Fibromyalgia (FM) is a chronic and complex condition that significantly impacts the quality of life of affected individuals. Multicomponent treatments have been established as the gold standard, but the complexity of FM highlights the need to develop new therapeutic strategies that improve both clinical symptoms and the emotional well-being of patients. Likewise, it is essential to investigate whether these interventions can contribute to regulating the altered levels of biomarkers associated with this condition and to analyze the predictive value of these biomarkers in clinical response. This thesis, structured as a compilation of publications, includes two main studies. The first article presents the protocol of the On&Out study, which establishes the methodological basis for evaluating the multicomponent intervention FIBROWALK, both in online format (FIBRO-On) and outdoor format (FIBRO-Out), compared to usual treatment (UT). The second article focuses on the empirical results of a sub-study exploring the short-term effects of both therapy formats on clinical variables, immunoinflammatory biomarkers, and brain-derived neurotrophic factor (BDNF), as well as the predictive capacity of these biomarkers in relation to therapeutic response. To assess the effects of the intervention, measurements were taken at baseline and at 12 weeks (post-intervention), analyzing clinical variables such as functional impact, pain, fatigue, depressive and anxiety symptoms, kinesiophobia, and physical function. Additionally, immunoinflammatory biomarkers (IL-6, CXCL8, IL-17A, IL-4, IL-10, high-sensitivity C-reactive protein) were measured in serum, along with BDNF levels in a sample of 120 participants (40 per group). The results indicated that both FIBRO-On and FIBRO-Out were effective in improving functional impact and reducing kinesiophobia compared to UT. Additionally, the FIBRO-Out group experienced a significant decrease in pain, fatigue, depressive symptoms, and levels of IL-6 and IL-10, as well as a reduction in the IL-6/IL-4 ratio. In contrast, FIBRO-On only showed a less pronounced increase in IL-6 compared to UT. Moreover, it was observed that an initial pro-inflammatory profile combined with high BDNF levels predicts a better clinical response in both intervention formats. These findings highlight that FIBRO-On and FIBRO-Out are effective therapeutic strategies for improving symptoms and modulating biomarkers in individuals with FM. However, aspects for optimization are suggested, such as the need to personalize the online intervention, incorporate more relevant biomarkers, and assess the long-term persistence of effects to determine whether the results are maintained. In conclusion, both the protocol and the empirical results presented in this thesis could contribute to expanding knowledge about FM and opening new lines of research to improve therapeutic interventions in this field.
Efectes immunoinflamatoris del programa FIBROWALK en format online o outdoor en fibromiàlgia: un assaig controlat aleatoritzat
Ferres Puigdevall, S. (Author). 18 Jun 2025
Student thesis: Doctoral thesis
Student thesis: Doctoral thesis