Fibromyalgia and EDS Comorbidity
Fibromyalgia and EDS Comorbidity Acibadem Healthcare Group, a renowned medical institution, offers expertise in the field of fibromyalgia and EDS comorbidity, providing comprehensive care tailored to individual needs. Let’s delve deeper into understanding fibromyalgia and EDS, the link between these conditions, and the impact they can have on your daily life.
Living with fibromyalgia and EDS comorbidity can be challenging, but it’s important to remember that you’re not alone. Our aim is to equip you with the knowledge and tools necessary to navigate this journey. From strategies for managing chronic pain and joint hypermobility to effective fatigue management and pain relief strategies, we will cover it all.
Stay tuned for the forthcoming sections where we’ll discuss the diagnosis process, treatment options, and explore practical techniques for managing specific symptoms of fibromyalgia and EDS comorbidity. Let’s embark on this journey together towards living a fulfilling life despite the challenges posed by these connective tissue disorders and musculoskeletal conditions.
Understanding Fibromyalgia and EDS
In order to gain a comprehensive understanding of fibromyalgia and EDS, it is important to first examine the individual conditions and their characteristics. Both fibromyalgia and EDS are connective tissue disorders that fall under the umbrella of musculoskeletal conditions.
Fibromyalgia
Fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, and tenderness. It is estimated that approximately 10 million Americans are affected by fibromyalgia, with women being more commonly diagnosed than men. Individuals with fibromyalgia often experience symptoms such as muscle stiffness, sleep disturbances, and cognitive difficulties.
Ehlers-Danlos Syndrome (EDS)
Ehlers-Danlos Syndrome (EDS) is a group of genetic connective tissue disorders that affect the body’s ability to produce collagen. Collagen is a protein that provides strength and elasticity to the skin, joints, and other organs. EDS is characterized by hypermobile joints, skin that is stretchy and fragile, and chronic musculoskeletal pain. There are several subtypes of EDS, each with its own specific symptoms and genetic mutations.
Overall, both fibromyalgia and EDS share common features, such as chronic pain and musculoskeletal abnormalities. However, it is important to note that while fibromyalgia primarily affects the muscles and soft tissues, EDS is primarily a disorder of connective tissues with a broader range of symptoms.
Let’s take a closer look at the key characteristics and symptoms of fibromyalgia and EDS in the table below:
| Fibromyalgia | Ehlers-Danlos Syndrome | |
|---|---|---|
| Characteristics | Chronic musculoskeletal pain | Hypermobile joints, stretchy skin |
| Symptoms | Muscle stiffness, fatigue, cognitive difficulties | Joint dislocations, skin fragility, chronic pain |
| Prevalence | Affects approximately 10 million Americans | Varies depending on subtype |
| Treatment | Pharmacological, non-pharmacological approaches | Individualized treatment plans, symptom management |
By understanding the unique characteristics and symptoms of both fibromyalgia and EDS, individuals and healthcare professionals can better navigate the challenges posed by these conditions and develop effective treatment strategies tailored to the needs of each individual.
The Link Between Fibromyalgia and EDS
Individuals with fibromyalgia and Ehlers-Danlos Syndrome (EDS) often find themselves facing a dual diagnosis that presents unique challenges. These conditions have a complex relationship, as they frequently coexist and can intensify each other’s symptoms. Chronic pain and joint hypermobility are two significant aspects that link fibromyalgia and EDS.
For those with fibromyalgia, the primary symptom is widespread and persistent chronic pain throughout the body. Similarly, individuals with EDS experience joint pain and instability due to joint hypermobility caused by connective tissue abnormalities. When these conditions co-occur, the chronic pain experienced in fibromyalgia can be exacerbated by the joint hypermobility of EDS, leading to more intense and widespread discomfort.
The intricate link between fibromyalgia and EDS goes beyond mere symptom overlap. The underlying mechanisms that contribute to the comorbidity of these conditions involve complex factors such as neurochemical imbalances, hormonal dysregulation, and genetic predisposition. These mechanisms intertwine to create a challenging landscape for individuals dealing with both fibromyalgia and EDS.
To further understand the link between these two conditions, consider the following table:
| Condition | Characteristic |
|---|---|
| Fibromyalgia | Widespread chronic pain throughout the body |
| Ehlers-Danlos Syndrome (EDS) | Joint hypermobility caused by connective tissue abnormalities |
| Comorbidity of Fibromyalgia and EDS | Mutual exacerbation of chronic pain and joint hypermobility |
As the table shows, the comorbidity of fibromyalgia and EDS results in the mutual intensification of key symptoms such as chronic pain and joint hypermobility. This overlap in symptoms underscores the need for comprehensive treatment approaches that address both conditions simultaneously, taking into account the unique challenges posed by their comorbidity.
In the following sections, we will explore various treatment options and strategies to manage these symptoms effectively and improve the quality of life for individuals living with fibromyalgia and EDS comorbidity.
Challenges and Impact of Fibromyalgia and EDS Comorbidity
Living with the comorbidity of fibromyalgia and EDS presents individuals with unique challenges that significantly impact their daily lives. Chronic pain, one of the defining characteristics of both conditions, can be debilitating and severely affect quality of life. The constant presence of pain can make even simple tasks difficult and lead to a sense of frustration and helplessness.
In addition to chronic pain, another common symptom experienced by individuals with fibromyalgia and EDS is fatigue. This fatigue is not the typical tiredness that can be remedied with a good night’s sleep; it is a pervasive and overwhelming exhaustion that can persist despite adequate rest. Fatigue management, therefore, becomes a crucial aspect of the overall treatment plan for individuals with fibromyalgia and EDS comorbidity.
The Impact of Chronic Pain
Chronic pain in fibromyalgia and EDS comorbidity can affect various aspects of a person’s life. It can limit mobility, making it difficult to engage in physical activities and exercise. This can lead to deconditioning of the muscles, further exacerbating pain and reducing functional abilities. The impact of chronic pain also extends beyond the physical realm and can have profound effects on mental well-being.
The constant presence of pain can contribute to feelings of anxiety, depression, and social isolation. It can interfere with work or school performance and strain relationships. Therefore, addressing chronic pain is crucial not only for physical comfort but also for maintaining overall psychological well-being.
Managing Fatigue effectively
Fatigue in fibromyalgia and EDS comorbidity is not easily alleviated and can significantly impair daily functioning. Effective fatigue management strategies play a vital role in helping individuals cope with this debilitating symptom. These strategies may include:
- Creating and following a structured daily routine to conserve energy
- Prioritizing activities and pacing oneself throughout the day
- Practicing good sleep hygiene and establishing a regular sleep schedule
- Incorporating relaxation techniques, such as deep breathing and mindfulness, to reduce stress and improve energy levels
- Engaging in low-impact exercises, such as walking or gentle stretching, to improve stamina and reduce fatigue
| Treatment Option | Description |
|---|---|
| Medications | Prescription medications, such as analgesics or antidepressants, may be prescribed to manage chronic pain and alleviate fatigue. |
| Physical Therapy | A tailored exercise program and physical therapy sessions can help improve strength, flexibility, and manage joint hypermobility. |
| Cognitive-Behavioral Therapy (CBT) | CBT can be beneficial in addressing the psychological impact of living with chronic pain and developing coping strategies. |
| Alternative Therapies | Complementary approaches like acupuncture, massage therapy, and mindfulness-based practices may provide additional relief and improve well-being. |
By implementing these fatigue management strategies, individuals with fibromyalgia and EDS can better navigate their daily lives and regain some control over their energy levels. It’s important to work closely with healthcare professionals to create a personalized plan that addresses individual needs and preferences.
Diagnosis of Fibromyalgia and EDS Comorbidity
In order to accurately diagnose the comorbidity of fibromyalgia and EDS, a dual diagnosis approach is essential. This means that both conditions, fibromyalgia and EDS, are taken into consideration during the diagnostic process. Healthcare professionals utilize specific criteria and medical tests to identify these conditions and their presence within individuals, particularly in relation to connective tissue disorders.
The diagnosis of fibromyalgia involves a thorough assessment of symptoms, medical history, and physical examination. The American College of Rheumatology (ACR) criteria for fibromyalgia, which includes the presence of widespread pain and the presence of tender points, is commonly used as a guideline for diagnosis. Additionally, healthcare professionals may also employ other diagnostic tools, such as blood tests, to rule out other conditions with similar symptoms.
When it comes to diagnosing EDS, there are several types and subtypes that are identified based on specific genetic mutations or clinical criteria. A detailed medical history, physical examination, and evaluation of joint hypermobility are crucial in the diagnosis process. In some cases, genetic testing may be conducted to confirm the presence of genetic mutations associated with EDS.
Given the overlap of symptoms between fibromyalgia and EDS, healthcare professionals take into account the coexistence of both conditions when making the diagnosis. This dual diagnosis approach allows for a more comprehensive understanding and treatment of the individual, considering the unique challenges posed by fibromyalgia and EDS comorbidity.
Treatment Options for Fibromyalgia and EDS Comorbidity
When it comes to managing fibromyalgia and EDS comorbidity, there are a variety of treatment options available. These options aim to address the chronic pain and joint hypermobility commonly experienced by individuals with these conditions. Treatment can encompass both pharmaceutical and non-pharmaceutical approaches, ensuring a comprehensive approach to symptom management.
Pharmaceutical Approaches
Pharmaceutical treatments play a crucial role in alleviating the symptoms of fibromyalgia and EDS comorbidity. Specific medications may be prescribed to help manage chronic pain and improve joint stability.
- Analgesics: Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to provide pain relief and reduce inflammation.
- Antidepressants: Certain antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can help manage chronic pain and improve mood.
- Anticonvulsants: Some anticonvulsant medications, such as gabapentin and pregabalin, have shown effectiveness in reducing nerve-related pain.
Non-Pharmaceutical Approaches
In addition to pharmaceutical treatments, non-pharmaceutical approaches can complement and enhance the management of fibromyalgia and EDS comorbidity. These approaches focus on addressing joint hypermobility and improving overall well-being.
- Physical therapy: A targeted exercise program designed by a physical therapist can help strengthen the muscles around the affected joints, providing better stability and reducing pain.
- Occupational therapy: Occupational therapy focuses on improving daily functioning and quality of life by teaching adaptive techniques and ways to modify activities to reduce joint stress.
- Lifestyle modifications: Simple changes in daily habits, such as maintaining proper posture, avoiding activities that strain the joints, and practicing gentle exercises like swimming or yoga, can significantly contribute to joint stability and pain management.
Alternative Therapies
Many individuals also explore alternative therapies to supplement their treatment plan. While scientific evidence may vary, some alternative therapies have shown promise in managing chronic pain and promoting overall well-being.
- Acupuncture: This traditional Chinese medicine technique involves the insertion of thin needles into specific points on the body to stimulate the flow of energy and reduce pain.
- Massage therapy: Massage therapy has been found to provide relaxation and pain relief by reducing muscle tension and improving circulation.
- Mind-body practices: Techniques such as meditation, deep breathing exercises, and mindfulness can help manage stress, improve sleep quality, and reduce pain perception.
It’s important for individuals with fibromyalgia and EDS comorbidity to work closely with their healthcare team to determine the most effective treatment options for their specific needs. A comprehensive treatment plan that combines pharmaceutical approaches, non-pharmaceutical interventions, and alternative therapies can significantly improve overall well-being and quality of life.
Managing Chronic Pain in Fibromyalgia and EDS Comorbidity
Individuals living with fibromyalgia and EDS comorbidity often face the daily challenge of managing chronic pain. Fortunately, there are various pain relief strategies that can help alleviate discomfort and improve quality of life. By combining pharmacological interventions with non-pharmacological methods, individuals can find effective ways to cope with pain.
Pharmacological Interventions
Medications play a crucial role in managing chronic pain in fibromyalgia and EDS comorbidity. Commonly prescribed medications include:
- Analgesics: Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can provide temporary relief from mild to moderate pain.
- Antidepressants: Certain antidepressant medications, particularly those in the class of selective serotonin and norepinephrine reuptake inhibitors (SNRIs), can help alleviate pain by targeting neurotransmitters associated with pain perception.
- Anticonvulsants: Some anticonvulsant medications, such as pregabalin or gabapentin, may be prescribed to reduce pain signals and improve overall pain management.
- Opioids: In severe cases of chronic pain, opioids may be considered for short-term use under close medical supervision. However, the use of opioids should be approached with caution due to the potential for dependency and side effects.
Non-Pharmacological Methods
Complementary and non-pharmacological approaches can significantly enhance pain management in fibromyalgia and EDS comorbidity. Consider incorporating the following strategies into your pain relief regimen:
- Physical Therapy: Working with a physical therapist can help improve strength, flexibility, and joint stability, reducing pain and enhancing overall function.
- Mindfulness Techniques: Practices such as meditation, deep breathing exercises, and guided imagery can help individuals manage pain by promoting relaxation, reducing stress, and improving pain tolerance.
- Heat and Cold Therapy: Applying heat packs or cold packs to affected areas can provide immediate relief from pain and reduce inflammation.
- Exercise: Engaging in regular low-impact exercises such as swimming, yoga, or tai chi can help strengthen muscles, improve flexibility, and reduce pain. It is important to consult with a healthcare professional before starting any exercise program.
- Lifestyle Modifications: Making healthy lifestyle choices, such as maintaining a balanced diet, getting adequate sleep, managing stress, and avoiding triggers, can help minimize pain flare-ups and improve overall well-being.
Remember, finding the right combination of pain relief strategies may take time and require individualized adjustments. It is essential to work closely with your healthcare team to develop a comprehensive pain management plan that addresses your specific needs and goals.
Strategies for Managing Joint Hypermobility in Fibromyalgia and EDS Comorbidity
Joint hypermobility is a common symptom experienced by individuals with fibromyalgia and EDS comorbidity. It can lead to instability, pain, and discomfort in daily life. Fortunately, there are several strategies that can help manage joint hypermobility and improve overall joint stability and function.
Physical Therapy
Physical therapy is an essential component of managing joint hypermobility. A licensed physical therapist can create a personalized exercise program that focuses on strengthening the muscles surrounding the affected joints. These exercises help provide stability and support to the joints, reducing the risk of injury and improving overall mobility.
Bracing
Bracing can provide additional support to hypermobile joints, promoting stability and reducing pain. Orthotic devices, such as braces or splints, can be used to limit excessive joint movement and provide external support. These devices can be customized to fit individual needs and can greatly enhance joint stability during daily activities.
Lifestyle Modifications
Simple lifestyle modifications can also play a significant role in managing joint hypermobility. Individuals with fibromyalgia and EDS comorbidity should avoid activities that put excessive stress on their joints. This may include avoiding high-impact exercises, lifting heavy objects, or repetitive movements that can strain the joints. Engaging in low-impact exercises, such as swimming or yoga, can help maintain joint flexibility while minimizing stress.
A balanced diet rich in nutrients, including omega-3 fatty acids and vitamin D, can support joint health. Staying hydrated and maintaining a healthy weight can also reduce the burden on joints and improve overall joint function. Additionally, it is important to adopt ergonomic practices, such as using proper body mechanics and supportive ergonomic furniture, to minimize joint stress during daily activities.
By incorporating these strategies into a comprehensive treatment plan, individuals with fibromyalgia and EDS comorbidity can effectively manage joint hypermobility and improve their overall quality of life.
| Strategies for Managing Joint Hypermobility | Brief Description |
|---|---|
| Physical Therapy | Customized exercise programs to strengthen muscles surrounding joints. |
| Bracing | Using orthotic devices to provide external support and limit excessive joint movement. |
| Lifestyle Modifications | Avoiding high-impact activities, maintaining a balanced diet, practicing proper ergonomics. |
Fatigue Management in Fibromyalgia and EDS Comorbidity
Fatigue is a common and debilitating symptom experienced by individuals with fibromyalgia and EDS comorbidity. It can significantly impact daily life and limit one’s ability to engage in activities. Effective fatigue management is essential to improve overall well-being and quality of life.
Conserving Energy
Conserving energy is a key strategy in managing fatigue. This involves pacing oneself and balancing activities and rest periods. Understanding personal limits and avoiding overexertion can help prevent exacerbation of symptoms. Breaking tasks into smaller, manageable steps and delegating tasks when necessary can also help conserve energy.
Improving Sleep Quality
Getting adequate and restful sleep is crucial for managing fatigue. Establishing a regular sleep routine, creating a comfortable sleep environment, and practicing relaxation techniques before bedtime can improve sleep quality. Avoiding stimulants such as caffeine and electronic devices before bed can also promote better sleep.
Addressing Underlying Causes
Fatigue in fibromyalgia and EDS comorbidity can have various underlying causes. Identifying and addressing these causes can help manage fatigue more effectively. For instance, addressing chronic pain through proper pain management strategies can alleviate fatigue. Additionally, addressing any underlying psychological factors such as stress, anxiety, or depression can also help reduce fatigue levels.
A Comprehensive Approach
An effective fatigue management plan for fibromyalgia and EDS comorbidity requires a comprehensive approach that considers both physical and psychological factors. This may involve a combination of medical interventions, such as medication adjustments or physical therapy, and lifestyle modifications, such as incorporating regular exercise and stress-reduction techniques. A multidisciplinary team approach with healthcare professionals specializing in pain management, sleep disorders, and psychology can provide valuable support and guidance.
By implementing these strategies and seeking appropriate professional guidance, individuals with fibromyalgia and EDS comorbidity can effectively manage fatigue and regain control over their lives.
Combating the Mental Health Impact of Fibromyalgia and EDS Comorbidity
Living with the comorbidity of fibromyalgia and EDS can take a toll on mental health. The chronic pain, physical limitations, and uncertain prognosis associated with these conditions can lead to increased stress, anxiety, and depression.
Individuals with fibromyalgia and EDS often have to cope with a reduced quality of life due to the impact of these connective tissue disorders. The constant battle against chronic pain can be mentally exhausting and emotionally draining.
Fortunately, there are strategies that can help combat the mental health challenges that come with fibromyalgia and EDS comorbidity. Seeking mental health support and incorporating self-care practices into daily life play crucial roles in maintaining emotional well-being.
Importance of Mental Health Support
Mental health support is essential for individuals facing the challenges of living with fibromyalgia and EDS comorbidity. Seeking assistance from mental health professionals, such as psychologists or therapists, can provide valuable guidance and coping techniques.
Therapy sessions can help individuals navigate the emotional impact of chronic pain, manage anxiety and depression, and develop healthy coping mechanisms. Therapists can also assist in addressing the challenges of adjusting to a new lifestyle and developing resilience in the face of these conditions.
In addition to professional support, connecting with support groups or online communities can provide a sense of belonging and validation. Sharing experiences and learning from others who face similar struggles can significantly impact mental health and overall well-being.
Strategies for Maintaining Emotional Well-Being
While seeking mental health support is crucial, individuals with fibromyalgia and EDS comorbidity can also incorporate self-care practices into their daily routines to combat the mental health impact.
- Engage in stress-relieving activities, such as meditation, yoga, or deep breathing exercises, to promote relaxation and reduce anxiety.
- Stay connected with loved ones and maintain a support network of understanding individuals who can provide emotional support and encouragement.
- Prioritize self-care activities that bring joy and fulfillment, such as engaging in hobbies, spending time in nature, or pursuing creative outlets.
- Practice positive self-talk and cultivate a mindset of self-compassion and acceptance. Recognize personal achievements and focus on strengths instead of dwelling on limitations.
- Seek healthy distractions through activities like reading, watching movies, or listening to music to help alleviate stress and divert attention from pain and discomfort.
By implementing these strategies, individuals can develop a strong foundation for maintaining their emotional well-being and enhancing their overall quality of life despite the challenges posed by fibromyalgia and EDS comorbidity.
| Benefits of Mental Health Support and Self-Care Strategies | How They Help in Combating the Mental Health Impact of Fibromyalgia and EDS Comorbidity |
|---|---|
| 1. Professional guidance 2. Coping techniques 3. Validation through support groups and online communities |
Provide valuable guidance and coping techniques for managing the emotional impact of chronic pain and adjusting to a new lifestyle. Offer a sense of belonging and validation through shared experiences and learning from others. |
| 1. Stress relief activities (e.g., meditation, yoga) 2. Maintaining a support network 3. Engaging in fulfilling self-care activities 4. Practicing positive self-talk and self-compassion 5. Healthy distractions |
Promote relaxation, reduce anxiety, and provide emotional support. Bring joy, fulfillment, and diversion from pain and discomfort. Cultivate a mindset of self-acceptance, focusing on strengths and personal achievements. |
Living a Fulfilling Life with Fibromyalgia and EDS Comorbidity
Living with fibromyalgia and EDS comorbidity can be challenging, but it is possible to lead a fulfilling life despite the chronic pain, joint hypermobility, and other symptoms associated with these connective tissue disorders. Taking a holistic approach to treatment and self-care is key in managing the impact of these musculoskeletal conditions.
One important aspect of living well with fibromyalgia and EDS is prioritizing self-care. This includes practicing good sleep hygiene, managing stress levels, and engaging in activities that promote relaxation and well-being. By taking care of your physical and mental health, you can better cope with the challenges these conditions present.
Connecting with support networks is also essential. Sharing experiences, finding understanding, and seeking advice from others who are living with similar conditions can provide a sense of validation and help you navigate the ups and downs of fibromyalgia and EDS. Support groups, online communities, and counseling services can offer valuable resources and compassionate guidance.
Despite the limitations imposed by chronic pain and joint hypermobility, it is important to find fulfilling activities that bring joy and a sense of purpose to your life. This may involve adapting hobbies and interests to accommodate your physical abilities or exploring new passions that align with your unique circumstances. By focusing on what you can do, rather than what you can’t, you can create a meaningful and gratifying life with fibromyalgia and EDS.
FAQ
What is the connection between fibromyalgia and EDS?
Fibromyalgia and EDS (Ehlers-Danlos syndrome) are two separate but commonly comorbid conditions. Both conditions involve connective tissue disorders and musculoskeletal conditions, which can contribute to chronic pain and joint hypermobility.
What is the Acibadem Healthcare Group's role in treating fibromyalgia and EDS comorbidity?
The Acibadem Healthcare Group is a leading healthcare organization that provides comprehensive treatment options for individuals with fibromyalgia and EDS comorbidity. They offer a range of services and therapies tailored to address the unique challenges of these conditions.
What treatment options are available for individuals with fibromyalgia and EDS comorbidity?
Treatment options for fibromyalgia and EDS comorbidity include both pharmaceutical and non-pharmaceutical approaches. These may include medications for pain relief, physical therapy, alternative therapies, and lifestyle modifications. The choice of treatment depends on the individual's specific needs and symptoms.
How are the chronic pain and joint hypermobility associated with fibromyalgia and EDS managed?
Chronic pain and joint hypermobility in fibromyalgia and EDS comorbidity can be managed through various strategies. These may include the use of medications, physical therapy, mindfulness techniques, and lifestyle modifications. It is important to work with healthcare professionals to develop a personalized pain management plan.
Can fatigue be effectively managed in individuals with fibromyalgia and EDS comorbidity?
Yes, fatigue management is an important aspect of treatment for individuals with fibromyalgia and EDS comorbidity. Strategies for managing fatigue may include conserving energy, improving sleep quality, and addressing underlying factors that contribute to fatigue. A comprehensive approach is necessary to effectively manage fatigue.
How are fibromyalgia and EDS comorbidity diagnosed?
The diagnosis of fibromyalgia and EDS comorbidity typically involves a dual diagnosis approach, considering both conditions. This may involve clinical evaluation, medical history assessment, and specific criteria and tests related to connective tissue disorders. It is important to consult with a healthcare professional for an accurate diagnosis.
What challenges do individuals with fibromyalgia and EDS comorbidity face?
Individuals with fibromyalgia and EDS comorbidity may face challenges such as chronic pain, joint hypermobility, and debilitating fatigue. These symptoms can significantly impact daily life and require effective management strategies and support.
How can the mental health impact of fibromyalgia and EDS comorbidity be addressed?
The mental health impact of fibromyalgia and EDS comorbidity, including depression, anxiety, and reduced quality of life, should be addressed alongside physical treatment. Seeking mental health support, maintaining a positive mindset, and practicing self-care strategies can help individuals cope with the psychological challenges.
Is it possible to live a fulfilling life with fibromyalgia and EDS comorbidity?
Despite the challenges posed by fibromyalgia and EDS comorbidity, it is possible to live a fulfilling life. Self-care, a holistic approach to treatment, and connecting with support networks can make a significant difference. By managing symptoms effectively and pursuing fulfilling activities, individuals can maintain a high quality of life.
