Research to Encourage Exercise for Fibromyalgia (REEF): Use of Motivational Interviewing, Outcomes From a Randomized-controlled Trial

Abstract

Objectives Regular exercise is associated with important benefits in patients with fibromyalgia (FM). Unfortunately, long-term maintenance of exercise after a structured program is rare. The present study tested the efficacy of Motivational Interviewing (MI) to promote exercise and improve symptoms in patients with FM. Methods 216 patients with FM were randomized to 6 MI sessions (n=107) or an equal number of FM self-management lessons (education control/EC, n=109). Co-primary endpoints were an increase of 30 minutes in moderate-vigorous physical activity and improvement in the Fibromyalgia Impact Questionnaire-Physical Impairment (FIQ-PI) score, assessed at pre-treatment, post-treatment, and 3- and 6-month follow-up. Secondary outcomes included clinically meaningful improvements in FIQ score, pain severity ratings, and a 6-minute walk test. Results There were no significant treatment group differences in either co-primary endpoint at 6-month follow-up. However, more MI participants than controls exhibited meaningful improvements in FIQ score at 6-month follow-up (62.9% vs. 49.5%, p=0.06). Compared to EC subjects, MI subjects also displayed a larger increment in their 6-minute walk test (43.9 vs. 24.8 meters, p=0.03). Additionally, MI was superior to EC in increasing the number of hours of physical activity immediately post-intervention and in reducing pain severity both immediately after the intervention and at 3-month follow-up. Conclusions Despite a lack of benefits on long term outcome, MI appears to have short-term benefits with respect to self-report physical activity and clinical outcomes. This is the first study in FM that explicitly addresses exercise maintenance as a primary aim.