Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice.

Editor's Comment: This study states that fear of movement is the logical consequence of post-exertional malaise (PEM) – the exacerbation of symptoms brought on by physical or mental exertion in patients with ME/CFS and fibromyalgia. (The inclusion of FM is puzzling, as people with FM do not experience PEM.) Illogically, the conclusion of the authors is that patients whose symptoms are worsened by exercise should engage in exercise training (GET) and psychological therapy (CBT). The authors did not state how either of those two therapies would remedy the severe exacerbation of symptoms described in their initial sentence.

By J. Nijs et al.

Abstract

Severe exacerbation of symptoms following physical activity is characteristic for chronic-fatigue syndrome (CFS) and fibromyalgia (FM). These exacerbations make it understandable for people with CFS and FM to develop fear of performing body movement or physical activity and consequently avoidance behaviour toward physical activity. The aims of this article were to review what measures are available for measuring fear of movement and avoidance behaviour, the prevalence fear of movement and avoidance behaviour toward physical activity and the therapeutic options with fear of movement and avoidance behaviour toward physical activity in patients with CFS and FM.

The review revealed that fear of movement and avoidance behaviour toward physical activity is highly prevalent in both the CFS and FM population, and it is related to various clinical characteristics of CFS and FM, including symptom severity and self-reported quality of life and disability. It appears to be crucial for treatment (success) to identify CFS and FM patients displaying fear of movement and avoidance behaviour toward physical activity. Individually tailored cognitive behavioural therapy plus exercise training, depending on the patient's classification as avoiding or persisting, appears to be the most promising strategy for treating fear of movement and avoidance behaviour toward physical activity in patients with CFS and FM.

Source: Clin Rheumatol. 2013 May 3. [Epub ahead of print]. Nijs J, Roussel N, Van Oosterwijck J, De Kooning M, Ickmans K, Struyf F, Meeus M, Lundberg M. Pain in Motion research group, Department of Human Physiology and Rehabilitation Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building L-Mfys, Pleinlaan 2, 1050, Brussels, Belgium, Jo.Nijs@vub.ac.be.

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4 thoughts on “Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice.”

  1. IanH says:

    This group of “CFS” proponents in Belgium have come up with another poorly done study.

    As a sufferer of ME with FM I have suffered PEM a lot and it never made me afraid of movement but cautious of overdoing it. I suggest these clinicians in Belgium don’t know the difference and they are deliberately looking for “psychological” criteria to denigrate the illness just as those who claim it is the result of faulty illness attributions.

    Not one of our patients or any of the people I know with ME/CFS have a fear of movement. Two of the people are “ex”-athletes who want to get back to training. We hold them back from it because every time they have exerted themselves in training they suffer from PEM. This is not attitudinal. For God’s sake you people in Belgium do some decent and some decent thinking.

    1. IanH says:

      “research” on the last line.
      “…do some decent research”.

    2. leyton says:

      Following Glandular Fever I had very severe CFS, all the classic symptoms. Symptoms that included ‘avoidance.’ Being ill with CFS, a neuro condition does lead to psychological symptoms that need to be addressed, not ignored.

      Good research that needs to be considered , not damned. Avoidance is a key issue for CFS sufferers. It is very hard to get the activity level right, which is why help with GET worked for me, and many others. Knee jerk criticism of addressing psychological factors with CFS is detrimental to those looking for help.

    3. sPeeDeeBee says:

      I think one has to be clear about whether the “fear” represents a normal response or is instead clinically neurotic. I don’t think it’s unusual to have a sort of dread toward the post-exertional malaise we experience. Perhaps it relates to the severity of the symptoms. When almost any type of activity can set you back 2 to 4 days, it’s pretty hard to psych up about expending the effort! For me personally, I try to keep my activity within the window of available energy, so that I don’t experience those flares. Increasing activity is something that occurs over weeks or months rather than days. I think the potential for serious deconditioning is obvious when someone is neurotically fearful of activity.

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