Physical activity monitoring in adolescents with juvenile fibromyalgia: Findings from a clinical trial of cognitive–behavioral therapy

Abstract

Juvenile fibromyalgia (JFM) is a chronic musculoskeletal pain condition that is associated with reduced physical function. Recent research has demonstrated that cognitive-behavioral therapy (CBT) is effective in improving daily functioning among adolescents with JFM. However, it is not known whether these improvements were accompanied by increased physical activity levels. Objectives To analyze secondary data from a randomized clinical trial of CBT to examine if CBT was associated with improvement in objectively measured physical activity and whether actigraphy indices corresponded with self-reported functioning among adolescents with JFM. Methods Participants were 114 adolescents (ages 11–18) recruited from pediatric rheumatology clinics that met criteria for JFM and were enrolled in a clinical trial. Subjects were randomly (1:1) assigned to receive either CBT or fibromyalgia education (FE). Participants wore a hip-mounted accelerometer for one week as part of their baseline and post-treatment assessments. Results The final sample included 68 subjects (94% female; mean age = 15.2 years) for whom complete actigraphy data was obtained. Actigraphy measures were not found to correspond with self-reported improvements in functioning. While self-reported functioning improved in the CBT condition compared to FE, no significant changes were seen in either group for activity counts, sedentary, moderate or vigorous activity. The CBT group had significantly lower peak and light activity at post-treatment. Conclusions Actigraphy monitoring provides a unique source of information about patient outcomes. CBT intervention was not associated with increased physical activity in adolescents with JFM indicating that combining CBT with interventions to increase physical activity may enhance treatment effects.

Physical activity levels in the treatment of juvenile fibromyalgia

“…1 Additionally, its prevalence is on the rise, and in the USA gout affects more than eight million indivi duals. 2 No wonder, then, that the American College of Rheumatology (ACR) commissioned guidelines for the management of gout. These guidelines have recently been published, 3,4 and extend previous recommendations from the European League Against Rheumatology (EULAR), 5 the British Society for Rheumatology 6 and other European or Asian professional societies.…”

“…1 In a paper recently published in Arthritis Care & Research, Kashikar-Zuck and colleagues further their work on the effect of CBT in juvenile fibromyalgia. 2 In this latest paper, they used physical activity, as monitored by actigraphy, as the primary outcome measure, reasoning that better coping skills and lower levels of depression would lead to increased physical activity. It is refreshing that physical activity was viewed as the outcome since physical activity is something that one can directly address therapeutically and, more or less, objectively measure rather than rely on patient self-report.…”

“…It is refreshing that physical activity was viewed as the outcome since physical activity is something that one can directly address therapeutically and, more or less, objectively measure rather than rely on patient self-report. Kashikar-Zuck et al 2 were careful in their measurement of physical activity with hip-mounted actigraphy which is, by consensus, the standard method of monitoring activity. They compared two groups of children age 11-18 years: those treated with eight sessions of CBT (n = 33), and those treated with eight sessions of education about fibromyalgia (n = 35).…”

Treatment Approaches of Juvenile Fibromyalgia Syndrome

“…Adolescents who received CBT reported greatly improved participation in school, social and daily activities at the end of treatment. According to the studies, CBT resulted in significant decreases in depressive symptoms, functional disability, pain, somatic symptoms and fatigue in adolescents with JFMS [15,34].…”

Exercise Interventions for Juvenile Fibromyalgia: Current State and Recent Advancements

“…Adolescents with JFM tend to be very sedentary, despite treatment recommendations that encourage physical exercise and greater participation in physical activity [3]. Along with greater sedentary behavior, evidence of deconditioning, reduction in strength and altered movement biomechanics have been documented in adolescents with JFM accompanied by self-reported fear of movement [4].…”