variable that some of the patients studied may also have co-morbid ME
and CFS in which autonomic dysfunction and exercise are also issues.
Nor do they state whether the patients became obese as a result of
exercise intolerance in which case the number of years the patient has
been ill may also be a variable to consider when sub-grouping
patients. These as well as the issues discussed below may guide future
studies. One of the other problems with Ribeiro et al is the smallness
of the cohort.
Arthritis Res Ther. 2012 Feb 20;14(1):103. [Epub ahead of print]
Autonomic dysfunction in women with fibromyalgia.
Kingsley JD.
Indiana State University, Arena C-23, Terre Haute, IN 47809, USA.
Abstract
ABSTRACT: Fibromyalgia (FM) is an idiopathic disease characterized by
widespread pain and a myriad of symptoms. Symptoms are diverse and
include not only pain but also anxiety, depression, orthostatic
intolerance, and cold intolerance. While the etiology of FM is not
fully understood, data have suggested that FM may stem from
dysfunction of the autonomic nervous system. This dysfunction has been
reported at rest, and after a physiological stressor such as exercise.
However, few studies have examined the responses during exercise. This
novel approach may shed some new light on the effect of exercise in
women with FM.
Discussion: In a recent issue of Arthritis Research & Therapy, Ribeiro
and colleagues [1] present data that lend further support to the
theory that women with fibromyalgia (FM) suffer from autonomic
dysfunction in response to, and during recovery from, acute exercise.
Alterations in autonomic function have been suggested to increase the
risk for cardiovascular events and mortality [2]. While the data are
not fully understood regarding the risk of premature cardiovascular
disease in women with FM specifically, it appears that there is
definitive evidence to support autonomic dysfunction at rest....
...The major findings of this study were relatively novel. The present
study reported that women with FM had a lower oxygen consumption
(VO2max) than healthy controls, which has been reported previously
[3]. More importantly, Ribeiro and colleagues reported that
chronotropic reserve was significantly lower in women with FM than
healthy controls. Furthermore, 57.1% of the women with FM presented
chronotropic incompetence compared to none of the healthy controls.
Lastly, there was a significant reduction in heart rate recovery at 1
minute and 2 minutes after the exercise bout in the women with FM
compared to healthy controls, suggesting an inability of the
parasympathetic system to recover....
...Currently, there are no blood markers for FM. The 'revised'
criterion for diagnosis of FM is based on a widespread pain index and
a symptom severity scale [10]. The issue with the autonomic testing is
that interpretation of the data is non-specific. To further clarify,
it has been suggested that body fat alters autonomic function in an
otherwise healthy individual. In addition, it has also been suggested
that 60% of all women with FM are overweight/obese as determined by
body mass index [11]. While our laboratory has reported autonomic
dysfunction in overweight women (body mass index of 25 to 29.9 kg/m2)
with FM [6,7], no one has assessed autonomic function in lean women
with FM compared to obese women with FM. The paper by Ribeiro and
colleagues also utilized overweight women with FM. However, all of
these data may be influenced by the body composition of the
participants, independent of FM....
In conclusion, while it appears that autonomic dysfunction is
associated with FM at rest, the data regarding responses following an
exercise bout are severely limited. In the article by Ribeiro and
colleagues, only 57% of the participants experienced the inability to
increase heart rate with exercise. In addition, the participants also
had an inability to recover from exercise. Ultimately, the prevalence
of cardiovascular disease in women with FM is unknown. However,
Ribeiro and colleagues and our laboratory suggest that the responses
of the autonomic nervous system to acute exercise, aerobic or
strength, may predispose women with FM to a cardiovascular event
post-exercise. However, at this point in time the consequence of
autonomic dysfunction after exercise on the development of
cardiovascular events is not fully understood. Therefore, more
research needs to focus on autonomic modulation in women with FM after
an acute bout of exercise to elucidate if these responses truly
increase the risk for a cardiovascular event.
PMID: 22353700 [PubMed - as supplied by publisher]
The full editorial can be read here:
http://arthritis-research.com/content/14/1/103
The full study of Cardiac autonomic impairment and chronotropic
incompetence in fibromyalgia - Roberta P da Cunha Ribeiro can be read
here: http://arthritis-research.com/content/13/6/R190
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