Association between chronic widespread pain and physical activity behaviour in people with fibromyalgia
BackgroundFibromyalgia is a prevalent chronic widespread pain condition, affecting 1 in 20 adults in the UK, predominantly women and associated with a significant psychosocial burden. Despite much interest in structured exercise for pain management, resulting in evidence-based guidelines recommending structured exercise as the first line of management for fibromyalgia, adherence to structured exercise remains a huge challenge in this population as factors contributing to exercise intolerance are not adequately explored. The overall aim of this PhD thesis was to explore the impact of biopsychosocial factors on pain and physical activity behaviour in people with fibromyalgia.MethodThree studies were conducted as part of this PhD. Study-1 examined the literature on the association between non-structured physical activity and pain intensity through a systematic review. Study-2 was a cross-sectional survey to examine the associations between physical activity, physical function and pain, and Study-3 consisted of qualitative interviews. A convergent mixed-method approach was taken to interpret the findings from the quantitative and qualitative studies to gain an in-depth understanding of contextual factors impacting pain and physical activity behaviour in people with fibromyalgia.FindingsThe systematic review revealed that the relationship between pain and physical activity is split. Half of the studies reported a statistically significant association between pain and physical activity categories, and the other half reported no statistically significant associations between physical activity categories and pain. The survey data demonstrated a weak association between pain and physical activity and found that depression, anxiety, and fatigue played critical roles in affecting the relationship between pain and physical activity in this population. The qualitative study findings suggested that people with fibromyalgia did not have appropriate guidance on tailored physical activity, leading to increased pain following exercise and sedentary behaviour. Fatigue was an intermediary factor between physical activity behaviour and pain, and those with access to multimodal therapy and social support reported more positive attitudes such as pacing and less pain following increased physical activities.ConclusionA multidisciplinary and multidimensional approach, incorporating patient education with behavioural components, targeting psychosocial factors, is essential to increase adherence to physical activity for people with fibromyalgia. There is also a need to improve public perception of fibromyalgia to facilitate social and workplace support.
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