THU0713-HPR Behaviour change interventions targeting physical activity in adults with fibromyalgia syndrome: a systematic review
Authors: T. O’Dwyer, L. Durcan, S. Maguire, D. Mockler, F. Wilson
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Recent EULAR guidelines for the management of fibromyalgia syndrome (FMS) strongly recommend aerobic and strengthening exercise programmes, which demonstrate positive effects on symptoms and physical function.<sup>1</sup> Despite these benefits, physical activity (PA) and exercise promotion remains a significant clinical challenge. Behaviour change theories and techniques are recommended as part of complex health interventions to change health behaviours<sup>2</sup>; their integration into interventions aimed at PA behaviour in people with FMS is not known. <h3>Objectives</h3> To review behaviour change interventions targeting PA and exercise behaviour of adults with FMS. <h3>Methods</h3> A systematic review of quasi-randomised and randomised controlled trials targeting PA behaviour in people with FMS was conducted. Studies were retrieved by searching MEDLINE (OVID), EMBASE, PEDro, PsychINFO, CINAHL, Scopus, Web of Science, and The Cochrane Central Register of Controlled Trials for keywords and medical subject headings relating to FMS, PA and exercise, and behaviour change. Two reviewers independently determined study eligibility. The Cochrane Risk of Bias tool was used to assess risk of bias and data extraction was completed using a standardised template. Due to heterogeneity of interventions and outcome measures, a planned meta-analysis was deemed inappropriate. <h3>Results</h3> The search strategy produced 2117 records, after removal of duplicates. Of these, 6 studies were ultimately deemed eligible for inclusion. Overall, the risk of bias of included studies varied from unclear to high. Median (IQR) study size was 114.5 (91.5) participants, with mean (SD) participant age ranging from 42.5 (7.6) to 53.1 (9.9) years. PA and exercise behaviours were the primary focus of three interventions and were components of broader interventions in three studies. Specific behaviour change theories informed two interventions. The number of behaviour change techniques (BCTs) included in studies ranged from 9 to 21; all interventions included elements of goal setting, problem solving, instruction, demonstration and practice of PA or exercise, and use of credible sources. Two studies reported objective measures of PA (pedometry and accelerometry); no significant improvements were sustained at 6 month follow-ups, although a significant post-intervention increase in steps-per-day favouring a behaviour change intervention compared to an education intervention was reported. Outcomes of self-reported measures of PA were conflicting. <h3>Conclusions</h3> To date, the small number of behaviour change interventions targeting PA in people with FMS have had limited success. This may be partly due to the varying application of behaviour change theories and techniques in interventions. If the potential benefits demonstrated in exercise trials are to be realised, future studies should incorporate behaviour change theories at the core of PA interventions and describe BCTs comprehensively so that the most effective techniques may be idenfitied. <h3>References</h3> [1] Macfarlane, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis2017;76:318–328. [2] National Institute for Health and Care Excellence NICE 2014 [28/01/2018]. 89. https://www.nice.org.uk/guidance/ph49/resources/behaviour-change-individual-approaches-pdf-19963663379 <h3>Disclosure of Interest</h3> None declared