600 Training & Testing Segura-Jiménez V et al. A Warm Water Pool-Based … Int J Sports Med 2013; 34: 600–605 accepted after revision October 14, 2012 Bibliography DOI http://dx.doi.org/ 10.1055/s-0032-1329991 Published online: December 20, 2012 Int J Sports Med 2013; 34: 600–605 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0172-4622 Correspondence Víctor Segura-Jiménez, BSc Department of Physical Activity and Sports University of Granada Carretera de Alfacar, s/n. 18011 Granada Spain Tel.: + 34/958/244 375 Fax: + 34/958/244 369 vsegura@ugr.es Key words ● ▶ immediate pain ● ▶ fibromyalgia ● ▶ women ● ▶ exercise therapy ● ▶ pool-based ● ▶ warm water A Warm Water Pool-Based Exercise Program Decreases Immediate Pain in Female Fibromyalgia Patients: Uncontrolled Clinical Trial increase of nitric oxide synthesis activity and reduced arginase activity in FM patients, which may be due to increased cyclooxygenase enzyme activity and oxidant/antioxidant imbalance [13]. Nitric oxide is an important transmitter in pain pathways [13]. Pain and fatigue significantly impair health related quality of life [44]. Additionally, pain has been identified as one of the most characteristic symptoms in FM patients [2, 4]. Moreover, there is an inverse association between pain and functional capacity levels in this population [11]. Physical activity plays a role in balancing these processes. Physically active FM patients appear to maintain their ability to modulate pain while those who are less active do not [29]. Although FM patients usually associate isometric muscle activity [22] and physical activity with greater pain and fatigue than healthy people [16], there is controversy about the absence [22] or presence [23] of significant changes in pressure pain thresholds before and after the static muscle activity. Some studies showed that pool exercise improves health status and chronic widespread pain in FM patients [27, 43]. Hydrotherapy (with Introduction ▼ Fibromyalgia (FM) is a chronic disease character- ized by musculoskeletal pain, as well as the pres- ence of multiple locations of tender points (TP) [45, 46]. The most prominent symptoms include fatigue, muscle stiffness, sleep disturbances, muscle pain and memory and cognitive difficul- ties [1, 37, 46]. Treatment of FM is a complicated and controversial process, but a wide range of effective pharmacological [42], cognitive behav- ioural [12] and exercise-based interventions [17] are available. Exercise therapy in FM patients has been usually focused on either pool and/or land- based exercises [9, 10, 18, 21, 30, 36]. There is a mounting evidence of central pain processing abnormalities in almost all FM patients [38,39]. These anomalies include hyperalgesia, allo- dynia, abnormal temporal summation of second pain, neuroendocrine abnormalities, and abnormal activation of pain-related brain regions [39]. FM syndrome seems to share similar characteristics with neuropathic pain syndromes, including inef- fective response to many analgesics [39]. There is an Authors V. Segura-Jiménez 1 , A. Carbonell-Baeza 1,2 , V. A. Aparicio 1,3 , B. Samos 1 , P. Femia 5 , J. R. Ruiz 1,4 , M. Delgado-Fernández 1 Affiliations 1 Department of Physical Education and Sports, School of Sport Sciences, University of Granada, Granada, Spain 2 Department of Physical Education, School of Sciences Education, University of Cádiz, Cádiz, Spain 3 Department of Physiology, Faculty of Pharmacy, University of Granada, Granada, Spain 4 Unit for Preventive Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden 5 Department of Biostatistics, University of Granada, Granada, Spain Abstract ▼ Fibromyalgia is characterized by chronic and extended musculoskeletal pain. The combination of exercise therapy with the warm water may be an appropriate treatment. However, studies focusing on the analysis of immediate pain during and after an exercise session are rare. This study aimed to determine the immediate changes of a warm water pool-based exercise program (12 weeks) on pain (before vs. after session) in female fibromyalgia patients. 33 Spanish women with fibromyalgia were selected to participate in a 12 weeks (2 sessions/week) low-moderate intensity warm water pool-based program. We assessed pain by means of a Visual Analogue Scale before and after each single session (i. e., 24 sessions). We observed immediate benefits on pain with a mean decrease ~15 % in all sessions, except in the fourth one. There was an association of pain difference (pre-post) session with pain pre ses- sion (p = 0.005; β = 0.097 ± 0.034) and with age (p < 0.001; β = 0.032 ± 0.008). There were no sig- nificant accumulative differences on pain, pre session, post session, and pre-post changes (all p > 0.05). Therefore this study showed that a warm water pool-based exercise program for 12 weeks (2 times/week) led to a positive immediate decrease in level of pain in female patients with fibromyalgia. Improvements were higher in older women and in those with more intense pain. Downloaded by: Universidad de Granada. Copyrighted material.