Obesity Moderates the Effects of Motivational Interviewing Treatment Outcomes in Fibromyalgia

Objective: Obesity is a common comorbid condition among patients with fibromyalgia (FM). Our objective was to assess if obesity moderates the treatment benefits of exercise-based motivational interviewing (MI) for FM. Methods: This is a secondary data analysis of a completed clinical trial of 198 FM patients who were randomized to receive either MI or attention control (AC). Using body mass index (BMI) to divide participants into obese (BMI >=30 kg/m2) and non-obese (BMI <30 kg m2) groups, mixed linear models were used to determine interaction between treatment arms and obesity status with regards to the primary outcome of global FM symptom severity (Fibromyalgia Impact Questionnaire, FIQ). Secondary measures included pain intensity (Brief Pain Inventory, BPI), 6-minute walk test, and self-reported physical activity (Community Health Activities Model Program for Seniors). Results: Of the 198 participants, 91 (46%) were non-obese and 107 (54%) were obese. On global FM symptom severity (FIQ), the interaction between treatment arms and obesity status was significant (P=0.02). In the non-obese group, MI was associated with a greater improvement in FIQ than AC. In the obese group, MI participants reported less improvement in FIQ compared to AC. The interaction analysis was also significant for BPI pain intensity (P=0.01), but not for the walk test and self-reported physical activity. Discussion: This is the first study to show that obesity negatively affects the treatment efficacy of MI in patients with FM. Our findings suggest that exercise-based MI may be more effective if initiated after weight loss is achieved

Does Vibration Training Improve Physical Function and Quality of Life in Fibromyalgia Syndrome?

poster abstractExercise and physical activity recommendations are an integral component of the overall management of fibromyalgia. Unfortunately, despite the known health, fitness, and symptom relief benefits, underlying pain and fatigue prevent most from initiating (or maintaining) physical activity and exercise programs, thereby contributing to sedentary lifestyles that lead to low levels of aerobic and muscular fitness. Therefore, it is important to identify alternative approaches to exercise programming in the overall management of fibromyalgia. Vibration training is a relatively new approach to exercise that has been shown to elicit numerous benefits; however little is known about the effects of this training method in fibromyalgia. Therefore, the primary aim of this study is to evaluate the effects of vibration training in improving musculoskeletal function, balance and postural control, and health-related quality of life in patients diagnosed with fibromyalgia

Active Virtual Reality Games Reduce Pain Sensitivity in Young, Healthy Adults

Separately, both physical activity and virtual reality can attenuate pain sensitivity in healthy adults. What is unknown is whether virtual reality combined with physical activity (active virtual reality) could have a greater hypoalgesic effect compared to non-active virtual reality distraction (passive virtual reality engagement). Objective: The purpose of this study was to determine whether playing physically active virtual reality games exert a greater hypoalgesic effect than a non-active virtual reality game. Methods: Participants (n = 36) played three different active virtual reality games (Beat Saber, Holopoint, and Hot Squat) and one non-active virtual reality game (Relax Walk) for 15 min on four different visits. During gameplay, participants wore accelerometers on the thigh, wrist, and waist to measure movement intensity and quantity. Pressure pain thresholds were measured on the forearm and thigh immediately prior to gameplay (pretest) and immediately following each gaming bout (posttest). Results: Analysis of the accelerometer data indicated that Hot Squat elicited greater whole-body and lower body moderate to vigorous physical activity compared to the other games. The ANOVA revealed an overall hypoalgesic effect of the virtual reality games on the forearm, regardless of game type. Results also showed a significant hypoalgesic effect on the thigh following gameplay for Hot Squat, Holopoint, and Relax Walk VR. The magnitude of pain reduction was significantly greater during Hot Squat compared to the other games. Conclusion: Virtual reality gameplay exerted a hypoalgesic effect on experimental pressure pain. Additionally, the data provided evidence of a potential enhanced hypoalgesic effect of physically active virtual reality compared to non-active VR on pressure pain sensitivity

Effects of volume of resistance training on muscular strength and endurance

The American College of Sports Medicine recommends a resistance exercise routine that consists of a minimum of 1 set of 8-12 repetitions on 8-10 exercises, 2 times per week. These guidelines are less than traditional programs and are based on the premises that longer programs are associated with lower adherence and that additional sets and repetitions produce little, if any, additional increases in strength. Therefore, the purpose of this study was to determine if greater gains in strength and endurance could be attained by doubling the recommended dose. Sixteen subjects were randomly assigned to one of two training groups that performed 1 or 2 sets of 8-12 repetitions for 10 weeks on 7 exercises (chest press, lat pull-down, leg ext., leg curl, shoulder press, triceps ext., biceps curl) and 8 subjects were assigned to a non-training group. Pre- and post-training 1repetition maximum (RM) and muscular endurance were measured. To assess endurance, subjects completed as many repetitions as possible at 75% of their pre-training 1-RM on all exercises except the shoulder press (60% of 1-RM). Both training groups showed a significant increase in 1-RM strength and endurance compared to controls (P < 0.05). Only the biceps curl exercise showed a significant difference in strength between the two training groups (P < 0.05). The 2 sets group increased post-training endurance to a greater degree than the 1 set group, but only the lat pull-down exercise was significant (P < 0.05).. Contrary to previous studies, these findings pertain to 8-10 exercises that use larger muscle groups. It was concluded that 1 set of 8-12 repetitions was as effective as 2 sets in increasing muscular strength and endurance.Thesis (M.S.)School of Physical Educatio

Predictors of Physical Activity in Patients with Fibromyalgia: A Path Analysis

Background/objective: The aim of this study was to identify psychological factors that influence moderate-vigorous physical activity (MVPA) participation in patients with fibromyalgia. Methods: In this secondary data analysis, 170 patients received personalized exercise plans and completed baseline and follow-up assessments of self-reported physical activity at weeks 12, 24, and 36. Structural equation modeling was used to examine the predictive strengths of psychological factors (exercise self-efficacy, perceived barriers, and intention) on MVPA participation. Results: Using a threshold increase in MVPA of 10 or greater metabolic equivalent hours per week (MET h/wk), 3 groups were defined based on subjects who achieved a minimum increase of 10 MET h/wk that was sustained for at least 12 weeks (SUS-PA), achieved an increase of 10 MET h/wk that was not sustained for at least 12 weeks (UNSUS-PA), and did not achieve an increase of 10 MET h/wk (LO-PA). Increases in exercise self-efficacy and intention and reductions in perceived barriers were associated with increased volume of PA, showing the greatest change in the SUS-PA, followed by UNSUS-PA. For the LO-PA group, there was no change in exercise self-efficacy, a decrease in intention, and an increase in barriers. Using path analysis, exercise self-efficacy and perceived barriers were associated with higher volumes of physical activity via greater intention to engage in MVPA. Conclusions: For patients with fibromyalgia, exercise self-efficacy, perceived barriers, and intention to exercise are important constructs for increasing physical activity. Our findings provide guidance for practitioners who seek to promote physical activity in fibromyalgia and suggestions for researchers aiming to improve prediction models

Research to Encourage Exercise for Fibromyalgia (REEF): Use of motivational interviewing design and method

Fibromyalgia (FM), defined as the presence of both chronic widespread pain and the finding of 11/18 tender points on examination, is an illness associated with major personal and societal burden. Supervised aerobic exercise is an important treatment modality to improve patient symptoms. Unfortunately, adherence to an exercise regimen after a structured supervised program is disappointingly low. Since FM is a chronic illness, studies are needed to test strategies that would enhance exercise adherence in these individuals. Individuals who are able to adhere to exercise almost always maintain the symptomatic benefits of exercise. The objective of this paper was to describe the protocol of the Research to Encourage Exercise for Fibromyalgia (REEF). REEF is a randomized attention-controlled trial that seeks to test the efficacy of 6 sessions of telephone delivered motivational interviewing (MI) that targets exercise adherence to improve FM-relevant clinical outcomes (i.e., physical function and pain severity). The trial has recently completed enrolling 216 subjects, and randomization has resulted in well-balanced groups. Details on the study design, MI program, and treatment fidelity are provided in the paper. Outcome assessments at week 12, week 24 and week 36 will test the immediate, intermediate and long-term effects of exercise-based MI on adherence (as measured by the Community Health Activities Model Program for Seniors/CHAMPS and accelerometer) and clinical outcomes. When completed, REEF will determine whether exercise-based MI could be utilized as a management strategy to sustain the clinical benefits of exercise for FM

Research to Encourage Exercise for Fibromyalgia (REEF): Use of Motivational Interviewing, Outcomes From a Randomized-controlled Trial

Objectives Regular exercise is associated with important benefits in patients with fibromyalgia (FM). Unfortunately, long-term maintenance of exercise after a structured program is rare. The present study tested the efficacy of Motivational Interviewing (MI) to promote exercise and improve symptoms in patients with FM. Methods 216 patients with FM were randomized to 6 MI sessions (n=107) or an equal number of FM self-management lessons (education control/EC, n=109). Co-primary endpoints were an increase of 30 minutes in moderate-vigorous physical activity and improvement in the Fibromyalgia Impact Questionnaire-Physical Impairment (FIQ-PI) score, assessed at pre-treatment, post-treatment, and 3- and 6-month follow-up. Secondary outcomes included clinically meaningful improvements in FIQ score, pain severity ratings, and a 6-minute walk test. Results There were no significant treatment group differences in either co-primary endpoint at 6-month follow-up. However, more MI participants than controls exhibited meaningful improvements in FIQ score at 6-month follow-up (62.9% vs. 49.5%, p=0.06). Compared to EC subjects, MI subjects also displayed a larger increment in their 6-minute walk test (43.9 vs. 24.8 meters, p=0.03). Additionally, MI was superior to EC in increasing the number of hours of physical activity immediately post-intervention and in reducing pain severity both immediately after the intervention and at 3-month follow-up. Conclusions Despite a lack of benefits on long term outcome, MI appears to have short-term benefits with respect to self-report physical activity and clinical outcomes. This is the first study in FM that explicitly addresses exercise maintenance as a primary aim