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01.12.2016 | Research article | Ausgabe 1/2016 Open Access

Arthritis Research & Therapy 1/2016

Decrease of fear avoidance beliefs following person-centered progressive resistance exercise contributes to reduced pain disability in women with fibromyalgia: secondary exploratory analyses from a randomized controlled trial

Arthritis Research & Therapy > Ausgabe 1/2016
Annie Palstam, Anette Larsson, Monika Löfgren, Malin Ernberg, Jan Bjersing, Indre Bileviciute-Ljungar, Björn Gerdle, Eva Kosek, Kaisa Mannerkorpi
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

The authors of this multicenter study have contributed as follows and their research site is also specified: AP (Gothenburg site) worked with study design, data analysis, interpretation of data, and the first draft of the manuscript. AL worked with study design and data analysis; ML (Stockholm site) worked with acquisition; ME (Stockholm site) participated in study conception and study design; JB (Gothenburg site) worked with acquisition and interpretation of data; IB-L (Stockholm site) participated in study design and acquisition; BG (Linköping site) worked with study conception, study design, and acquisition; EK (Stockholm site) worked with study conception, study design, and acquisition; KM (Gothenburg site) worked with study conception, study design, acquisition, analysis, and interpretation of data. All the authors were involved in writing the manuscript and revising it critically for important intellectual content. All the authors approved the final version of the article.



Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. Women with FM also report disability, in terms of negative consequences on activities of daily living. Our recent randomized controlled trial (RCT) is the first study of resistance exercise to show positive effects on pain disability. The resistance exercise program of our RCT emphasized active involvement of participants in planning and progression of the exercise, using the principles of person-centeredness, to support each participant’s ability to manage the exercise and the progress of it. The aim of this sub-study was to investigate explanatory factors for reduced pain disability in women with FM participating in a 15-week person-centered progressive resistance exercise program.


A total of 67 women with FM were included in this sub-study of an RCT examining the effects of person-centered progressive resistance exercise performed twice a week for 15 weeks. Tests of physical capacity and health-related questionnaires were assessed at baseline and after the intervention period. Multivariable stepwise regression was used to analyze explanatory factors for improvements in pain disability.


Reduced pain disability was explained by higher pain disability at baseline together with decreased fear avoidance beliefs about physical activity (R 2 = 28, p = 0.005). The improvements in the disability domains of recreation and social activity were explained by decreased fear avoidance beliefs about physical activity together with higher baseline values of each disability domain respectively (R 2 = 32, p = 0.025 and R 2 = 30, p = 0.017). The improvement in occupational disability was explained by higher baseline values of occupational disability (R 2 = 19, p = 0.001).


The person-centered resistance exercise intervention, based on principles of self-efficacy, had a positive effect on recreational, social and occupational disability. The reduced pain disability seemed to be mediated by decreased fear avoidance beliefs. Age, symptom duration, pain intensity, and muscle strength at baseline had no explanatory value for reduced pain disability, indicating that the person-centered resistance exercise program has the potential to work for anyone with FM who has interest in physical exercise.
The trial was registered on October 21, 2010 with identification number: NCT01226784.
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