Research to encourage exercise for fibromyalgia (REEF): use of motivational interviewing design and method
Open accessAbstract
Fibromyalgia (FM), defined as the presence of both chronic widespread pain and the finding of 11/18 tender points on examination, is an illness associated with major personal and societal burden. Supervised aerobic exercise is an important treatment modality to improve patient symptoms. Unfortunately, adherence to an exercise regimen after a structured supervised program is disappointingly low. Since FM is a chronic illness, studies are needed to test strategies that would enhance exercise adherence in these individuals. Individuals who are able to adhere to exercise almost always maintain the symptomatic benefits of exercise. The objective of this paper was to describe the protocol of the Research to Encourage Exercise for Fibromyalgia (REEF). REEF is a randomized attention-controlled trial that seeks to test the efficacy of 6 sessions of telephone delivered motivational interviewing (MI) that targets exercise adherence to improve FM-relevant clinical outcomes (i.e., physical function and pain severity). The trial has recently completed enrolling 216 subjects, and randomization has resulted in well-balanced groups. Details on the study design, MI program, and treatment fidelity are provided in the paper. Outcome assessments at week 12, week 24 and week 36 will test the immediate, intermediate and long-term effects of exercise-based MI on adherence (as measured by the Community Health Activities Model Program for Seniors/CHAMPS and accelerometer) and clinical outcomes. When completed, REEF will determine whether exercise-based MI could be utilized as a management strategy to sustain the clinical benefits of exercise for FM.
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In adults with fibromyalgia, aerobic exercise therapy combined with stretching exercise was effective for physical function in the short term.
“aerobic ET combined with FM education and combination of aerobic ET with stretching ET were effective in the short term [48,57].”
From Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials (2022) · cites this paper as [57]
Methods and Design §2.4 describes supervised sessions combining stretching and aerobic exercise for participants with fibromyalgia. The Results section reports enrollment and baseline characteristics, not short-term treatment outcomes. This source therefore supports the existence of the combined regimen but not the claim that it improved physical function in the short term. (LLM, conf=0.86)
Experimental — accuracy not yet measuredStrong evidence indicated that exercise therapy combined with patient education significantly reduced pain intensity in the short term.
“Moreover, strong evidence showed that ET combined with PE reduced significantly pain intensity in the short term [56,57].”
From Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials (2022) · cites this paper as [57]
The Introduction (page not supplied) says supervised exercise has improved fibromyalgia symptom severity in prior trials. The Methods describe exercise alongside an educational video, but this design paper reports no short-term pain-reduction result for the combination and does not characterize the evidence for it as strong. (LLM, conf=0.83)
Experimental — accuracy not yet measuredModerate evidence suggested that affective self-awareness intervention and motivational interviewing to encourage exercise reduced pain intensity in the short and long term.
“Moderate evidence suggested that affective self-awareness intervention and motivational interviewing for encourage exercise reduced pain intensity in the short and long term [57,63].”
From Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials (2022) · cites this paper as [57]
The Introduction and Methods describe motivational interviewing to encourage exercise in people with fibromyalgia, with pain severity to be assessed at weeks 12, 24 and 36. This is a trial design paper: it does not report that motivational interviewing reduced pain at any time point or grade the evidence as moderate. The affective self-awareness intervention is not described in this source. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn adults with fibromyalgia, aerobic exercise therapy combined with fibromyalgia education was effective for physical function in the short term.
“aerobic ET combined with FM education and combination of aerobic ET with stretching ET were effective in the short term [48,57].”
From Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials (2022) · cites this paper as [57]
The Introduction reports that supervised exercise improved physical function in people with fibromyalgia. The Methods describe aerobic exercise and fibromyalgia education, but this design-and-method paper does not report that the combination improved physical function in the short term; the Abstract says outcome assessments were still planned. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredModerate evidence indicated that aerobic exercise therapy combined with fibromyalgia education reduces disability in adults with fibromyalgia in the short, medium and long term.
“Moderate evidence suggested that combination of aerobic ET with FM education reduced significantly disability in the short, medium and long term [57].”
From Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials (2022) · cites this paper as [57]
The Introduction (page unavailable) says supervised exercise has improved physical function in people with fibromyalgia, which supports the general exercise-benefit claim. But this design-and-method paper does not report evidence that exercise combined with fibromyalgia education significantly reduced disability at short-, medium-, and long-term follow-up; the Abstract says those outcomes were still to be assessed. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Moderate evidence indicated that motivational interviewing to encourage exercise reduces disability in adults with fibromyalgia in the short term.
“Moderate evidence showed that FM education and motivational interviewing to encourage exercise reduced significantly disability in the short term [38,57].”
From Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials (2022) · cites this paper as [57]
The Introduction describes a trial of motivational interviewing to encourage exercise in people with fibromyalgia, with physical function among its intended outcomes. But the Abstract says outcome assessments will test its effects, and the Results report enrollment and baseline characteristics—not a short-term reduction in disability. This paper therefore does not support the claimed significant reduction or the characterization of the evidence as moderate. (LLM, conf=0.88)
Experimental — accuracy not yet measuredModerate evidence from this review indicates that active therapies improve pain intensity in adults with fibromyalgia in the long term.
“Our results also showed moderate evidence that active therapies improved pain intensity, disability and physical function in the long term, and sleep quality, anxiety and depression in the short term [11,44,45,47,48,51,52,54,55,57,58].”
From Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials (2022) · cites this paper as [57]
The Introduction says supervised exercise improves fibromyalgia symptoms and that people who continue exercising are most likely to maintain those benefits; the Discussion describes pain reduction as a clinical benefit of exercise. But this design-and-method paper does not report a review finding of moderate evidence that active therapies generally improve long-term pain intensity. (LLM, conf=0.83)
Experimental — accuracy not yet measuredModerate evidence from this review indicates that active therapies improve disability in adults with fibromyalgia in the long term.
“Our results also showed moderate evidence that active therapies improved pain intensity, disability and physical function in the long term, and sleep quality, anxiety and depression in the short term [11,44,45,47,48,51,52,54,55,57,58].”
From Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials (2022) · cites this paper as [57]
The Introduction says supervised exercise improves physical function in people with fibromyalgia and that those who continue exercising are most likely to maintain its benefits. But this paper describes a trial design, not a review; it does not grade the evidence as moderate or establish a long-term improvement in disability from active therapies generally. No page number was available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredModerate evidence from this review indicates that active therapies improve anxiety in adults with fibromyalgia in the short term.
“Our results also showed moderate evidence that active therapies improved pain intensity, disability and physical function in the long term, and sleep quality, anxiety and depression in the short term [11,44,45,47,48,51,52,54,55,57,58].”
From Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials (2022) · cites this paper as [57]
The paper’s Introduction describes supervised aerobic exercise as a way to improve fibromyalgia symptoms, and Methods §2.6 lists anxiety among the outcomes to be measured. But this is a design-and-method paper: its Results report enrollment and baseline characteristics, not treatment effects. It does not establish that active therapies improve anxiety in the short term or grade the evidence as moderate. (LLM, conf=0.78)
Experimental — accuracy not yet measuredModerate evidence from this review indicates that active therapies improve physical function in adults with fibromyalgia in the long term.
“Our results also showed moderate evidence that active therapies improved pain intensity, disability and physical function in the long term, and sleep quality, anxiety and depression in the short term [11,44,45,47,48,51,52,54,55,57,58].”
From Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials (2022) · cites this paper as [57]
The Introduction (page unavailable) says supervised exercise has improved physical function in people with fibromyalgia and that those who continue exercising are most likely to maintain benefits. But this paper describes the REEF trial's design; the Discussion says its long-term outcomes had yet to be assessed. It does not establish moderate evidence that active therapies improve physical function in the long term. (LLM, conf=0.84)
Experimental — accuracy not yet measuredModerate evidence indicated that fibromyalgia education reduces disability in adults with fibromyalgia in the short term.
“Moderate evidence showed that FM education and motivational interviewing to encourage exercise reduced significantly disability in the short term [38,57].”
From Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials (2022) · cites this paper as [57]
The Methods and Design section (2.4; page unavailable) describes fibromyalgia education as the attention-control intervention. The paper reports baseline data and says outcome assessments will test effects later; it does not report a short-term reduction in disability from education. Searches for education, disability improvement, and short-term outcomes found no such result. (LLM, conf=0.76)
Experimental — accuracy not yet measuredModerate evidence from this review indicates that active therapies improve sleep quality in adults with fibromyalgia in the short term.
“Our results also showed moderate evidence that active therapies improved pain intensity, disability and physical function in the long term, and sleep quality, anxiety and depression in the short term [11,44,45,47,48,51,52,54,55,57,58].”
From Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials (2022) · cites this paper as [57]
The Introduction identifies sleep disturbance as a fibromyalgia symptom and says supervised exercise can improve symptoms generally, but does not say it improves sleep quality. The Results report enrollment and baseline characteristics, not treatment effects; our copy provides no finding about short-term sleep improvement or its strength of evidence. (LLM, conf=0.76)
Experimental — accuracy not yet measuredModerate evidence from this review indicates that active therapies improve depression in adults with fibromyalgia in the short term.
“Our results also showed moderate evidence that active therapies improved pain intensity, disability and physical function in the long term, and sleep quality, anxiety and depression in the short term [11,44,45,47,48,51,52,54,55,57,58].”
From Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials (2022) · cites this paper as [57]
The Results section reports enrollment and baseline characteristics for an ongoing trial, not treatment effects. The Methods and Design section describes depression measures, but neither it nor the other passages found reports moderate evidence that active therapies improve depression in the short term (searched: depression, exercise, short-term improvement). (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Ang, D. C., Kaleth, A. S., Bigatti, S., Mazzuca, S., Saha, C., Hilligoss, J., Lengerich, M., & Bandy, R.
- Affiliations
- Indiana University Indianapolis (US)
- Indiana University – Purdue University Indianapolis (US)
- Corresponding author
- Ang, Dennis C.
- Venue
- Contemporary Clinical Trials
- Publisher
- Elsevier BV
- Published
- 2011-01
- Volume
- 32
- Issue
- 1
- Pages
- 59-68
- ISSN
- 1551-7144 (ISSN-L)
- PMC
- PMC3005851
- OpenAlex
- W2071951413
- Cited by
- 51
- References
- 118
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 4 · 2020: 1 · 2019: 1 · 2017: 6 · 2016: 3 · 2015: 8 · 2014: 4 · 2013: 10 · 2012: 7
- FWCI
- 3.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Contemporary Clinical Trials (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Purdue University Indianapolis (Indiana University) (submittedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR054324)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- fibromyalgia, exercise adherence, motivational interviewing, telephone-delivered intervention, physical function, pain intensity, accelerometer, intervention fidelity
- MeSH terms
- Adult, Clinical Protocols, Counseling, Exercise Therapy, Female, Fibromyalgia, Humans, Interviews as Topic, Male, Middle Aged, Motivation, Patient Compliance, Research Design, Telephone, Health Behavior, Exercise
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