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Motivational interviewing may encourage exercise in persons with fibromyalgia by enhancing self efficacy

2004; Wiley; Volume: 51; Issue: 5 Linguagem: Inglês

10.1002/art.20684

2151-4658

Kim Dupree Jones, Carol S. Burckhardt, Jill A. Bennett,

Occupational Health and Performance

Introduction Fibromyalgia (FM) is a common, costly, and debilitating chronic pain syndrome diagnosed in nearly 10 million Americans, 90% of whom are women (1). By definition, people with FM have chronic widespread pain and specified tender point areas (2). Other symptoms include disrupted sleep, fatigue, decreased cognition, postexertional exercise pain, and exercise intolerance (3). Additionally, people with FM report difficulty performing personal care activities, depression and anxiety, and disruption in their family and social lives (4–6). All of these factors combine to produce a formidable impact on their quality of life and a clear obligation on the part of health care researchers and clinicians to respond. One promising intervention for relieving a variety of FM symptoms is regular exercise. The majority of people with FM are aerobically unfit (7,8) and have both poor muscle strength and limited flexibility (9–11). Deconditioned muscle is more prone to muscle microtrauma, which causes localized pain and triggers widespread pain through disordered central nervous system processing (i.e., central sensitization) (12,13). A negative cycle of muscle deconditioning occurs in FM in large part due to exercise-induced pain that limits exercise tolerance. Dysfunctions in multiple hormonal channels may contribute to exercise-induced pain, due to their critical role in muscle homeostasis and repair following exercise (14–17). FM-specific exercise classes enhance patients’ beliefs in their ability to exercise by providing options that are realistic and directly impact the ability to carry out activities of daily living. Disincentives, such as pain, fatigue, and limited range of motion, are minimized in these courses while specific strengthening exercises that limit eccentric muscle work are emphasized. Despite the preponderance of scientific evidence that supports FM-specific exercises as a cornerstone in the comprehensive management of fibromyalgia (18–21), most people need more than advice to exercise—they need assistance overcoming the barriers to exercise. Commitment to a daily regimen of exercise demands considerable motivation if it is to be life long, but factors that motivate or deter individuals with FM from starting and maintaining an exercise program are largely unknown. What is missing for many people is the confidence that they can exercise in spite of their FM symptoms, and the belief that exercise will help them manage their disease and improve their quality of life (22). In our recent study of exercise in women with FM, 91% of the participants completed the exercise classes, compared with published reports of 13–80% completion of other FM exercise intervention studies (23,24). The purpose of this article is to suggest that building self efficacy for exercise is an important component of FMspecific exercise programs. In addition, motivational interviewing (MI) (25) will be proposed as a method for encouraging persons with FM to begin exercising and continue attending classes, even when such barriers as pain could provide an excuse to quit. The authors have conducted several studies of FM-specific exercise programs that incorporate the principles of self efficacy. We recently added MI as a communication strategy to help patients work through barriers to ongoing exercise. We propose that MI may enhance self efficacy by providing a safe, nonjudgmental means of discussing initiation and maintenance of health-promoting behaviors, such as regular exercise.