CBT ‘has no impact’ on juvenile fibromyalgia physical activity

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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  1. Andrew Andrew Australia says:

    Patients didn't increase their activity levels because they often can't do so without an increase in symptoms.

    The same is observed in CBT (or graded exercise therapy) for CFS patients (where an increase in activity has not been observed either).

    Graded Exercise Therapy ironically is no better because patients are forced to substitute self-caring activities for exercise.

    Unfortunately, many of these patients will not be rehabilitated without efficacious pharmacological treatments being developed first.

  2. Rhoda Rhoda Canada says:


    I contracted fibromyalgia after an operation.  It started with extreme fatigue and then the pain set in, especially in my legs/knee areas.

    It go so bad that I could not work effectively.  I have been granted ODSP, however, that is not much compensation, and I feel I could likely work part time, which is allowed with ODSP- however you can only make a percentage of your monthly allowance.

    I am currently being treated with Fentanyl patches, which are remarkable.  I tried Lyrica, and found that I was dropping things and not in control of my hands and arms-that drug was a terrible experience for me.  The Fentanyl 50 mcg is working, with me not working, I may need more if I were to take a part time job.

    I don't believe I could effectively return to work full time unless the job was one of low low stress-and then I might need more Fentanyl in case I started developing pain.

    This is a terrible illness, and I hope they research the origins and find a cure.

    • sueUK sueUK United Kingdom says:

      Ive had FM for 7 years now  but only just been diagnosed a few months ago after having years of being told it was my age/Menopause/Hormones/nuerotic!  I find Fentalyn works for me aswell but I do have a neck injury that causes me extra pain aswell as the fibro pain, I've also tried Gabapentine (got stomach pains and put on 28LBs weight)& Pregabatin (did nothing).
      There are so many sites out there , it so confusing esp. if you have a Fibro/drugs/lack of sleep fog. Alot of info is on USA sites as I think the UK is still in the dark ages with FM as in "its all in the mind they say"!! so difficult! I'm looking into The Marshall Protocol, USA based.Also Dr Andrew Holman USA has found alot of FM sufferes have PC3= Positional Cord Compression in neck and not diagnosed and can mimmick FM symptoms! thou you can still have both aswell.you need to have MRI taken with your neck bent not straight! Also CoQ10 Supplementation? and a Dr Theoharides 2012 study Quercetin and Luteolin (Neuroprotek formular)but a specific one for FM is in the making and exspected soon according to his site,I have been advised by a forum that his is the best! and not to use others.  dont know if any of this is any interest to you but its always handy share as it might help others. Also Vit D Supplements are supposed to be bad for you even thou I had a low vit D count! also a known thing with FM, but 1 thing at a time as a human guinea pig and not mega rich either as all these things cost. At the mo i'm trying taking Anti histamins Ketotifen as of 4th Oct.thou v.small doses to see if helps! I dont know if you do much research but hope thi might be of interesst,its worth trying to keep a eye on things as UK doctors are not informed and I end up telling them as they really dont seem interested and only want to give you anti depressants to get you out of the surgery as quick as possible. If only they could be in our shoes for a week they would soon change their tune! Keep trying,Good Luck with a P/T Job.

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