title: 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 randomized controlled trial.
abstract: 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.
  
  
  
  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.
  
  
  
  Reduced pain disability was explained by higher pain disability at baseline together with decreased fear avoidance beliefs about physical activity (R (2) = 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 (R (2) = 32, p = 0.025 and R (2) = 30, p = 0.017). The improvement in occupational disability was explained by higher baseline values of occupational disability (R (2) = 19, p = 0.001).
  
  
  
  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. The trial was registered on October 21, 2010 with ClinicalTrials.gov identification number: NCT01226784 .
authors.affiliation: Institute of neuroscience and physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. annie.palstam@gu.se.
authors.forename: Annie
authors.initials: A
authors.lastname: Palstam
authors.affiliation: Institute of neuroscience and physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|University of Gothenburg Centre for Person Centered Care (GPCC), Gothenburg, Sweden.
authors.forename: Anette
authors.initials: A
authors.lastname: Larsson
authors.affiliation: Dep of Clinical Sciences, Karolinska Institutet and Dep of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
authors.forename: Monika
authors.initials: M
authors.lastname: Löfgren
authors.affiliation: Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, SE-141 04, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Ernberg
authors.affiliation: Sahlgrenska University Hospital, Rheumatology, Göteborg, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Bjersing
authors.affiliation: Dep of Clinical Sciences, Karolinska Institutet and Dep of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
authors.forename: Indre
authors.initials: I
authors.lastname: Bileviciute-Ljungar
authors.affiliation: Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Pain and Rehabilitation Centre, Linköping, Sweden.|Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Gerdle
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Spine Center, Stockholm, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Kosek
authors.affiliation: Institute of neuroscience and physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|University of Gothenburg Centre for Person Centered Care (GPCC), Gothenburg, Sweden.
authors.forename: Kaisa
authors.initials: K
authors.lastname: Mannerkorpi
mesh_terms: D000328:Adult; D000368:Aged; D001362:Avoidance Learning; D005239:Fear / Q000523:psychology*; D005260:Female; D005356:Fibromyalgia / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000523:psychology*; D009629:Person-Centered Psychotherapy; D055070:Resistance Training / Q000379:methods*; D055815:Young Adult
keywords: Disability; Fibromyalgia; Pain; Person-centered; Resistance exercise