Elsevier

Clinical Biomechanics

Volume 60, December 2018, Pages 157-163
Clinical Biomechanics

The influence of balance, physical disability, strength, mechanosensitivity and spinal mobility on physical activity at home, work and leisure time in women with fibromyalgia

https://doi.org/10.1016/j.clinbiomech.2018.10.009Get rights and content

Highlights

  • Women with fibromyalgia showed impaired balance, strength and mechanosensitivity.

  • Fibromyalgia sample had higher disability and activities dependence than controls.

  • Work physical activity was related to the impaired dynamic balance in this sample.

  • Leisure physical activity was associated with age and range of spinal inclination.

Abstract

Background

Fibromyalgia syndrome is a chronic disease consisting of widespread pain, fatigue, sleep disturbances, and cognitive impairments, among other symptoms, which affect daily physical activity. However, the influence of functional status on physical activity involved in leisure, household and work activities has not been researched previously. The main objective was to evaluate balance, strength, spinal mobility, mechanosensitivity and function levels as related factors of physical activity in female with fibromyalgia.

Methods

Thirty-four patients with Fibromyalgia and 22 matched controls were included in a cross-sectional study. Dynamic and static balance, general and daily activities disability, lumbosacral mechanosensitivity, spinal range of motion, lower limb strength, physical activity in leisure, household and work activities were registered. We tested for differences between groups by using independent sample t-tests. The influence of demographics, symptoms and physical outcomes on physical activity was statistically analyzed using bivariate and multivariate regression analyses.

Findings

There was a significant association between leisure-time physical activity scores and age (r = 0.564), spinal flexion (r = 0.512), spinal extension (r = 0.421) and the total range of spinal inclination (r = 0.533). Fifty-eight percent of the variance of leisure-time physical activity was explained by age and range of spinal flexion-extension. Similarly, functional mobility was associated with physical activity at home and work scores (r = 0.459), explaining 21% of its variance.

Interpretation

A higher time spent in leisure, household and work activities was related to higher age, spinal range of motion and lower functional mobility in women with Fibromyalgia. Rehabilitation intervention programs should promote physical activity at home, work and leisure time.

Introduction

Fibromyalgia syndrome (FMS) is a multi-faceted and chronic disease with an unknown aetiology. Clinical symptoms of the disease commonly compromise the autonomy, function and independence of patients with FMS. The most prevalent signs and symptoms in FMS are low back pain, headaches, arthritis diseases, muscle spasms and balance impairment (Bellato et al., 2012; Bennett et al., 2007). Hence, disability produced by FMS may lead to considerable health and social expenditure (Grodman et al., 2011).

Balance involves multiple sensory stimuli for the development of proper neuromuscular activity and for maintaining stability (Horak, 2006). Postural control is also affected in women with FMS, leading to a greater risk and frequency of falls (Jones et al., 2009). The FMS patients have also shown lesser balance confidence and higher risks of falls in comparison with healthy controls; particularly, balance could be affected when patients performed physical activities (i.e. gait) under a cognitive distraction (Jones et al., 2009; Jones et al., 2011). On the other hand, reduced spinal mobility has been linked to a decrease in independency in the elderly and its influence on functional tasks and activities of daily living (Battaglia et al., 2014). Likewise, postural control could be also related to spinal mobility and independence levels in the daily activities in FMS patients. As such, the population with FMS exhibits higher levels of sedentary lifestyles, compromised muscle strength and a reduced functional capacity for carrying out daily, work, and leisure activities, probably due to higher levels of inactivity (Giannotti et al., 2014).

In general, the knowledge of diary level of physical activity in women with FMS remains uncertain (López et al., 2016). To the best of our knowledge, the impact of FMS symptoms and health-function parameters on the physical activity in leisure and domestic tasks has not been studied yet. However, the pilot study conducted by Guymer et al. (2016) with FMS patients showed that the disease impairments have an impact on the ability to work. It is essential to establish physical function levels in everyday activities in these patients, as well as the possible risk factors influencing these levels. Understanding the factors involved in physical activity participation and the barriers to participation is important to maximize intervention effectiveness. Health professionals could implement new evaluation and procedural strategies for patients with FMS, who often find it difficult to adapt to their natural surroundings following a flare-up.

For these reasons, the objectives of the current study are: 1) to evaluate balance, strength, spinal mobility and function levels in the daily activities of female patients diagnosed with fibromyalgia; 2) to determine whether there are differences between a group of women with fibromyalgia and a group of healthy women in terms of these physical condition measurements; 3) to assess the association between these physical health factors and physical activity levels in leisure, home and work activities in women diagnosed with fibromyalgia.

Section snippets

Methods

From a total of 115 women, 56 were distributed in two groups (FMS group and healthy control group), aged between 36 and 75 years. The FMS group included 34 patients diagnosed with FMS, with an age range from 37 to 75 years old, and who were members of Granadina Association of Fibromyalgia and Chronic Fatigue - AGRAFIM (Granada, Spain). The control group included 22 subjects without FMS, matched by BMI and age. The age of this group ranged from 36 to 62 years old. A flow diagram of with the

Sociodemographic and clinical characteristics of the total sample

From a total of 115 women, 56 (48.7%) met the inclusion criteria and were recruited from the AGRAFIM association to participate in the present study. A total of 34 consecutive patients with FMS and 22 non-FMS controls were finally enrolled. The mean (SD) age of the global sample was 51.73 (7.75) years, with a mean (SD) weight of 71.33 (13.78) kg and height of 1.64 (0.08) meters. Both groups were statistically similar in terms of age, weight, height and BMI at baseline (Table 1).

Differences between groups for dynamic and static balance, general and activities of daily living disability, lumbosacral mechanosensitivity, spinal range of motion and lower limbs strength

There were

Discussion

The current study has shown that the group of women diagnosed with FMS showed significant differences between groups (FMS vs healthy control), exhibiting the FMS sample higher disability, lower independence in work-related activities and greater lumbosacral mechanosensitivity than the control group (López et al., 2016; Luciano et al., 2010; Oude Voshaar et al., 2014). The range of motion for spinal extension and quadriceps strength in both lower limbs were found to be better in the group of

Conclusions

Women with FMS exhibited more impaired static and dynamic balance, lower limbs strength and higher lumbosacral mechanosensitivity in comparison with healthy women. The symptoms exhibited by women who suffered FMS greatly seem to entail higher disability and lower independence, especially in work-related activities. In addition, physical activity related to the activities at work was mainly related to the impaired functional mobility in performance an activity which requires cognitive efforts.

Declarations of interest

None.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Acknowledgements

The authors acknowledge to the collaboration of patients and associations involved in this study.

References (40)

  • G. Battaglia et al.

    Changes in spinal range of motion after a flexibility training program in elderly women

    Clin. Interv. Aging

    (2014)
  • E. Bellato et al.

    Fibromyalgia syndrome: etiology, pathogenesis, diagnosis, and treatment

    Pain Res. Treat.

    (2012)
  • R.M. Bennett et al.

    An internet survey of 2,596 people with fibromyalgia

    BMC Musculoskelet. Disord.

    (2007)
  • R.M. Bennett et al.

    Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria

    Arthritis Care Res.

    (2014)
  • K. Berg et al.

    Measuring balance in the elderly: preliminary development of an instrument

    Physiother. Can.

    (1989)
  • M.H. Cardiel et al.

    How to measure health status in rheumatoid arthritis in non-English speaking patients: validation of a Spanish version of the Health Assessment Questionnaire Disability Index (Spanish HAQ-DI)

    Clin. Exp. Rheumatol.

    (1993)
  • J.L. Etnier et al.

    Exercise, fibromyalgia, and fibrofog: a pilot study

    J. Phys. Act. Health

    (2009)
  • E. Giannotti et al.

    Medium-/long-term effects of a specific exercise protocol combined with patient education on spine mobility, chronic fatigue, pain, aerobic fitness and level of disability in fibromyalgia

    Biomed. Res. Int.

    (2014)
  • I. Grodman et al.

    Understanding fibromyalgia and its resultant disability

    Isr. Med. Assoc. J.

    (2011)
  • E.K. Guymer et al.

    Fibromyalgia onset has a high impact on work ability in Australians

    Intern. Med. J.

    (2016)
  • View full text