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A popular notion is that of a relentless sympathetic hyperactivity and hyporeactivity based on heart rate variability (<jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content>) analyses and responses to various physiological stimuli. However, some exactly opposite findings suggesting normal\/hypersympathetic reactivity in patients with fibromyalgia do exist. This heterogeneous picture along with multiple comorbidities accounts for the quantitative and qualitative differences in the degree of dysautonomia present in patients with<jats:styled-content style=\"fixed-case\">FM<\/jats:styled-content>. We contend that<jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content>changes in fibromyalgia may not actually represent increased cardiac sympathetic tone. Normal muscle sympathetic nerve activity (<jats:styled-content style=\"fixed-case\">MSNA<\/jats:styled-content>) and normal autonomic reactivity tests in patients with fibromyalgia suggest defective vascular end organ in fibromyalgia. Previously, we proposed a model linking deconditioning with physical inactivity resulting from widespread pain in patients with fibromyalgia. Deconditioning also modulates the autonomic nervous system (high sympathetic tone and a low parasympathetic tone). A high peripheral sympathetic tone causes regional ischaemia, which in turn results in widespread pain. Thus, vascular dysregulation and hypoperfusion in patients with<jats:styled-content style=\"fixed-case\">FM<\/jats:styled-content>give rise to ischaemic pain leading to physical inactivity. Microvascular abnormalities are also found in patients with<jats:styled-content style=\"fixed-case\">FM<\/jats:styled-content>. Therapeutic interventions (e.g. exercise) that result in vasodilatation and favourable autonomic alterations have proven to be effective. In this review, we focus on the vascular end organ in patients with fibromyalgia in particular and its modulation by exercise in general.<\/jats:p>","DOI":"10.1111\/cpf.12000","type":"journal-article","created":{"date-parts":[[2012,11,5]],"date-time":"2012-11-05T05:16:06Z","timestamp":1352092566000},"page":"83-91","source":"Crossref","is-referenced-by-count":54,"title":["Autonomic nervous system profile in fibromyalgia patients and its modulation by exercise: a mini review"],"prefix":"10.1111","volume":"33","author":[{"given":"Poorvi","family":"Kulshreshtha","sequence":"first","affiliation":[{"name":"Department of Physiology Kalinga Institute of Medical Sciences KIIT University Bhubaneswar Odisha India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kishore K.","family":"Deepak","sequence":"additional","affiliation":[{"name":"Department of Physiology All India Institute of Medical Sciences New Delhi 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