Composite Physical Function Scale Research Articles

Functional fitness and physical independence in later years: cut-off values and validation

BackgroundTo establish and validate the criterion-referenced standards of functional fitness in predicting physical independence in 80 + years.MethodsA group of 2,749 older community dwellers (60–84 years) were recruited, and 2,050 were identified with moderate-to-high independent living ability according to the proposed minimum composite physical function score. The Senior Fitness Test battery was applied to measure functional fitness at five-year intervals. The declining rate for each fitness dimension was calculated based on the differences between any two adjacent age groups and was adjusted according to the reported degradation rate differences between the cross-sectional and longitudinal studies.ResultsThe age-and-sex-specific criterion-referenced standards were identified for muscle strength, cardiovascular endurance, and dynamic balance that older adults should possess at 60–79 to maintain independent living abilities. Moderate to high consistency (k = 0.622–0.650) and associations (φ = 0.641–0.694) were found between the predicted physical independence by criterion-referenced standards of functional fitness and the results from the composite physical function scale. Moreover, the predicted independent living abilities in later years from the criterion-referenced standards of functional fitness showed high test-retest reliability (Pa = 0.90–0.96).ConclusionThe criterion-referenced standards for functional fitness are valid and reliable to predict independent living abilities in later years, and provide the threshold to identify the limitations in physical fitness and detect the risks of functional disabilities among older adults in an early stage.

The European Portuguese Version of the Composite Physical Function Scale: Cross-Cultural Adaptation and Validation in Community-Dwelling Older Adults.

This study aims to perform the cross-cultural adaptation to European Portuguese of the Composite Physical Function Scale and to assess its validity and reliability in a sample of community-dwelling older adults. The scale was translated into European Portuguese, back translated, and piloted in a sample of 16 representative individuals. Its validity and reliability were tested in an independent sample of 114 community-dwelling older adults (52 were tested twice to assess test-retest reliability). The results showed that the scale had good internal consistency (α = .90), construct validity (ρ = .71) and measurement error (78.8% agreement), and excellent test-retest reliability (κ = .98). However, a ceiling effect was found as 28% of the participants achieved the highest possible score. Although the scale has good measurement properties, the presence of ceiling effects is indicative that this tool is not able to distinguish higher levels of intrinsic capacity within community-dwelling older adults.

Translation, cross-cultural adaption, validity and reliability of a composite physical function scale for adults aged 65 + years in a Danish context

BackgroundTo prevent or postpone dependence on help in everyday activities, early identification of adults aged 65 + years at risk of functional decline or with progressing functional decline is essential. The American Composite Physical Function (CPF) scale was developed to detect and prevent this age-conditioned decline. In this study, the aim was to translate and adapt the scale into a Danish version and assess the validity and reliability in Danish adults aged 65 + years.MethodsA forward–backward translation procedure was used, followed by an expert panel review to finalise the Danish version of the CPF scale. In the subsequent pre-test, three-step cognitive interviews and hypotheses testing were performed to evaluate the validity, and a test–retest was done to assess reliability.ResultsIn the pre-test, 47 adults participated in three-step cognitive interviews, and 45 adults answered an online version of the scale. In terms of content validity, the scale was relevant and easy to answer, although many informants skipped the instruction to the questionnaire, which may negatively impact face validity. Construct validity showed a significant difference in CPF scores in adults aged 65 + years by residence and activity level and a decreasing CPF score with increasing age. The reliability test showed an excellent kappa (0.92).ConclusionThe scale covering daily activities helps to identify adults aged 65 + years with reduced physical functions or at risk of loss of independence. Further research is needed to assess the CPF predictive value for adults aged 65 + years at risk of or with a progressing physical decline.

Risk phenotype for sarcopenia in older adults from Amazonas, Brazil; a cross-sectional study.

There are several markers for the suspicion, identification, and confirmation of sarcopenia. To analyse the importance of several markers for assessing sarcopenia by classifying phenotypes based on five domains: symptomatology, muscle function, muscle mass, physical performance, and physical function. A cross-sectional study analysing 312 older adults (72.6±7.8 yrs) was conducted in Novo Aripuanã, Amazonas, Brazil. Symptoms of sarcopenia were determined with the SARC-Calf; muscle function was assessed using the 30-Chair Stand test (CST), 30-CST power, and handgrip strength (HGS) with and without normalisation for body mass/height; the skeletal muscle mass index (SMMI) was estimated from anthropometry; physical performance was determined through the 4-m gait speed (GS) and 6-min walking test (6MWT); and physical function was determined with the Composite Physical Function Scale (CPF). Cluster analysis revealed two phenotypes (at risk vs not at risk for sarcopenia) and the contribution of each marker (ranged from 0 to 1). In men, the contribution of each marker was: 1 for SARC-Calf, 0.18 for SMMI, 0.09 for 30-CST power and 0.06 for HGS; in women: 1 for SARC-Calf, 0.25 for 30-CST power, 0.22 for SMMI, 0.06 for GS, 0.04 for HGS, and 0.03 for CPF. Considering the cutoff values proposed by Rikli and Jones (2013) for physical function and Cruz-Jentoft et al. (2019) for the other domains, the risk profile for sarcopenia was characterized by: high SARC-Calf in both sexes (men:51.8 vs 3.6%, p<0.001; women:71.2 vs 1.1%, p<0.001), low SMMI (men:73.2 vs 44.6%, p<0.002; women:44.1 vs 23.6%, p = 0.002); in women, low GS (38.7 vs 12.4%, p<0.001) and low CPF (29.7 vs 15.7%, p = 0.020), and no differences in HGS between groups in both sexes. SARC-Calf, SMMI, and 30-CST were more relevant markers for sarcopenia risk in older adults of both sexes, GS and CPF played also an important role in women.

Mediating effect of muscle power on the relationship of physical activity with physical fitness and physical function in older women.

This study analyzed if the associations of physical activity with physical fitness and physical function in older women are mediated by muscle power. Participants were 54 older women (age 73.5±6.8yrs). Moderate-to-vigorous intensity physical activity (minday-1) was measured by accelerometry. Lower limb muscle power (W/kg) was estimated from a single two-leg countermovement jump performed on a force platform. Physical fitness (lower body strength, agility/dynamic balance, and aerobic endurance) was objectively assessed through the Senior Fitness Test Battery, respectively: 30s chair stand (repetitions), 8-ft up-and-go (s), and 6-min walk test (m). Physical function was subjectively evaluated via the 12-item Composite Physical Function Scale Questionnaire (score). Mediation effects were estimated using bootstrapped 95% confidence intervals and were deemed significant if 0 was not included in the intervals. Mediation analysis controlling to age revealed an indirect effect of moderate-to-vigorous intensity physical activity through muscle power on all physical fitness components, specifically lower body strength (B=0.048, 95% BootCI [0.013, 0.114]), agility/dynamic balance (B=-0.009, 95% BootCI [-0.024, -0.002]) and aerobic endurance (B=0.656, 95% BootCI [0.142, 1.597]) and on physical function global score (B=0.040 95% BootCI [0.009, 0.094]). These results suggest that physical activity of at least moderate intensity is relevant to daily functional competence, by promoting the maintenance or improvement of muscle power.

Recovery in Mobility by Community-Living Older Adults following Fragility Hip Fracture

Aims This study describes recovery of mobility during inpatient rehabilitation and 12-weeks at home post-discharge in a group of community-living older adults following a fragility hip fracture and surgical repair. Methods A prospective descriptive design employed repeated measures of five mobility measures at inpatient rehabilitation admission, discharge, and at home 2-, 6-, and 12-weeks post-discharge. Mobility scores were compared to age- and sex-reference scores from the literature. Results The greatest gains in recovery were made during inpatient rehabilitation with continued improvement (p<.001) at home over 12-weeks on performance-based (Functional Independence Measure, Timed Up and Go, 6-Minute Walk, and Berg Balance Scale) and self-report (Composite Physical Function Scale) measures. Normative sex- and age-reference scores were not achieved at 12-weeks post-discharge. Conclusions The deficit in recovery to normative scores indicates that these older adults will continue to be at risk of further decline in functional and physical performance, and institutionalization.

Physical Function Of Aged Population Is Predicted By Motor Competence And Physical Fitness

Fitness and cognitive status on aging has been widely studied and well reported on literature. Independence and functioning are decisive in elders life quality. Motor competence has been associated to children physical activity levels and healthy weight status. Whether or not Motor Competence has additional value in promoting physical function on aging is not well stablished. PURPOSE: to investigate the relationship and influence of motor competence, physical fitness and cognitive status on physical functioning, in aged population. METHODS: institutionalized participants were recruited as a convenience sample in three day-care centers (N=283, women N=184, mean age = 82.05±7.70 years). Physical functioning was assessed through self-report using a composite physical function scale. Physical fitness was evaluated with the Senior Fitness Test. Motor competence was evaluated as the proficiency in overarm throw a tennis ball, measuring the ball velocity, and standing long jump. Cognitive performance was assessed with Mini-Mental State Examination test. T test was used to test the difference between women and men in all variables. Pearson correlation between physical functioning, physical fitness and motor competence was performed. Stepwise regression was used to identify the predictor variables of physical functioning. Significance was set at p < 0.05. RESULTS: Men had significant better motor competence and physical fitness results than women. In women, the highest correlation were found between physical functioning and Chair stand (r=0.25), standing long jump (r=0.19) and 2-min step (r=0.19). In men, the highest correlation were found on 2-min step (r=0.30) and overarm throw (r=0.27). Stepwise regression retained the following variables: 2.44 m up-&-Go, standing long jump, and sex (F(3; 212) = 33.73; p < 0.001, R2 = 0.32). Men has an estimate of more 2.162 points in physical functioning than women. Physical functioning is estimate to increased 1 point for every -0.151 s in 2.44 m Up-&-Go, and 1 point for every 0.051 cm in standing long jump. CONCLUSION: Despite having found significant moderate to low correlations in both men and women, it seems that both Motor Competence and Fitness status has important influence on physical functioning.

Muscle Power Mediates The Relationship Between Physical Activity And Functional Fitness In Older Women

Muscle power is critical for older people to independently and safely perform the activities of daily living. Physical activity in general and resistance training, in particular, are essential for the prevention of muscle power loss with ageing. PURPOSE: To analyze the associations between moderate-vigorous intensity physical activity (MVPA) and functional fitness in older women, including the role of muscle power in mediating these associations. METHODS: Participants were 54 older women with a mean age 73.5±6.8yrs. MVPA (min day−1) was measured by accelerometry. Lower limb peak muscle power (W/kg) was assessed using a mechanography ground reaction force platform. Functional fitness (lower body strength, agility/dynamic balance, and aerobic endurance) was objectively assessed through physical fitness tests from the Senior Fitness Battery, respectively: 30s chair stand (repetitions), 8-foot up-and-go (s), and 6-minute walk test (m). Functional fitness was also subjectively evaluated via the 12-item Composite Physical Function Scale Questionnaire which gives a global score of physical function (points). Direct and indirect mediation model effects were estimated using the PROCESS macro developed by Preacher and Hayes, and 95% bootstrap confidence intervals were constructed to test the hypothesis that muscle power mediated associations. Age was examined as a covariate. RESULTS: A significant portion (40-78%) of the total effect of MVPA on functional fitness in older women was explained by muscle power. The indirect effects were observed on physical function global score (β=0.040 95% CI [0.010, 0.099]) and in each of the functional fitness parameters: lower body strength (β=0.048, 95% CI [0.013, 0.117]), agility/dynamic (β=-0.009, 95% CI [-0.024, - 0.002]) and aerobic endurance (β=0.656, 95% CI [0.146, 1.694]). There were no direct effects of MVPA on functional fitness. CONCLUSION: To improve functional fitness in older women, physical activity interventions should consider the mediating role of muscle power and include activities that require force to be rapidly generated.

Effects of silent myocardial ischemia on functional fitness and physical independence in 60–79-year-old adults

ObjectiveWe examined the effect of silent myocardial ischemia (SMI) on functional fitness levels and physical independence in 60–79-year-old individuals. MethodsWe conducted a cross-sectional study with 716 older adults and used an electrocardiograph and an ambulatory electrocardiogram to diagnose those with SMI. Physical independence was assessed using the Composite Physical Function scale, whereas physical fitness was assessed using the Senior Fitness Test battery. ResultsThe 60-79-year-old females and males with SMI were more likely to have lower scores for lower and upper body strength, agility/dynamic balance, and aerobic endurance (p < 0.05) than those without SMI. The scores for lower and upper body flexibility in all age groups for both genders were not significant (p > 0.05). Binary logistic regression analysis revealed that old adults with SMI had a higher risk of losing physical independence later in life than those without SMI (p < 0.05). ConclusionThis study showed that individuals with SMI have lower fitness levels and increased risk of losing physical independence than those without SMI.

Criterion-Referenced Fitness Standards Associated with Maintaining Functional Capacity in Chilean Older Adults.

The aim of the current study was to develop fitness standards associated with maintaining physical capacity in older adults at two different levels-that needed for advanced functioning and that needed for maintaining moderate (independent) functional ability. This was a cross-sectional study of 406 Chilean adults aged 60 and more. Functional capacity was measured through the Composite Physical Function (CPF) scale. A battery of validated fitness tests for this population was used. Based on the results of the CPF, two variables were created: "advanced physical capacity" (defined as those scoring 24 on the CPF scale) and "moderate (independent) physical capacity," defined as those scoring between 14 and 23 on the CPF scale. Fitness cut-off values were calculated for each of the two created variables to evaluate the risk of losing the independence through Receiver Operating Characteristic (ROC) curves analysis and logistic regression. The developed cut-off points provide important information for professionals working directly with older adults, to detect the risk of losing functionality and independence.

Sarcopenia and physical independence in older adults: the independent and synergic role of muscle mass and muscle function.

BackgroundThe loss of skeletal muscle mass (MM) or muscle function (MF) alone increases the risk for losing physical independence in older adults. We aimed to examine the independent and synergic associations of low MM and low MF, both criteria of sarcopenia, with the risk for losing projected physical independence in later life (+90 years old).MethodsCross‐sectional analyses were conducted in 3493 non‐institutionalized older adults (1166 males). Physical independence was assessed with a 12‐item composite physical function scale. Logistic regression was used to estimate the odds‐ratio (OR) for being at risk for losing physical independence.ResultsApproximately 30% of the participants were at risk for losing physical independence at 90 years of age. Independent analysis demonstrated that participants with low MM had 1.65 (95%CI: 1.27–2.31) increased odds for being at risk for losing physical independence and participants with low MF had 6.19 (95%CI 5.08–7.53) increased odds for being at risk. Jointly, having a low MM and a low MF increased the risk for losing physical independence to 12.28 (95%CI 7.95 to 18.96).ConclusionsAlthough low MM represents a risk factor for losing physical independence, low MF seems to play a more dominant role in this relationship, with the presence of both sarcopenia criteria representing a substantial risk for losing physical independence in later life.

Fitness but not weight status is associated with projected physical independence in older adults.

Obesity and fitness have been associated with older adults’ physical independence. We aimed to investigate the independent and combined associations of physical fitness and adiposity, assessed by body mass index (BMI) and waist circumference (WC) with the projected ability for physical independence. A total of 3496 non-institutionalized older adults aged 65 and older (1167 male) were included in the analysis. BMI and WC were assessed and categorized according to established criteria. Physical fitness was evaluated with the Senior Fitness Test and individual test results were expressed as Z-scores. Projected ability for physical independence was assessed with the 12-item composite physical function scale. Logistic regression was used to estimate the odds ratio (OR) for being physically dependent. A total of 30.1 % of participants were classified as at risk for losing physical independence at age 90 years. Combined fitness and fatness analysis demonstrated that unfit older adults had increased odds ratio for being physically dependent in all BMI categories (normal: OR = 9.5, 95 %CI = 6.5–13.8; overweight: OR = 6.0, 95 %CI = 4.3–8.3; obese: OR = 6.7, 95 %CI = 4.6–10.0) and all WC categories (normal: OR = 10.4, 95%CI = 6.5–16.8; middle: OR = 6.2, 95 %CI = 4.1–9.3; upper: OR = 7.0, 95 %CI = 4.8–10.0) compared to fit participants that were of normal weight and fit participants with normal WC, respectively. No increased odds ratio was observed for fit participants that had increased BMI or WC. In conclusion, projected physical independence may be enhanced by a normal weight, a normal WC, or an increased physical fitness. Adiposity measures were not associated with physical independence, whereas fitness is independently related to physical independence. Independent of their weight and WC status, unfit older adults are at increased risk for losing physical independence.

The Effects of Exercise on the Physical Fitness of High and Moderate-Low Functioning Older Adult Women.

Introduction. Understanding how exercise affects individuals with varying levels of functional ability will provide further insight into the role of exercise during the aging process. It will also aid in the development of exercise programs that are appropriate for a wider spectrum of older adults. Specifically it was the primary aim of this study to determine and compare the effects of 10 weeks of community-based exercise on the cardiovascular endurance, muscular strength, flexibility, and balance fitness components of older adult women with high and moderate-low levels of physical function. Methods. Participants were placed in either the high functioning (n = 13) or moderate/low functioning (n = 17) groups based on their level of physical functioning. Fitness components were measured by the Senior Fitness Test and physical function was determined by the Composite Physical Function scale. Results. The results of the 3 × 2 mixed ANOVA statistical analysis showed no significant interaction effect for time ⁎ group for any of the six subtests (chair stand, arm curls, 2-minute step, chair sit-and-reach, back scratch, and 6-foot up-and-go) of the SFT. However, the main effect of time was significant for all fitness components and the main effect of group was significant for all fitness components except lower extremity flexibility. Discussion. Community-based exercise programs offering a variety of exercise types to people with varying levels of functional ability can be useful in maintaining or improving fitness and independence. These programs may also be capable of improving the self-efficacy of lower functioning older adults toward performing daily tasks.

Breaking-up sedentary time is associated with impairment in activities of daily living

Identifying modifiable behaviors associated with prevention of activities of daily living (ADL) impairments is vital to implement preventive strategies for independent living in elderly. We aimed to examine the associations between objectively measured breaks in sedentary time with ADL impairments and physical independence. Cross-sectional assessments were carried out in 371 participants (131 male) aged 65–103years from the Portuguese surveillance system of physical activity. Physical activity (PA) and sedentary time (ST) were assessed with accelerometry, and ADL impairments and physical independence with the self-reported 12-item composite physical function scale. Using ROC analyses a cut-off of 7 hourly breaks in sedentary time was identified which maximized the sensitivity and specificity in diagnosing physical dependence. Logistic regression analysis demonstrated that, independently of moderate-to-vigorous PA (MVPA), participants performing ≤7 hourly breaks in sedentary time had 2 to 7 fold increased odds for impairment in 10 of the 12 ADL. When stratifying ADL into basic, instrumental and advanced ADL we verified that less than 7 hourly breaks in sedentary time was associated with a 2 to 5 fold increased odds for impairments and physical dependence, independent of MVPA. No associations were observed between meeting PA guidelines and basic, instrumental, and advanced ADL impairment although time in MVPA was lower in participants showing impairments. In conclusion, the frequency of breaks in sedentary time in older ages is independently associated with lower risk for ADL impairments and physical dependence. Our findings support interventions to encourage older adults to increase overall PA by interrupting sedentary time.

P02.66. Efficacy of acupuncture for fibromyalgia - RCT

Methods Fifty fibromyalgia patients were randomized into two groups based on predetermined eligibility criteria. Experienced acupuncturists provided real or simulated acupuncture two to three times per week to complete ten sessions within four to six weeks. Fibromyalgia Impact Questionnaire (FIQ), Multidimensional Pain Inventory (MPI), Composite Physical Function Scale (CPF) and 30-second chair stand were used to determine the improvements in pain, physical function, and lower body strength, respectively. Data were collected at baseline, at the end of the fifth treatment, at the end of the tenth treatment and at six-month follow up. The study was approved by the local IRB.

Positive Associations Between Physical and Cognitive Performance Measures in Fibromyalgia

Cherry BJ, Zettel-Watson L, Chang JC, Shimizu R, Rutledge DN, Jones CJ. Positive associations between physical and cognitive performance measures in fibromyalgia. Objective To investigate the associations between perceived physical function (self-report) and physical and cognitive performance (objective assessments) in persons with fibromyalgia (FM). Design Correlational study. Setting Exercise testing laboratory in Southern California. Participants Community-residing ambulatory adults meeting the American College of Rheumatology 1990 criteria for FM (N=68; mean age, 59.5y). Interventions Not applicable. Main Outcome Measures Composite Physical Function scale, Senior Fitness Test (3 items), Fullerton Advanced Balance scale, 30-foot walk, Trail Making Test parts A and B, Digit Symbol Substitution Test, a composite score of these 3 cognitive measures, attention/executive function composite, processing speed composite, problem solving, inhibition, and episodic memory composite. Results Hierarchical regression analyses showed that after controlling for age and FM symptoms, better physical performance (based on assessments, not self-report) was associated with higher cognitive function in attention/executive function, processing speed, problem solving, and inhibition. Conclusions Researchers should continue to investigate the relationship between physical and cognitive function in both clinical and nonclinical populations, as well as explore changes across time. Because physical activity has been associated with neural improvements, further research may identify whether particular mechanisms, such as neurogenesis, synaptogenesis, or changes in inflammatory marker levels, are involved.

Impact of Employment and Caregiving Roles on the Well-Being of People with Fibromyalgia Syndrome

ObjectiveThis study examined the associations between social roles [namely, employment and caregiving] and health status, quality of life, physical functioning, and depression in individuals 50+ years of age with and without fibromyalgia syndrome [FMS].MethodsSeventy people with FMS [93 percent female, mean age 60 years] and 76 people without FMS [67 percent female, mean age 68 years] completed questionnaires and assessments, including the Composite Physical Function scale and Beck Depression Inventory-II.ResultsAlthough the FMS group had significantly poorer outcomes overall, roles predicted better outcomes among the FMS group when compared with the non-FMS group. Specifically, linear regressions revealed that, for the FMS group, increased roles were positively associated with better health status, quality of life, and physical functioning, as well as fewer depression symptoms. For the non-FMS group, number of roles was positively linked with depression and not significantly associated with any of the ot...

Physical Performance as a Predictor of Attention and Processing Speed in Fibromyalgia

Cherry BJ, Weiss J, Barakat BK, Rutledge DN, Jones CJ. Physical performance as a predictor of attention and processing speed in fibromyalgia. Objective To explore the associations between physical (both self-report and objective measures) and cognitive function for persons with fibromyalgia (FM). Design Correlational study. Setting An exercise testing laboratory in southern California. Participants Community-residing and functionally independent (not wheelchair-bound) adults meeting the American College of Rheumatology 1990 criteria for FM (N=51) with a mean age of 54 years and no history of stroke. Interventions Not applicable. Main Outcome Measures Composite Physical Function Scale, Fibromyalgia Impact Questionnaire, adapted Trail Making Test parts A (TMT-A) and B (TMT-B), Digit Symbol Substitution Test, a composite index of TMT-A, TMT-B, and Digit Symbol Substitution Test combined, and physical performance assessments. Results Hierarchical regression analyses indicated that better objective physical performance predicted increased cognitive function for TMT-A and the composite cognitive score after controlling for age and symptom burden. That is, as the physical performance level decreased, cognitive performance levels decreased. Conclusions Findings suggest that research is needed to determine whether patterns of physical activity participation, through their effects on physical fitness and performance, can enhance cognitive performance in persons with FM. Physiologic changes in specific brain regions in FM (eg, hippocampus, neural pain regions) suggest that further research is also warranted in determining specific relationships between biomarkers and cognitive performance in persons with FM.

Effects of Topical Essential Oil on Exercise Volume After a 12-Week Exercise Program for Women with Fibromyalgia: A Pilot Study

We determined--in women with fibromyalgia (FM)--effects of essential oils used with a 12-week exercise program on exercise volume, pain, physical performance, and physical function. This was a randomized clinical trial comparing 024 essential oil with sham oil combined with exercise. SETTINGS included community sites in southern California. The study included 20 women randomized to 024 oil, 23 to sham oil. Women were trained in oil application before exercise, at bedtime on exercise days; the 12-week program included weekly group sessions with trained leaders guided by a prerecorded regimen (allowing choice of program level) plus 2 days of home exercise with the recorded regimen. Primary: Exercise volume (number of days exercised multiplied by exercise level--intensity and duration). Secondary: Pain (Brief Pain Inventory), measures of physical performance (30-second chair stands, 6-minute walk, multidimensional balance), and self-reported physical function (Composite Physical Function scale). The average participant was 54 years old, had some college education, was married, Caucasian, and minimally/mildly depressed. There was no significant difference in exercise volume between women using 024 as compared with those using sham oil after 12 weeks (depression as covariate). There were no significant group nor pre- to postexercise changes in pain intensity or interference. There were greater positive changes in 30-second chair stands, 6-minute walk distance, and multidimensional balance scores in the 024 group than in the sham group, but these were not significant. The counterirritant 024 oil was not different from the sham oil in its effect on exercise volume (frequency, exercise level--intensity and duration) for women with FM. It is unknown whether 024 actually decreases local pain when used with exercise. Increases in physical function found, while not significant, may be attributable to the exercise regimen or to the interaction of the oils and exercise regimen.