Physical activity, sedentary time, and exercise: influence on pain, disease impact and health-related quality of life in women with fibromyalgia

  1. Gavilán Carrera, Blanca
Dirigida por:
  1. Manuel Delgado Fernández Director/a
  2. Victor Segura Jimenez Director

Universidad de defensa: Universidad de Granada

Fecha de defensa: 20 de noviembre de 2020

Tribunal:
  1. Pablo Tercedor Sánchez Presidente/a
  2. Irene Cantarero Villanueva Secretario/a
  3. Francisco de Borja Sañudo Corrales Vocal
  4. Cecilia Peñacoba Puente Vocal
  5. Pedro Miguel Ribeiro da Silva Vocal

Tipo: Tesis

Resumen

Fibromyalgia is a chronic condition of unknown etiology, characterized by chronic widespread pain in addition to multiple comorbidities. Fibromyalgia greatly impacts health-related quality of life (HRQoL) and poses a burden for health care system. It is of clinical and public health interest to identify factors associated to a better prognosis of the disease, especially in the form of non-pharmacological therapies. The overall objective of this Doctoral Thesis has been to analyze the influence of physical activity (PA), sedentary time (ST), and exercise on disease impact, pain, and HRQoL in women with fibromyalgia. To address these aims, six studies were conducted in the context of two projects: the al-Ándalus cohort study and the al-Ándalus trial. Project I (studies 1-5) included a total of 407 women with fibromyalgia that were re-evaluated after 2 and 5 years. PA intensity levels (light, moderate, and moderate-to-vigorous [MVPA]) and ST variables (duration and patterns of accumulation of prolonged periods) were measured using triaxial accelerometry. Project II (study 6) included a total of 244 women with fibromyalgia that were quasi-randomized to either land-based exercise (n=80), water-based exercise (n=79) or usual care (n=85) groups. The intervention groups performed multicomponent exercise (including aerobic, muscle-strengthening, and flexibility training) for 24 weeks and participants were assessed at baseline (pre-test), at week 24 (post-test), and at 12-week follow-up. The same outcomes were evaluated in both projects, including: disease impact (Revised Fibromyalgia Impact Questionnaire [FIQR]), pain (algometry, visual analog scale [VAS], pain subscale of FIQR, and pain subscale from 36-item Short-Form Health Survey [SF-36]), and HRQoL (SF-36). The main findings of this Doctoral Thesis suggest that, in women with fibromyalgia: i) higher PA and lower ST are linked to better HRQoL, being ST and MVPA independently associated. Participants meeting the PA recommendations have better HRQoL, ii) Higher levels of total and prolonged ST accumulated in different bout lengths are individually and jointly associated with worse disease impact and HRQoL. These associations were generally independent of MVPA, iii) Replacing 30 minutes of ST with light PA or MVPA in isotemporal substitution models is associated with lower disease impact and better HRQoL, iv) Objectively measured variables (pressure pain threshold, PA, and ST) slightly change towards less favorable values at 2- and 5-year follow-up, while self-reported outcomes (disease impact, pain, and HRQoL) show a trend for improvement over years. Baseline ST or light PA levels do not predict future outcomes and contradictory findings for baseline MVPA are found. Changes in ST (negatively), light PA, and MVPA (positively) predict future pain and HRQoL, v) 24 weeks of land- or water-based multicomponent exercise do not improve overall disease impact. Modest benefits in pain and physical HRQoL (for land-based exercise) and in mental HRQoL (for water-based exercise) are obtained. These improvements are more consistent and persistent for land-based exercise when a fair level of attendance is reached, whereas benefits of exercise in warm water are independent of exercise adherence. The results of this Doctoral Thesis provide greater insights on the influence of PA intensity levels, ST duration and patterns, and multicomponent exercise performed in two settings, in relation to disease impact, pain, and HRQoL in women with fibromyalgia. Future research complementing these findings will enhance our understanding about the preventive and therapeutic value of daily activity and exercise as modifiable health behaviors in this population.