Aerobic exercise can improve muscle metabolism and pain through mitochondrial pathways.When comparing different exercise programs, aerobic exercise is capable of modulating the autonomic nervous function of fibromyalgia patients, whereas resistance exercise does not show such effects. A 2022 meta-analysis found that aerobic training showed a high effect size while strength interventions showed moderate effects. Meditative exercise seems preferable for improving sleep, with no differences between resistance, flexibility and aquatic exercise in their favorable effects on fatigue.Despite its benefits, exercise is a challenge for patients with fibromyalgia, due to the chronic fatigue and pain they experience. They perceive it as more effortful than healthy adults. Exercise may intimidate them, in fear that they will be asked to do more than they are capable of. They may also feel that those who recommend or deliver exercise interventions do not fully understand the possible negative impact of exercise on fatigue and pain. This is especially true for non-personalized exercise programs. Adherence is higher when the exercise program is recommended by doctors or supervised by nurses. A recommended approach to a graded exercise program begins with small, frequent exercise periods and builds up from there. In order to reduce pain, it is recommended to use an exercise program of 13 to 24 weeks, with each session lasting 30 to 60 minutes. Aerobic
Aerobic exercise for fibromyalgia patients is the most investigated type of exercise. It includes activities such as walking, jogging, spinning, cycling, dancing and exercising in water.
Hydropneumothorax is defined as the presence of both air and fluid within the pleural space. An upright chest x-ray will show air fluid levels. The horizontal fluid level is usually well defined and extends across the whole length of one of the hemithorax. Signs and symptoms
This can be remembered by the 4 S:
straight line dullness,
shifting dullness,
splash,
sound of coin. Causes
Iatrogenic: Introduction of air during pleural fluid aspiration in effusion
Presence of a gas-forming organism
Thoracic trauma

Diagnosis
Diagnosis can be via CXR. CT is better to outline borders of air fluid levels, however, CT has a greater radiation exposure. Treatment
Treatment includes ICD (intercostal drainage) of fluid and air and treatment of underlying conditions. References


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