title: Physical activity monitoring in adolescents with juvenile fibromyalgia: findings from a clinical trial of cognitive-behavioral therapy.
abstract: OBJECTIVE
  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. Our objective was to analyze secondary data from a randomized clinical trial of CBT to examine whether 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 years) 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 1 week as part of their baseline and posttreatment assessments.
  
  
  RESULTS
  The final sample included 68 subjects (94% female, mean age 15.2 years) for whom complete actigraphy data were 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 posttreatment.
  
  
  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.
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA. Susmita.Kashikar-Zuck@cchmc.org
authors.forename: Susmita
authors.initials: S
authors.lastname: Kashikar-Zuck
authors.forename: Stacy R
authors.initials: SR
authors.lastname: Flowers
authors.forename: Daniel
authors.initials: D
authors.lastname: Strotman
authors.forename: Soumitri
authors.initials: S
authors.lastname: Sil
authors.forename: Tracy V
authors.initials: TV
authors.lastname: Ting
authors.forename: Kenneth N
authors.initials: KN
authors.lastname: Schikler
mesh_terms: D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005356:Fibromyalgia / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory / Q000379:methods*; D009043:Motor Activity / Q000502:physiology*