Supervised and Home Training in Fibromyalgia

Primary outcomes

1. Change in lower body strength

   Time frame: 12-weeks

   30-s chair stand (30CST) test: Sit-to-stand from a chair during 30 seconds (measured in seconds)

2. Change in functional mobility

   Time frame: 12-weeks

   Timed Up and Go (TUG) Test (measured in seconds)

3. Change in Handrigp Strength

   Time frame: 12-weeks

   Handgrip Strength (HGS) test: muscle strength measured with manual dynamometers (Kgf)

4. Change in aerobic capacity

   Time frame: 12-weeks

   2-Minute Step Test (TMST): march in place for 2 minutes, lifting their knees to a height halfway between the iliac crest and the patella.The number of full knee lifts (repetitions) completed in 2 minutes is recorded.

5. Change in lower body flexibility

   Time frame: 12-weeks

   Chair Sit-and-Reach Test: measures lower body flexibility (hamstrings and lower back) in centimeters (cm). It involves sitting on a chair, extending one leg, and reaching toward the toes to assess mobility. The measurement is taken by recording the distance between the fingertips and the toes. Positive score (+): Fingertips go past the toes.Zero score (0): Fingertips touch the toes. Negative score (-): Fingertips fall short of the toes.

   A ruler or tape measure is used to record the exact distance.

6. Change in upper body flexibility

   Time frame: 12-weeks

   Back Scratch Test: measures upper body flexibility, particularly shoulder mobility, in centimeters (cm). It involves reaching one hand over the shoulder and the other behind the back to touch or overlap fingers.

   Positive score (+): Fingers overlap (measured as the overlap distance). Zero score (0): Fingers just touch. Negative score (-): Fingers do not touch (measured as the gap distance).

   A ruler or tape measure is used to record the exact distance.

7. Change in psychological parameters (depression)

   Time frame: 12-weeks

   Beck Depression Inventory (BDI): measures depression severity using a numerical score. It consists of 21 items, each rated on a 4-point scale (0 to 3) based on symptom severity.

   Total score range: 0 to 63 (higher scores indicate more severe depression).

   Interpretation:

   0-13: Minimal depression 14-19: Mild depression 20-28: Moderate depression 29-63: Severe depression

   The final score is obtained by summing the responses.

8. Change in psychological parameters (anxiety).

   Time frame: 12-weeks

   State-Trait Anxiety Inventory (STAI-Y): measures anxiety levels using a numerical score. It consists of 20 items assessing temporary (state) anxiety on a 4-point scale (1 = not at all to 4 = very much so).

   Total score range: 20 to 80 (higher scores indicate greater anxiety).

   Interpretation:

   20-37: Low anxiety 38-44: Moderate anxiety 45-80: High anxiety

   The final score is obtained by summing the responses.

9. Change in psychological parameters (enjoyment).

   Time frame: 12-weeks

   he Physical Activity Enjoyment Scale (PACES) is a self-report questionnaire used to measure an individual's enjoyment of physical activity. It assesses positive and negative feelings related to exercise to evaluate motivation and adherence potential.

   It include 18 items rated on a 7-point Likert scale (from 1 = strongly disagree to 7 = strongly agree). Some items are reverse-scored. After adjusting reverse-scored items, all scores are summed to give a total score ranging from 18 to 126, with higher scores indicating greater enjoyment of physical activity.

   A higher total score suggests a more positive emotional response to exercise, which is often linked to better adherence and motivation.

10. Change in psychological parameters (fear of movement).

    Time frame: 12-weeks

    The TSK is a self-report questionnaire designed to assess fear of movement or re-injury due to physical activity, commonly used in patients with chronic pain.

    Scoring and Interpretation:

    The standard TSK has 17 items, each rated on a 4-point Likert scale (1 = strongly disagree to 4 = strongly agree). Some items are reverse-scored. The total score ranges from 17 to 68, with higher scores indicating greater fear of movement. Scores above 37 often suggest clinically significant kinesiophobia.

11. Change in psychological parameters (anticipated pain).

    Time frame: 12-weeks

    The PCS is a 13-item self-report questionnaire designed to assess exaggerated negative thoughts and feelings related to actual or anticipated pain. It evaluates three components: rumination, magnification, and helplessness.

    Scoring and Interpretation:

    Each item is rated on a 5-point scale (0 = not at all to 4 = all the time), yielding a total score from 0 to 52. Higher scores indicate greater levels of pain catastrophizing, which are associated with increased pain perception, emotional distress, and poorer treatment outcomes.

12. Change in psychological parameters (alexithymia).

    Time frame: 12-weeks

    The TAS-20 is a 20-item self-report questionnaire designed to assess alexithymia, a difficulty in identifying and describing emotions. It measures three dimensions: difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking.

    Scoring and Interpretation:

    Each item is rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). After reverse-scoring appropriate items, the total score ranges from 20 to 100.

    • 51: Non-alexithymic

    52-60: Possible alexithymia

    • 61: Alexithymic Higher scores indicate greater difficulty with emotional awareness and expression.

13. Change in physical activity levels.

    Time frame: 12-weeks

    The GPAQ is a tool developed by the WHO to assess physical activity levels across three domains: work, transport, and leisure. It captures frequency, duration, and intensity of activity, as well as sedentary behavior.

    Scoring and Interpretation:

    Responses are converted into MET-minutes/week (Metabolic Equivalent Tasks) for each domain. Total physical activity is classified into low, moderate, or high levels based on WHO guidelines. Higher MET scores indicate greater physical activity engagement.

14. Change in psychological parameters (pain severity).

    Time frame: 12-weeks

    The BPI is a self-report tool used to assess pain severity and the impact of pain on daily functioning. It evaluates both the intensity of pain and how it interferes with aspects of life such as mood, walking, work, and sleep.

    Scoring and Interpretation:

    Pain severity and interference are each rated on 0-10 scales. Scores are averaged separately for severity and interference:

    Severity: 0 = no pain, 10 = worst possible pain.

    Interference: 0 = no interference, 10 = complete interference. Higher scores indicate more severe pain and greater disruption to daily life.

15. Change in psychological parameters (pain intensity).

    Time frame: 12-weeks

    The NRS is a simple, self-reported tool where individuals rate their current pain intensity on a scale from 0 (no pain) to 10 (worst imaginable pain).

    Scoring and Interpretation:

    Patients select a number that best represents their pain level.

    0: No pain

    1-3: Mild pain

    4-6: Moderate pain

    7-10: Severe pain It's commonly used to monitor pain over time or in response to treatment.

16. Change in psychological parameters (fatigue).

    Time frame: 12-weeks

    The MAF is a self-report tool designed to assess fatigue across multiple dimensions, including severity, distress, impact on daily activities, and timing, over the past week.

    Scoring and Interpretation:

    The MAF includes 16 items, with most rated on a 10-point scale. It yields a Global Fatigue Index (GFI) ranging from 1 to 50, where higher scores indicate greater fatigue. The GFI provides a comprehensive view of how fatigue affects quality of life.

17. Change in psychological parameters (sleep quality).

    Time frame: 12-weeks

    The MOS Sleep Scale consists of 12 items assessing sleep quality, disturbances, and patterns, using a 5-point Likert scale. The scores are summed to produce subscale scores for sleep disturbance, sleep adequacy, and sleep problems. Higher scores on the disturbance subscale indicate greater sleep difficulties, while higher scores on the adequacy subscale suggest better sleep quality. Scores are interpreted based on the overall sleep impact, with higher scores reflecting poorer sleep quality.

18. Change in psychological parameters (psychophysical well-being).

    Time frame: 12-weeks

    The SF-36 consists of 36 items assessing eight health domains: Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health. Responses are scored on a 0-100 scale, with higher scores indicating better health status. Domain scores are then combined to create a Physical Component Summary (PCS) and a Mental Component Summary (MCS), which provide an overall measure of physical and mental well-being.

19. Change in psychological parameters (fibromyalgia impact).

    Time frame: 12-weeks

    The FIQ consists of 21 items, assessing the impact of fibromyalgia on physical functioning, work, pain, fatigue, and sleep. Responses are rated on a scale from 0 to 10, with higher scores indicating greater impairment. The total score ranges from 0 to 100, with higher scores reflecting a greater impact of fibromyalgia on the individual's daily life and well-being.

20. Cahnge in upper body strength

    Time frame: 12-weeks

    The Arm Curl Test measures upper body strength and endurance, typically performed by having participants repeatedly curl a weighted dumbbell (5 pounds for women, 8 pounds for men) for as many repetitions as possible in 30 seconds.

    Scoring and Interpretation: The score is the total number of successful curls completed within 30 seconds. A higher number of curls indicates better upper body strength and endurance. Scores are interpreted based on age and gender norms, with higher scores reflecting better physical fitness.

21. Change in body mass index

    Time frame: 12-weeks

    BMI is calculated by dividing a person's weight in kilograms by their height in meters squared (kg/m²).

    Underweight: BMI < 18.5

    Normal weight: BMI 18.5-24.9

    Overweight: BMI 25-29.9

    Obesity: BMI ≥ 30

    A higher BMI typically indicates an increased risk for health issues related to weight, while a lower BMI may signal malnutrition or underweight.