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Decrease of fear avoidance beliefs following person-centered progressive resistance exercise contributes to reduced pain disability in women with fibromyalgia: secondary exploratory analyses from a randomised controlled trial

Journal article
Authors Annie Palstam
Anette Larsson
Löfgren Monica
Ernberg Malin
Jan Bjersing
Indre Bileviciute-Ljungar
Björn Gerdle
Kosek Eva
Kaisa Mannerkorpi
Published in Arthritis Research & Therapy
Volume 18
Issue 1
Pages Article number: 116
ISSN 1478-6362
Publication year 2016
Published at Institute of Neuroscience and Physiology, Department of Health and Rehabilitation
University of Gothenburg Centre for person-centred care (GPCC)
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
Institute of Medicine, Department of Rheumatology and Inflammation Research
Pages Article number: 116
Language en
Keywords Fibromyalgia, Pain, Disability, Resistance exercise, Person-centered
Subject categories Other Medical Sciences


Background: Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. Women with FM also report disability, in terms of negative consequences on activities of daily living. Our recent randomized controlled trial (RCT) is the first study of resistance exercise to show positive effects on pain disability. The resistance exercise program of our RCT emphasized active involvement of participants in planning and progression of the exercise, using the principles of person-centeredness, to support each participant’s ability to manage the exercise and the progress of it. The aim of this sub-study was to investigate explanatory factors for reduced pain disability in women with FM participating in a 15-week person-centered progressive resistance exercise program. Methods: A total of 67 women with FM were included in this sub-study of an RCT examining the effects of person-centered progressive resistance exercise performed twice a week for 15 weeks. Tests of physical capacity and health-related questionnaires were assessed at baseline and after the intervention period. Multivariable stepwise regression was used to analyze explanatory factors for improvements in pain disability. Results: Reduced pain disability was explained by higher pain disability at baseline together with decreased fear avoidance beliefs about physical activity (R2 = 28, p = 0.005). The improvements in the disability domains of recreation and social activity were explained by decreased fear avoidance beliefs about physical activity together with higher baseline values of each disability domain respectively (R2 = 32, p = 0.025 and R2 = 30, p = 0.017). The improvement in occupational disability was explained by higher baseline values of occupational disability (R2 = 19, p = 0.001). Conclusion: The person-centered resistance exercise intervention, based on principles of self-efficacy, had a positive effect on recreational, social and occupational disability. The reduced pain disability seemed to be mediated by decreased fear avoidance beliefs. Age, symptom duration, pain intensity, and muscle strength at baseline had no explanatory value for reduced pain disability, indicating that the person-centered resistance exercise program has the potential to work for anyone with FM who has interest in physical exercise. identification number: NCT01226784.

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