Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis

Factors associated with participation in a walking intervention for veterans who smoke and have chronic pain

This analysis was part of the Pain and Smoking Study (PASS), a randomized trial of a cognitive behavioral intervention (CBI) for Veterans with chronic pain who smoke. The objective of this study was to examine factors associated with participation in the walking component of the intervention. Demographics and clinical characteristics were obtained at baseline. Completion of two or more CBI counseling sessions was required to be included in analyses. Average daily step counts obtained via pedometer in the prior week were recorded in up to three telephone counseling sessions. Participants were then categorized as "sedentary" (≤ 4999 daily steps) or "not sedentary" (≥ 5000 daily steps). Multivariable logistic regression was used to model variance in activity categorization. Overall, 91.0% of participants were men, 70.5% were white, mean age was 58.4 years, mean BMI was 28.6, median pack years was 20.5, and 43.8% were depressed. Veterans reported moderate pain intensity (4.9/10) and pain interference (5.4/10). Pain locations included: lower extremity (67.4%), back (53.4%) and upper extremity (28.1%). Median daily steps were 2491 [IQR: 1720-3550] (sedentary) (n = 65), 7307 [IQR: 5952-8533] (not sedentary) (n = 24), and 3196 [IQR: 2237-5067] (overall) (n = 89). Veterans with older age (odds ratio (OR): 1.10, 95% confidence interval (CI): 1.04, 1.17) and presence of LE pain (OR: 5.98, 95% CI: 1.82, 19.65) had increased odds of being "sedentary." Integrated smoking cessation and chronic pain self-management interventions that include a walking component may need to consider the impact of age and pain location on participation.Trial registration: The trial is registered at www.ClinicalTrials.gov (NCT02971137). First posted on November 22, 2016.

Proactive physical activity programs in lung cancer surgical patients at short and mid-term: A systematic review and meta-analysis

OBJECTIVE

To assess the effects of proactive physical activity (PA) programs on lung cancer patients undergoing lung resection at short and mid-term.

METHODS

We conducted a literature search through MEDLINE, Science Direct, Web of Science, and the Cochrane Library (last search October 2023). The GRADE System and the Cochrane tool were applied to quality assessment. The included studies focused on the application of proactive PA interventions among lung cancer surgical patients compared to usual or standard care. We performed a meta-analysis addressing hospital stay, cancer-related symptoms, quality of life, and exercise capacity at short and mid-term.

RESULTS

We selected 9 studies, which included 798 lung cancer patients. Proactive interventions were applied in combination with respiratory training and exercise in most of the studies. The treatment status was heterogeneous. Significant results in favour of proactive interventions were observed for hospital stay, cancer-related symptoms, quality of life, and short and mid-term exercise capacity.

CONCLUSIONS

Proactive PA interventions showed positive effects for reducing length stay, enhancing exercise capacity at short and mid-term, alleviating cancer-related symptoms, and improving the quality of life for lung cancer surgical patients.

PRACTICE IMPLICATIONS

Proactive interventions can optimize the timing and setting of PA results around lung surgical treatment.

Psychologically Informed Physical Therapy Management of Chronic Musculoskeletal Pain in Culturally Diverse Populations: An Intervention Logic Model

Culturally and linguistically diverse (CALD) individuals are underrepresented in pain research, including studies of psychologically informed physical therapy (PIPT) for musculoskeletal pain. This perspective describes a conceptual framework for PIPT management of chronic musculoskeletal pain that identifies essential elements which can be culturally tailored to meet the needs of different CALD populations. Essential interventions, determinants of behavior change, and clinical outcomes were identified from studies of existing PIPT interventions for chronic pain. PIPT approaches shared the following essential interventions: (1) cognitive skill training, (2) general aerobic activity, (3) impairment-based therapeutic exercises, and (4) graded functional movement training. An intervention logic model was developed to conceptualize how these interventions might promote active coping behaviors and greater engagement in physical activity, therapeutic exercise, and functional mobility. The model included physical and cognitive-emotional processes that may contribute to behavioral changes which ultimately reduce pain-related disability. To illustrate cultural tailoring of model constructs, we describe how intervention delivery and assessments were customized for Latino persons with chronic spine pain at a health center located near the United States (US)-Mexico border. A literature review of sociocultural influences on the pain experience of Latino persons was conducted, and essential elements of the model were operationalized to ensure that therapeutic goals, language, content, and processes were compatible with Latino cultural beliefs, values, and behaviors. Future research using the proposed model to adapt and test PIPT interventions for other CALD populations may help identify shared and divergent mechanisms of treatment response for culturally tailored pain management programs. PERSPECTIVE: A novel conceptual framework may help inform cultural tailoring of psychologically informed physical therapy management approaches for chronic musculoskeletal pain by maintaining fidelity to essential treatment elements while also leveraging the unique sociocultural context of different culturally and linguistically diverse communities to improve health outcomes.

The effectiveness of aerobic exercise compared to other types of treatment on pain and disability in patients with orofacial pain: A systematic review

PURPOSE

To compile and synthesise the evidence regarding the effectiveness of aerobic exercise (AE) compared with other treatments to reduce pain and disability of individuals with orofacial pain (OFP).

METHODS

Electronic searches were conducted on five databases (MEDLINE, Embase, CINAHL, Cochrane Library, and Scopus). Randomised controlled trials (RCT) or controlled trials including adults of both sexes with painful OFP diagnoses were targeted. The intervention of interest was AE (e.g., walking, cycling, running, among others), compared to any other conservative and non-conservative therapy. The primary outcome was pain intensity. The risk of bias (RoB) was determined using a compiled set of items and the Cochrane RoB-2 tools. The overall certainty of the evidence was evaluated with the GRADE approach.

RESULTS

Out of 4.669 records screened, four manuscripts were included. However, three of them used the same population but presented different outcomes. These studies included subjects with headache associated with temporomandibular disorders (TMD) and general TMD. Both studies used aerobic exercise (AE) as the intervention of interest. Manual therapy (MT) plus exercise (Ex) (strengthening exercise (Str ex) or general exercises) were used as a comparison group. The combined treatment, including a multimodal therapy (AE + MT + Str ex), was superior to MT + Ex (MD: -8.65 points [95% CI -13.73, -3.57]) on pain intensity (orofacial pain [OFP] and headache intensity) at the end of the treatment and also after 12-week follow-up (MD: -9.43 points [95% CI -14.97, -3.89]). Also, the combination of three treatment modalities (AE + MT + Ex) was better on quality of life than AE alone (MD: -14.60 points [95% CI -16.74, -12.46]) and MT + Ex (MD: -12.30 point [95% CI -14.50, -10.10]) at the end of the treatment.

CONCLUSIONS

Aerobic exercise plus MT and general exercises achieved the greatest positive effects on pain and other outcomes in the short/medium term in patients with OFP. However, the scientific evidence supporting the isolated effects of AE for OFP is limited, indicating the need for more studies. Further studies are also needed to elaborate guidelines when using AE for individuals with OFP.

How to Promote Walking in Women with Fibromyalgia: A Look at Catastrophizing, Goal Conflict, and Avoidance from a Self-Emotional Regulatory Perspective

The aim of this study was twofold: to explore the concordance between two measures of physical activity (accelerometer and IPAQ) among female fibromyalgia (FM) patients, as well as to examine the impact of psychosocial variables (catastrophism, activity avoidance) on walking among these patients. Helplessness, activity avoidance, and commitment to physical activity were evaluated in 132 FM women. After the first assessment, an accelerometer was placed by a psychologist on each participant for seven consecutive days. Eight days later, accelerometers were collected, and participants were evaluated again using the IPAQ. Two models were tested to analyze mediation and a moderated mediation effect. The mediating role of activity avoidance between helplessness and minutes walked was corroborated regarding the objective measure of walking. The effect of helplessness on minutes walked during a week was mediated by activity avoidance and assessed by accelerometers. Cognitive variables played a contextual role when trying to promote exercise. Activity avoidance must be understood as a key variable in physical activity promotion, specifically in the promotion of walking with the aim to do exercise in individuals with FM.

The Effect of Walking on Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis

Background

Previous literature lacks summative information on the mental health benefits achieved from different forms of walking.

Objective

The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety.

Methods

This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool.

Results

This review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD -0.591, 95% CI -0.778 to -0.403; I2=84.8%; τ2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD -0.446, 95% CI -0.628 to -0.265; I2=81.1%; τ2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD -1.863, 95% CI -2.764 to -0.962; I2=86.4%; τ2=0.8929) and those who were not depressed (RCTs: n=39; SMD -0.442, 95% CI -0.604 to -0.280; I2=77.5%; τ2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD -0.126, 95% CI -0.343 to 0.092; I2=58%; τ2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD -0.053, 95% CI -0.311 to 0.206, I2=67.7%, τ2=0.1421; P=.69).

Conclusions

Various forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future.

The Use of Exercise Prescription in Australian Osteopathy Practice: Secondary Analysis of a Nationally Representative Sample of the Profession

Introduction

Exercise is beneficial for improving general health, wellbeing, and specific medical conditions. In musculoskeletal conditions such as chronic low back and neck pain, prescribed exercise has been found to be moderately effective in decreasing pain and improving function. Osteopaths are primary contact health professionals who manage predominantly musculoskeletal complaints. This work presents a secondary data analysis of the Australian osteopathy practice-based research network and profiles the characteristics of osteopaths who often use exercise prescription in patient care. Methodology. Secondary analysis of a cross-sectional survey of 992 osteopaths was registered with the Osteopathy Research and Innovation Network, an Australian practice-based research network. Demographics, practice, and treatment characteristics of Australian osteopaths who "often" use exercise prescription in patient care were examined.

Results

Seven-hundred and thirty-three Australian osteopaths (74%) indicated that they use exercise prescription "often" in patient care. Australian osteopaths who often use exercise prescription are more likely to be colocated with another osteopath (ORa 1.54) and send referrals to an exercise physiologist (ORa 1.94) and a specialist medical practitioner (ORa 1.72). Those osteopaths who often used exercise prescription were also more likely to discuss physical activity (ORa 5.61) and nutrition (ORa 1.90). Australian osteopaths who use exercise prescription often were more likely to treat patients with sports injuries (ORa 2.43) and use soft tissue techniques (ORa 1.92), trigger point techniques (ORa 2.72), and sports taping (ORa 1.78).

Conclusion

Osteopaths who utilise exercise prescription were more likely to discuss physical activity, diet, and nutrition and utilise referral networks with specialist medical practitioners and exercise physiologists. Australian osteopaths who often use exercise prescriptions were also more likely to treat patients with sport injury. The results suggest that most Australian osteopaths use exercise prescription and have referral networks with other health professionals for patient management. Further work is required to explore the type of exercise prescription used and for what conditions.

Nordic Walking as a Non-Pharmacological Intervention for Chronic Pain and Fatigue: Systematic Review

OBJECTIVE

We aimed to analyze and summarize the available scientific evidence on the benefits of Nordic walking for people with chronic pain and fatigue.

LITERATURE SURVEY

This systematic review adhered to PRISMA guidelines and conducted a comprehensive search across five databases using the PICO strategy.

METHODOLOGY

Inclusion criteria encompassed randomized trials evaluating Nordic walking for pain and fatigue. Two authors independently screened studies, extracted data, and assessed methodological quality using the PEDro scale.

SYNTHESIS

A total of 14 studies were included, with sample sizes ranging from 20 to 136 participants. The methodological quality of the included studies varied from fair (five studies) to good (nine studies). The interventions consisted of supervised Nordic walking sessions lasting 6 to 24 weeks, with a frequency of 2 to 4 days per week and duration of 25 to 75 min. The results of this review suggest that Nordic walking had beneficial effects in six of the eight studies that analyzed participant fatigue. However, Nordic walking did not show greater beneficial effects on fatigue than walking (two studies) or than not performing physical activity (one study). Additionally, six of the nine studies that examined the effects of Nordic walking on participants' perceptions of pain showed beneficial results. However, five studies that compared Nordic walking with control groups did not find any significant inter-group differences on pain.

CONCLUSIONS

Based on our findings, Nordic walking exercise programs provide a potentially efficient method for alleviating pain and fatigue in people with chronic conditions. Its straightforwardness and ease of learning make it accessible to a broad spectrum of participants, which can result in higher adherence rates and lasting positive effects.

Physical activity should be the primary intervention for individuals living with chronic pain A position paper from the European Pain Federation (EFIC) 'On the Move' Task Force

BACKGROUND

There is clear evidence demonstrating the benefits of physical activity (PA) on pain and overall health, however, PA is challenging for many individuals living with chronic pain. Even non-exercise specialists can (cost) effectively promote PA, but many health professionals report a number of barriers in providing guidance on PA, suggesting that it is not consistently promoted. This expert position paper summarizes the evidence and provides five recommendations for health professionals to assess, advise and support individuals living with any chronic pain condition with a long life expectancy in adopting and sustaining physically active lifestyles.

METHODS

This position paper was prepared by the 'On The Move' Task Force of the European Pain Federation EFIC. Final recommendations were endorsed by the European Pain Forum, Pain Alliance Europe and the Executive Board of EFIC.

RESULTS

We recommend that all health professionals (1) Take a history of the persons' PA levels, and put PA on the agenda, (2) Advise that PA is important and safe for individuals living with chronic pain, (3) Deliver a brief PA intervention and support individuals living with chronic pain in becoming physically active, (4) Discuss acceptable levels of PA-related soreness and pain and (5) Provide ongoing support in staying physically active.

SIGNIFICANCE

Physical activity is safe and offers several advantages, including general health benefits, low risk of side effects, low cost and not requiring access to healthcare. Adoption of these recommendations can improve the quality of care and life of individuals living with chronic pain and reduce their overall health risks.

Stepped Care for Patients to Optimize Whole Recovery (SC-POWR): An Effectiveness Trial Evaluating a Stepped Care Model for Individuals With Opioid Use Disorder and Chronic Pain

Many patients who receive treatment for opioid use disorder (OUD) report experiencing chronic pain (CP), which is associated with high levels of ongoing nonmedical opioid use and low retention in OUD treatment. In pilot studies of patients with OUD receiving buprenorphine or methadone who had CP, cognitive behavioral therapy (CBT) attenuated nonmedical opioid use compared with treatment-as-usual (TAU), but patients in both treatment arms exhibited similar pain improvements. Adding exercise and stress reduction to this model may augment pain-related outcomes. With funding from National Institutes of Health, we plan to conduct a randomized clinical trial of 316 patients with OUD and CP to test the effectiveness of TAU compared with Stepped Care for Patients to Optimize Whole Recovery (SC-POWR) to reduce nonmedical opioid use and pain (primary outcomes) (Aim 1) and decrease pain intensity and interference, alcohol use, anxiety, depression and stress, and improve sleep (secondary outcomes) (Aim 2). Eligible participants will be randomized to receive TAU (buprenorphine or methadone and at least once a month individual or group counseling) or SC-POWR (ie, TAU and up to 12 CBT sessions) for 24 weeks. Based on prespecified nonresponse criteria, SC-POWR may be stepped up at week 6 to receive onsite weekly group sessions of exercise (Wii Fit, Tai Chi) and "stepped up" again at week 15 to receive weekly group sessions of stress reduction (relaxation training, auricular acupuncture). They will be followed for another 24 weeks to evaluate durability of treatment response for illicit opioid use, alcohol use, pain, anxiety, depression, stress, sleep, and retention in medications for OUD (Aim 3).

Diagnosis and Treatment of Low Back Pain: Synopsis of the 2021 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline

ABSTRACT

Low back pain is a significant issue in the US Department of Veterans Affairs and Department of Defense populations as well as the general US population at large. This type of pain can be distressing to those who experience its effects, leading patients to seek relief of their symptoms. In 2022, leadership within the US Department of Veterans Affairs and US Department of Defense approved a joint clinical practice guideline for the management of low back pain. The guideline provides evidence-based recommendations for assessing and managing low back pain. Development of the guideline included a systematic evidence review, which was guided by 12 key questions. A multidisciplinary team, which included clinical stakeholders, reviewed the evidence that was retrieved and developed 39 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system. The scope of the clinical practice guideline is broad; however, the authors have focused on key recommendations that are important for clinicians in the evaluation and nonoperative treatment of low back pain, including pharmacologic therapies and both noninvasive and invasive nonpharmacologic treatments.

The Impact of Exercise Prescription Variables on Intervention Outcomes in Musculoskeletal Pain: An Umbrella Review of Systematic Reviews

BACKGROUND

Musculoskeletal pain conditions are the largest contributors to disability and healthcare burden globally. Exercise interventions improve physical function and quality of life in individuals with musculoskeletal pain, yet optimal exercise prescription variables (e.g. duration, frequency, intensity) are unclear.

OBJECTIVE

We aimed to examine evidence gaps, methodological quality and exercise prescription recommendations in systematic reviews of exercise for musculoskeletal pain.

METHODS

In our prospectively registered umbrella review, PubMed, SPORTDiscus, Cochrane Database of Systematic Reviews, EMBASE, and CINAHL were searched from inception to 14 February 2023. Backward citation tracking was performed. We included peer-reviewed, English language, systematic reviews and meta-analyses of randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared exercise with conservative treatment, placebo or other exercise interventions in adults with musculoskeletal pain. Data were extracted from the following groups of reviews based on their reporting of exercise prescription data and analysis of the relationship between prescription variables and outcomes: (1) those that did not report any exercise prescription data, (2) those that reported exercise prescription data but did not perform a quantitative analysis and (3) those that performed a quantitative analysis of the relationship between exercise prescription variables and outcomes. Outcome measures were physical function, pain, mental health, adverse effects and adherence to treatment. AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews) was used to assess methodological quality.

RESULTS

From 6757 records, 274 systematic reviews were included. 6.6% of reviews did not report any exercise prescription data, and only 10.9% quantitatively analyzed the relationship between prescription variables and the outcome(s). The overall methodological quality was critically low in 85% of reviews.

CONCLUSION

High methodological quality evidence is lacking for optimal exercise training prescription variables in individuals with musculoskeletal pain. To better inform practice and evidence gaps, future systematic reviews should (1) identify optimum exercise prescription variables, for example, via dose-response (network) meta-analysis, (2) perform high-quality reviews per AMSTAR-2 criteria and (3) include outcomes of mental health, adverse events and exercise adherence.

PROSPERO REGISTRATION NUMBER

CRD42021287440 ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021287440 ).

Perspectives of the World Health Organization's physical activity guidelines among patients with musculoskeletal conditions: A mixed-methods survey

INTRODUCTION

Physical activity (PA) promotion is a core element of musculoskeletal rehabilitation. Many people with musculoskeletal conditions do not meet PA guidelines, such as those provided by the World Health Organization (WHO). This study aimed to explore the level of awareness and perspectives on the WHO PA guidelines among people with musculoskeletal conditions and identify how patients can be supported with PA in clinical practice.

METHODS

A mixed-method cross-sectional survey was conducted using a uniquely developed questionnaire, which was disseminated to patients attending outpatient physiotherapy or occupational therapy appointments. The questionnaire collected data on participant characteristics, awareness and perspectives on the WHO guidelines and suggestions for supporting patients with PA in clinical practice. Descriptive statistics and content analysis were used to analyse the quantitative and qualitative data respectively.

RESULTS

One-hundred and two responses were included in the analysis. Forty-two percent of respondents were aware of the guidelines, 50% knew why they existed and 53% felt they were achievable. Perspectives varied, ranging from the guidelines being positive and aiding motivation to being unachievable. Some respondents felt an individualised approach is required. Suggestions for supporting patients with PA included facilitating social support, providing education, exercise groups and personalised advice, and signposting to community services.

CONCLUSION

There is limited awareness of the WHO PA guidelines and a variety of perspectives on the guidelines among patients with musculoskeletal conditions. There is a need to enhance the promotion of the guidelines in clinical practice, whilst considering local context and individual patient's circumstances.

Improving multimodal physical function in adults with heterogeneous chronic pain; Protocol for a multisite feasibility RCT

BACKGROUND

Chronic pain is associated with substantial impairment in physical function, which has been identified as a top concern among persons with pain. GetActive-Fitbit, a mind-body activity program, is feasible, acceptable, and associated with improvement in physical function among primarily White, sedentary individuals with pain. In preparation for a multisite efficacy trial, we must examine feasibility across multiple sites with diverse patient populations. Here we describe the protocol of a multisite, feasibility RCT comparing GetActive-Fitbit with a time- and attention-matched educational comparison (Healthy Living for Pain). We aim to 1) test multisite fidelity of clinician training; 2) evaluate multisite feasibility benchmarks, including recruitment of chronic pain patients taking <5000 steps/day and racial and ethnic minorities; and 3) optimize fidelity and study protocol in preparation for a future multisite efficacy trial.

METHODS

Clinician training fidelity was assessed via roleplays and mock group sessions. Feasibility (i.e., recruitment, acceptability, credibility, adherence, satisfaction), multimodal physical function (e.g., self-report, 6-Minute Walk Test, step-count), and other psychosocial outcomes are assessed at baseline, posttest, and 6 months. Protocol optimization will be assessed using exit interviews and cross-site meetings.

RESULTS

The trial is ongoing. Clinician training is complete. 87 participants have been recruited. 54 completed baseline assessments and randomization, 44 are mid-intervention, and 9 have completed the intervention and posttest.

CONCLUSIONS

This study addresses the critical need for feasible, acceptable mind-body-activity interventions for chronic pain that follow evidence-based guidelines and improve all aspects of physical function across diverse populations. Results will inform a future fully-powered multisite efficacy trial.

CLINICAL TRIAL REGISTRATION

NCT05700383.

Effects of Nature-Based Multisensory Stimulation on Pain Mechanisms in Women with Fibromyalgia Syndrome: A Randomized Double-Blind Placebo-Controlled Trial

BACKGROUND

The term "nature-based sensory stimuli" refers to the sensory information produced by biotic and abiotic agents from natural environments. The literature has reported the beneficial effects of these agents on various pain dimensions in non-clinical populations.

AIMS

To evaluate the potential analgesic effects of nature-based multisensory stimulation in women with fibromyalgia syndrome.

METHODS

A randomized, double-blind, placebo-controlled, parallel-group trial with a 1:1 allocation ratio was conducted. Forty-two women with fibromyalgia syndrome interacted with either different plant species with flowers, stones, and soil organic matter or their synthetic imitations for 30 minutes. Outcome measurements were performed before and after the intervention, including clinical pain intensity using the Numeric Rating Scale, cold pain thresholds using the Cold Pressor Test, mechanical hyperalgesia and wind-up using a monofilament, and pressure pain thresholds using a pressure algometer.

RESULTS

Analyses revealed group × time interactions for clinical pain intensity (F = 7.915, p = .008), cold-water immersion time (F = 7.271, p = .010), mechanical hyperalgesia (F = 4.701, p = .036), and pressure pain threshold (p ≤ .017). Between-group differences were found in clinical pain intensity (p = .012), cold pain thresholds (p = .002), and pressure pain thresholds (p < .05). The experimental group exhibited reduced clinical pain intensity (p = .001) and increased pressure pain thresholds (p ≤ .034).

CONCLUSIONS

Women with fibromyalgia syndrome may benefit from multisensory stimulation using biotic and abiotic agents from natural environments for 30 minutes. Interacting with flowering plants and soil components appears to induce analgesic effects.

How to Generate Self-Efficacy despite Pain: The Role of Catastrophizing and Avoidance in Women with Fibromyalgia

BACKGROUND AND OBJECTIVE

Fibromyalgia-related pain is influenced by numerous factors, including severity, as well as cognitive profiles based on pain catastrophizing or activity patterns. In this context, self-efficacy is identified as a potential predictor for explaining certain health outcomes. This study aimed to contribute to exploring the role of pain avoidance (as activity pattern) between pain severity and self-efficacy along pain catastrophizing.

METHODS

Through a cross-sectional study, a total of 264 women with fibromyalgia completed self-report measures of pain severity, pain avoidance, pain catastrophizing, and self-efficacy. The severity of the symptoms, the time elapsed since diagnosis, and the time elapsed since the onsets of symptoms were included as covariates to control. Regression-based moderated-mediation analysis was used to test the conditional effect of pain severity on self-efficacy via pain avoidance at varying levels of pain catastrophizing.

RESULTS

Pain avoidance mediated the effect of pain severity on self-efficacy. The indirect effects showed a moderated effect when patients scored high on the pain catastrophizing scale. The model evaluated, where catastrophic pain moderates the indirect effect of pain intensity on self-efficacy through pain avoidance, explained 49% of the variance.

CONCLUSIONS

Catastrophic beliefs associated with pain as being uncontrollable increase the relationship between pain severity and pain avoidance. In turn, pain avoidance is associated with a low perception of capacity.

The acceptability and feasibility of conducting a randomised controlled trial to test the effectiveness of a walking intervention for older people with persistent musculoskeletal pain in primary care: A mixed methods evaluation of the iPOPP pilot trial

INTRODUCTION

Persistent musculoskeletal (MSK) pain is associated with physical inactivity in older people. While walking is an acceptable form of physical activity, the effectiveness of walking interventions in this population has yet to be established.

OBJECTIVES

To assess the acceptability and feasibility of conducting a randomised controlled trial (RCT) to test the effectiveness of a healthcare assistant-led walking intervention for older people with persistent MSK pain (iPOPP) in primary care.

METHODS

A mixed method, three arm pilot RCT was conducted in four general practices and recruited patients aged ≥65 years with persistent MSK pain. Participants were randomised in a 1:1:1 ratio to: (i) usual care, (ii) usual care plus a pedometer intervention, or (iii) usual care plus the iPOPP walking intervention. Descriptive statistics were used in an exploratory analysis of the quantitative data. Qualitative data were analysed using thematic analysis. A triangulation protocol was used to integrate the analyses from the mixed methods.

RESULTS

All pre-specified success criteria were achieved in terms of feasibility (recruitment, follow-up and iPOPP intervention adherence) and acceptability. Triangulation of the data identified the need, in the future, to make the iPOPP training (for intervention deliverers) more patient-centred to better support already active patients and the use of individualised goal setting and improve accelerometry data collection processes to increase the amount of valid data.

CONCLUSIONS

This pilot trial suggests that the iPOPP intervention and a future full-scale RCT are both acceptable and feasible. The use of a triangulation protocol enabled more robust conclusions about acceptability and feasibility to be drawn.

The multifaceted benefits of walking for healthy aging: from Blue Zones to molecular mechanisms

Physical activity, including walking, has numerous health benefits in older adults, supported by a plethora of observational and interventional studies. Walking decreases the risk or severity of various health outcomes such as cardiovascular and cerebrovascular diseases, type 2 diabetes mellitus, cognitive impairment and dementia, while also improving mental well-being, sleep, and longevity. Dose-response relationships for walking duration and intensity are established for adverse cardiovascular outcomes. Walking's favorable effects on cardiovascular risk factors are attributed to its impact on circulatory, cardiopulmonary, and immune function. Meeting current physical activity guidelines by walking briskly for 30 min per day for 5 days can reduce the risk of several age-associated diseases. Additionally, low-intensity physical exercise, including walking, exerts anti-aging effects and helps prevent age-related diseases, making it a powerful tool for promoting healthy aging. This is exemplified by the lifestyles of individuals in Blue Zones, regions of the world with the highest concentration of centenarians. Walking and other low-intensity physical activities contribute significantly to the longevity of individuals in these regions, with walking being an integral part of their daily lives. Thus, incorporating walking into daily routines and encouraging walking-based physical activity interventions can be an effective strategy for promoting healthy aging and improving health outcomes in all populations. The goal of this review is to provide an overview of the vast and consistent evidence supporting the health benefits of physical activity, with a specific focus on walking, and to discuss the impact of walking on various health outcomes, including the prevention of age-related diseases. Furthermore, this review will delve into the evidence on the impact of walking and low-intensity physical activity on specific molecular and cellular mechanisms of aging, providing insights into the underlying biological mechanisms through which walking exerts its beneficial anti-aging effects.

Bringing the Walk with Ease Programme to the UK: a mixed-methods study to assess the relevance, acceptability, and feasibility of implementation for people with arthritis and musculoskeletal conditions

Developed in the United States (US), Walk With Ease (WWE) is a popular evidence-based, 6-week community walking programme for adults with arthritis, delivered in either an instructor-led or self-directed format. While WWE has expanded into communities across the USA, it is relatively unknown in other countries across the globe. This study, in collaboration with community and patient partners, aimed to examine the relevance, acceptability and feasibility of introducing WWE into a UK context. After initial cultural adaptation, participants were recruited into the study. Eligible (≥18 years, doctor diagnosed arthritis (confirmed or self-report), self-reported joint symptoms in last 30 days, BMI ≥25 kg/m2, and <150 min/week of moderate/vigorous PA) and consented participants were randomized into two groups: WWE programme or usual care. A mixed-methods analysis approach integrated quantitative data (physical performance assessment; baseline and post-six week programme questionnaire) and qualitative data (narrative interviews exploring participants' pre- and post-WWE experiences and stakeholders' perceptions). Of 149 participants, the majority were women (70%) aged ≥60 years (76%). Among the 97 receiving the programme, 52 chose instructor-led; 45 chose self-directed. Participants found WWE relevant and acceptable-99% indicating they would recommend WWE to family/friends. Within both WWE formats, mixed differences representing improvement were observed at 6 weeks from baseline for physical performance and arthritis symptoms. Emergent themes included improved motivation, health, and social well-being. WWE is a relevant and acceptable walking programme with scope for wider implementation to support UK health and well-being policy strategies.

Sleep characteristics and pain in middle-aged and older adults: Sex-specific impact of physical and sitting activity

OBJECTIVES

The relationship between poor sleep health and worse pain is established. Physical activity has been successful in reducing chronic pain and improving sleep in aging adults. Despite known sex differences (more women than men experiencing chronic pain and insomnia), sex-specific patterns of interactive associations between physical activity, sleep, and pain remain unexplored. This study tested whether physical and sitting activity moderated associations between sleep characteristics and pain intensity, and whether sex further moderated these relationships.

METHODS

Participants aged 50+ (N = 170, Mage = 64.34, 72 women) completed an online survey measuring pre-sleep arousal (Pre-sleep Arousal Scale), sleep (Pittsburgh Sleep Quality Index), past month average pain intensity, and physical activity (International Physical Activity Questionnaire). Multiple regressions evaluated whether minutes of physical activity (total, vigorous, moderate, walking) or sitting activity, pre-sleep arousal, sleep, sex, or their interaction was associated with pain. Analyses controlled for education, difficulty walking, body mass index, total medical conditions, pain medication, and depressive/anxiety symptoms.

RESULTS

In women, vigorous activity interacted with total pre-sleep arousal and somatic pre-sleep arousal in its association with pain. Higher total arousal and somatic arousal were associated with worse pain intensity only for women who reported highest levels of vigorous activity. No such associations were observed for men or for other physical or sitting activity levels.

CONCLUSIONS

Vigorous physical activity may exacerbate the association between more pre-sleep arousal and worse pain in middle-aged and older women. Research should explore potential sex-specific mechanisms (e.g., inflammatory cytokines, arousal neural networks) underlying these results.

Addressing the Chronic Pain-Early Cognitive Decline Comorbidity Among Older Adults: Protocol for the Active Brains Remote Efficacy Trial

BACKGROUND

Chronic pain and early cognitive decline, which are costly to treat and highly prevalent among older adults, commonly co-occur, exacerbate one another over time, and can accelerate the development and progression of Alzheimer disease and related dementias. We developed the first mind-body activity program (Active Brains [AB]) tailored to the needs of older adults with chronic pain and early cognitive decline. Results from our previous study strongly supported the feasibility of conducting AB remotely and provided evidence for improvements in outcomes.

OBJECTIVE

We are conducting a single-blinded, National Institutes of Health stage-2, randomized clinical trial to establish the efficacy of AB versus a time-matched and dose-matched education control (Health Enhancement Program [HEP]) in improving self-reported and objective outcomes of physical, cognitive, and emotional functions in 260 participants. The methodology described in this paper was informed by the lessons learned from the first year of the trial.

METHODS

Participants are identified and recruited through multidisciplinary clinician-referred individuals (eg, pain psychologists and geriatricians), the Rally Research platform, social media, and community partnerships. Interested participants complete eligibility screening and electronic informed consent. Baseline assessments include self-report, performance-based measures (eg, 6-min walk test) and objective measures (eg, Repeatable Battery for the Assessment of Neuropsychological Status). Participants are mailed a wrist-worn ActiGraph device (ActiGraph LLC) to passively monitor objective function (eg, steps) during the week between the baseline assessment and the beginning of the programs, which they continue to wear throughout the programs. After baseline assessments, participants are randomized to either AB or HEP and complete 8 weekly, remote, group sessions with a Massachusetts General Hospital psychologist. The AB group receives a Fitbit (Fitbit Inc) to help reinforce increased activity. Assessments are repeated after the intervention and at the 6-month follow-up. Coprimary outcomes include multimodal physical function (self-report, performance based, and objective). Secondary outcomes are cognitive function (self-report and objective), emotional function, and pain.

RESULTS

We began recruitment in July 2022 and recruited 37 participants across 4 cohorts. Of them, all (n=37, 100%) have completed the baseline assessment, 26 (70%) have completed the posttest assessment, and 9 (24%) are actively enrolled in the intervention (total dropout: n=2, 5%). In the three cohorts (26/37, 70%) that have completed the AB or HEP, 26 (100%) participants completed all 8 group sessions (including minimal makeups), and watch adherence (1937/2072, 93.48%, average across ActiGraph and Fitbit devices) has been excellent. The fourth cohort is ongoing (9/37, 24%), and we plan to complete enrollment by March 2026.

CONCLUSIONS

We aim to establish the efficacy of the AB program over a time-matched and dose-matched control in a live video-based trial and test the mechanisms through theoretically driven mediators and moderators. Findings will inform the development of a future multisite effectiveness-implementation trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05373745; https://classic.clinicaltrials.gov/ct2/show/NCT05373745.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47319.

Comparison of the effectiveness of eHealth self-management interventions for pain between oncological and musculoskeletal populations: a systematic review with narrative synthesis

OBJECTIVES

The aim of this systematic review is to compare the effectiveness of eHealth self-management interventions on pain intensity between oncological and musculoskeletal populations and to examine barriers and facilitators of the use of eHealth self-management tools.

CONTENT

In March 2021, a systematic search of the literature was conducted using the databases PubMed and Web of Science. Studies that investigated the effect of eHealth self-management interventions on pain intensity in an oncological and/or a musculoskeletal population were included.

SUMMARY

No study was found with a direct comparison of the two populations. Of the ten included studies, only one (musculoskeletal) found a significant interaction effect in favor of the eHealth program and three (musculoskeletal and breast cancer) showed a significant time-effect of the eHealth intervention. In both populations user-friendliness of the tool was considered as a facilitator, the length of the program and the lack of an in-person session as barrier. Due to the absence of a direct comparison, no conclusion can be made on how the effectiveness differs between both populations.

OUTLOOK

Further research should incorporate patient-experienced barriers and facilitators and there is a high need of studies making the direct comparison of the effect of an eHealth self-management intervention on pain intensity in an oncological vs. a MSK population.

Use of Rehabilitation Therapy in Palliative Care Patients

Palliative care is a unique area of veterinary medicine, where primary goals include maintaining quality of life, as opposed to treating with a curative intent. Using the disablement model and client partnership allows for the development of a function-targeted treatment plan individualized to patient and family needs. Rehabilitation modalities, especially when combined with adaptive pain management, are well-suited to palliative care because they can greatly enhance a patient's ability to achieve improved function and quality of life. These areas join in a concept called palliative rehabilitation which combines the unique needs of these patients and the tools accessible to the rehabilitation practitioner.

Infralimbic YTHDF1 is necessary for the beneficial effects of acute mild exercise on auditory fear extinction retention

Exposure therapy is the most effective approach of behavioral therapy for anxiety and post-traumatic stress disorder (PTSD). But fear is easy to reappear even after successful extinction. So, identifying novel strategies for augmenting exposure therapy is rather important. It was reported that exercise had beneficial effects on cognitive and memory deficits. However, whether exercise could affect fear memory, especially for fear extinction remained elusive. Here, our results showed that exposure to acute mild exercise 1 or 2 h before extinction training can augment recent fear extinction retention and 2 h for the remote fear extinction retention. These beneficial effects could be attributed to increased YTHDF1 expression in medial prefrontal cortex (mPFC). Furthermore, by using an AAV-shRNA-based approach to silence YTHDF1 expression via stereotactic injection in prelimbic cortex (PL) or infralimbic cortex (IL), respectively, we demonstrated that silence YTHDF1 in IL, but not in PL, blunted augmentation of exposure therapy induced by acute mild exercise and accompanied with decreased NR2B and GluR1 expression. Moreover, YTHDF1 modulated dendritic spines remodeling of pyramidal neuron in IL. Collectively, our findings suggested that acute mild exercise acted as an effective strategy in augmenting exposure therapy with possible implications for understanding new treatment underlying PTSD.

Non-pharmacological therapies in Fibromyalgia: New horizons for physicians, new hopes for patients

INTRODUCTION

Fibromyalgia (FM) is a chronic musculoskeletal condition characterised by reduced quality of life and severe limitations in daily living activities. Considering the wide spectrum of symptoms and the ineffectiveness of a single pharmacological approach, the latest clinical guidelines recommend non-pharmacological therapies as both an alternative and a better-tolerated approach. Several studies have been conducted to determine the effectiveness of non-pharmacological therapies in the management of FM.

AIMS

Through a literature review, this paper aims to describe the different complementary therapies and investigate their potential sustainability and effectiveness on FM symptoms in the short and/or long term.

METHODS

We searched the PubMed and Google Scholar databases using broad search terms up to June 2022, to identify all types of study designs restricted to human subjects on non-pharmacological therapies in FM.

RESULTS

Recent evidence demonstrated that physical activity is the mainstay of therapeutic management, highlighting the relevance of walking as the best method of exercise in FM patients. Nevertheless, adherence to physical activity remains fraught with obstacles that could be overcome with a multimodal and multidisciplinary approach involving a wide range of passive therapies. The effectiveness of passive non-pharmacological therapies remains however unproven in the long term. They can be therefore suggested as 'adjunct' or 'bridge' therapy to improve adherence to physical activity.

CONCLUSION

To conclude, FM management requires a multimodal and symptom-based approach, guided by the predominant bothersome symptom on the one hand, and the preferences of each patient on the other hand.

Association of phase angle with sarcopenia in chronic musculoskeletal pain patients: a retrospective study

BACKGROUND

In chronic musculoskeletal pain patients, detection of sarcopenia is of significant clinical interest. Phase angle, which can be measured through bioelectrical impedance analysis (BIA), can detect sarcopenia; however, the evidence in chronic musculoskeletal pain patients is limited. This study aimed to assess the relationship between phase angle and sarcopenia in patients with chronic musculoskeletal pain. Our hypothesis was that phase angle would be a useful indicator to identify sarcopenia in patients with chronic musculoskeletal pain.

METHODS

A total of 190 patients (51 men and 139 women) with chronic musculoskeletal pain were included in this retrospective cross-sectional study. Patient data of backgrounds, numeric rating scale score for pain, skeletal muscle index, and phase angle assessed using BIA were retrospectively reviewed. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria 2019.

RESULTS

A total of 51 patients (26.7%), including 10 men (19.6%) and 41 women (29.5%), were diagnosed with sarcopenia. Phase angle, sarcopenia-related factors, age, and body mass index (BMI) differed significantly in patients with and without sarcopenia. On multiple logistic regression analysis, the prevalence of sarcopenia was significantly correlated with phase angle and BMI. The areas under the curve exhibited high accuracy in discriminating sarcopenia in men and moderate accuracy in both sexes and in women.

CONCLUSIONS

Phase angle may be a valid discriminator of sarcopenia in patients with chronic musculoskeletal pain.

Sedentary Behavior and Pain after Physical Activity in Women with Fibromyalgia-The Influence of Pain-Avoidance Goals and Catastrophizing

BACKGROUND

Fibromyalgia is characterized by chronic pain and fatigue that triggers a functional disability caused by the lack of activity. Pain catastrophizing may contribute to avoiding activity with the intention of managing pain levels. Based on the sedentary behavior with fibromyalgia, the present study assessed the preference of pain-avoidance goals and pain catastrophizing as mediator and moderator variables, respectively, that influence pain perception after a 6-min-walking test.

METHODS

The sample was composed of 76 women with fibromyalgia (mean age = 55.05, SD = 7.70). Previous sedentary behavior, preference for pain-avoidance goals, and pain catastrophizing were evaluated before starting the walking-test. Subsequently, pain perception was evaluated.

RESULTS

A significant moderated-mediation model was found in which pain-avoidance goals mediated the relationship between sedentarism and pain after a walking-test, and pain catastrophizing moderated the relationship between the preference for pain-avoidance goals and pain perception. Specifically, high levels of pain catastrophizing contributed to increased pain perceptions after completing the test (B = 0.570, p = 0.03, CI 95% (0.09, 0.11)].

CONCLUSIONS

The results suggest that motivational interventions can improve the symptoms because their objectives are focused on managing conflict goals. These interventions should focus on catastrophic cognitions considering that pain catastrophizing is deemed to be one of the major inhibitors of physical activity in fibromyalgia.

An Analysis of the Role of Mental Health in a Randomized Trial of a Walking Intervention for Black Veterans With Chronic Pain

Black patients and those with co-occurring mental health disorders are disproportionately affected by chronic pain, but few interventions target these populations. This is a secondary analysis of a randomized trial of a walking-focused proactive counseling intervention for Black Veterans with chronic musculoskeletal pain (ACTION). The primary aim was to examine intervention effectiveness among Veterans with an electronic health record-documented mental health diagnosis [depressive disorder, anxiety disorder, substance use disorder, post-traumatic stress disorder or serious mental illness (n = 205)] and those without a diagnosis (n = 175). About 380 Black Veterans receiving care at the Atlanta VA Health Care System were enrolled from 2016 to 2019 and randomized to the intervention or usual care (UC) (1:1). The intervention featured 6 telephone coaching sessions over 8-14 weeks to encourage walking. Participants with a mental health disorder were more likely to complete all counseling sessions (56% vs 38%) and reported improvements in global perceptions of pain and pain intensity/interference (secondary outcomes) at 3-months vs UC. Among participants without a mental health disorder, the intervention was associated with an improvement in pain-related disability at 6-months (primary outcome). Black chronic pain patients with co-occurring mental health disorders may require more intensive treatment to affect improvement in pain-related disability. PERSPECTIVE: This study examines the effectiveness of a walking intervention for chronic pain among Black Veterans with a mental health disorder. These patients were more engaged with the intervention than those without a mental health disorder. However, they did not experience reductions in pain-related disability, suggesting more intensive treatment is needed.

Therapeutic exercise interventions in rat models of arthritis

Arthritis is the leading cause of musculoskeletal pain and disability worldwide. Nearly 50% of individuals over the age of 65 have arthritis, which contributes to limited function, articular pain, physical inactivity, and diminished quality of life. Therapeutic exercise is often recommended in clinical settings for patients experiencing arthritic pain, however, there is little practical guidance regarding the use of therapeutic exercise to alleviate arthritic musculoskeletal pain. Rodent models of arthritis allow researchers to control experimental variables, which cannot be done with human participants, providing an opportunity to test therapeutic approaches in preclinical models. This literature review provides a summary of published findings in therapeutic exercise interventions in rat models of arthritis as well as gaps in the existing literature. We reveal that preclinical research in this field has yet to adequately investigate the impact of experimental variables in therapeutic exercise including their modality, intensity, duration, and frequency on joint pathophysiology and pain outcomes.

Effects of Walking as Physical Exercise on Functional Limitation through Pain in Patients with Fibromyalgia-How Does Catastrophic Thinking Contribute?

Background: Aerobic exercise has a beneficial impact on physical and mental health. However, patients with fibromyalgia do not always report perceiving these improvements. Objective: The aim of this study was to examine whether catastrophic thinking moderated the effects of perceived pain severity once an active and regular lifestyle had been established on functional limitation in chronic pain patients, in particular in fibromyalgia patients. Methods: The sample consisted of a total of 491 women with fibromyalgia diagnosed according to the criteria of the American College of Rheumatology. Participants completed an ad-hoc item about lifestyle related to walking pattern, the Brief Pain Inventory, the Pain Catastrophization Scale, and the Fibromyalgia Impact Questionnaire-Revised. To examine the relationship between the variables, a moderate mediation analysis was performed through the macro PROCESS (model 14). Results: The relationship between the performance of the recommended walking pattern and functional limitation was mediated by the severity of pain (B = −5.19, SE = 1.59, t = −3.25, 95% CI = [−4.06, −0.28], p < 0.001). Furthermore, it was found that the mediating effect of pain severity was moderated by catastrophic thinking (Index = −0.014, SE = 0.007, 95% CI [0.002, 0.030]). Conclusions: The positive effect of walking on functionality through the reduction of pain levels is favored when patients present low catastrophizing, which affects the relevance of including interventions focused on the reduction of catastrophizing in the prescription of physical exercise in patients with fibromyalgia as the treatment of choice.

When It Hurts, a Positive Attitude May Help. The Moderating Effect of Positive Affect on the Relationship Between Walking, Depression, and Symptoms in Women with Fibromyalgia

BACKGROUND

Increased exercise is a marker of health in fibromyalgia (FM). However, patients frequently avoid physical activity as a way of minimizing the pain they feel. This deprives them of opportunities to obtain positive reinforcement, increasing functional impact.

AIMS

This study examines the mediating role of depressive symptoms between walking (as physical exercise), functional impact, and pain, at different levels of positive affect (PA) among women with fibromyalgia.

DESIGN

Cross-sectional correlational study.

SETTINGS

Mutual aid associations for fibromyalgia in Spain.

PARTICIPANTS

231 women diagnosed with FM.

METHODS

Moderate mediation analyses were conducted using PROCESS.

RESULTS

First, a simple mediation model showed that depression mediated the effect of walking on functional impact, but not on pain. Additionally, the moderated mediated model showed that this effect was significant at medium and high levels of PA, but not when levels of PA were low.

CONCLUSIONS

Provision of resources focused on positive affect seem to increase the positive effects of walking on functional impact through the reduction of depressive symptoms. Nurses can improve adherence of patients with FM to walking behavior through increasing positive affect.

Taking ACTION to Reduce Pain: a Randomized Clinical Trial of a Walking-Focused, Proactive Coaching Intervention for Black Patients with Chronic Musculoskeletal Pain

BACKGROUND

Black patients in the USA are disproportionately affected by chronic pain, yet there are few interventions that address these disparities.

OBJECTIVE

To determine whether a walking-focused, proactive coaching intervention aimed at addressing contributors to racial disparities in pain would improve chronic pain outcomes among Black patients compared to usual care.

DESIGN

Randomized controlled trial with masked outcome assessment ( Clinicaltrials.gov : NCT01983228).

PARTICIPANTS

Three hundred eighty Black patients at the Atlanta VA Health Care System with moderate to severe chronic back, hip, or knee pain.

INTERVENTION

Six telephone coaching sessions over 8-14 weeks, proactively delivered, using action planning and motivational interviewing to increase walking, or usual care.

MAIN MEASURES

Primary outcome was a 30% improvement in pain-related physical functioning (Roland Morris Disability Questionnaire [RMDQ]) over 6 months among Black patients, using intention-to-treat. Secondary outcomes were improvements in pain intensity and interference, depression, anxiety, global impression of change in pain, and average daily steps.

KEY RESULTS

The intervention did not produce statistically significant effects on the primary outcome (at 6 months, 32.4% of intervention participants had 30% improvement on the RMDQ vs. 24.7% of patients in usual care; aOR=1.61, 95% CI, 0.94 to 2.77), nor on other secondary outcomes assessed at 6 months, with the exception that intervention participants reported more favorable changes in pain relative to usual care (mean difference=-0.54, 95% CI, -0.85 to -0.23). Intervention participants also experienced a significant reduction in pain intensity and pain interference over 3 months (mean difference=-0.55, 95% CI, -0.88 to -0.22).

CONCLUSIONS

A novel intervention to improve chronic pain among Black patients did not produce statistically significant improvements on the primary outcome relative to usual care. More intensive efforts are likely required among this population, many of whom were economically disadvantaged and had mental health comorbidities and physical limitations.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT01983228.

Results of ELBRUS clinical non-interventional study

Objective: non-interventional study ELBRUS (Etoricoxib in the Treatment of Back Pain) was conducted to investigate the efficacy and safety of daily administration of Rixia® (Etoricoxib) 60 mg per day in patients with chronic non-specific low back pain (CNSLBP).

Patients and methods. The study included 50 patients (31 women and 19 men, mean age 54.3±16.8 years) with CNSLBP. Educational conversation, cognitive therapy, regular therapeutic exercises, identification and treatment of comorbidities were conducted. Patients received etoricoxib 60 mg once daily. Pain intensity was assessed on a 10-point numerical rating scale (NRS), pain-related disability was assessed on the Oswestry Scale (ODS), and emotional state was assessed on the Hospital Anxiety and Depression Scale (HADS).

Results and discussion. The causes of CNSLBP were: in 5 (10%) patients – sacroiliac joint involvement, in 14 (28%) – lower lumbar facet joints involvement, in 3 (6%) – myofascial pain, the remaining 28 (56%) patients had a combination of several reasons. As a result of complex treatment, the intensity of pain at rest decreased on average from 4.0±2.5 to 1.4±1.3 points, while moving – from 6.6±1.9 to 2.8±1.8 points, at night – from 2.7±2 to 0.7±0.9 points according to the NRS, disability – from 39±18.9 to 19.9±14.6% according to the ODS, the severity of anxiety – from 6.5±3.9 to 3.3±2.4 points and depression from 5.0±3.7 to 3.1±2.9 points according to HADS (p<0.001). The duration of treatment was 14.14±3.6 days on average. No adverse events were observed during treatment with etoricoxib. Conclusion. The efficacy and safety of etoricoxib in the complex therapy of patients with CNSLBP was noted. Keywords: chronic nonspecific low back pain, non-steroidal anti-inflammatory drugs, etoricoxib, Rixia®>˂0.001). The duration of treatment was 14.14±3.6 days on average. No adverse events were observed during treatment with etoricoxib.

Conclusion. The efficacy and safety of etoricoxib in the complex therapy of patients with CNSLBP was noted. 

The Influence of the Fear of Negative Evaluation on Activity Avoidance in Fibromyalgia: Exploring Pain Acceptance and Positive Affect as Resilience Variables

To examine the mediating role of pain acceptance (PAcc) between fear of negative evaluation (FNE) and activity avoidance (AV) at different levels of positive affect (PA) (moderator) among women diagnosed with fibromyalgia (FM) (moderate mediation model). This study was cross-sectional in design. A convenience sample of women with FM (n = 231) completed measures of pain severity, FNE, PAcc, AV, and PA. A simple mediation model and a moderate mediation model was constructed and analyzed using the SPSS macro-PROCESS. First, PAcc mediated the effect of FNE on AV (β = .02, SE = 0.008; [95% CI [0.0075, 0.0394]). Second, a mediated effect of PAcc between FNE and AV moderated by PA at medium and high levels of PA were found (m: 0.23; β = -.22, p = .0006; h: 9.59; β = -.34, p = .0002. Future work should seek to validate study findings in diverse samples of FM patients. Additionally, future work should explore how FM self-management interventions that include PAcc can promote increased activity among women suffering from FM with medium to high levels of PA.

The facilitation of trunk muscles by abdominal bracing during walking in chronic low back pain patients

Walking is known to be beneficial for chronic low back pain (LBP) patients and fast walking recruits more trunk muscles. Abdominal bracing has also been shown to improve LBP and facilitate several trunk muscles. We aimed to investigate the effects of walking velocity and abdominal bracing on the activation of trunk muscles in chronic LBP patients during walking. Forty-six volunteers with chronic LBP underwent walking exercise on the treadmill without ("non-braced walking") and with abdominal bracing ("braced walking") at speeds of 4, 5, and 6 km/h, with the surface electrodes placed on their trunk muscles to measure muscle activity. The root mean square values of the surface electromyography amplitude data were obtained at the multifidus of lower (ML) and upper lumbar (MU), erector spinae of lower lumbar (EL) and thoracic (ET), rectus abdominis (RA), and external oblique (EO). All muscles activated significantly more at faster walking. The "braced walking" facilitated the ET and RA significantly more than the "non-braced walking". The interaction between the walking speed and abdominal bracing was significant at ML, MU, and RA. The increase in muscle activation observed at lower speed diminished as speed increased. Since "braced walking" seems to additionally facilitate the trunk muscles especially at slower gait speeds, patients who cannot walk fast may still be able to train their muscles by "braced walking."

Correlation between standing posture during work and low back and lower limb pain among cleaners and caregivers of older adults

ABSTRACT Maintaining a standing posture during work has been associated with musculoskeletal symptoms. Few studies, however, assess the standing time using objective measures. Thus, this study aimed to verify whether standing time at work is associated with lower back and lower limb pain in the last seven days and last 12 months in caregivers of older adults and cleaners. This is a cross-sectional study. Standing time at work was quantified using inclinometers attached to the workers’ thigh and spine. Musculoskeletal symptoms were assessed using the Nordic Musculoskeletal Questionnaire. Data were analyzed using the point-biserial correlation coefficient (rpb) between standing time at work and the presence of musculoskeletal symptoms. The analyses were performed using the SPSS software, adopting 5% significance level. Workers spend most of their time standing still (41.3%) or walking (39.3%). The presence of symptoms in the lower back was positively correlated with standing time (rpb=0.52; p<0.05). Walking time was negatively correlated with symptoms at the hip in the last 12 months (rpb=−0.53; p<0.05) and running time with symptoms at the hip, in the last seven days, (rpb=−0.43; p<0.05) and the lower back (rpb=−0.43; p<0.05). Longer standing time was correlated with the presence of symptoms in the lower back. Meanwhile, less time walking and running were correlated with the presence of musculoskeletal symptoms in the hips and lower back.

Correlação entre a postura em pé durante o trabalho e dor na coluna lombar e nos membros inferiores em trabalhadoras da limpeza e cuidadoras de idosos

RESUMO A postura em pé durante o trabalho tem sido associada a sintomas musculoesqueléticos. Entretanto, há poucos estudos que avaliam o tempo em pé utilizando medidas objetivas. Assim, o objetivo deste estudo foi verificar se o tempo em pé no trabalho está associado com dor na coluna lombar e nos membros inferiores nos últimos sete dias e 12 meses em cuidadoras de idosos e trabalhadoras da limpeza. Trata-se de estudo transversal, em que o tempo em pé no trabalho foi quantificado por meio de inclinômetros fixados na coxa e na coluna vertebral, e os sintomas musculoesqueléticos foram avaliados por meio do Questionário Nórdico de Sintomas Osteomusculares. Os dados foram analisados por meio da correlação ponto bisserial (rpb) entre o tempo em pé no trabalho e a presença de sintomas musculoesqueléticos. As análises foram realizadas por meio do software SPSS e o nível de significância adotado foi de 5%. Verificou-se que as trabalhadoras passam a maior parte do tempo em pé paradas (41,3%) ou andando (39,3%). Houve correlação positiva entre a presença de sintoma na lombar e o tempo em pé (rpb=0,52; p<0,05) e correlação negativa entre o tempo andando e sintomas no quadril (rpb=−0,53; p<0,05) nos últimos 12 meses e o tempo correndo e sintomas no quadril (rpb=−0,43; p<0,05) e na coluna lombar (rpb=−0,43; p<0,05) nos últimos sete dias. O maior tempo em pé foi correlacionado com a presença de sintomas na lombar; enquanto o menor tempo andando e correndo foram correlacionados com a presença de sintomas no quadril e na coluna lombar.

Mindful Walking in Patients with Chronic Low Back Pain: A Randomized Controlled Trial

Aim:

The objective of this study was to investigate the effectiveness of a mindful walking program (MWP) in patients with chronic low back pain (CLBP).

Methods:

The trial was a two-armed, randomized, controlled single-center open clinical trial. The study was performed in the Outpatient Clinic for Integrative Medicine of the Charité–Universitätsmedizin Berlin. The participants were adults aged 18–65 years with CLBP (≥3 months) and an average low back pain within the past 7 days measured on a visual analog scale (VAS, 0 = no pain, 100 = worst imaginable pain) of at least 40 mm. The patients received either eight weekly MWP sessions or no intervention (control). The primary outcome was the perceived pain intensity assessed with a VAS (0–100 mm) after 8 weeks. The secondary outcomes included back function assessed by the Hannover Functional Questionnaire Backache (FFbH-R) and perceived stress assessed by the 14-item Cohen's Perceived Stress Scale (PSS-14). The results were obtained by analysis of covariance adjusted for the respective baseline values.

Results:

In total, 55 patients were randomized (MWP: n = 29, 82.8% female, mean (±standard deviation) age: 52.5 ± 8.6 years, pain: 56.4 ± 14.1 mm; control: n = 26, 84.6% female, 54.8 ± 7.5 years, pain: 55.4 ± 13.1 mm). After 8 weeks, compared with the control conditions, the MWP was not associated with a statistically significant benefit for pain (VAS), adjusted mean − 9.6 [−22.3 to 3.1], p = 0.136, clinical benefits for back function (FFbH-R), adjusted mean 2.2 [−4.2 to 8.6], p = 0.493, or stress (PSS-14), adjusted mean − 1.6 [−4.8 to 1.6], p = 0.326.

Conclusion:

In conclusion, compared with no intervention, mindful walking did not significantly improve pain, back function, or perceived stress in patients with CLBP.

Clinical Trial registration:

ClinicalTrials.gov (NCT01893073).

Is it possible to discriminate workers with a higher prevalence of low back pain considering daily exposure time in a work-related lumbar posture? A diagnostic accuracy study

The study aimed to develop and validate a cut-off for daily postures to discriminate workers with low back pain. The self-reported episode of low back pain in the last year and during the previous week and the total spent time in occupational postures of 529 workers were used to screen workers who more likely would report low back pain. The receiver operating characteristics curve verified the ability of daily time in each posture in discriminating workers with low back pain in a training sample. Then, the chi-squared test and measurements of the diagnostic accuracy were performed in the testing sample. The daily time spent in a given posture was not able to accurately discriminate against workers with low back pain. Total time spent walking was the only daily posture that discriminated workers with low back pain in the last year in the testing sample, albeit with low accuracy. Practitioner Summary: The daily time spent in a given posture was not able to accurately distinguish workers with low back pain. Total spent time in walking presented modest diagnostic accuracy and should be interpreted cautiously. The spent time in a particular posture did not detect workers with LBP in the last week.

The Role of Walking in the Relationship between Catastrophizing and Fatigue in Women with Fibromyalgia

Walking is one of the most beneficial treatments for fibromyalgia patients. However, adherence to walking behavior is low due to the initially associated symptoms (including pain and fatigue). Although the association of catastrophism with greater symptoms is known, the results regarding fatigue have not always been consistent. Nevertheless, it is unknown whether the association between catastrophism and fatigue could, in turn, be conditioned by whether the patients walk or not. Therefore, our goal was to explore the moderating effect of walking on the association between catastrophizing and fatigue in patients with fibromyalgia. A cross-sectional study was carried out with 203 women with fibromyalgia. We used the Multidimensional Fatigue Inventory to assess fatigue and the Pain Catastrophizing Scale to assess pain catastrophizing (differentiating between its three dimensions). An ad hoc item was used to evaluate walking (moderator). Lower scores for fatigue and pain catastrophizing were found among patients who walked versus those who did not. Walking moderated the relationship between rumination and fatigue (Beta = 0.16, t = 1.96, p = 0.049) and between magnification and fatigue (Beta = 0.22, t = 21.83, p = 0.047). Helplessness showed no direct or interaction effect for fatigue. Nevertheless, higher rumination and magnification were associated with higher fatigue only in patients who walked. Therefore, to promote adherence to walking and reduce the effects of catastrophizing on fatigue, it seems necessary to manage rumination and magnification among patients who walk.

Individuals with fibromyalgia have a different gait pattern and a reduced walk functional capacity: a systematic review with meta-analysis

Background

The aim of the present study was to perform a systematic review and meta-analysis comparing walking test performance and gait pattern between individuals with and without fibromyalgia (FM).

Methodology

This systematic review was registered in PROSPERO with the following reference: CRD42018116200.The search for the scientific articles in this systematic review was carried out using the MEDLINE, SCOPUS, PEDRO, CINHAL and WEB OF SCIENCE databases. A combination of three conceptual groups of terms was used: (1) fibromyalgia; (2) walk (performance) tests; and (3) gait analysis. The included articles were analyzed for both functional and pattern of walking data of patients with FM. In order to provide a better estimate of the difference between individuals with and without FM on gait, a meta-analysis was performed on the 6MWT (6-minute walk test).

Results

Thirty-six studies were analyzed, with a total population of 4.078 participants (3.369 FM and 709 individuals without FM). From a functional point of view, the 6MWT distance covered by the group of individuals without FM was significantly greater than that of the individuals with FM in all the analyzed studies. In addition, when comparing the results obtained in the gait pattern analysis, it was observed that individuals with FM walked slower, with a shorter stride length and lower cadence compare to individuals without FM.

Conclusions

It is possible to affirm that individuals with FM perform walking tests differently than individuals without FM. It was observed that individuals with FM walk performing a cycle of shorter length and lower frequency, producing a slower gait, which results in a shorter distance traveled, in the same period of time, with respect to healthy subjects.

Assessing Walking Programs in Fibromyalgia: A Concordance Study between Measures

This study analyzes the degree of agreement between three self-report measures (Walking Behavior, WALK questionnaire and logbooks) assessing adherence to walking programs through reporting their components (minutes, rests, times a week, consecutive weeks) and their concordance with a standard self-report of physical activity (IPAQ-S questionnaire) and an objective, namely number of steps (pedometer), in 275 women with fibromyalgia. Regularized partial correlation networks were selected as the analytic framework. Three network models based on two different times of assessment, namely T1 and T2, including 6 weeks between both, were used. WALK and the logbook were connected with Walking Behavior and also with the IPAQ-S. The logbook was associated with the pedometers (Z-score > 1 in absolute value). When the behavior was assessed specifically and in a detailed manner, participants’ results for the different self-report measures were in agreement. Specific self-report methods provide detailed information that is consistent with validated self-report measures (IPAQ-S) and objective measures (pedometers). The self-report measures that assess the behavioral components of physical activity are useful when studying the implementation of walking as physical exercise.

Pain-Related Worrying and Goal Preferences Determine Walking Persistence in Women with Fibromyalgia

Physical activity and exercise are relevant behaviors for fibromyalgia health outcomes; however, patients have difficulties undertaking and maintaining an active lifestyle. With a cross-sectional design, this study explored the role of pain-related worrying and goal preferences in the walking persistence of women with fibromyalgia. The sample included 111 women who attended a tertiary health setting. We adapted the Six-Minute Walk Test where participants decided either to stop or continue walking in five voluntary 6 min bouts. Women who were categorized higher in pain-related worrying reported higher preference for pain avoidance goals (t = -2.44, p = 0.02) and performed worse in the walking task (LongRank = 4.21; p = 0.04). Pain avoidance goal preference increased the likelihood of stopping after the first (OR = 1.443), second (OR = 1.493), and third (OR = 1.540) 6 min walking bout, and the risk of ending the walking activity during the 30 min task (HR = 1.02, [1.0-1.03]). Influence of pain-related worrying on total walking distance was mediated by goal preferences (ab = -3.25). In interventions targeting adherence in physical activity and exercise, special attention is needed for women who are particularly worried about pain to help decrease their preference for short-term pain avoidance goals relative to long-term goals such as being active through walking.

[Noninvasive Treatments for Acute and Chronic Back Pain]

Noninvasive Treatments for Acute and Chronic Back Pain Abstract. The therapy of back pain - especially the medication with opioids - can be challenging for the treating physician. Specific back pain can often be diagnosed by imaging and successfully treated by surgery or medication. In contrast, nonspecific back pain can be worsened by inappropriate imaging, questionable surgical indications and uncontrolled drug use. For the therapy of nonspecific back pain, maintaining daily activity and exercise therapy is central. Opioids are effective drugs for short-term use. However, long-term use often leads to opioid-induced hyperalgesia and hormonal dysfunction with decreased quality of life and libido. Furthermore, opioids can lead to abuse and addiction. After an ineffective treatment with non-opioids, opioids may be given for a limited time period (if possible shorter than four weeks) according to international guidelines.

Exploring the Preference for Fatigue-avoidance Goals as a Mediator Between Pain Catastrophizing, Functional Impairment, and Walking Behavior in Women With Fibromyalgia

OBJECTIVES

Along with the symptoms of pain and fatigue, pain catastrophizing and avoidance behaviors are highly prevalent and associated with functional impairment in fibromyalgia (FM) patients. Although pain and fatigue affect patients' quality of life, research has been exclusively focused on how pain affects physical activity and exercise. The aim of this study was to analyze the role of pain catastrophizing and preference for fatigue-avoidance goals in walking behavior and functional impairment in women with FM.

MATERIALS AND METHODS

In this cross-sectional study the sample was composed of 76 participants aged 18 years and older (mean age=55.05, SD=7.70). The study evaluated pain catastrophizing, preference for fatigue-avoidance goals, functional impairment, and walking behavior along with sociodemographic variables and clinical data.

RESULTS

Pain catastrophizing was associated with preference for fatigue-avoidance goals and this preference was associated with greater functional impairment and less distance walked. Path analysis supported the mediating role of preference for fatigue-avoidance goals in the relationship between pain catastrophizing and walking behavior and between pain catastrophizing and functional impairment. Furthermore, pain catastrophizing predicted greater preference for fatigue-avoidance goals which predicted more problems in functioning and less distance walked.

DISCUSSION

The present study may help clarify the connection between the factors that stop individuals with FM from implementing beneficial behaviors such as walking, and thus, allowing for the design of psychological interventions that seek to maintain physical functioning despite experiencing fatigue.

Do Cognitive Abilities Influence Physical and Mental Fatigue in Patients with Chronic Pain after Walking According to a Clinical Guideline for Physical Exercise?

The objective of this study is to explore the mediator role of cognitive fusion and chronic pain acceptance on the effects that the walking pattern, following an established clinical guideline for physical exercise, can have on fatigue (physical and mental) in patients with chronic pain. The sample consisted of a total of 231 women with fibromyalgia with a mean age of 56.91 years (Standard Deviation SD = 9.58 years, range 30−78 years). The results show a significant indirect effect of the walking pattern on both physical and mental fatigue through cognitive fusion and chronic pain acceptance. Specifically, walking predicted less cognitive fusion, which predicted greater chronic pain acceptance, which, in turn, predicted less mental and physical fatigue (Beta-B- = −0.04, Standard Error SE = 0.02, 95% Confidence Interval 95% CI = [−0.09, −0.02]; B = −0.09, SE = 0.05, 95% CI = [−0.22, −0,15], respectively). It can be concluded that the walking pattern is linked to both physical and mental fatigue through cognitive defusion and chronic pain acceptance. These cognitive abilities would allow fibromyalgia patients to perceive an improvement in both physical and mental fatigue by carrying out the walking pattern. Emphasizing the training of cognitive defusion and pain acceptance would improve the adherence of these patients to walking.

Motivational Determinants of Objective Physical Activity in Women with Fibromyalgia Who Attended Rehabilitation Settings

Being physically active has positive effects on fibromyalgia functioning. However, promoting an active lifestyle in these patients continues to be a relevant clinical challenge. Our aim was to test a motivational model to explain light (LPA) and moderate-vigorous physical activity (MVPA). A cross-sectional prospective study was conducted at a tertiary level of care. Participants completed sociodemographic, clinical, motivational (physical activity self-efficacy and goal preferences) and behavioral measures (activity avoidance). LPA and MVPA were measured with triaxial accelerometers, starting the same day of the aforementioned assessment. Out of 211 women, 183 completed this measure. Structural models were performed. Our results show that the best fit indices (CFI = 0.97, SRMR = 0.04) showed a model with direct influence of PA self-efficacy on MVPA (p < 0.01) and indirect influence on LPA (p < 0.001). LPA received the influence of PA self-efficacy mainly through activity avoidance (p < 0.01). Clinical variables did not have any effect on PA intensities. Thus, the motivational variables showed different paths to explain two PA intensities. Targeting PA self-efficacy in rehabilitation settings is needed to enhance both daily LPA and MVPA intensities.

Virtual Mind-Body Program for Obese Knee Osteoarthritis Patients with Comorbid Depression: Development and Feasibility Pilot (Preprint)

Background

Knee osteoarthritis (KOA) is the most common joint disorder in the United States and a leading cause of disability. Depression and obesity are highly comorbid with KOA and accelerate knee degeneration and disability through biopsychosocial mechanisms. Mind-body physical activity programs can engage biological, mechanical, and psychological mechanisms to improve outcomes in KOA, but such programs are not currently available.

Objective

This mixed methods study aims to adapt a mind-body activity program for the unique needs of patients with KOA, depression, and obesity (GetActive-OA) delivered via live video.

Methods

Participants were adults (aged ≥45 years) from rural Kentucky with obesity (BMI≥30 kg/m²), idiopathic KOA with mild to moderate radiographic changes, and elevated depressive symptoms (9-item Patient Health Questionnaire ≥10) recruited from 2 orthopedic centers. In phase 1, we developed GetActive-OA and the study protocol using qualitative focus group feedback from the study population (N=9; 2 focus groups, 90 minutes) and multidisciplinary expertise from clinical psychologists and orthopedic researchers. In phase 2, we explored the initial feasibility, credibility, and acceptability of GetActive-OA, live video delivery, and study procedures via an open pilot with exit interviews (N=5; 1 group). This research was guided by National Institutes of Health (NIH) model stage IA.

Results

Phase 1 qualitative analyses revealed nuanced information about challenges with coping and increasing activity, high interest in a mind-body activity program, program participation facilitators (flexibility with technology) and barriers (amotivation and forgetfulness), and perceived challenges with data collection procedures (blood and urine samples and homework). Phase 2 quantitative analyses showed that GetActive-OA met most a priori feasibility markers: acceptability (80%), expectancy (100%), credibility (100%), clinician adherence (90%), homework adherence (80%), questionnaire data collection (100%), program satisfaction (100%), and safety (100%). Adherence to ActiGraph wear (80% baseline, 20% posttest) and collection of blood samples (60%) were low. Participation in GetActive-OA was associated with signals of improvements in general coping (Cohen d=2.41), pain catastrophizing (Cohen d=1.24), depression (Cohen d=0.88), anxiety (Cohen d=0.78), self-efficacy (Cohen d=0.73), pain (Cohen d=0.39), and KOA symptoms (Cohen d=0.36). Qualitative exit interviews confirmed quantitative findings and provided valuable information to optimize the program and protocol.

Conclusions

Patients with KOA, depression, and obesity from rural Kentucky were interested in a live video mind-body activity program. GetActive-OA shows promise; however, the program and protocol require further NIH stage I refinement before formal efficacy testing (NIH model stage II).

International Registered Report Identifier (IRRID)

RR2-10.1016/j.conctc.2021.100720