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Cardiac autonomic impairment and chronotropic incompetence in fibromyalgia

Roberta Potenza da Cunha Ribeiro1, Hamilton Roschel12, Guilherme Gianini Artioli12, Thalita Dassouki1, Luiz Augusto Perandini1, Ana Luisa Calich1, Ana Lúcia de Sá Pinto1, Fernanda Rodrigues Lima1, Eloísa Bonfá1 and Bruno Gualano12*

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

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Arthritis Research & Therapy 2011, 13:R190  doi:10.1186/ar3519

Published: 18 November 2011



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.

abnormal heart-rate response; cardiovascular risk; autonomic dysfunction