The purpose of this study was to evaluate and compare the effectiveness of muscle-strengthening exercises (MS) and a walking program (WA) in reducing pain in patients with fibromyalgia. Ninety women, 30-55 years of age, diagnosed with fibromyalgia according to the American College of Rheumatology 1990 criteria, were randomized into 3 groups: WA Group, MS Group, and control group. Pain (visual analog scale) was evaluated as the primary outcome. Physical functioning (Fibromyalgia Impact Questionnaire, FIQ), health-related quality of life (Short-Form 36 Health Survey, SF-36), and use of medication were evaluated as secondary outcomes. Assessments were performed at baseline, 8, 16, and 28 weeks. Intention-to-treat and efficacy analyses were conducted. Sixty-eight patients completed the treatment protocol. All 3 groups showed improvement after the 16-week treatment compared to baseline. At the 28-week follow-up, pain reduction was similar for the WA and MS groups (P = 0.39), but different from the control group (P = 0.01). At the end of the treatment, 80% of subjects in the control group took pain medication, but only 46.7% in the WA and 41.4% in the MS groups. Mean FIQ total scores were lower for the WA and MS groups (P = 0.96) compared with the control group (P < 0.01). Patients in the WA and MS groups reported higher scores (better health status) than controls in almost all SF-36 subscales. MS was as effective as WA in reducing pain regarding all study variables; however, symptoms management during the follow-up period was more efficient in the WA group.

The association of progressive strength training for the quadriceps and the proprioceptive training is effective for the prevention of falls, increasing the muscle power, the static and dynamic balance and increasing the speed of the motor responses, therefore improving the performance of daily activities.

BACKGROUND: Osteoarthritis of the knee is defined as a progressive disease of the synovial joints and is characterized by failure of joint damage repair. The objective here was to compare the effectiveness of sensory-motor training versus resistance training among patients with knee osteoarthritis. DESIGN AND SETTING: Randomized, single-blinded controlled trial conducted at the outpatient service of the University of Santo Amaro. METHODS: A total of 64 patients were randomly assigned to sensory-motor training or resistance training. The evaluations were performed at baseline and 16 weeks after the intervention and included pain evaluation on a visual analogue scale, isometric quadriceps femoris force measurement using a dynamometer, Timed Up and Go test, Tinetti balance scale, Western Ontario and McMaster Universities osteoarthritis index, and the SF-36 quality-of-life questionnaire. Data analysis was performed using analysis of variance with repeated measurements and Cohen’s effect size. RESULTS: Sensory-motor training may be a plausible alternative and showed a small effect on pain and a medium effect on maximal voluntary isometric contraction. Resistance training showed a small effect on balance and a medium effect on mobility. CONCLUSION: Resistance training and sensory motor training for the lower limbs among patients with knee osteoarthritis seemed to present similar effects on pain and function. However, because there was a considerable risk of type 2 error, further randomized clinical trials are still needed to provide a sound conclusion.

BackgroundSleep deprivation contributes to many abnormalities: immune system deficiencies, pain, fatigue and impaired quality of life. About 54-70% of patients with rheumatoid arthritis (RA) have sleep complaints and this can influence the control of disease activity [1,2].ObjectivesPrimary objective was to evaluate the influence of the level of RA activity on objective variables measured by by polysomnography (PSG). Secondary objective was to evaluate the correlation of the quality of sleep, evaluated subjectively by the Pittsburgh Sleep Quality Index (PSQI), with common complaints such as pain, depression and functional capacity.MethodsWomen with a diagnosis of RA according to the ACR/EULAR 2010 criteria and sleep quality complaints (PSQI >5) were submitted to whole-night PSG in a sleep laboratory [3]. Disease Activity Score (DAS28) was also used in the evaluation of RA and the women were divided in two groups: DAS28 <3.2 (group A) and the other with DAS28 ≥3.2 (group B). Pain (by the visual analogue scale, VAS), depression (evaluated using the Beck Depression Inventory, BDI), and functional capacity (by the Timed Up & Go Test, TUG).The generalized linear model (GLM) test was used to compare the variables between groups. Pearson correlation was calculated. Statistical analysis considered α ≤0.05.ResultsIn the study period, 43 women were evaluated. Group A (DAS28: 2.23±0.62 mm/h) had 16 participants and was aged 54.75±7.05 years. Group B (DAS28: 4.38±0.84 mm/h) had 27 women aged 54.37±7.17 years. Both groups had a low sleep efficiency (78.76±8.47 and 78.14±13.33; p=0.87) and superficial sleep (> %N1): 10.09±4.32 versus 9.58±4.63 (p=0.72). Both had also a short period of REM sleep (16.41±7.13 versus 16.98±5.65; p=0.77). Group B had a higher wake after onset sleep (A: 67.79±33.49 versus B: 74.17±50.02; p=0.65) and higher arousal index (A: 13.21±7.04 events/h versus B: 17.75±29.16 events/h; p=0.54) and higher apnea-hypopnea index (A: 4.61±5.45 events/hour e B: 11.27±12.82 events/hour; p=0.05). A significant correlation was found between PSQI and pain (r =0.43; p=0.004) and a positive correlation with TUG (r =0.33; p=0.03) e BDI results (r =0.60; p=0.001).ConclusionsWomen with higher DAS28 tend to have a higher frequency of sleep disorders, impaired quality of life, function and more depression, which clearly demonstrates the extent of the impairment caused by RA.ReferencesIber C, Ancoli-Israel S, Chesson A, Quan S. for the American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 1st ed. Westchester, IL: American Academy of Sleep Medicine; 2007Disclosure of InterestNone declared