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El porcentaje de población mayor se está incrementando en España. El envejecimiento produce una involución de las capacidades físicas, lo que origina un deterioro del estado físico y una reducción de la funcionalidad. Estos hechos condicionan graves problemas de salud pública por la aparición de enfermedades degenerativas con el consiguiente coste económico para su tratamiento. Conforme avanza la edad se produce una pérdida de fuerza de piernas y fuerza de brazos, un descenso no constante del VO2máx y una reducción progresiva no lineal y específica por articulación y movimiento articular de la flexibilidad. Además, en personas mayores los frecuentes trastornos de equilibrio alteran el patrón de la marcha. Y por último se producen modificaciones sustanciales de la composición corporal con disminución de la masa libre de grasa, lo que condiciona un descenso del gasto energético en reposo y el incremento de la masa grasa.

Background The relationship between estimates of total and central body fat with fibromyalgia pain, fatigue and overall impact has not been fully described. We aimed to assess the individual and combined association of body fat (total and central) with pain, fatigue and the overall impact in fibromyalgia women; and to study the possible mediation role of physical fitness in these associations. Methods A total of 486 fibromyalgia women with a mean (standard deviation) age of 52.2 (8.0) years participated. Pain was measured with self-reported measures and algometry, whereas fatigue with the Multidimensional Fatigue Inventory. The impact of fibromyalgia was measured with the Revised Fibromyalgia Impact Questionnaire (FIQR) total score. Total and central body fat were assessed by means of bioelectrical impedance and waist circumference, respectively. The Functional Senior Fitness Test battery and the handgrip strength test were used to assess physical fitness. Results Total and central body fat were positively associated with pain- and fatigue-related measures and the FIQR total score (β from 0.10 to 0.25; all, p

Objective: To examine the association of maternal physical activity before and during pregnancy with academic performance in youth. Methods: This study included 1868 youth (6–18 years) and their mothers. Mothers recalled their physical activity before and during pregnancy. Mothers were categorized into four groups: ‘‘remained active’’, ‘‘became inactive’’, ‘‘became active’’ and ‘‘remained inactive’’. Academic performance was assessed through school records. Results: Boys whose mothers practiced physical activity before or during pregnancy had significantly higher scores in academic performance indicators independently of physical activity, fitness, current body mass index (BMI) and birthweight than those whose mothers did not practice physical activity before or during pregnancy (all p50.05). In addition, boys whose mothers remained active had higher scores in all academic indicators (ranging from +0.358 to +0.543) than boys whose mothers remained inactive. Boys whose mothers remained active had higher scores in Language (score +0.546; 95% CI, 0.150–0.940), average of Math and Language (score +0.468; 95% CI, 0.100–0.836) and grade point average (GPA) (score +0.368; 95% CI, 0.092–0.644) than boys whose mothers became active. Conclusions: Maternal physical activity before and during pregnancy may positively influence youth’s academic performance. Continuing maternal physical activity practice during pregnancy may have greater benefits for youth’s academic performance.

Biodanza is a useful therapy for the fibromyalgia management; however, there is no evidence of its effectiveness on acute pain. The objectives of the present study were: to determine the changes of a 3-month Biodanza program on acute pain severity (before vs. after session) and cumulative pain severity in women with fibromyalgia; and to check the associations of acute pain severity reduction with presession pain severity, body fat percentage, and satisfaction with the session. This was a 3-month low-moderate intensity (rate of perceived exertion around 12, based on a 6-20 point scale) Biodanza intervention study (1 session/week). Twenty-seven women with fibromyalgia (54.2 ± 6.2 years) participated. Pain severity was assessed before and after each single session with a visual analog scale. There were immediate changes in all sessions (p = .001-.028), except in the first, second, and fourth sessions. An overall 16% decrease of acute pain severity before and after each session was noted (mean presession pain vs. postsession pain, 5.8 ± 2.1 vs. 4.9 ± 2.4; respectively). There was an independent association of pain severity reduction (presession-postsession) with presession pain severity (unstandardized coefficient B = .21 ± .05; standardized coefficient β = .25; p .001), body fat percentage (B = -.05 ± .02; β = -.18; p = .003), and satisfaction with the session (B = .40 ± .15; β = .16; p = .007). There was a significant cumulative effect decrease in postsession pain severity (p .001; 95% confidence interval [CI] = -.14, -.05) and presession-postsession pain severity (p = .007; 95% CI = .02, .12) along the 3-month intervention. No significant cumulative effect in presession pain severity was identified (p .05). In conclusion, Biodanza is an alternative therapy that reduced acute pain severity in women with fibromyalgia. The intervention also yielded cumulative pain severity reduction, which were higher in those women with fibromyalgia presenting higher presession pain severity and lower body fat percentage. The satisfaction with the session was also a key factor positively associated with pain reduction.

We aimed to investigate the symptom profiles in subsets of fibromyalgia patients according to the subgroups created from the satisfaction of the 1990 American College of Rheumatology (ACR) diagnostic criteria (1990c) and/or the modified 2010 ACR preliminary diagnostic criteria (m-2010c).A total of 913 (84 men) participants took part in this cross-sectional study. Participants were grouped as follows: i) 285 who did not fulfil any ACR diagnostic criteria (non-fibromyalgia); ii) 73 who fulfilled the 1990c only; iii) 96 who fulfilled the m-2010c only; iv) 459 who fulfilled both ACR diagnostic criteria. Experimental and clinical pain, chronic pain self-efficacy, pain catastrophising, fibromyalgia severity, fatigue, health-related quality of life, depression, state anxiety and physical fitness were assessed by means of several questionnaires and tests.Overall, the differences were consistent across all study outcomes (all, overall p0.001), showing that the subgroup fulfilling both diagnostic criteria had the worst profile of all the subgroups, whereas those fulfilling any diagnostic criteria (non-fibromyalgia participants) had the most favourable results. Furthermore, the subgroup fulfilling the m-2010c only had a worse profile than the subgroup fulfilling the 1990c only, and presented similar but slightly better results than those fulfilling both diagnostic criteria.Our results reinforce the understanding of fibromyalgia as a heterogeneous condition. Subgrouping of fibromyalgia patients is highly recommendable, since these subgroups show diverse clinical pictures and therefore treatment options should be individually tailored to their specific profile. The combination of 1990c and the m-2010c is potentially useful to identify subgroups of fibromyalgia patients.

To characterize the levels of objectively measured time spent in sedentary activities (sedentary time) and physical activities in female patients with fibromyalgia and compare them with the levels in age-matched healthy control women.The study comprised 413 female patients with fibromyalgia (mean ± SD age 51.9 ± 7.4 years) and 188 female control subjects (age 50.9 ± 7.5 years). Sedentary time, the amount of time spent engaged in physical activity, and step counts were measured using triaxial accelerometry. The amounts of time (minutes/day) during which the participants were engaged in sedentary behaviors as well as in physical activity of different intensities (light, moderate, and moderate-to-vigorous) and the step counts were calculated.The amount of time spent in sedentary behavior was longer in patients with fibromyalgia compared with controls (estimated mean ± SEM difference 39 ± 8 minutes/day; P0.001). The patients with fibromyalgia spent less time than controls engaged in light physical activity (mean ± SEM difference -21 ± 7 minutes/day; P = 0.005), moderate physical activity (mean ± SEM difference -17 ± 3 minutes/day; P 0.001), and moderate-to-vigorous physical activity (mean ± SEM difference -19 ± 3 minutes/day; P0.001). The patients with fibromyalgia took fewer steps/day compared with the control subjects (mean ± SEM difference -1,881 ± 262 steps/day; P0.001). Only 20.6% of the patients with fibromyalgia and 46.3% of the control subjects fulfilled the recommendation for 150 minutes/week of moderate-to-vigorous physical activity in bouts of at least 10 minutes/bout (χ(2) = 41.8, P0.001). Similarly, only 16.0% of the patients fulfilled the recommendation for ≥10,000 steps/day compared with 44.7% of the control subjects (χ(2) = 56.8, P0.001). Both the patients and the control subjects were more active (physical activity of all intensities and numbers of steps) on weekdays than on weekend days (all P ≤ 0.001).Female patients with fibromyalgia spent more time in sedentary behaviors and were less physically active than age-matched controls. The low proportions of female patients with fibromyalgia and control subjects who met the physical activity and step count recommendations is worrisome.

This population-based cross-sectional study aimed to characterize the association of different components of physical fitness with pain levels, pain-related catastrophizing, and chronic pain self-efficacy in women with fibromyalgia (FM).A total of 468 women with FM participated. The experience of pain was assessed with different tools (algometry, a numeric rating scale [revised FM impact questionnaire], a visual analog scale, and the bodily pain subscale on the Short Form 36 health survey). We also assessed pain-related catastrophizing and chronic pain self-efficacy. Physical fitness was assessed with performance-based tests (Senior Fitness Test battery and handgrip dynamometry). A standardized composite score was computed for each component of physical fitness (aerobic fitness, muscle strength, flexibility, and motor agility), and their average comprised a clustered global fitness profile.Overall, higher physical fitness was consistently associated with lower levels of pain, lower pain-related catastrophizing, and higher chronic pain self-efficacy (regardless of the pain assessment method and the fitness test evaluated). Muscle strength and flexibility were independently associated with pain (P0.005 for both), and participants with high muscle strength plus high flexibility (combined effect) had the lowest levels of pain in this population. Aerobic fitness and flexibility were independently associated with pain-related catastrophizing (P0.001 for both) and chronic pain self-efficacy (P0.001 for both), and participants with high flexibility plus high aerobic fitness (combined effect) had the best catastrophizing and self-efficacy profiles.Our results suggest that higher physical fitness is associated with lower levels of pain, lower pain-related catastrophizing, and higher chronic pain self-efficacy in women with FM. These results might have implications for future intervention studies in this population.

[Background] The high prevalence of women that do not reach the recommended level of physical activity is worrisome. A sedentary lifestyle has negative consequences on health status and increases health care costs. The main objective of this project is to assess the cost-effectiveness of a primary care-based exercise intervention in perimenopausal women., [Methods/Design] The present study is a Randomized Controlled Trial. A total of 150 eligible women will be recruited and randomly assigned to either a 16-week exercise intervention (3 sessions/week), or to usual care (control) group. The primary outcome measure is the incremental cost-effectiveness ratio. The secondary outcome measures are: i) socio-demographic and clinical information; ii) body composition; iii) dietary patterns; iv) glycaemic and lipid profile; v) physical fitness; vi) physical activity and sedentary behaviour; vii) sleep quality; viii) quality of life, mental health and positive health; ix) menopause symptoms. All outcomes will be assessed at baseline and post intervention. The data will be analysed on an intention-to-treat basis and per protocol. In addition, we will conduct a cost effectiveness analysis from a health system perspective., [Discussion] The intervention designed is feasible and if it proves to be clinically and cost effective, it can be easily transferred to other similar contexts. Consequently, the findings of this project might help the Health Systems to identify strategies for primary prevention and health promotion as well as to reduce health care requirements and costs., This study was supported by the project: “Cost effectiveness of an exercise intervention program in perimenopausal women”. Reference: PI-0667-2013 and funded by the Ministry of Health of the Junta de Andalucía. AS-M (grant number: FPU12/00963) and VS-J (grant number: AP2010-0963) were supported by the Spanish Ministry of Education. ICA-G (grant number: BES-2011-047133) and FE-L (grant number: BES-2014-067612) were supported by the Ministry of Economy and Competitiveness. VAA was also supported by the Andalucía Talent Hub Program launched by the Andalusian Knowledge Agency, co-funded by the European Union’s Seventh Framework Program, Marie Skłodowska-Curie actions (COFUND – Grant Agreement n° 291780) and the Ministry of Economy, Innovation, Science and Employment of the Junta de Andalucía.

The purpose of the current study was to compare physical activity (PA) levels and sedentary time between two accelerometers, the SenseWear Pro3 Armband (SWA) and the Actigraph GT1M, in Spanish female fibromyalgia patients.Patients wore the SWA and the Actigraph for 7 consecutive days. Total minutes/day spent in sedentary, light, moderate and moderate-to-vigorous PA were analysed. The agreement between the SWA and the Actigraph were assessed by using Bland-Altman plots.Total PA, light, moderate, and moderate-vigorous PA levels in total-week, weekdays and weekends were higher (all, p ≤ 0.001), and sedentary time in total-week, weekdays and weekends lower (all, p0.001) for the SWA when compared to the Actigraph. Concordance correlation coefficients between the SWA and the Actigraph ranged from 0.12 to 0.45 and Pearson's correlation coefficients ranged from 0.28 to 0.77. The Bland-Altman plots showed an overall lack of agreement between both methods.The present study showed that the SWA and the Actigraph provide different estimates of PA and sedentary time in Spanish female fibromyalgia patients. Caution must be taken when using different devices and the location on the body must be noted. Our results suggest that the PA levels and sedentary time provided by both devices should be interpreted independently across studies.

To characterize a representative sample of fibromyalgia women based on a set of relevant factors known to be related to this disease. To distinguish specific factors of the disease from other symptoms that might also exist in non-fibromyalgia women. To test whether fibromyalgia affects more severely physical or psychological outcomes.A total of 459 fibromyalgia women vs. 214 non-fibromyalgia (control) women from Southern Spain (Andalusia) took part in this cross-sectional study. Several instruments were used to assess tenderness, impact of fibromyalgia, fatigue, health-related quality of life, mental health, and cognitive performance.Overall, fibromyalgia women showed a worse status in pain, fatigue, health-related quality of life, depression, and anxiety than controls (P0.01). In general, the observed associations presented very large effect sizes (Cohen׳s d from ~1 to ~5.5). No differences between fibromyalgia and controls were observed in cognitive and memory performance, except for delayed recall, but the observed effect size was low (~0.25). The effect size observed for the global physical component (~3.3) was larger than that for the global psychological component (~1.3), all P0.001.Our results reinforce the understanding of fibromyalgia as a polysymptomatic distress condition with pain as its main symptom. Our findings support that fibromyalgia seems to have a greater impact on physical than on psychological outcomes, though both are largely affected.

To characterise the anthropometric and body composition profile of a sample of fibromyalgia women and men from southern Spain and compare them with non-fibromyalgia controls.The cross-sectional study comprised 566 (51.9 ± 8.3 years) fibromyalgia women vs. 249 (49.3 ± 9.9 years) control women; and 24 (47.0 ± 8.4 years) fibromyalgia men vs. 56 (49.7 ± 11.5 years) control men. Body composition and cardiorespiratory fitness were assessed by means of a bioelectric impedanciometer and the 6-minute walk test, respectively.All body composition para-meters (except muscle mass) differed between fibromyalgia and control women (all, p0.01) even after controlling for several key variables (all, p0.05). The effect sizes observed were small-medium. When cardiorespiratory fitness was included as covariate, body composition was no longer different between the women study groups. No differences in body composition were observed between fibromyalgia and control men (all, p0.05). Weight status differed between women groups, with 11% lower normal-weight and 17% higher obesity prevalence for the fibromyalgia women group (p0.001), but not between men groups (p=0.711). Seventy-two percent of the fibromyalgia women and 79% of the fibromyalgia men were overweight-obese. Sixty-one percent of the control women and 83% of the control men were overweight-obese.Obesity is a greater common condition among fibromyalgia women compared to their counterparts from southern Spain, which might be explained by lower levels of cardiorespiratory fitness in fibromyalgia. However, fibromyalgia and control men do not differ on either body composition or weight status, in spite of the lower cardiorespiratory fitness found in the fibromyalgia men group.

[Background] An objective diagnosis of sedentary behaviour as well as of the physical activity and fitness levels in youth and to better understand how lifestyle is associated with cardiovascular disease risk factors and other phenotypes is of clinical and public health interest, and might be informative for developing intervention studies focused on the promotion of physical activity in these population. The aim of this methodological paper is to describe the design and assessment in the UP&DOWN study., [Methods/Design] The UP&DOWN study is a multi-center follow-up design where 2225 Spanish primary and secondary schoolchildren from Cadiz and Madrid, respectively, as well as 110 Spanish adolescents with Down syndrome from Madrid and Toledo were recruited to be assessed. Nine main measurement categories are assessed: i) socio-demographic and early determinants; ii) environmental determinants; iii) physical activity and sedentary behaviour; iv) health-related fitness; v) blood pressure and resting heart rate; vi) mental health; vii) dietary patterns; viii) blood samples; and ix) genetic analysis. During the 3-yr follow-up study, socio-demographic and early determinants, and genetic analysis are only assessed in the first year. Blood sampling is assessed in the first year and the third year (2nd follow-up), and all the other measurements are assessed every year., [Discussion] The findings of the UP&DOWN study may help the Health Information Systems and policy makers to identify the target population for primary prevention and health promotion policies, and to develop and test preventive strategies. Moreover, these data will allow following the trends at population level, as well as to modify/adapt/create new evidence-based physical activity guidelines at national level. The findings will also serve as a scientific platform for interventional studies., This study was supported by the DEP 2010-21662-C04-00 (DEP 2010-21662-C04-01, DEP 2010-21662-C04-02, DEP 2010-21662-C04-03, DEP 2010-21662-C04-04) RYC-2010-05957 grants from the National Plan for Research, Development and Innovation (R + D + i) MICINN.

Background:The use of fitness testing for the identification of women at high-risk of metabolic syndrome (MS), and therefore of cardiovascular disease, is clinically relevant.Objective:The purpose of this study was to determine the ability of a set of physical fitness tests to establish the risk of MS in perimenopausal Moroccan women.Methods:The study comprised 151 women (45–65 years) from the North of Morocco. We used standardized field-based fitness tests to assess cardiorespiratory fitness, muscular strength, flexibility and balance. Fatness was assessed by impedanciometry and anthropometry. We also measured resting heart rate, blood pressure and plasma fasting glucose, total cholesterol, low density lipoprotein (LDL)-cholesterol, high density lipoprotein (HDL)-cholesterol and triglycerides.Results:Women with MS performed worse in most of the fitness tests studied. Among the fitness test studied, the six-minute walk test was the most associated to MS. Receiver operating characteristics curve analyses revealed that the six-minute walk test threshold that best discriminated between the presence and absence of MS was 480.5 m (area under curve (AUC): 0.719, 95% confidence interval (CI): 0.62–0.82; pConclusions:Including cardiorespiratory fitness as a MS risk factor may improve early identification of at-risk Moroccan women. Fitness testing provides useful information and is cheap, easy to perform, and not time-consuming, which makes its use in this specific clinical settings feasible.

To analyse the effect of a 24-week physical training programme in water and on land on women with fibromyalgia.A controlled study was conducted from December 2009 to May 2010. Seventy-two women with fibromyalgia (age: 51.79±7.87 years) were assigned to an exercise group (3 sessions/week, 2 sessions in water, 1 session on land) (n=42) and to a control group (n=30). The variables analysed were: number of tender points, visual analogue scale (VAS) of pain, algometer score, functional capacity (leg strength, hand-grip dynamometry, flexibility, agility, balance, aerobic endurance, heart response), body composition (body mass index, fat mass index, skeletal muscle mass index and percentage of body fat) and psychological variables (Fibromyalgia Impact Questionnaire [FIQ] and Short Form Health Survey 36 [SF-36]).The exercise group improved in the algometer score (p0.001), positive tender points (p=0.005), VAS (p0.001) and FIQ (p0.001). Improvements were also detected in functional capacity (leg strength, p=0.001; hand-grip dynamometry, p=0.001; flexibility, p0.001; balance, p=0.006; 6-minute walk test, p0.001; mean heart rate, p=0.031; maximum heart rate, p0.001 and VO2 max, p0.001). There was a decrease in the percentage of body fat (p=0.040). There was also an improvement in the subscales of the SF-36; vitality (p=0.004), mental health (p=0.001) social role functioning (p=0.020) and general health functioning (p=0.002).The findings of this study show that a 24-week physical training programme (3 sessions/week, of which 2 sessions are in water and 1 session is on land) reduces pain and disease impact and improves functional capacity in women with fibromyalgia.

To evaluate and compare the effectiveness of a 16-week multidisciplinary (exercise plus psychological therapy) and biodanza intervention in women with fibromyalgia.Thirty-eight women with fibromyalgia were distributed to a 16-week multidisciplinary (3-times/week) intervention (n=21) or Biodanza (1-time/week) intervention (n=17). We assessed tender point, body composition, physical fitness and psychological outcomes (Fibromyalgia Impact Questionnaire, the Short-Form Health Survey 36 questionnaire (SF-36), the Hospital Anxiety and Depression Scale, Vanderbilt Pain Management Inventory (VPMI), Rosenberg Self-Esteem Scale and General Self-Efficacy Scale).We observed a significant group*time interaction effect for the scales of SF-36 physical role (P=0.038) and social functioning (P=0.030) and for the passive coping scale in VPMI (P=0.043). Post hoc analysis revealed a significant improvement on social functioning (P=0.030) in the multidisciplinary group whereas it did not change in the Biodanza group. Post hoc analysis revealed a reduction in the use of passive coping (positive) (P less than 0.001) in the multidisciplinary group. There was no significant interaction or time effect in body composition and physical fitness.16 weeks of multidisciplinary intervention induced greater benefits than a Biodanza intervention for social functioning and the use of passive coping strategies in women with fibromyalgia.

Background A discrepancy between subjective (i.e., patients9 perceptions) and objective (i.e., clinical observations) of physical function (PF) has been reported in fibromyalgia (FM). This discordance, with a worse subjective PF than objective PF, may have negative consequences for health-related outcomes such as the ability to pursue valued activities in daily life. Therefore, it seems important to find modifiable factors associated with this discrepancy between objective and subjective PF in FM. Objectives The present cross-sectional study examined 1) the existence of discordance between subjective and objective PF, 2) the independent association of catastrophizing and self-efficacy with subjective and objective PF, and 3) the independent association of catastrophizing and self-efficacy with the discrepancy between subjective and objective PF. Methods A total of 427 FM women filled out the Pain Catastrophizing Scale, Chronic Pain Self-efficacy Scale, and PF subscales of the SF-36 (SF-36-PF) and of the Revised FM Impact Questionnaire (FIQ-R-PF). Objective PF was measured by performance-based tests: the Senior Physical Fitness Test Battery plus handgrip strength test. Subjective and objective PF were transformed to standardized z-scores ([value-mean]/standard deviation; using means and standard deviations of a general population sample, n=230). These scores reflect the deviation of FM patients from the general population in standard deviation units. Results In one-way analysis of variance (ANOVA), subjective PF was poorer than objective PF (P Conclusions Subjective PF is worse than objective PF in FM. High catastrophizing and low self-efficacy are not only independently associated with low subjective and objective PF but also with a greater discordance between subjective and objective PF in FM. Our findings suggest that clinical trials that combine cognitive therapy (focused on increasing subjective PF and self-efficacy and reducing catastrophizing) and physical exercise (focused on enhancing objective PF) have potential to be effective in FM. References Hidding A, et al. J Rheumatol 1994;21(5),818–23. Acknowledgement This study was funded by the Spanish Ministries of Economy and Competitiveness [I+D+I DEP2013–40908-R, I+D+I DEP2010–15639, BES-2014–067612 and BES-2011–047133] and Education [FPU12/00963 and FPU14/12518]. VAA was supported by the Andalucia Talent Hub Program launched by the Andalusian Knowledge Agency, co-funded by the European Union9s Seventh Framework Program, Marie Sklodowska-Curie actions (COFUND – Grant Agreement No. 291780) and the Ministry of Economy, Innovation, Science and Employment of the Junta de Andalucia. Disclosure of Interest None declared

Physical inactivity and sedentary behaviours are considered as risk factors for global mortality and primary contributors to the obesity epidemic. We assessed the psychometric properties and transcultural adaptation into Spanish of the Sedentary Behaviour Questionnaire in fibromyalgia patients.The Spanish version of the Sedentary Behaviour Questionnaire (SBQ-S) was translated and cognitively pretested following cross-cultural adaptation guidelines. Test-retest reliability was evaluated in 114 fibromyalgia patients. Fifty-one participants wore a body monitoring device (SWA) for nine consecutive days and filled the SBQ-S twice (separated by a one-week interval). Measures of sedentary time assessed by the SBQ-S and the SWA were compared.Overall reliability of the SBQS scores was good. The intraclass correlation coefficients were excellent for the SBQ-S total scores (from 0.83 to 0.86), and varied from moderate to excellent for 10 of the 11 sedentary behaviours (from 0.52 to 0.96). There was no significant association between the SBQ-S and the SWA for the weekday, weekend, and total sedentary time (from r -0.06 to -0.03). Differences between the SBQ-S and the SWA increased as the hours per day of sedentary time increased (beta coefficients varied from -0.713 to -0.330, all p0.02).The SBQ-S developed in this study presents a good reliability and poor convergent validity when compared with the SWA in the Spanish fibromyalgia patients studied.

The aim of this study was to assess the psychometric properties and transcultural adaptation into Spanish of the Multidimensional Fatigue Inventory in fibromyalgia patients.The Spanish version of the Multidimensional Fatigue Inventory (MFI-S) was translated and cognitively pretested following cross-cultural adaptation guidelines. Test-retest reliability, convergent validity, and operational qualities were evaluated in a total of 116 fibromyalgia patients. Convergent validity was assessed comparing MFI-S with a visual analogue scale for global fatigue.The intra-class correlation coefficients varied from moderate to excellent (from 0.64 to 0.91) and the standard errors of the mean ranged from 0.5 to 1.1 points for the five MFI-S domains. The coefficient of repeatability was less than 2 standard deviations and the limits of agreement ranged from 2 to 4 points for the MFI-S domains. A weak to fair significant relationship was found between each MFI-S domain and the visual analogue scale (from 0.21 to 0.32). The mean time required to complete the MFI-S was 3.2±2.0 minutes. None of the patients needed external help to complete the MFI-S, and there were very few missing values.The MFI-S developed in this study presents a good reliability and reasonable construct validity for Spanish fibromyalgia patients unaffected by cognitive dysfunction and severe depression. This questionnaire is quick, easy to administer and interpret.

Background: The al-Andalus physical activity intervention study is a randomised control trial to investigate the effectiveness of a land- and water-based exercise intervention for reducing the overall impact of fibromyalgia (primary outcome), and for improving tenderness and pain-related measures, body composition, functional capacity, physical activity and sedentary behaviour, fatigue, sleep quality, health-related quality of life, and cognitive function (secondary outcomes) in women with fibromyalgia. Methods/Design: One hundred eighty women with fibromyalgia (age range: 35-65 years) will be recruited from local associations of fibromyalgia patients in Andalucía (Southern Spain). Patients will be randomly assigned to a usual care (control) group (n = 60), a water-based exercise intervention group (n = 60) or a land-based exercise intervention group (n = 60). Participants in the usual care group will receive general physical activity guidelines and participants allocated in the intervention groups will attend three non-consecutive training sessions (60 min each) per week during 24 weeks. Both exercise interventions will consist of aerobic, muscular strength and flexibility exercises. We will also study the effect of a detraining period (i.e., 12 weeks with no exercise intervention) on the studied variables. Discussion: Our study attempts to reduce the impact of fibromyalgia and improve patients’ health status by implementing two types of exercise interventions. Results from this study will help to assess the efficacy of exercise interventions for the treatment of fibromyalgia. If the interventions would be effective, this study will provide lowcost and feasible alternatives for health professionals in the management of fibromyalgia. Results from the al- Andalus physical activity intervention will help to better understand the potential of regular physical activity for improving the well-being of women with fibromyalgia., This study was supported by the Consejeria de Turismo, Comercio y Deporte (CTCD-201000019242-TRA), the Spanish Ministry of Science and Innovation (I + D + I DEP2010-15639, grants: BES-2009-013442, BES-2011-047133, RYC-2010-05957, RYC-2011-09011), the Swedish Heart-Lung Foundation (20090635), the Spanish Ministry of Education (AP-2009-3173), Granada Research of Excelence Initiative on Biohealth (GREIB), Campus BioTic, University of Granada, Spain and European University of Madrid. Escuela de Estudios Universitarios Real Madrid. 2010/04RM.

Summary Objetive: To analyze the association of weight status with anxiety, depression, quality of life and physical fitness in fibromyalgia (FM) patients. Methods: The sample comprised 175 Spanish female FM patients (51.2 ± 7 years). We assessed quality of life by means of the Short-Form-36 Health Survey (SF36) and anxiety and depression by means of the Hospital Anxiety and Depression Scale (HADS). We used standardized fieldbased fitness tests to assess cardiorespiratory fitness, muscular strength, flexibility, agility, and static and dynamic balance. BMI was calculated and categorized using the international criteria. Results: 33% of the sample was normal-weight, 35% overweight and 33% obese. HADS-anxiety and HADS-depression levels increased across the weight status categories. Obese patients had higher anxiety and depression levels compared to normal-weight patients (p < 0.05) whereas no differences were observed between overweight and obese patients. Physical functioning, bodily pain, general health (all p < 0.01) and mental health (p < 0.05) subscales from the SF36 were worse across the weight status categories. Likewise, levels of cardiorespiratory fitness, dynamic balance/motor agility (both p < 0.05) and upper-body flexibility (p < 0.001) decreased as the weight status increased. Pairwise comparisons showed significant differences mainly between the normal-weight versus obese groups. Conclusion: Obese female FM patients displayed higher levels of anxiety and depression and worse quality of life, cardiorespiratory fitness, dynamic balance/ motor agility and upper-body flexibility than their normal-weight peers.

Background. The purpose was to analyze the effects of Tai-Chi training in women with fibromyalgia (FM). Methods. Thirty-two women with FM (mean age, 5 1 . 4 ± 6 . 8 years) attended to Tai-Chi intervention 3 sessions weekly for 28 weeks. The outcome measures were: tenderness, body composition, functional capacity and psychological outcomes (Fibromyalgia impact questionnaire (FIQ), Short Form Health Survey 36 (SF-36)). Results. Patients showed improvements on pain threshold, total number of tender points and algometer score (all 𝑃 < 0 . 0 0 1 ). The intervention was effective on 6-min walk ( 𝑃 = 0 . 0 0 6 ), back scratch ( 𝑃 = 0 . 0 0 2 ), handgrip strength ( 𝑃 = 0 . 0 0 6 ), chair stand, chair sit & reach, 8 feet up & go and blind flamingo tests (all 𝑃 < 0 . 0 0 1 ). Tai-Chi group improved the FIQ total score ( 𝑃 < 0 . 0 0 1 ) and six subscales: stiffness ( 𝑃 = 0 . 0 0 5 ), pain, fatigue, morning tiredness, anxiety, and depression (all 𝑃 < 0 . 0 0 1 ). The intervention was also effective in six SF-36 subscales: bodily pain ( 𝑃 = 0 . 0 0 3 ), vitality ( 𝑃 = 0 . 0 1 8 ), physical functioning, physical role, general health, and mental health (all 𝑃 < 0 . 0 0 1 ). Conclusions. A 28-week Tai-Chi intervention showed improvements on pain, functional capacity, symptomatology and psychological outcomes in female FM patients.

The study aimed to determine the effects of a 4-month Tai Chi intervention on tenderness, functional capacity, symptomatology, and quality of life in men with fibromyalgia. The effect of a 3-month detraining period was also analyzed. Six men with fibromyalgia (age 52.3 ± 9.3 years) followed a 4-month Tai Chi intervention. The outcome variables were tenderness, functional capacity (30-second chair stand, handgrip strength, chair sit and reach, back scratch, blind flamingo, 8 feet up and go, and 6-minute walk tests), and self-administered questionnaires. A significant improvement ( p = .028) after the intervention period for the chair sit and reach test was found, such improvement was maintained after the detraining phase. Tenderness, symptomatology, and quality of life did not significantly change after the intervention period or the detraining phase. In summary, a 4-month Tai Chi intervention improved lower body flexibility in men with fibromyalgia. This improvement persisted after the detraining period.

The objective of this study was to determine the effects of a 3-month Biodanza intervention in women with fibromyalgia (FM).This was a controlled trial.The study was conducted at a university research laboratory and social center.The study comprised 59 women with FM recruited from a local association of patients with FM. Participants were allocated to the Biodanza intervention group (n = 27) or usual-care group (n = 32).The Biodanza intervention was carried out once a week for 3 months.The outcome measures included the following: Pain threshold, body composition (body-mass index and estimated body fat percentage), physical fitness (30-second chair stand, handgrip strength, chair sit and reach, back scratch, blind flamingo, 8 feet up and go, and 6-minute walk test) and psychologic outcomes (Fibromyalgia Impact Questionnaire [FIQ], Short-Form Health Survey 36, Vanderbilt Pain Management Inventory, Hospital Anxiety and Depression Scale, General Self-Efficacy Scale, and Rosenberg Self-Esteem Scale).We observed a significant interaction effect (group*time) for pain threshold of several tender points (left [L] and right [R] side of the anterior cervical and supraspinatus, trapezius L and lateral epicondyle R, algometer score, tender points count), body fat percentage, and FIQ total score. In the intervention group, post hoc analysis revealed a significant improvement in pain threshold of the anterior cervical R and L and supraspinatus R and L tender points (all p 0.05), algometer score (p = 0.008), tender point count (p = 0.002), body fat percentage (p = 0.001), and FIQ total score (p = 0.003).A 3-month (one session per week) Biodanza intervention shows improvements on pain, body composition, and FM impact in female patients.

The purpose of this study was to examine the relationship between the 6-minute walk test (6-MWT) and tenderness, symptomatology, quality of life, and coping strategies in women with fibromyalgia. One hundred eighteen women with fibromyalgia aged 51.9 ± 7.3 years participated in the study. The examination included the 6-MWT, tender points, and the following questionnaires: Fibromyalgia Impact Questionnaire (FIQ), Short-Form Health Survey 36 (SF-36), and Vanderbilt Pain Management Inventory. Fair correlations between the 6-MWT and the subscales of physical impairment (FIQ) and physical function (SF-36) were observed (ρ -0.365 and 0.347, respectively, both p.001). The 6-MWT showed a weak relationship with tenderness (ρ 0.201 and -0.191 for algometer score and tender points count, respectively, both p.05). The relationship between the 6-MWT and global score of FIQ, and FIQ subscales of pain and fatigue were weak (ρ -0.201, -0.211, and -0.226, respectively, all p.05). The 6-MWT showed a weak relationship with bodily pain and vitality scales of SF-36 (ρ 0.256 and 0.258, respectively, both p = .005) and with passive and active coping strategies (ρ -0.255 and 0.223, both p.05). This study in women with fibromyalgia shows significant relationships, ranging from weak to fair, between the 6-MWT and tenderness, symptomatology, quality of life, and coping strategies. These findings indicate that functional capacity, as assessed by the distance walked in 6 minutes, might be important when planning the assessment, treatment, and monitoring of patients with fibromyalgia.

To describe the anthropometric profile and body composition of women from Southern Spain diagnosed with fibromyalgia (FM) and to compare the observed values with values from other studies conducted on FM patients and with national reference values.The body composition of 104 women diagnosed with FM was assessed using an eight-electrode impedance meter. The reliability of the body composition measurement was tested in a randomly selected sub-sample (n=28). The reliability study showed a test-retest systematic error close to zero in most of the parameters studied.The women with FM who were studied had a mean weight of 71.3±13.4 kg, height of 158±6 cm, body mass index of 28.6±5.1 kg/m(2), body fat mass of 38.6±7.6%, total body water of 31.6±3.8 l and muscle mass of 23.4±3.0 kg. In general, there were no substantial differences in weight and body mass index between women with FM and those analyzed in other Spanish and European studies involving FM patients, nor when they were compared with regional or national reference values. However, the prevalence of obesity in the women with FM under study was 33.7%, a higher figure than that from the national reference data for obesity in similarly aged women (i.e. 26,4%).The results suggest that obesity is a common condition in women diagnosed with FM, its prevalence in this population being higher than the national reference values. This study provides detailed information about the body composition characteristics of women with FM.

Objective: To compare the levels of physical activity (PA) assessed with questionnaires (Leisure Time Physical Activity Instrument [LTPAI], Physical Activity at Home and Work Instrument [PAHWI]) and accelerometry in patients with fibromyalgia; and to analyze the test-retest reliability of these questionnaires. Design: Cross-sectional study. Setting: Local fibromyalgia association. Participants: Participants (NZ99; 5 men) with fibromyalgia with a mean age of 50.2� 9.5 years. Interventions: Not applicable. Main Outcome Measures: Participants carried an accelerometer for 1 week and completed the LTPAI and PAHWI twice (separated by a 1-wk interval). The LTPAI and PAHWI were summed to obtain overall values of PA. Results: Time spent in total, moderate, and moderate-vigorous PA was higher (P

ResumenEl objetivo del presente estudio fue realizar una revisión sistemática de la efectividad de los programas de intervención basados en actividad física (AF) y control dietético sobre el sobrepeso y/u obesidad en población infantil y adolescente. La búsqueda bibliográfica fue realizada en bases de datos electrónicas abarcando el período comprendido entre el 1 de julio de 2006 y el 30 de abril de 2012. Del total de 1.696 estudios encontrados inicialmente, se incluyeron 28 artículos que describieron 23 programas de AF y orientación alimentaria destinados a niños y adolescentes con sobrepeso/obesidad. Diecisiete programas fueron dirigidos a niños y adolescentes y 6 fueron diseñados específicamente para adolescentes. En 10 de los estudios, la condición física (CF) fue adicionalmente valorada. Los resultados parecen señalar que la AF asociada con orientación nutricional produce efectos positivos en la reducción del peso e índice de masa corporal (IMC). Resaltamos la necesidad de diseñar programas específicos para adolescentes, así como valorar objetivamente la eficacia de dichos programas a largo plazo en poblaciones de niños y adolescentes con sobrepeso/obesidad.AbstractThe aim of this study was to realize one systemic review the effectiveness of intervention programs which were based on physical activity (PA) and dietary control of overweight and/or obese children and adolescents. The literature search was conducted in electronic databases covering the time period between July 1th, 2006 to April 30th, 2012. From 1,696 studies initially reviewed, 28 articles describing 23 programs were included. We have included studies with exercise programs and nutritional counseling for overweight and/or obese children and adolescents. Interventions which were excluded were those which involved the use of drugs, studies conducted in adolescents with hormonal disorders and eating disorders, book chapters, conference proceedings and dissertations. Seventeen programs were targeted towards children and adolescents and six were designed specifically for adolescents. In ten studies, the physical fitness (PF) was further assessed. Due the methodological heterogeneity found, these results are insufficient to determine the effectiveness of intervention programs regarding PA and diet. The results seem to indicate that AF associated with nutrition counseling has positive effects on reducing weight and body mass index (BMI). We emphasize the need to design specific programs for adolescents, as well as the as well assess the effectiveness of long term programs in populations of children and adolescents with overweight and obesity.

Obesity may influence fibromyalgia severity. The present study aimed to examine fibromyalgia (FM) symptomatology, quality of life (QoL), and functional capacity across obesity class categories. A total sample of 208 obese FM patients and 108 obese control women were included in the study. The sample was further categorized following the international criteria for obesity classes: obesity I (BMI 30.0–34.99 kg/m2), obesity II (BMI 35.0–39.99 kg/m2), and obesity III (BMI ≥40.0 kg/m2). QoL was assessed by means of the Short-Form-36 Health Survey (SF-36) and FM symptomatology with the Fibromyalgia Impact Questionnaire (FIQ). Standardized field-based fitness tests were used to assess cardiorespiratory fitness, muscular strength, flexibility, agility, and balance. All the dimensions of QoL, as measured by SF-36, were worse in obese FM patients compared to the obese control group (all p < 0.001). Obese FM patients also scored worse in the entire functional capacity tests studied (all p < 0.001). Except for the higher FIQ-depression across obesity status categories (p < 0.05), no differences between obesity status groups were found in QoL and FM impact. However, upper-body muscular strength and cardiorespiratory fitness were worse across obesity class categories and pairwise comparisons showed differences mainly between obesity I and II (p < 0.05, and p < 0.01, respectively). The absence of clear differences in QoL and FM symptomatology among obesity classes suggests that just avoiding any obese status may be a useful advice for a better management of the disease. Nevertheless, upper-body muscular strength and cardiorespiratory fitness, which are important health indicators highly related to the mortality risk, were worse across obesity categories.

Objectives. To examine the validity of self-reported flexibility with International Fitness Scale (IFIS) against upper and lower flexibility in fibromyalgia and healthy women. To study the testretest reliability of the IFIS flexibility item in female fibromyalgia patients. Methods. For validity purpose, the final sample comprised 413 fibromyalgia and195 controlwomen. For the test-retest (one-week interval) reliability purpose, 101 fibromyalgiawomenparticipated. Flexibility level was both self-reported (i.e. IFIS) and performancebased using standard fitness tests (i.e. “chair sit and reach” and “back scratch”). One-way analysis of variance (ANOVA) was used to examine the associations of self-reported flexibility (very poor, poor, average and good/very good) and performance-based flexibility. Post hoc group comparisons were used to assess the differences across categories of self-reported fitness. The testretest reliability of the IFIS was tested with weighted Kappa (k) coefficients. Results. Fibromyalgia women reporting a “poor”, “average” or “good/very good” flexibility on IFIS had better performance-based test resultsonflexibility comparedwith those reporting “verypoor” flexibility level (all p