week, thus representing the frequency of sessions. The recommended T1 to attain health-related benefits is 42 and may range up to 90 or beyond..

Muscle Strength Assessment

Many patients with FMS, either generalized or localized, are deconditioned. When specific muscular weakness is detected and exercise programs are directed towards strengthening of these groups, computerized muscle strength recording equipment may be useful. This may be used by both the therapist and the patient in a number of ways, including important biofeedback information for the setting and realization of therapeutic goals. Volition plays an important role in these assessments. They have less value when used to assess functional ability, particularly in the setting of disability assessments.

Muscle Function and Structure

There has been no defined abnormality of muscle structure that is of use in the everyday clinic situation .113. Muscle function is limited by the deconditioning effect that can be assessed by the methods described earlier. Physiologic changes within the muscle itself have not yielded information that goes beyond the pure research area.

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