Fibromyalgia and Activity

Mental Activity

Zachowanie prawidłowej aktywności umysłowej w fibromialgii jest niezwykle ważne. W przebiegu fibromialgii u niektórych chorych dochodzi do zaburzeń funkcji poznawczych.

"I can deal with the pain, but the memory and thinking problems really worry me."
"The physical symptoms weren't as frightening as the memory problems."
"The most devastating effect for me has been the cognitive impairment."

If you have fibromyalgia (FM), then these quotes may describe what you have felt as well. Many FM patients complain of cognitive (or mental) symptoms such as memory failures (both long-term and short-term), difficulties with attention, and with finding the right words. Our research focuses on these cognitive problems in FM patients.

Our research shows that there really is cognitive dysfunction in FM patients. This is important because even though FM patients report cognitive symptoms, physicians and scientists must consider the possibility that because FM patients experience many symptoms, there may be a tendency to mistake normal, everyday lapses on cognition as something more serious. However, we have found that FM patients perform more poorly than age- and education-matched controls on tests of several different types of cognitive function. For example, FM patients could recall fewer words when given a list of words to remember and recall later. FM patients also performed more poorly on a test of working memory. Working memory refers to your ability to hold something in mind briefly while you use that information for some other mental process. It is your mental desktop. Multiplying large numbers in your head is a good example of a task that uses working memory. In addition, FM patients had lower scores on vocabulary tests, and had lower scores on a verbal fluency test. In the verbal fluency task, people are shown a letter and are asked to write down as many words as they can think of that start with that letter. It tests how quickly you can access your stored knowledge of words. Thus, our results show that FM patients do indeed have some cognitive dysfunction.

In fact, the cognitive performance of FM patients was equivalent to that of adults who were twenty years older than the FM patients on several of our tests. Moreover, the FM performance and that of the older adults was worse when compared to control subjects the same age, gender, and education level as the FM patients. Our research on aging shows that memory declines reliably every decade, and our results with FM patients suggest that FM patients were cognitively twenty years older in their performance on some tasks.

However, there was one key difference between the FM patients and the older controls. Older adults are typically slower than young adults on cognitive tests that measure how rapidly they process information. This slow processing explains many other symptoms of cognitive aging. But the FM patients were faster than the older adults, and in fact, were just as fast as the younger, age-matched controls. So although FM patients may perform similarly to older adults on some cognitive tasks, the underlying cause is not likely the same.

Professional Activity

If you have fibromyalgia, you probably have to work with a number of different therapists in order to keep your symptoms under control. This is rather normal, and nothing to be alarmed about. One of the therapists that you may be referred to is called an occupational therapist. What do these therapists do for you? How can they help you with the symptoms and what techniques do they use to allow you to live your life the way you want to live it? Let’s take a look here.

What is Occupational Therapy?

Occupational therapy, in short, is a type of therapy that helps people to be able to do everything that they need to do. It’s not just about exercise and flexibility – it’s about helping people to determine the best way for them to continue with your daily tasks. If you have issues with your hands and feel that you won’t be able to open up your jacket or button your pants, they can help you learn how to use your hands better or show you modified ways to do those things.

If you can’t be on your feet for a long period of time and you need to clean your home or do other tasks that involve being on your feet, occupational therapy can give you assistance in learning new ways to do so. Work is another area where occupational therapy shines. This may seem obvious, because the word “occupational” insinuates work. But they will come into the place that you work and see what you do. If there is anything that seems to be a struggle for you or you need some additional assistance with, the occupational therapist will take the time to help you figure out the best way to go about adjusting your workload and such.

The point is to help you stay at work, instead of allowing whatever is ailing you to push you out of work. So, if you have to make adjustments, you can learn how to do them, and you can work with your employer in order to ensure that you have what you need in order to succeed in the workplace. A diagnosis doesn’t have to be a retirement notice. There is an emotional end to occupational therapy as well. Sometimes, problems with physical health, aging, and other life events can make it difficult for you to function in a healthy manner. You know how upsetting and frustrating it can be to deal with your pain, and mental health struggles are a common side effect of disorders like chronic fatigue and fibromyalgia, so it’s a great thing to be able to deal with those issues in a healthy manner. Occupational therapy can help in a variety of other ways as well – it’s about helping the whole person and making sure that they are able to live a happy and fulfilling life, even if you’re dealing with pain and disability.

What can I gain from Occupational Therapy?

First off, as someone with fibromyalgia, they’re going to sit down with you and figure out some sort of plan. This plan could be any number of things, but it will include ways for you to adjust your lifestyle so that fibromyalgia doesn’t cause you more problems than it needs to. If the fibromyalgia is affecting areas of your body like your knees and legs, for example, an occupational therapist may suggest things like mobile chairs and stair lifts in order to help you get from one area of your home to the other. If it’s becoming hard for you to bend over, or it causes you more pain to do so, you can rearrange your home or your workspace in order to accommodate you a lot better. It’s all about helping you adjust while empowering you.

Then, they may sit down and talk to you about your mental symptoms. Is fibro fog an issue for you? Then they may help you to get in touch with resources that can help improve your memory and reduce the amount of fibro fog that you’re dealing with. They may get you access to puzzles and other fun activities that will grant you entertainment while allowing you to use your mind. If you’re having memory issues, they may teach you ways to remember more easily, or give you tips on improving your memory. As the patient, you’re in control, but they will help you determine the right path for these treatments. All in all, your occupational therapist will become an important part of your life. They will come and work with you on a regular basis, which you will have already outlined during the initial few meetings with them. They will come and assist you with certain tasks and, if you see any changes in your pain or stress, they will help to modify your program so that it better fits your current circumstances.

Occupational therapy is very flexible and flows with you and your specific needs, making it a wonderful addition to any therapeutic plan or setup you have in place. An occupational therapist can be a huge asset to your treatment team, especially if you’ve found that you’ve been debilitated by some of your fibromyalgia symptoms. Your doctor can direct you toward an occupational therapist if you are in need of assistance from one. There are usually a number of them in the area, because they are usually working with older adults in nursing homes and such, so finding one should be a simple task. On top of that, your insurance should also cover their assistance if your doctor states that you are in need of help from one.

Recommended Books
Occupational Therapy in Community-Based PracticeWillard and Spackman's Occupational TherapyDocumenting Occupational Therapy PracticeIntroduction to Occupational Therapy

Physical Activity

According to the 2012 Canadian Guidelines for Management of FMS, regular physical activity should form the cornerstone of treatment, and this approach received the highest grade of recommendation.

The Ottawa Panel Evidence-Based Clinical Practice Guidelines for the Management of FMS recommend both aerobic exercises and strengthening exercises.5,6 The Ottawa panel review included 16 studies of a variety of aerobic fitness interventions.5 These aerobic exercise interventions were found to result in improvements in a variety of outcomes, including: pain relief, psychological well-being, endurance, anxiety, self-efficacy, depression, quality of life, muscle strength, cardio respiratory fitness, physician general awareness and flexibility.

The Ottawa Panel, in a review of five selected randomized controlled trials, also found that strengthening exercises resulted in clinical benefits in muscle strength, pain relief, physical disability, depression and quality of life at end of treatment at 12 weeks.6

Similarly, a study by García-Martínez et al compared 12 women with FMS who completed a 12-week program of combined aerobic, strength and flexibility exercise with a usual care control group.7 They found the exercise program was effective in improving functional capacity and psychological status. Plus, subjects in the exercise group experienced benefits in self-esteem and self-concept, which were related to gains in health-related quality of life.

Due to the nature of FMS, individuals with this condition are generally less physically active, having lower perceived functional ability, and demonstrate impaired functional performance.1,8 The main reason for reduced fitness in individuals with FMS is thought to be their lowered overall activity level.9 However, an exercise approach that is too vigorous will result in increased pain and fatigue for individuals with FMS. Therefore, to gain optimal benefits from exercise and ensure long-term adherence, care must be taken to prevent exercise-related pain and discomfort and adverse effects related to exercise such as musculoskeletal injury and fatigue.1 A carefully graded, individualized and gradual intensity progression for deconditioned individuals with fibromyalgia toward “moderate” intensity is recommended.

Due to patients’ complaints of pain and fatigue, finding the correct dosage of exercise and ensuring adherence can be clinically challenging. Many patients will benefit from close monitoring and supervision from healthcare professionals, such as physical therapists.

Strengthening programs should begin with lower resistance than age-predicted norms.1 Busch et al recommend the intensity and duration of exercise sessions should be reduced when significant post-exertion pain or fatigue is experienced and the intensity increased by 10% after two weeks of exercise without exacerbating symptoms.1

To facilitate adherence, exercise of the patient’s choice is encouraged and should be adjusted according to the individual’s ability. This may be an aerobic, strengthening, water, home-based or group program, depending on availability to an individual patient.4 Self-efficacy is important for adherence and may be facilitated in group exercise sessions to provide support and motivation.

Aquatic Physical Therapy

Aquatic therapy is a commonly used treatment technique for individuals with FMS. A systematic review by Lima et al found that aquatic physical therapy resulted in an improvement in quality of life, physical function and stiffness when compared with no treatment after 20 weeks. However, when comparing aquatic vs. land physical therapy, there were no significant differences noted in pain or depression.10

When prescribing an aquatic therapy program, a number of different factors must be included to achieve the best results for the patient. The temperature should not exceed 30ºC when performing aerobic activities, such as running in water.10 However, because warm water has many favorable effects for individuals with FMS, exercises, such as stretching, mobility and strengthening, that do not have a strong aerobic component that would result in the patient overheating, should be performed at greater than 32ºC.

Busch et al concluded that although land- and water-based exercises may have similar outcomes based on some measures, exercising in water may be preferable to land-based exercise for individuals who are severely deconditioned or who have high levels of pain.

Multimodal Approach

To maximize outcomes, a multimodal approach tailored to each individual patient’s needs should be used. Physical therapy for patients with FMS should include education, aerobic exercise and strengthening exercise. Although not as strongly supported in the literature, patients with FMS may also benefit from manual therapy techniques, such as joint, soft tissue and myofascial mobilization.

Physical therapy interventions should be individualized to each patient’s needs, as determined by a thorough history and clinical examination. Nijs et al also recommend that patients be educated about the nature of their symptoms and illness and that education be used to introduce and implement various other treatment options, such as activity management and stress management.

Bourgault et al recently studied the effects of a program that combined exercise therapy and educational/psychological tools for self-management of FMS. Twenty-three patients received intervention and were compared with 20 patients on a wait list. Patient empower­ment and active patient participation were integral components of the intervention, teaching patients to self-manage their illness and to take control over their pain management. Results after 11 weeks of treatment indicated that this interdisciplinary self-management intervention for FMS was effective in improving the patients’ global impression of change in terms of pain, functioning and QOL as well as in increasing their perceived pain relief, both at the end of the program and at three months post-intervention.

Martins et al found patients with FMS benefited from a weekly interdisciplinary program (WIP) consisting of educational activities, physical therapy, stretching, ergonomics, posture guidance combined with cognitive-behavioral strategies and approaches to psychosocial and occupational factors.13 The team included a physician, occupational therapist, physiotherapist, social worker and psychologist. The WIP group showed an increase in functional capacity and motivation for exercise, as well as greater control of such symptoms as sleep, anxiety and depression. Depression and anxiety were both decreased in the WIP group compared with the control group, and better sleep patterns were noted in participants in the weekly program.

Holistic Approach

Holistic forms of exercise, such as tai-chi, yoga and Pilates, may be especially beneficial for those with fibromyalgia due to the potential psychosocial and emotional benefits.

Pilates: Pilates is an increasingly popular exercise approach that focuses on improving overall body flexibility and strength, with a strong emphasis on core strength, improved posture and effective breathing techniques, all of which are commonly impaired in patients with FMS. Due to the low-impact nature of Pilates, patients with fatigue may tolerate it better than other forms of aerobic exercise.

Altan et al performed a study in which they compared pain, Fibromyalgia Impact Questionnaire (FIQ) scores, number of tender points, algometric score, chair test and Nottingham Health Profile (NHP) (assessed Quality of Life) for a group that participated in Pilates and a group that performed only a home exercise program. Measurements were taken pretest, immediately post-test (12 weeks), and at a 12-week follow-up (24 weeks). Results showed that in the Pilates group there was an improvement in pain and FIQ at 12 weeks, and FIQ continued to improve at 24 weeks. There was also an improvement in number of tender points, NHP and algorithmic score. The control group, which consisted of a home exercise program, showed no improvement in pain or FIQ at either the 12- or 24-week follow-up. However, there was an improvement in number of tender points and algorithmic score at both 12 and 24 weeks.

Tai-Chi: Tai-chi is a form of exercise that offers low to moderate activity and also contains breathing, relaxation and mental concentration. It’s thought to result in improved balance, coordination, gait, muscle strength and flexibility. A low- to moderate-intensity tai-chi program for 12 weeks has been shown to decrease pain in individuals with FMS after individual sessions and may have a cumulative effect in pain reduction after longer-term participation (longer than 16 weeks).

Social Activity

Supportive social contact is a huge buffer against a chronic illness like fibromyalgia, says Connie O’Reilly, Ph.D., of Beaverton, OR. But couples may have to rethink and recreate a social life based on new realities. On an individual basis, patients may need to consider new pastimes that are fun but don’t drain their energy bank or overwork sore muscles (see the article on New Hobbies).

"Develop new mutual interests," O’Reilly suggests to help couples maintain a social life. "The kind of socializing may be different than it was before the illness." It’s important to continue to make plans, but be sure to have contingency plans for those inevitable disruptions because of pain or fatigue. Be prepared to be flexible with a time or date, or take a rain check.

“You need to try to let go of this idea that you can or should try to prevent someone else from being upset or disappointed,” O’Reilly says. Pushing yourself to meet social commitments will only make your fibromyalgia worse. And it’s also important to let your partner do what he needs to do to achieve his social needs.

“Your job is to engage in good self-care so that you don’t feel jealous or resentful when your partner does choose to go out without you. Your partner’s job is to decide what he needs to do to make certain he takes care of himself,” she says.

“Needs for the couple to socialize together shouldn’t be relegated to the trash heap,” says Don Uslan, M.A., M.B.A., L.M.H.C., a therapist in Seattle, WA. “Couples who are not used to individual socializing may have a very difficult time with this concept. But there aren’t a lot of choices. Either the well spouse learns to do certain things alone or with her own group of friends, so she can meet some social needs and lessen any possible resentment. Or the couple will have to learn to enjoy and accept a less active form of socializing together.”

There are challenges in living with a chronic illness that “good will and good intentions cannot solve on their own,” says Uslan. This is when couples therapy or professional counseling may be needed.

Barbara Suter, Ph.D., a therapist in New York City, says, in addition, an outside support group could act as psychological support for the well spouse to let-off steam or even be a social outlet. And "if time is too limited, perhaps an online group could be an option."

"A couple may be fortunate enough to go for many years before a major challenge strikes. Or it may be early in the relationship," Uslan says. “If you didn’t come down with fibromyalgia, it might have been something else, cardiac problems or severe back pain. The end result is the same. Either both parties are in it for the long haul, or one partner will try to find some way out, usually by blaming the person with the illness for some failure of not living up to the relationship contract. So, if it’s clear that both parties are in it for the long haul, they just need tools and techniques to figure out how to cope."

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