Prescribed Versus Preferred Intensity Resistance Exercise in Fibromyalgia Pain.

Roberta P Da Cunha Ribeiro,Fernanda R Lima,Ana L De Sá Pinto,Diogo S Domiciano,Marco A G Pontes Filho,Bruno Gualano,Hamilton Roschel,Tathiane C Franco,Ana J Pinto

doi:10.3389/fphys.2018.01097

Abstract

Exercise is the treatment of choice for fibromyalgia (FM), but little is known about resistance exercise prescription to modulate pain in this condition. This study aimed to compare the effects of different resistance exercise models, comprising self-selected or prescribed intensity, on pain in FM patients. In a cross-over fashion, 32 patients underwent the following sessions: (i) standard prescription (STD; 3 × 10 repetitions at 60% of maximal strength); (ii) self-selected load with fixed number of repetitions (SS); (iii) self-selected load with volume load (i.e., load × sets × repetitions) matched for STD (SS-VM); and (iv) self-selected load with a free number of repetitions until achieving score 7 of rating perceived exertion (SS-RPE). Pain, assessed by Visual Analogic Scale (VAS) and Short-Form McGill Pain Questionnaire (SF-MPQ), was evaluated before and 0, 24, 48, 72, and 96 h after the sessions. Load was significantly lower in SS, SS-VM, SS-RPE than in STD, whereas rating perceived exertion and volume load were comparable between sessions. VAS scores increased immediately after all sessions (p < 0.0001), and reduced after 48, 72, 96 h (p < 0.0001), remaining elevated compared to pre-values. SF-MPQ scores increased immediately after all exercise sessions (p = 0.025), then gradually reduced across time, reaching baseline levels at 24 h. No significant differences between sessions were observed. Both prescribed and preferred intensity resistance exercises failed in reducing pain in FM patients. The recommendation that FM patients should exercise at preferred intensities to avoid exacerbated pain, which appears to be valid for aerobic exercise, does not apply to resistance exercise.

Highlights

Fibromyalgia (FM) is a chronic syndrome of unknown etiology characterized by widespread pain, physical dysfunction, fatigue, psychological distress resulting in pain-related catastrophizing, cognitive dysfunction, sleep, and mood disturbances (Fietta et al, 2007; Hauser et al, 2008)
Load was significantly lower in symptom severity (SS), SS-VM, SS-RPE than in standard prescription (STD)
The main findings of this study were threefold: (i) the patients preferred lower load than what was prescribed; (ii) all the resistance exercise models led to increased pain following exercise, which tended to decrease over time; (iii) the preferred intensity exercises were as ineffective as the prescribed intensity exercise to reduce pain

Summary

Introduction

Fibromyalgia (FM) is a chronic syndrome of unknown etiology characterized by widespread pain, physical dysfunction, fatigue, psychological distress resulting in pain-related catastrophizing, cognitive dysfunction, sleep, and mood disturbances (Fietta et al, 2007; Hauser et al, 2008). Aerobic exercise has been largely recommended to improve well-being, physical capacity and functionality during management of FM (Newcomb et al, 2011). Studies corroborating these beneficial effects are numerous, and evidence-based guidelines for the prescription of aerobic exercise programs (e.g., intensity, frequency, duration, length) have been reported (Hauser et al, 2010). A systematic review concluded that there is evidence ( rated as low quality) suggesting that moderate- to high-intensity resistance training can improve multidimensional function, muscle strength, tenderness, and pain in FM patients (Busch et al, 2013). In contrast to aerobic exercise, little is known about the effective prescription of resistance exercise to improve FM symptoms, in particular pain (Nelson, 2015)

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