Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


A Randomized Attention-Controlled Study of Motivational Interviewing To Encourage Exercise in Fibromyalgia: Week 12 Interim Analysis.

Ang3,  Dennis C., Kaleth1,  Anthony S., Bigatti2,  Sylvia M., Mazzuca3,  Steven A., Saha2,  Chandan K., Bandy2,  Robert W.

Indiana Univ Purdue Univ Indianapolis
Indiana University
Indiana University, Indianapolis, IN

Background:

Aerobic exercise is an important treatment option for the management of fibromyalgia (FM). Unfortunately, the early benefits of structured, supervised exercise programs are often compromised by declining adherence as the exercise regimen transitions to an unsupervised, often home-based, program. Individuals who are able to maintain adherence almost always prolong the symptomatic benefits of exercise. We sought to determine the efficacy of motivational interviewing (MI) to maintain long-term adherence and extend the health benefits of exercise for FM patients.

Methods:

Subjects met ACR diagnostic criteria for FM and had moderate pain severity at baseline (Brief Pain Inventory (BPI) >= 4). Subjects were randomized to MI or attention control (AC) conditions. All were advised to adopt a standard regimen of aerobic exercise and received two supervised training sessions. Subjects assigned to MI (n=107) participated in six counseling by telephone over the next 12 weeks. Subjects assigned to AC (n=109) participated in an identical schedule of telephone discussions about topics relevant to FM self-management (e.g., pain, fatigue, sleep). Clinical outcomes (BPI and Fibromyalgia Impact Questionnaire (FIQ)) were assessed at baseline and weeks 12, 24 and 36.

Results:

Most of the sample was female (96%), white (88%), married (61%), and employed (54%). Mean body mass index (BMI) was 31.4 kg/m2. Baseline distributions for FIQ Total and BPI (mean ± SD = 67.0 ± 12.7 and 6.0 ± 1.3, respectively) suggested moderate-to-severe FM severity. The average self-reported total of physical activity (PA) of moderate or greater intensity (CHAMPS) was only 1.7 hours/wk. Treatment groups were similar at baseline with respect to demographic and clinical characteristics and retention rates at week 12 (MI: 91% vs. AC: 94%). Mean change (±SD) over 12 weeks in exercise adherence and clinical outcome measures are tabled below.

OutcomeMI (N = 96)AC (N = 101)P-value¶
Hours/wk of >=moderate intensity physical activity*2.8 ± 5.11.0 ± 3.60.007
Pain severity†-1.3 ± 1.5-0.9 ± 1.80.069
Symptom severity‡-14.2 ± 14.7-10.4 ± 17.40.105
*Community Health Activities Model Program for Seniors (CHAMPS)
†BPI (range; 0–10); Negative change represents improved pain
‡FIQ Total (range: 0–100): negative change represents improved symptoms
¶From ANCOVA, adjusted for baseline score and disease duration

Conclusion:

MI is a directive, client-centered counseling style that focuses on enhancing motivation to change by helping clients explore and resolve ambivalence about a target behavior (e.g., exercise). Compared to AC, participants in the MI group reported greater improvement in both physical activity and clinical measures. Pending long-term efficacy data, exercise-based MI appears to be a promising tool to encourage increased PA and improve clinical symptoms in patients with FM.

To cite this abstract, please use the following information:
Ang, Dennis C., Kaleth, Anthony S., Bigatti, Sylvia M., Mazzuca, Steven A., Saha, Chandan K., Bandy, Robert W.; A Randomized Attention-Controlled Study of Motivational Interviewing To Encourage Exercise in Fibromyalgia: Week 12 Interim Analysis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :797
DOI: 10.1002/art.28565

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