Friday, January 20, 2012

Cardiac autonomic impairment and chronotropic incompetence in fibromyalgia

Roberta P da Cunha Ribeiro1, Hamilton Roschel1,2, Guilherme G Artioli1,2, Thalita Dassouki1, Luiz A Perandini1, Ana L Calich1, Ana L de Sá Pinto1, Fernanda R Lima1, Eloísa Bonfá1 and Bruno Gualano1,2*:

Corresponding author: Bruno Gualano Author Affiliations 1 Division of Rheumatology, School of Medicine, University of Sao Paulo, Brazil. Av. Dr. Arnaldo, 455, Cerqueira César, Brazil 2 School of Physical Education and Sport, University of Sao Paulo, Brazil. Av. Prof. Mello Moraes, 65, Butantã, Brazil For all author emails, please log on. Arthritis Research & Therapy 2011, 13:R190 doi:10.1186/ar3519

The electronic version of this article is the complete one and can be found online at: Received: 19 May 2011 Revisions received: 25 August 2011 Accepted: 18 November 2011 Published: 18 November 2011 © 2011 da Cunha Ribeiro et al.; licensee BioMed Central Ltd.

This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited


We aimed to gather knowledge on the cardiac autonomic modulation in patients with fibromyalgia (FM) in response to exercise and to investigate whether this population suffers from chronotropic incompetence (CI).

Fourteen women with FM (age: 46 ± 3 years; body mass index (BMI): 26.6 ± 1.4 kg/m2) and 14 gender-, BMI- (25.4 ± 1.3 kg/m2), and age-matched (age: 41 ± 4 years) healthy individuals (CTRL) took part in this cross-sectional study. A treadmill cardiorespiratory test was performed and heart-rate (HR) response during exercise was evaluated by the chronotropic reserve. HR recovery (deltaHRR) was defined as the difference between HR at peak exercise and at both first (deltaHRR1) and second (deltaHRR2) minutes after the exercise test.


FM patients presented lower maximal oxygen consumption (VO2 max) when compared with healthy subjects (22 ± 1 versus CTRL: 32 ± 2 mL/kg/minute, respectively; P < 0.001). Additionally, FM patients presented lower chronotropic reserve (72.5 ± 5 versus CTRL: 106.1 ± 6, P < 0.001), deltaHRR1 (24.5 ± 3 versus CTRL: 32.6 ± 2, P = 0.059) and deltaHRR2 (34.3 ± 4 versus CTRL: 50.8 ± 3, P = 0.002) than their healthy peers. The prevalence of CI was 57.1% among patients with FM.

Patients with FM who undertook a graded exercise test may present CI and delayed HR recovery, both being indicative of cardiac autonomic impairment and higher risk of cardiovascular events and mortality.

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