CBT Plus Exercise Training Improves the Physical Fitness of Fibromyalgia Patients

According to a recent study published in the Annals of the Rheumatic Diseases, the physical fitness of patients with fibromyalgia improves significantly following a combination of CBT (cognitive behavior therapy) and exercise training. In the current study, participants with high-risk fibromyalgia were randomly assigned to one of two groups: (1) a wait-list control (WLC) and (2) a treatment condition (TC) consisting of 16 twice-weekly CBT sessions plus tailored exercise training. Participants in the TC also attended a follow up session at 3 months post treatment. Results showed that the fitness level of participants in the treatment condition improved significantly compared to those in the control.

Van, K. S., Kraaimaat, F. W., Wirken, L., Evers, A. W. M., Van, L. W., Van, H. T., Vedder, A., … Van, R. P. L. C. M. (December 01, 2011). Tailored cognitive-behavioural therapy and exercise training improves the physical fitness of patients with fibromyalgia. Annals of the Rheumatic Diseases, 70, 12, 2131-2133.

Combination of CBT and Exercise May Ease Fibromyalgia

newstudy-graphic-66x60.jpgA new study conducted by researchers at Radboud University Nijmegen Medical Center in the Netherlands tested the effectiveness of Cognitive Behavioral Therapy (CBT) combined with exercise to treat fibromyalgia. This syndrome, that affects about 5 million adults in the U.S., causes widespread aches and pains, specific “tender points”, fatigue, and sleep problems. Though the cause of Fibromyalgia is unknown and it is difficult to treat, research has proven combinations of treatments more effective than a single treatment alone. Types of treatments for this syndrome include painkillers, antidepressants, CBT, and exercise therapy.

The study participants were “high-risk” fibromyalgia patients, those whose symptoms were judged to cause significant distress. First the participants were divided into two groups, based on how they handled their pain–those who avoided activities they feared would increase their pain and those who maintained their usual activities despite their pain. Both groups were then further divided into two randomly assigned groups–one group underwent 16 sessions of CBT-plus-exercise therapy and the other were placed on a wait-list for treatment. The CBT was specifically tailored as follows: For the patients who avoided activities, the CBT focused on dealing with the fear of pain and setting goals for increasing their daily activity. For the patients who maintained their activities, the CBT focused on setting more realistic goals and pacing daily activity to avoid overdoing it. After each CBT session, all of the patients had an exercise session with a physical therapist.

Immediately following the treatment period, and six months later, both the avoidant and the overactive therapy groups were faring better than those on the wait-list. After six months, 2/3 of the patients in the therapy groups had experienced noticeable changes in their daily lives, as compared to 1/3 of the wait-list patients. These improvements were in measures of physical well-being, such as pain, fatigue, and disability. They manifested themselves in the patients’ comparative ease in walking, climbing stairs, and doing household chores. Additionally, 62% of patients in the therapy groups experienced improvements in anxiety or depression symptoms, compared to 33% of patients on the wait-list.

Fibromyalgia – real disease getting real benefit from CBT

People with Fibromyalgia suffer on many levels. They live with a chronic and painful, life-altering, multi-system disease that affects about 2% of the general U.S. population. For many years, they also suffered from widespread skepticism and debate about the disease itself. Was it real? Wasn’t it the same as Chronic Fatigue Syndrome, which the media disparagingly called Yuppie Flu?

Thankfully, the uncertainty officially ended in 1990 when the American College of Rheumatology established criteria for its diagnosis. This was a positive step; however, appropriate treatment would remain unclear.

A good deal of research has emerged since then and a recent review of treatment protocols for Fibromyalgia showed that the best outcomes involved pharmacologic therapies in combination with Cognitive Behavioral Therapy (CBT). Exercise and patient education, part and parcel of a CBT approach, were also important.

Cognitive therapy strategies “help patients understand the effect that thoughts, beliefs, and expectations have on their symptoms.” It was also very important to use the strategies to help patients prioritize time to achieve balance in their daily lives.