CBT ‘has no impact’ on juvenile fibromyalgia physical activity

Oct 1 2012

By medwireNews Reporters

Cognitive behavior therapy (CBT) is not associated with increased physical activity levels in adolescents with juvenile fibromyalgia (JFM), research shows.

Overall, there was a very low engagement in moderate-to-vigorous activity in patients undergoing CBT, with more than 95% of participants not meeting the guideline-recommended exercise requirements.

Patients did report significant improvements in daily physical functioning and overall wellbeing.

"However, in taking a closer look at actual physical activity levels using objective actigraphy measurements, these improvements do not appear to translate into increased engagement in physical activity," report investigators.

The study, published in Arthritis Care and Research and led by Susmita Kashikar-Zuck (Cincinnati Children's Hospital Medical Center, Ohio, USA), included 68 patients aged 11 to 18 years old with JFM.

Patients were randomly allocated in a 1:1 ratio to receive either CBT or fibromyalgia education. All patients wore a hip-mounted accelerometer for 1 week as part of the baseline and post-treatment assessments.

Overall, patients were sedentary prior to treatment, with less than 3% meeting the recommended 60 minutes of daily physical activity.

Among the fibromyalgia education patients, there was no change in physical activity levels from pre- to post-treatment.

Similarly, there were no changes in the CBT group for time spent sedentary or average physical activity counts. In fact, there was a nonsignificant trend toward increased sedentary time and lower physical activity levels after treatment with CBT.

In addition, there was a significant decrease in peak activity levels and time spent in light activity for the CBT group from pre- to post-treatment.

"Following treatment, 97% of patients continued to fall below the recommended guidelines of physical activity," report Kashikar-Zuck and colleagues.

Nevertheless, self-reported impairment and disability scores were significantly improved for the CBT-treated patients, while they remained unchanged for those who underwent fibromyalgia education.

"The results of this study confirm that objective monitoring of physical activity provides a unique and important source of information that is quite distinct from self-report in studies of adolescents with chronic pain," conclude the researchers.

The reason for the lack of improvement might be because CBT emphasizes strategies that are cognitive in nature, including distractions, challenging negative thoughts, and problem solving, they say.

Kashikar-Zuck et al suggest that future studies should consider enhancing CBT with education about physical activity, including the benefits of targeted aerobic exercise or strength training.

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