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

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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.