The Role of Aerobic Exercise in Fibromyalgia-A Physiologic Perspective

The incidence of fibromyalgia may be taken as low to moderate. Fibromyalgia is a chronic disorder that is characterized by widespread musculoskeletal pain in association with fatigue and neuropsychiatric disturbances such as impaired attention and concentration, depression, anxiety, poor sleep, and even paresthesias. It is most common in women aged 22-55. The diagnosis can be made in a patient with chronic pain and fatigue for >3 months with normal inflammatory markers such as CRP or ESR.

The precise etiology of fibromyalgia is unknown, but it likely involves abnormal central processing of painful stimuli. Possible contributing factors include physical and emotional stressors. Although exercise can temporarily exacerbate the pain of fibromyalgia, whether gradual incremental aerobic exercise improves function and reduces pain remains a perplexity. This article intends to solve just that. Tricyclic antidepressants and serotonin-norepinephrine reuptake can be considered in patients with severe or refractory symptoms. With endurance training, the physiologic changes that occur in the heart allow for increased maximum cardiac output via an increase in stroke volume without a substantial increase in maximal heart rate (cardiac output = stroke volume*heart rate). To meet the metabolic demands of frequent endurance exercise such as long-distance swimming, walking, cycling, the body gradually increases both red blood cell mass and plasma volume to increase oxygen-carrying capacity. In addition, active skeletal muscles develop local arteriolar vasodilation, which reduces systemic vascular resistance and also improves oxygen uptake. An increase in preload occurs due to increased blood volume and reduced systemic vascular resistance. In response, the left ventricle undergoes eccentric hypertrophy to improve its diastolic filling capacity, allowing it to increase stroke volume proportional to an increase in preload. This will improve blood flow throughout the body, including to the brain in fibromyalgia (sounds logical, doesn’t it).
Cardiovascular exercise gets the heart pumping, the muscles moving, and the brain cells working.

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