Exercise For exercise, the basic approach recommended for patients with fibromyalgia is called graded exercise , which uses strength training and regular low-impact aerobic exercise starting at a low level and building to higher intensity and length of time. Both of these types are important for raising the pain threshold, although it may take months for the individual to recognize the benefits. Walking, swimming, water aerobics and using stationary bicycles are typical beginning points in graded exercise. Because of pain, individuals with fibromyalgia are not able to begin at a level that would be considered normal for a healthy person. For example, one program started patients out with two weekly sessions of six minutes each. By week 12, the exercise sessions lasted 25 minutes each. This gradual approach is necessary because patients who try strenuous exercise too early have an increase in pain, leading them to be discouraged about exercise and to stop doing it. Individuals should do stretching exercises for about 10 minutes before they begin aerobic exercise.
Cognitive behavior therapy Cognitive therapy should be aimed at strengthening the individual’s belief in his or her abilities and teaching ways of dealing with stressful situations. A major goal is to change any self-defeating behaviors that individuals may have. Using assigned tasks and self-observation, patients gradually drop the perceptions that they are helpless against the pain that dominates their lives and shift to the perception that pain is only one negative factor in their life and that it can be managed. Such therapy can be provided through individual counseling with a therapist, classes, or self-paced programs available on CDs or through other media. Cognitive therapy is especially important for setting limits, a critical behavior for individuals with fibromyalgia to learn. A cognitive therapy program will typically include activities such as keeping a diary, confronting negative thoughts, setting limits, seeking out pleasurable activities, prioritizing tasks, and accepting relapses. A study conducted by the Touch Research Institute compared the effect of massage therapy to relaxation therapy on sleep, substance P, and pain in patients with fibromyalgia. Over a five- week period, the participants assigned to the massage therapy group reported an increase in the number of sleep hours and a decrease in their sleep movements. In addition, those who received massage therapy had decreased substance P levels, decreased pain, and fewer tender points. 14 Another study compared the effects of massage therapy and transcutaneous electrical stimulation on the subjects’ pain, stiffness, fatigue, sleep patterns, and cortisol levels.15 The individuals received 30-minute therapy sessions twice a week. The study found that those who received massage therapy had lower anxiety and depressed-mood scores. Cortisol levels as measured in the saliva were also lower for the massage therapy group.
Massage
The American College of Rheumatology states that
therapeutic massage to manipulate the muscles and soft tissues of the body may alleviate pain, discomfort, muscle spasms, and stress. 13 In addition, myofascial release therapy, which works on a broader range of muscles, can gently stretch, soften, lengthen, and realign the connective tissue to ease discomfort.
General, whole-body approaches rather than specific interventions are most appropriate for individuals with fibromyalgia. Such approaches could include hydrotherapy and relaxation methods.
PART 4: PARKINSON’S DISEASE
Parkinson’s disease (PD) is a slowly progressive neurologic condition that affects the motor system. The four primary symptoms are tremor, stiffness of the limbs and trunk, slowness of movement, and impaired balance and coordination. As the symptoms worsen, daily activities such as walking and dressing become impaired, and feelings of depression and anxiety are common. PD is the most common of the major movement disorders, a category of conditions characterized by a central nervous system malfunction that results in the muscles not receiving appropriate messages from the brain. The reported prevalence of PD varies, but most estimates put the number of people with the disease in the United States at 1 to 1½ million. Some 50,000 new cases are diagnosed each year, and that number is expected to rise as the population ages, because What is Parkinson’s disease? Parkinson’s disease occurs because of a breakdown in the communication between the brain and the muscles. The chemical dopamine, a neurotransmitter, is manufactured in a deep area of the brain called the substantia nigra . Dopamine stimulates cells in the basal ganglia, a region at the base of the brain that controls muscle movement. Causes The reasons the substantia nigra cells die are unknown. A family history of PD is present in 5–10 percent of patients. 1 The focus of researchers looking into causes for PD has been on genetics and environmental exposures.
PD most often affects people over the age of 50, with the average age of onset at 60 years. The disease affects 1 in 100 people over the age of 60, according to the National Parkinson Foundation. 1 When it affects people before age 40 it is called young-onset Parkinson disease . Of the million-plus people with PD, an estimated 5–10 percent are in this younger age group. Parkinson’s occurs in all races, but it is somewhat more prevalent among Caucasians. It is also occurs slightly more in men than in women. Recent research has shown that massage techniques reduce symptoms of PD. Such research findings do not come as a surprise to those with Parkinson’s disease, many of whom have regularly sought massage as a way to alleviating stiffness and body aches and reducing stress. With PD, for reasons that are as yet unknown, cells in the substantia nigra unexpectedly and prematurely die, thus reducing the production of dopamine. Symptoms of PD appear when about 70–80 percent of the dopamine-producing cells have been destroyed. PD is not a fatal illness, and it has not been shown to shorten people’s lives. In a small number of cases, genetic mutations are responsible for PD. However, these mutations have not been found in most people with the disease, and researchers are reasonably certain that genetics alone do not cause PD.
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Book Code: MTX1323
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