运动对疼痛抑郁共病的研究

Introduction: This study explored the exercise habits of community-dwelling older adults with chronic pain, examining the relationship between pain, physical activity, daily life impacts, and psychological effects. Method: The study was conducted through a cross-sectional approach and semi-structured interviews with five participants aged fifty and above. Result: The findings revealed that exercise participation among those with chronic pain was significantly lower than in the non-pain participants, particularly for those exercising more than three times weekly (p = 0.012). Hypertension (59.64%) and arthritis (39.32%) were common among the respondents. Pain was predominantly reported in the lower back, legs, shoulders, and arms, severely affecting quality of life. Additionally, anxiety and depression were increasingly prevalent in this population, presenting greater challenges than financial constraints or lack of motivation. Lower impact exercises like walking were more doable, and social support and a good environment increased exercise engagement. Conclusions: We determined that interventions for older adults with chronic pain should address both physiological and psychological factors to boost exercise participation. This research emphasizes feasible exercise types and key factors to enhance engagement. Future research should focus on developing targeted intervention programs that incorporate these findings to improve the quality of life for this population.

Exercise and weight loss are commonly recommended to patients with chronic pain; these interventions can relieve extra stress on the joints, reduce the perception of pain and combat comorbidities such as obesity, anxiety and depression. However, exercise can also exacerbate existing pain, presenting challenges for adherence to exercise and weight loss regimens. Here, we summarise the unique case of a patient who presented with chronic pain that developed during a natural weight loss regimen. The patient sought assessment due to diffuse pain that commenced after significant weight loss and was exacerbated with continued adherence to lifestyle modifications. He received a diagnosis of fibromyalgia and is currently being treated with nerve blocks and local anaesthetic injections of trigger points. This case of onset of fibromyalgia and chronic pain following lifestyle changes and weight loss underscores the need for further research aiming to understand the complex relationship between exercise, weight loss and chronic pain.

Pain accompanied by depressive symptoms is a common reason for seeking medical assistance, and many chronic pain patients experience comorbid depression. The brain-derived neurotrophic factor (BDNF) is a well-known neurotrophin expressed throughout the nervous system, playing a crucial role in neuronal growth and neuroplasticity. This study aimed to examine the effects of exercise on BDNF expression in the nervous system and reserpine (RSP)-induced pain-depression dyad. RSP (1 mg/kg) was subcutaneously administered once daily for three days in mice. The exercise was performed using a rota-rod tester for seven consecutive days following RSP administration. Pain responses were evaluated using von Frey filaments, and depression-like behaviors were assessed through forced swimming and open field tests. Immunofluorescence staining was performed to examine the changes in BDNF expression in the dorsal root ganglion (DRG), spinal cord, and hippocampus. Administration of RSP reduced mechanical paw withdrawal threshold, increased immobility time in the forced swimming test, and decreased movement in the open field test. The immunoreactivity of BDNF was increased in the DRG and spinal dorsal regions, and decreased in the hippocampus after RSP administration. Physical exercise significantly reduced the RSP-induced mechanical hypersensitivity and depression-like behaviors. In addition, exercise suppressed not only the increased expression of BDNF in the DRG and spinal dorsal regions but also the decreased expression of BDNF in the hippocampus induced by RSP administration. These findings suggest that repetitive exercise could serve as an effective and non-invasive treatment option for individuals experiencing both pain and depression by modulating BDNF expression.

Background: Chronic post-surgical pain is a condition persisting for not less than 3 months after surgical intervention. It is evaluated that 25–60% of women who underwent breast cancer excision suffer from post-mastectomy pain syndrome, and anxiety, depression, sleep disturbance, and catastrophizing. Physical activity can reduce the risk of chronic diseases and has a good impact on mood and cognitive function. The aim of this study was to estimate the influence of physical activity on the intensity of pain, depression, and anxiety in women who underwent mastectomy for breast cancer removal. Methods: A prospective observational unicentric cohort study was performed. Patients were females who underwent unilateral or bilateral mastectomy. The Numerical Rating Scale (NRS) was used to measure pain intensity, Beck’s Depression Inventory (BDI) for depression, and Generalized Anxiety Disorders-7 (GAD-7) for anxiety evaluation. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ). Interleukin (IL)-17, IL-1β, cortisol, adrenocorticotropic hormone (ACTH), and brain-derived neurotrophic factor (BDNF) were also evaluated in the blood of patients. All evaluations were assessed 3 and 6 months after the surgery. Results: Adequate physical activity reduced the intensity of pain, depression, and anxiety symptoms in women affected by post-mastectomy pain syndrome. Moreover, adequately active women showed a reduction in biomarkers of inflammation, cortisol, ACTH, and an increase of BDNF. Conclusions: Our results suggest that physical activity can improve the quality of life, reduce the intensity of pain and inflammatory markers, and be useful in the reduction of associated anxiety and depression.

ABSTRACT Previous researches have found that chronic neck pain was closely related to depression. However, the relation between chronic neck pain, sleep quality, exercise and depression remains unclear. This study aims to evaluate the association between these factors, based on the assumption that sleep quality and exercise are potential mediators in the relationship between chronic neck pain and depression. This cross-sectional study enrolled 231 patients with chronic neck pain who were referred to outpatient clinics in department of neurology between July and December 2016. Data analysis was performed using a structural equation model to evaluate the mediating effects of sleep quality and exercise frequency on the relation between chronic neck pain intensity and depression. A positive correlation between neck pain intensity and depression was unveiled. In addition, sleep quality was identified as a significant positive mediator between neck pain intensity and depression, and exercise can help relieve depression. Poor sleep quality leads to an increase of the symptoms of depression for people with high neck pain intensity which can be effectively relieved via additional exercise.

OBJECTIVE The purpose of this study was to investigate the relationship between pain intensity, disability, exercise time, and computer use time and depression in office workers with nonspecific chronic low back pain. STUDY DESIGN/SETTING A cross-sectional correlational study. SUBJECTS Sixty-one office workers diagnosed with nonspecific chronic low back pain METHODS: The participants' body mass index was calculated using their height and weight. The amount of time the participants spent using a computer or exercising per week was analysed. The Beck Depression Inventory was used to determine the degree of depression in the participants. The Oswestry disability index and the numeric pain rating scale were used to assess the severity and pain intensity of the participants. RESULTS There was a significant correlation between the Beck Depression Inventory, the Oswestry disability index (r = 0.419, p < .05), and the computer use time (r = 0.369, p < .05) of the participants. There was a correlation between the Oswestry disability index and the numeric pain rating scale (r = 0.677, p < .01). There were significant correlations among the sub items of the Oswestry disability index with the Beck Depression Inventory, in the order of personal management activities (r = 0.539, p < .01), standing (r = 0.519, p < .01), social activities (r = 0.421, p < .05), travelling (r = 0.381, P < .05), and walking (r = 0.357, p < .05). CONCLUSION Our hypothesis as a results of this study is that the depression of office workers with non-specific chronic low back pain is correlated with the computer using time and the degree of disability. Especially among their various disabled items, personal management activities, standing, social activities, travelling, and walking is related to depression.

Introduction Chronic pain is a common symptom significantly affecting the quality of life of breast cancer survivors. Despite the achievement of pharmacological interventions, the barriers associated with this approach such as inaccessibility, misuse and side effects drive research into effective non-pharmacological interventions to improve chronic pain management, quality of life, anxiety and depression. Breathing exercise (BE) can be a promising option, but research evidence is sparse. This pilot study aims to examine the feasibility and preliminary effect of using an evidence-based BE intervention for chronic pain management in breast cancer survivors. Method and analysis This study will be a two-parallel-arm, open-labelled, phase II randomised controlled trial with 1:1 allocation. Seventy-two participants will be recruited from a tertiary hospital in China and randomly allocated to either a BE intervention group (n=36) or a control group (n=36). The participants in the intervention group will receive the usual care, a pain information booklet and a 4-week self-administered BE intervention; the participants in the control group will receive the usual care and the pain information booklet only. The assessment will be conducted at three time points: baseline (week 0), immediately after the intervention completion (week 5) and 4 weeks after the intervention completion (week 9). The primary outcomes will be the acceptability and feasibility assessment of the study protocol and methodological procedures. The secondary outcomes will be the effects of BE on pain, quality of life, anxiety and depression in breast cancer survivors. Descriptive statistics will be applied to present the primary outcomes and the Generalised Estimating Equation Model will be utilised to analyse the clinical outcomes. Ethics and dissemination This study has received ethical approvals from the Human Research Ethics Committee at Charles Darwin University (H21089) and the Clinical Trial Ethics Committee at the Affiliated Hospital of Southwest Medical University (KY2022107). Findings from this study will be presented at academic conferences and submitted to peer-reviewed journals for publication. Trial registration number ClinicalTrials.gov: NCT05257876.

(1) Background: This exploratory study aims to explore the relationship between nonspecific chronic spinal pain (nCSP) and insomnia symptoms, by examining the interconnections, strengths, and directional dependence of the symptoms. In addition, we aim to identify the key symptoms of the nCSP–insomnia relationship and shed light on the bidirectional nature of this relationship. (2) Methods: This study is a secondary analysis of the baseline data (cross-sectional) from a randomized controlled trial, which examined the added value of Cognitive Behavioral Therapy for Insomnia (CBT-I) combined with cognition-targeted exercise therapy, conducted in collaboration with the Universiteit Gent and Vrije Universiteit Brussel (Belgium). One hundred and twenty-three nCSP patients with comorbid insomnia were recruited through the participating hospitals, advertisements, announcements in local newspapers, pharmacies, publications from support groups, and primary care. To explore the interconnections and directionality between symptoms and the strengths of the relationships, we estimated a regularized Gaussian graphical model and a directed acyclic graph. (3) Results: We found only one direct, but weak, link between sleep and pain, namely, between average pain and difficulties maintaining sleep. (4) Conclusions: Despite the lack of strong direct links between sleep and pain, pain and sleep seem to be indirectly linked via anxiety and depression symptoms, acting as presumable mediators in the network of nCSP and comorbid insomnia. Furthermore, feeling slowed down and fatigue emerged as terminal nodes, implying their role as consequences of the network.

Background Approximately 20% of patients experience chronic pain after total knee arthroplasty (TKA). Due to the growing number of TKA procedures, this will affect an increasing number of people worldwide. Catastrophic thinking, dysfunctional illness perception, poor mental health, anxiety and depression characterize these non-improvers, and indicate that these patients may need individualized treatment using a treatment approach based on the bio-psycho-social health model. The present study developed an internet-delivered cognitive behavioral therapy (iCBT) program to be combined with exercise therapy and education for patients with knee osteoarthritis (OA) at increased risk of chronic pain after TKA. Methods The development process followed the first two phases of the UK Medical Research Council framework for complex interventions. In the development phase, the first prototype of the iCBT program was developed based on literature review, established iCBT programs and multidisciplinary workshops. The feasibility phase consisted of testing the program, interviewing users, condensing the program, and tailoring it to the patient group. A physiotherapist manual was developed and adapted to physiotherapists who will serve as mentors. Results The development process resulted in an iCBT program consisting of 10 modules with educational texts, videos and exercises related to relevant topics such as goalsetting, stress and pain, lifestyle, automatic thoughts, mindfulness, selective attention, worry and rumination. A physiotherapist manual was developed to guide the physiotherapists in supporting the patients through the program and to optimize adherence to the program. Conclusions The iCBT program is tailored to patients at risk of chronic pain following TKA, and may be useful as a supplement to surgery and/or exercise therapy. A multicentre RCT will evaluate the iCBT program in combination with an exercise therapy and education program. This novel intervention may be a valuable contribution to the treatment of OA patients at risk of chronic pain after TKA. Trial registration The RCT is pre-registered at ClinicalTrials.gov: NCT03771430 11/12/2018. 

(1) Background: Fibromyalgia (FM) is a syndrome marked by chronic widespread pain, fatigue, sleep issues, and other symptoms. Interventions like physical exercise can potentially enhance physical function in individuals with FM. This study aimed to assess physical function, perceived physical fitness, balance confidence, and fear of falling in women with FM based on their levels of pain, depression, fatigue, and sleep problems. (2) Methods: Participants underwent a series of tests and questionnaires to evaluate physical and perceptual aspects. These included the Time Up and Go, Four Step Square Test, 6-Minute Walking Test, Maximum Handgrip Strength, Back Scratch, International Fitness Scale, Activities-Specific Balance Confidence Scale, and Fall Efficacy Scale—International. Participants were categorised by the severity of their pain, depression, fatigue, and sleep problems (mild, moderate, severe). A Kruskal–Wallis test assessed intergroup differences, while Spearman’s rho evaluated correlations between the study variables and symptom levels. (3) Results: Perceived physical condition varied significantly with symptom severity. Symptoms and sleep problems were notably linked to fear of falling, though no significant differences emerged in the physical tests. (4) Conclusions: In women with fibromyalgia, symptom severity was primarily related to perceptual and subjective aspects of physical condition and fall safety.

Background: Non-specific chronic neck pain is a prevalent musculoskeletal disorder with a significant impact on individuals’ quality of life. The lack of consensus on effective therapeutic management complicates the establishment of standardized treatment protocols. Home exercise programs have yielded positive results. This study aimed to assess the effectiveness of a telerehabilitation program distributed through videoconferencing for patients with non-specific chronic neck pain compared to a home-based exercise program. Methods: A randomized controlled trial was conducted involving 36 participants who were divided into two groups: the experimental group (n = 18) received manual therapy combined with telerehabilitation, while the home-based group (n = 18) received the same manual therapy treatment along with recommendations for home exercises. Key outcome measures, including neck-related disability, kynesiophobia, anxiety and depression, pain intensity, pressure pain threshold, quality of life, and adherence to self-treatment, were evaluated at baseline and post-treatment. Results: No statistically significant differences were observed between groups. However, both groups demonstrated improvements in all study variables except for the mental component of quality of life immediately post-treatment. Conclusions: After eight weeks of manual therapy and exercise, both the telerehabilitation and home-based exercise programs resulted in significant improvements in disability, pain, and kynesiophobia, indicating that telerehabilitation is as effective as home-based exercise.

Objective To identify the factors associated with the pain-related functional interference level in people with chronic low back pain. Design Cross-sectional. Subjects/Patients Chronic low back pain patients. Methods Sociodemographic data, pain intensity, pain-related functional interference, physical functioning and fitness, sleep quality, anxiety and depression, social support, and health-related quality of life were recorded. Descriptive and bivariate analyses were performed. A linear regression model was carried out to identify the factors associated with the pain-related functional interference level. Results 99 participants were involved (mean age: 54.37 SD: 12.44; women: 67.7%). 37.4%, 27.3%, and 35.4% were classified into low, moderate, and high pain-related functional interference level groups, respectively. Higher pain-related functional interference was associated with higher pain intensity (β: 0.724; p = 0.026), worse sleep quality (β: 0.077; p = 0.012), worse quality of life (physical (β: –0.539; p < 0.001) and mental (β: –0.289; p < 0.001), and lower consumption of weak opioids (β: –3.408; p = 0.037). Conclusion Beyond the pain experience and intensity among people with chronic low back pain, several biopsychosocial factors associated with this condition has been identified. Furthermore, higher pain intensity, worse sleep quality, worse quality of life, and weak opioids’ consumption have been related to the pain-related functional interference of this population.

The coronavirus disease 2019 (COVID-19) pandemic has affected the lives of people worldwide. The first declaration of a state of emergency in Japan, based on the Act on Special Measures for the Prevention and Control of the Novel Coronavirus, was issued from 16 April 2020 to 14 May 2020 to reduce person-to-person contact. Restrictions on going out, participating in community activities, and visiting hospitals were in place. This study investigates the short-term effects of the COVID-19 pandemic on patients with chronic pain. This study included outpatients with chronic pain undergoing treatment at the Pain Center of Nara Medical University Hospital. The patients had completed questionnaires for a disability during the study period, from 1 July to 30 September 2019 (baseline), 1 October to 31 December 2019 (pre-pandemic), and 1 July to 30 September 2020 (during the pandemic). The questionnaire covered changes in disability, pain intensity, health-related quality of life (QOL), anxiety, depression, catastrophic thinking, and the presence/absence of exercise habits at baseline, pre-pandemic, and during the pandemic. Of the 245 eligible patients, there was no significant disability difference between baseline, pre-pandemic, and during the pandemic (p = 0.14). Similarly, pain intensity, health-related QOL, anxiety, depression, and the presence/absence of exercise habits did not significantly differ between baseline, pre-pandemic, and during the pandemic either. The current study observed significant differences in terms of catastrophic thinking (p = 0.02). The effects of the COVID-19 pandemic on patients with chronic pain were not apparent in the short-term. Clinical trail registration: UMIN000043174

AIM To evaluate the effectiveness of PainReApp, an mHealth system, based on physical exercise recommendations for patients with chronic pain (low back pain, fibromyalgia and diabetic neuropathic pain) based on pain intensity, quality of life, anxiety and/or depression, and sleep quality. DESIGN Single-blinded randomized controlled trial. METHODS One hundred patients from three different chronic conditions (low back pain, fibromyalgia and neuropathic diabetic pain) will be recruited and randomized into two groups to receive the intervention with a physical activity program guided by the PainReApp system (experimental group) or with the program information in paper format (control group). All patients will attend a first face-to-face session in which the smartphone application usage (experimental group) and exercise execution will be explained (both groups). Data will be collected at baseline, 4, 12 and 24 weeks. Nevertheless, the users of the application will have a daily registry of the exercise performed and the self-perceived difficulty. The primary outcomes of the trial will be the intensity of pain and quality of life. Anxiety and/or depression and sleep quality will be also assessed to evaluate the influence of the physical activity at multiple levels. DISCUSSION Physical exercise is becoming one of the leading evidence-based interventions to treat chronic pain. It needs to be adapted to the necessities of each pain condition. One of the major problems is the low adherence to the proposed program. New strategies that empower the patients, such as the m-Health, are reliable and useful tools to ease this end. IMPACT To the best of our knowledge, this is the first long-term randomized controlled trial researching the impact of an m-health system on chronic pain from different origin. The intervention is based on international physical exercise recommendations and can be performed without specific material, allowing the home-based practice. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ACTRN12621000783820).

No abstract available

Introduction: Chronic low back pain is the leading cause of disability, which reduces quality of life and increases the healthcare costs. Psychosocial factors (depression, kinesiophobia and somatization) may also have an important role in the appearance and duration of chronic nonspecific low back pain. Depression may predispose low back pain, while the chronicity of pain affects the degree of disability, which is also related to mental health. Many studies suggest the association between depression and low back pain by explaining a significant physiological link. Different types of manual therapy are used in the treatment of chronic low back pain, but recent studies suggest that a rehabilitation models which combine manual therapy and exercise, provide better results compared to individual (separate) applications. The aim of this research was to examine the effects of the rehabilitation program, which in-cludes manual yumeiho therapy and exercise, on depression in people suffering from chronic nonspecific low back pain. Methods: The study included 21 participants, aged 40 to 60 (M=51.1, SD=5.9) who suffer from chronic nonspecific low back pain. The study included the initial and final depression test and the initial and final neuropathic pain test. Between the initial and the final testing, a three-week therapeutic procedure of yumeiho manual therapy and exercise was performed (15 treatments). Repeated estimates of depression and neuropathic pain were tested 30 and 60 days after the implementation of the rehabilitation protocol. Results: Statistically significant improvements were noted between the initial and the final test in both observed variables. Significant improvements (lower depression and neuropathic pain) have also been noted 30 and 60 days after the implementation of the rehabilitation pro-tocol (in relation to the initial state). Conclusion: The findings indicate that the rehabilitation protocol, involving manual yumeiho therapy and exercise, is an effective method for treating depression and neuropathic pain in people suffering from chronic nonspecific low back pain. Considering the lack of research on the effects of manual therapy by yumeiho technique, the results contribute to a better under-standing of technique which, although used in practice, has not been suficiently explored. Further research is required, on comparing this rehabilitation model to other methods, as well as longer follow-up in the post-rehabilitation period.

Chronic pain syndromes like fibromyalgia, chronic pelvic pain, interstitial cystitis/bladder pain syndrome, and chronic migraine cause significant disability and impair quality of life for many women. Evaluation of chronic pain can be complex because women often have overlapping syndromes as well as comorbid anxiety and depression. Multidisciplinary care including nonpharmacologic treatments like exercise and mindfulness-based therapies as well as pharmacologic medications improve function and decrease pain. With their wide knowledge base, primary care providers are well-equipped to primarily manage chronic pain in their women patients.

Chronic neck pain is associated with balance and gait disturbances [1,2]. The effects of tele rehabilitation- based stabilization training on balance and gait in chronic idiopathic neck pain (CINP) are still unknown.This study aimed to compare the effects of tele rehabilitation-based scapular and core stabilization training on balance, gait, functionality, pain and depression in CINP.Forty-one individuals with CINP (36 females, 5 males) were participated in the study. Participants were randomized into two groups as scapular stabilization (SS) group (n=20, 17 females, 3 males, age 20.00 [19.0-21.0] years, visual analogue scale (VAS) score 6.00 [5.0-6.0]) and the core stabilization (CS) group (n=21, 19 females, 2 males, age 20.00 [19.0-21.0] years, VAS score 5.00 [5.0-6.0]). Tele rehabilitation-based exercise sessions were conducted with mutual videoconferencing synchronously in groups of 2-3 participants, 45-60 minutes’ duration, once a-week for 8 weeks. Postural stability (PS) and limits of stability (LOS) were measured by a computerized balance platform. Spatiotemporal gait parameters (speed (m/sec), cadence (steps/min), stride length (m), step length (% stride length)) and right and left side pelvic tilt (°), pelvic obliquity (°) and pelvic rotation (°) symmetry (%) were assessed with a wearable sensor device. The gait was assessed during two different walking conditions. Firstly, the participants walked at usual (normal) walking speed on the 10-meter walking path. Secondly, they walked this distance at the maximum speed they could walk safely. Neck Disability Index (NDI) for functionality, VAS for pain intensity and Beck Depression Inventory (BDI) for depression were used at baseline and after 8 weeks. Normally distributed variables were presented as mean and SD, non-normally distributed variables were presented as median (interquartile range[IQR]).After 8 week tele rehabilitation-based training, pain intensity, functionality, depression, PS (overall, anteroposterior), LOS, cadence, speed, and stride length (left) during normal walking, stride length (right) during fast walking, pelvic tilt and pelvic rotation symmetry for both walking condition significantly improved in the both groups (p <0.05). Cadence (120.90 ±9.70 vs. 127.11 ±10.10, p < 0.001) and stride length-left (1.49 ±0.21 vs. 1.51 ± 0.20, p= 0.005) during fast walking, stride length-right (1.32 ± 0.19 vs. 1.38 ± 0.21, p= 0.001) during normal walking and pelvic oblique symmetry during both normal (98.10 [97.65-98.85] vs. 98.60 [97.95-98.85], p=0.002) and fast (97.40 [96.15-98.10] vs. 98.50 [97.90-98.95], p < 0.001) walking improved in the CS group, while no improvement occurred in the SS group (p> 0.05).This study showed that tele rehabilitation-based stabilization training improved balance, gait, functionality, pain and depression in CINP significantly. Core stability training appears to be more effective than scapular stability training in improving LOS, gait parameters, and pelvic symmetry in this population.[1]Uthaikhup S, Sunkarat S, Khamsaen K, Meeyan K, Treleaven J. 2014. The effects of head movement and walking speed on gait parameters in patients with chronic neck pain. Man Ther. 19(2):137–141.https://doi.org/10.1016/j.math.2013.09.004[2]de Zoete RMJ, Osmotherly PG, Rivett DA, Farrell SF, Snodgrass SJ. 2017. Sensorimotor Control in Individuals With Idiopathic Neck Pain and Healthy Individuals: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 98(6):1257–1271.https://doi.org/10.1016/j.apmr.2016.09.121NIL.None Declared.

Background Low back pain (LBP) is one of the most disabling diseases and a major health issue. Despite the evidence of a link between paraspinal and gluteal muscle dysfunction and LBP, it is unknown whether aquatic exercises can lead to improvements in paraspinal and gluteal muscle morphology and function, and whether improvements in overall muscle health are associated with improvements in patients’ outcomes. The unique properties of water allow a water-based exercise program to be tailored to the needs of those suffering from LBP. This study uses magnetic resonance imaging (MRI) to investigate the effect of an aquatic exercise program versus standard exercise on 1) paraspinal and gluteal muscle size, quality and strength and 2) pain, disability, and psychological factors (pain related fear, depression, anxiety, sleep quality) in chronic LBP. Methods This study will include 34 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 65, who will be randomly assigned (1:1) to the aquatic exercise group or land-based standard care exercise group. Both groups will receive 20 supervised sessions, twice per week over 10 weeks. MRIs will be obtained along the lumbosacral spine (L1-L5) and pelvis at the start and end of the intervention to assess the effect of each exercise intervention on paraspinal and gluteal muscle size and quality. Pre- to post-intervention changes in all outcomes between each group will be assessed, and the association between the changes in back muscle quality and clinical outcomes will be examined. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment. Discussion This study will determine if water-based exercises targeting the lower back and gluteal muscles can lead to important changes in muscle quality and function, and their possible relation with patients’ pain and functional improvements. Our findings will have strong clinical implications and provide preliminary data to design a community program to better support individuals with chronic LBP. Trial registration NCT05823857, registered prospectively on April 27^th, 2023.

The aim of this study is to investigate if telerehabilitation is just as effective as the same face-to-face exercise program in patients with chronic neck pain (NP). 140 participants will participate in this non-inferiority randomized controlled trial. Primary outcomes will be pain intensity and disability, and secondary outcomes will be kinesiophobia, catastrophizing, fear avoidance beliefs, anxiety and depression symptoms, self-efficacy for pain and global perceived effect. It will be collected at baseline, 6 weeks and 6 months after intervention. The analysis of non-inferiority will be calculated by mixed linear models considering the non-inferiority margin. The results of this clinical trial will be able to overcome the barriers that physiotherapists face for the success of their therapies. In addition, it may reduce the high demands and public health costs with NP. Brazilian Clinical Trials Registry (RBR-6VBSMB). Clinical Trial Registration: REBEC (Brazilian Registry of Clinical Trials) RBR-6VBSMB (ClinicalTrials.gov).

BackgroundMost people suffering chronic pain are plagued by sleeping difficulties. Cognitive behaviour therapy has produced promising results for insomnia comorbid with chronic pain, but the access to such treatment is often limited. Over the last ten years, interventions aiming to increase cognitive flexibility and physical activity have been assumed to be effective treatments for a variety of conditions, including insomnia and chronic pain. If proven effective, these treatments could constitute the first steps in a stepped care model for chronic pain and insomnia.MethodsTwo hundred ninety-nine chronic pain subjects were randomized to Exercise, ACT-based stress management (ACT-bsm), or an active control group. Two hundred thirty-two participants (78%) received their allocated intervention at least to some extent. These participants were evaluated using mixed model analyses for changes in sleep (Insomnia Severity Index, ISI), pain intensity, depression, and anxiety immediately after treatment, six months and twelve months after treatment.ResultsThe mixed model analyses revealed that Exercise had a positive effect on insomnia compared with the control group and the effect remained after 12 months. No clear effect (i.e., both for completers and for completers together with treatment non-completers) upon ISI was found for the ACT-bsm. Pain intensity decreased significantly both in the exercise group and in the control group. For the two psychological variables (i.e., symptoms of anxiety and depression) were found significant improvements over time but no group differences. The treatment effects for ISI and pain intensity did not reach clinical significance per definitions presented in other relevant studies.ConclusionsBeneficial significant effects on insomnia was confirmed in the exercise condition. However, these changes were probably not clinically important. For pain intensity a general decrease was found in the Exercise condition and in the control condition, while no change occurred in ACT-bsm. No group differences were found for the two psychological variables.Trial registrationThe study was registered in Clinical Trials (Trial registration: ClinicalTrials.gov Id: NCT02399644, 21 January 2015, retrospectively registered).

Many patients who receive treatment for opioid use disorder (OUD) report experiencing chronic pain (CP), which is associated with high levels of ongoing nonmedical opioid use and low retention in OUD treatment. In pilot studies of patients with OUD receiving buprenorphine or methadone who had CP, cognitive behavioral therapy (CBT) attenuated nonmedical opioid use compared with treatment-as-usual (TAU), but patients in both treatment arms exhibited similar pain improvements. Adding exercise and stress reduction to this model may augment pain-related outcomes. With funding from National Institutes of Health, we plan to conduct a randomized clinical trial of 316 patients with OUD and CP to test the effectiveness of TAU compared with Stepped Care for Patients to Optimize Whole Recovery (SC-POWR) to reduce nonmedical opioid use and pain (primary outcomes) (Aim 1) and decrease pain intensity and interference, alcohol use, anxiety, depression and stress, and improve sleep (secondary outcomes) (Aim 2). Eligible participants will be randomized to receive TAU (buprenorphine or methadone and at least once a month individual or group counseling) or SC-POWR (ie, TAU and up to 12 CBT sessions) for 24 weeks. Based on prespecified nonresponse criteria, SC-POWR may be stepped up at week 6 to receive onsite weekly group sessions of exercise (Wii Fit, Tai Chi) and “stepped up” again at week 15 to receive weekly group sessions of stress reduction (relaxation training, auricular acupuncture). They will be followed for another 24 weeks to evaluate durability of treatment response for illicit opioid use, alcohol use, pain, anxiety, depression, stress, sleep, and retention in medications for OUD (Aim 3).

Background: Office workers who need to use a computer while maintaining a static position for prolonged periods have more chance of having low back pain (LBP). Objective: The objective of the study is to investigate the effect of yoga on stress, anxiety, depression, and spinal mobility in computer users with chronic LBP (CLBP). Materials and Methods: In this randomized control trial, eighty computer users (42.6 ± 8.45 years of age; suffering from CLBP since 5.20 ± 3.01 years; 51 males and 29 females) who use a computer for their professional work, recruited from Bengaluru, India, were randomized into two groups: yoga group (n = 40) and physical exercise group (n = 40). The yoga group practiced an integrated module comprising yoga postures and mindfulness meditation, and the physical exercise group practiced physical exercise designed for LBP (1 h/day, 3 days/week for 16 weeks). Assessments of dial-type goniometer and Depression Anxiety Stress Scale-42 were performed at baseline, after 8 weeks, and after 16 weeks. Results: Stress, anxiety, and depression scores were significantly lower in the yoga group as compared to the physical exercise group at 16 weeks (P < 0.001), whereas spinal flexion (P < 0.001), spinal extension (P < 0.001), right lateral flexion (P = 0.001), and left lateral flexion (P = 0.007) scores were significantly higher in the yoga group as compared to the physical exercise group at 16 weeks. Conclusion: Yoga is more effective in reducing stress, anxiety, and depression and improving spinal mobility in computer users with CLBP than physical exercise designed for LBP.

Background Contemporary management of chronic low back pain involves combined exercise and pain education. Currently, there is a gap in the literature for whether any exercise mode better pairs with pain education. The purpose of this study was to compare general callisthenic exercise with a powerlifting style programme, both paired with consistent pain education, for chronic low back pain. We hypothesised powerlifting style training may better compliment the messages of pain education. Methods An 8-week single-blind randomised controlled trial was conducted comparing bodyweight exercise (n  =  32) with powerlifting (n  =  32) paired with the same education, for people with chronic low back pain. Exercise sessions were one-on-one and lasted 60-min, with the last 5–15 min comprising pain education. Pain, disability, fear, catastrophizing, self-efficacy, anxiety, and depression were measured at baseline, 8-weeks, 3-months, and 6-months. Results No significant between-group differences were observed for pain (p≥0.40), or disability (p≥0.45) at any time-point. Within-group differences were significantly improved for pain (p ≤ 0.04) and disability (p ≤ 0.04) at all time-points for both groups, except 6-month disability in the bodyweight group (p  =  0.1). Behavioural measures explained 39–60% of the variance in changes in pain and disability at each time-point, with fear and self-efficacy emerging as significant in these models (p ≤ 0.001) Conclusions Both powerlifting and bodyweight exercise were safe and beneficial when paired with pain education for chronic low back pain, with reductions in pain and disability associated with improved fear and self-efficacy. This study provides opportunity for practitioners to no longer be constrained by systematic approaches to chronic low back pain.

Background Nonspecific chronic low back pain (CLBP) is a complex symptom with numerous possible causes and influencing factors. Understanding how modifiable factors affect the course of CLBP is important for preventing progression. As the COVID-19 pandemic has changed the lifestyle of many people, this study paper assessed whether it also changed the influence of modifiable lifestyle factors (regular exercise and sedentary behaviour) and mental health factors (anxiety and depression) on CLBP pain intensity and disability by comparing the strength of these associations before and during the pandemic. We hypothesised that the importance of regular physical activity and good mental health for CLBP patients would increase during the pandemic. Methods These questions were investigated in a cross-sectional study of insurance claims data and self-reported data from various questionnaires from 3,478 participants in a German CLBP health intervention (2014–2021) by calculating pre- and intra-pandemic odds ratios (OR) and 95% confidence intervals (CI) for each variable of interest and outcome. Potential confounders were also considered. Pandemic status was treated as an effect modifier. Based on the date of enrolment, participants were classified as “pre-pandemic” or “pandemic”. Results Regularly exercising ≥ 4 h/week significantly reduced the odds of high disability for men (OR 0.49, 95% CI 0.31 – 0.79, p  = 0.003) and women (OR 0.30, 95% CI 0.14 – 0.563, p  = 0.002) and reduced the probability of severe pain in women (OR 0.37, 95% CI 0.21 – 0.65, p  < 0.001). Each one-point increase in PHQ-4 score for anxiety and depression increased the OR of high pain intensity by 1.25 points (95% CI 1.18 – 1.34, p  < 0.001). A clear impact of COVID-19 lockdowns was observed. In individuals who exercised ≥ 4 h/week the OR of high disability was 0.57 (95% CI 0.36 – 0.92, p  = 0.021) in the pre-pandemic group compared to 0.29 (95% CI 0.12 – 0.56, p  = 0.002) in the pandemic group. The probability of high disability increased from an OR of 1.42 (95% CI 1.33 – 1.52, p  < 0.001) per marginal increase in the PHQ-4 scale before the pandemic, to an OR of 1.73 (95% CI 1.58 – 1.89, p  < 0.001) during the pandemic. Conclusions The magnitude of association of the factors that influenced high pain intensity and disability increased during the pandemic. On the one hand, the protective effect of regular exercising was greater in participants surveyed during lockdown. On the other hand, a higher risk through anxiety or depression during the lockdown was identified. An additional study with objective measures of sedentary behaviour and physical activity is needed to validate these results. More in-depth investigation of lockdown-induced associations between reduced daily physical activity, increased levels of anxiety and depression, and their effects on CLPB could also be worthwhile. Trial registration This study used routinely collected data from a CLBP intervention that was previously evaluated and registered in the German Registry of Clinical Trials under DRKS00015463 (04/09/2018). The original ethics approval, informed consent and self-reported questionnaire have remained unchanged and are still valid.

No abstract available

Background: This study aimed to determine the short-term effects of dry needling (DN) combined with a standard exercise program on pain and quality of life in patients with chronic mechanical neck pain (CMNP). Methods: Thirty-one patients with CMNP were randomly allocated to the experimental and control groups. The experimental group received DN and underwent a standard exercise program (one DN session and six exercise sessions) for two weeks, whereas the control group underwent the same exercise program alone for two weeks. The participants’ scores in the Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), Short Form-36 Quality of Life Scale (SF-36 QOLS), and Beck Depression Inventory (BDI) before and after the intervention were assessed. Results: The control and experimental groups’ post-test NDI, NPRS, SF-36 QOLS, and BDI scores significantly differed from their baseline scores (p ≤ 0.05). The between-group comparison of the post-test scores using Wilcoxon rank-sum test revealed no significant differences between the NDI, NPRS, BDI, and SF-36 QOLS scores of both groups (p ≥ 0.05). Conclusions: One session of trigger point DN (TrP-DN) with exercise and exercise alone showed the same pain and quality-of-life outcomes after a two-week intervention. We did not recognise TrP-DN as an efficient intervention, not because we obtained evidence that it is ineffective, but because there were inadequate high-quality studies on the subject and unavailable data on the minimum quantity of injections required for better DN outcomes in CMNP patients.

Background Increased social distance is one of the manifestations of social impairment. Chronic low back pain (CLBP) is one of factors associated with increased social distance and social withdrawal. Exercise therapy is an effective means to social impairment. However, whether exercise could reduce social distance in patients with CLBP remains unknown. This study aimed to investigate the effect of exercise on social distance in middle-aged and elderly patients with CLBP. Methods The longitudinal intervention recruited 29 middle-aged and elderly patients with CLBP from various communities in Yangpu District, Shanghai, China. The participants received exercise intervention for 8 weeks. The assessments were conducted before and after the intervention, including social distance, pain intensity, unpleasantness of pain, Roland-Morris Questionnaire (RMDQ), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS). Intention to treat analysis was performed. Results After the 8-week exercise intervention, the social distance of patients with CLBP was shorter than that before intervention and showed significant difference (p < 0.05). The scores of pain intensity, unpleasantness of pain, RMDQ, SAS, and SDS also decreased and were significantly different between pre- and post-intervention (p < 0.05). In addition, the social distance, pain intensity, unpleasantness of pain, RMDQ, SAS, and SDS scores of the moderate CLBP group decreased more after the intervention compared with those of the mild CLBP group. Conclusion The 8-week exercise intervention cannot only shorten the social distance in middle-aged and elderly patients with CLBP but also relieve pain, disability, and negative emotions.

Purpose: Exercise therapy is the most common conservative treatment for LBP as it is easily accessible and can be individually tailored to the needs of the patient, but no evidence has been presented that one exercise approach is superior to the other. Exercise has generally been associated with improving psychosocial aspects of pain, such as kinesiophobia, depression, and anxiety in LBP patients, but its effect on the paraspinal muscles needs to be focused on. For this reason, the aim of our study is to evaluate different types of exercises that will help increase neuromuscular facilitation and core stability in paraspinal muscles by considering patient satisfaction. Methods: A total of thirty-seven female patients with chronic low back pain were included in the study. The Oswestry Low Back Pain Questionnaire was used to assess functionality. Core stability was evaluated with a stabilizer. Pain intensity and satisfaction were measured with visual analog scale. Patients' kinesiophobia was assessed by using Tampa Kinesiophobia Scale. Patients were randomized into three groups according to the interventions as; proprioceptive neuromuscular facilitation (PNF) exercise group (n = 9), core stability exercise group (n = 14) and control (n = 14) group. The duration of applications was 3 days per week with a total of 6 weeks. Results: There was a group difference for core muscle strength (p = .045), Oswestry score (p = .001), pain intensity score (p = .003) and Tampa score (p = .001). There were significant gains for core muscle strength and Oswestry scores for proprioceptive neuromuscular facilitation and core stability groups (p < .05). Conclusion. Core stabilization exercises have additional effects to improve rehabilitation outcomes for patients and also the level of patient satisfaction was importantly different between all groups in favor to core stability with chronic low back pain.

Background Fibromyalgia (FM) is characterized by widespread chronic pain. Although pain is the main symptom, approximately 90% of patients have depression. This study aimed to analyze the effects of Resistance Training (RT) with low and high intensity on depression in patients with FM. Methods Thirty-eight women with FM and 31 healthy women were allocated to the low-intensity, high-intensity, preferred-intensity, and control groups. The patients underwent 8 weeks of supervised RT, with two sessions per week of approximately 1 h. The low-intensity resistance training group (LIRT) performed two sets of 12 maximum repetitions. The high-intensity resistance training group (HIRT) performed four sets with six maximum repetitions, and the preferred intensity group (PI) performed three sets, with eight to 12 repetitions, according to the patient’s tolerance. The healthy control group did not perform any type of exercise. Depression was assessed using the Beck depression inventory before the start of the intervention, after 4 and 8 weeks. Results FM patients have higher levels of depression than women without the disease. After 4 weeks, there was a difference in depressive symptoms between the HIRT and LIRT (p = 0.048), and the PI and LIRT (p = 0.048). Conclusion Prescribing RT with low or high intensity did not significantly reduce depression in patients with FM after 8 weeks, however, analyses between groups after 4 weeks indicated that low-intensity training is more effective than high-intensity training. The prescription of RT exercise to FM could vary among low, high, and preferred intensity, following the patient’s tolerance for pain. Clinical trial registration https://ensaiosclinicos.gov.br/rg/RBR-74pcmw, RBR-74pcmw.

PURPOSE Physical exercise is increasingly being promoted by healthcare for chronic pain conditions with beneficial outcomes such as: pain and fatigue reduction, and increased quality of life. Nevertheless, knowledge about biochemical consequences of physical exercise in chronic pain is still relatively poor.The endocannabinoid system has been suggested to play a role for acute exercise-induced reward and pain inhibition. The aim of this study is to investigate the chronic outcomes of resistance exercise on levels of endocannabinoids and related lipids in fibromyalgia (FM). METHODS This study examine the outcomes of a 15-week person-centered resistance exercise program on plasma levels of the lipid mediators; anandamide, 2-arachidonoylglycerol (2-AG), oleoylethanolamide (OEA), palmitoylethanolamide (PEA), and stearoylethanolamide (SEA) sampled from 37 women with FM and 33 healthy controls. The associations between clinical scorings of pain, depression, anxiety, fatigue, and muscle strength with levels of these lipid mediators before and after the exercise program are also analysed. RESULTS After the 15 weeks exercise program anandamide levels were significantly increased and SEA levels significantly decreased in FM. Pain intensity and depression scorings decreased and muscle strength increased, and in a multivariate context muscle strength was positively associated with 2-AG levels after the resistance exercise program in FM. CONCLUSIONS The increased anandamide and decreased SEA in women with fibromyalgia after the 15 weeks program might point to a chronic effect of resistance exercise. Pain and depression scorings decreased in the fibromyalgia group after the program but no associations between pain, depression and lipid level changes were assured.

No abstract available

ABSTRACT Background Prevalence of chronic musculoskeletal pain and depressive symptoms in adults is high; however, whether there is an association between these conditions in older adults is unknown. Objective The aim of this study was to investigate the association of depressive symptoms with chronic musculoskeletal pain, and specifically with chronic LBP and knee osteoarthritis (OA), in community-dwelling older adults. In addition, we explored whether physical activity can mitigate these associations. Methods A cross-sectional study design. A cross-sectional study design. Participants recruited were older adults (age ≥60 years) living in the community. Chronic musculoskeletal pain was assessed by specific questions regarding the presence of chronic LBP and knee OA. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale. Multivariable regression model adjusted for potential confounders (i.e., age, sex, economic status, body composition, and physical activity) was used to investigate the association between chronic musculoskeletal pain and depressive symptoms. Separate analyses were also conducted for older adults with LBP and with knee OA. Results A total of 509 (69% women) older adults were recruited. The regression analysis showed that musculoskeletal pain was associated with higher depressive symptoms ($\beta $β = 2.52, 95% CI: 0.50 to 4.54; p-value < .05) compared with older adults without chronic musculoskeletal pain. Similarly, in the fully adjusted model, which included physical activity, LBP was associated with higher depressive symptoms ($\beta $β = 2.80, 95% CI: 0.82 to 4.79; p-value < .01). The association between knee OA and depressive symptoms was not statistically significant after adjusting for physical activity ($\beta $β = 2.00, 95% CI: −0.13 to 4.13; p-value = .06). Conclusion Older adults with chronic musculoskeletal pain have higher depressive symptoms scores, when compared to those without musculoskeletal pain. Physical activity does not seem to influence this association.

OBJECTIVE The objective of this cross-sectional study was to compare the physical activity level between individuals with and without rotator cuff related shoulder pain (RCRSP), and, in individuals with RCRSP, investigate whether biopsychosocial factors are associated with the physical activity level. METHODS Seventy-four participants with and 84 participants without RCRSP wore a fitness tracking watch for seven consecutive days to assess physical activity (step count, moderate-to-vigorous physical activity (MVPA)-minutes). Additionally, participants with RCRSP completed questionnaires on their level of pain, disability, and physical activity (short version of the International Physical Activity Questionnaire [IPAQ]), as well as on biopsychosocial factors, including resilience, stress, catastrophizing, anxiety and depressive symptoms, self-efficacy, and social support. Statistical analysis included Mann-Whitney U tests and General Linear Models for group comparisons, as well as multiple regression analyses to explore predictors of physical activity. RESULTS No significant between-group difference was found concerning step count and MVPA-minutes. Age and depressive symptoms explained 14% of the variance in step count, while age and resilience explained 15% of MVPA-minutes variance. Additionally, resilience was associated with IPAQ (P < 0.05), indicating that higher resilience correlates with greater reported physical activity (odds ratio: 2.32 [1.27, 4.22]). CONCLUSION While individuals with RCRSP did not show lower physical activity levels compared to their healthy counterparts, greater physical activity was associated with younger age, lower depressive symptoms, and higher resilience in individuals with RCRSP. Future research should explore whether resilience and physical activity interventions can prevent the transition to persistent RCRSP.

No abstract available

Background Depression has been associated with episodes of musculoskeletal pain. However, it is not clear whether such relationships could be mitigated according to the physical activity level. Aim To describe, during the COVID-19 pandemic, the relationship between depression and musculoskeletal pain according to the physical activity levels. Design Cross-sectional study. Methods This research was conducted in Brazil between May 5 and March 17, 2020. Participants (N = 1872; 58% women) were invited through social media to answer a structured online questionnaire. Depressive symptoms were assessed through self-report of perception of depression during quarantine. Musculoskeletal pain was assessed based on the Nordic questionnaire identifying nine possible pain points in the body. Physical activity was assessed based on the weekly frequency, intensity, and duration of each session of physical activity the participants engaged in during COVID-19. The logistic binary regression analyzed the associations between depressive symptoms and musculoskeletal pain according to the participants’ level of physical activity. Results Depressive symptoms were associated with pain in six different regions of the body in physically inactive participants. In physically inactive participants, those with depressive symptoms 1.51 (95% CI = 1.04-2.19) and 2.78 (95% CI = 1.81-4.26) times more likely to have pain in one or two and ≥three regions body regions, respectively. In active participants, depressive symptoms were not associated with pain. Conclusion During the COVID-19 pandemic, depression was associated with musculoskeletal pain in physically inactive participants.

Background Chronic pain is a globally prevalent condition. It is closely linked with psychological well-being, and it is often concomitant with anxiety, negative affect, and in some cases even depressive disorders. In the case of musculoskeletal chronic pain, frequent physical activity is beneficial. However, reluctance to engage in physical activity is common due to negative psychological associations (eg, fear) between movement and pain. It is known that encouragement, self-efficacy, and positive beliefs are effective to bolster physical activity. However, given that the majority of time is spent away from personnel who can give such encouragement, there is a great need for an automated ubiquitous solution. Objective MyBehaviorCBP is a mobile phone app that uses machine learning on sensor-based and self-reported physical activity data to find routine behaviors and automatically generate physical activity recommendations that are similar to existing behaviors. Since the recommendations are based on routine behavior, they are likely to be perceived as familiar and therefore likely to be actualized even in the presence of negative beliefs. In this paper, we report the preliminary efficacy of MyBehaviorCBP based on a pilot trial on individuals with chronic back pain. Methods A 5-week pilot study was conducted on people with chronic back pain (N=10). After a week long baseline period with no recommendations, participants received generic recommendations from an expert for 2 weeks, which served as the control condition. Then, in the next 2 weeks, MyBehaviorCBP recommendations were issued. An exit survey was conducted to compare acceptance toward the different forms of recommendations and map out future improvement opportunities. Results In all, 90% (9/10) of participants felt positive about trying the MyBehaviorCBP recommendations, and no participant found the recommendations unhelpful. Several significant differences were observed in other outcome measures. Participants found MyBehaviorCBP recommendations easier to adopt compared to the control (βint=0.42, P<.001) on a 5-point Likert scale. The MyBehaviorCBP recommendations were actualized more (βint=0.46, P<.001) with an increase in approximately 5 minutes of further walking per day (βint=4.9 minutes, P=.02) compared to the control. For future improvement opportunities, participants wanted push notifications and adaptation for weather, pain level, or weekend/weekday. Conclusions In the pilot study, MyBehaviorCBP’s automated approach was found to have positive effects. Specifically, the recommendations were actualized more, and perceived to be easier to follow. To the best of our knowledge, this is the first time an automated approach has achieved preliminary success to promote physical activity in a chronic pain context. Further studies are needed to examine MyBehaviorCBP’s efficacy on a larger cohort and over a longer period of time.

Although chronic multi-site musculoskeletal pain is known to cause decreased physical function and impair work and social life, there is insufficient research about its impact on health-related quality of life (HRQoL) in women. The aim of this study was to investigate multiple factors affecting HRQoL in women with chronic multi-site musculoskeletal pain. This study included 227 women with two or more musculoskeletal areas which were painful during the last 3 months. The HRQoL and musculoskeletal system symptoms were evaluated with the Nottingham Health Profile (NHP) and the Nordic Musculoskeletal Questionnaire (NMQ), respectively. Physical activity level, social functionality and depressive symptoms were assessed with the International Physical Activity Questionnaire-Short Form (IPAQ- SF), Social Functioning Scale (SFS) and Beck Depression Inventory (BDI), respectively. Significant predictors for the total score on the NHP were found to be the number of children (p < 0.001), social engagement/withdrawal scale (p:0.094), the number of regions with musculoskeletal pain during the last year (p:0.002) and last 7 days (p:0.036), depressive symptoms (p < 0.001), current employment status (p:0.084), and the presence of chronic disease (p < 0.001). The results of this study demonstrated that both sociodemographic characteristics, and social and psychological factors may affect the HRQoL in women with chronic multi-site musculoskeletal pain.

Background The aim of this study was to examine the relationship between psychological characteristics and physical activity levels, measured as the average number of steps per day, in people with knee osteoarthritis (OA). Methods This study analysed baseline data from a randomized controlled trial (Australian New Zealand Clinical Trials Registry reference: ACTRN12612000308897). A total of 167 adults aged over 50 years, with knee pain rated as four or more on an 11-point numeric rating scale, and knee OA diagnosed using American College of Rheumatology clinical criteria, were recruited from the community (62 men and 105 women, mean age, 62.2 ± 7.5 years). The average number of steps per day over seven consecutive days was measured using an accelerometer-based device. Psychological characteristics evaluated were: depressive symptoms (Depression Anxiety Stress Scale), self-efficacy (Arthritis Self-Efficacy Scale for pain and other symptoms), fear of movement (Brief Fear of Movement Scale for Osteoarthritis), and pain catastrophizing (Pain Catastrophizing Scale). The association between the average number of steps per day and psychological characteristics was analyzed using a multiple linear regression analysis, with the average number of steps per day as the dependent variable, adjusting for each psychological characteristic separately, and age, sex, body mass index, and pain entered as covariates. Results There was evidence that the amount of physical activity was associated with fear of movement (coefficient [B]: − 117, 95% confidence interval [95%CI]: − 227 to − 8) and with pain catastrophizing (B: -44, 95%CI: − 86 to − 1). The association with self-efficacy was similar (B:117, 95%CI: − 12 to 246). However, the direction of the association with depressive symptoms was less clear (B: -59, 95%CI: − 138 to 19). Conclusions The results of this study revealed that the relationship was such that lower fear of movement and lower pain catastrophizing may be associated with more steps per day. It may be hypothesized that fear of moving and pain catastrophizing lead to activity avoidance and that strategies to improve these disease-related psychological aspects may be useful in enhancing physical activity participation, although this hypothesis is highly speculative and needs further testing given the cross-sectional design of this study.

The aim of this cross-sectional study was to explore which variables were associated with physical inactivity in people living with HIV living in a fishing community in Uganda. Secondary aims were to explore the reasons for and barriers to physical activity (PA). Two hundred and fifty-six individuals living with HIV (77 men, 40.5 ± 10.3 years) completed the Physical Activity Vital Sign (PAVS), Patient Health Questionnaire-9 (PHQ-9), and the Alcohol Use Disorders Identification Test. Women had a 1.62 (95% CI = 1.01–2.57), those not having a job a 2.81 (95% CI = 2.00–3.94), and those with depression a 5.67 (95% CI = 2.27–14.17) higher odds for not being physically active for 150 min/week at moderate intensity. Employment and depression status were the only independent significant predictors explaining 27.2% of the PAVS variance. Becoming more healthy and energetic again and reducing stress were the most important PA motives, and musculoskeletal pain, body weakness, and lack of time were the most important PA barriers.

No abstract available

Purpose: Chronic pain is a major public health concern and has been linked to cognitive decline. However, the effect of pain occurring simultaneously in two musculoskeletal sites on dementia risk remains unclear. In this study, we aimed to examine whether dual-site pain (DSP; in this study defined as cooccurring chronic low back and knee pain) is associated with an increased risk of dementia in community-dwelling older adults. Patients and Methods: We analyzed data from 2060 participants aged ≥65 years in the Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study. DSP was defined as the presence of both chronic low back and knee pain lasting >3 months. Participants without DSP served as the reference group. Incident dementia was identified from long-term care insurance certification records, and Cox proportional hazards models were used to estimate hazard ratios (HRs) adjusting for demographic and vascular risk factors, depressive symptoms, and physical activity. Results: Over 6 years, 197 participants (9.6%) developed dementia. The incidence was higher in the DSP group (16.5%, 26/158) than in the control group (9.0%, 171/1902). After adjustment, DSP remained significantly associated with dementia (HR = 1.57, 95% CI: 1.02–2.42). Conclusion: Dual-site pain involving the low back and knee is a significant risk factor for dementia among older adults. Early identification and management of DSP may help preserve cognitive health, highlighting the need for integrated strategies addressing both musculoskeletal and cognitive well-being.

OBJECTIVE We studied predictors of sickness absences (SA) due to musculoskeletal pain over two years among 386 municipal female kitchen workers. METHODS Pain and SA periods (no/yes) due to pain in seven sites during the past three months were assessed at 3-month intervals over two years by questionnaire. Age, musculoskeletal pain, multisite pain (pain in ≥3 sites), musculoskeletal and other somatic diseases, depressive symptoms, physical and psychosocial workload, body mass index, smoking, and leisure-time physical activity (LTPA) at baseline were considered as predictors. Trajectory analysis and multinomial logistic regression were used. RESULTS Three trajectories of SA emerged, labelled as "none" (41% of the subjects), "intermediate" (48%), and "high" (11%). With the "none" trajectory (no SA) as reference, pain in all musculoskeletal sites excepting the low back predicted belonging to the "intermediate" [odds ratio (OR) 1.82-2.48] or "high" (OR 2.56-3.74) trajectory adjusted for age; multisite pain predicted membership of the "intermediate" [OR 2.15, 95% confidence interval (95% CI) 1.38-3.34] or "high" (OR 4.66, 95% CI 2.10-10.3) trajectories. In a mutually adjusted final model, smoking (OR 2.12, 95% CI 1.22-3.69), multisite pain (OR 1.87, 95% CI 1.15-3.02), and overweight/obesity (OR 1.71, 95% CI 1.08-2.72) predicted belonging to the "intermediate" trajectory, while depressive symptoms (OR 3.57, 95% CI 1.57-8.10), musculoskeletal diseases (OR 3.18, 95% CI 1.37-7.37), and multisite pain (OR 2.72, 95% CI 1.15-6.40) were associated with the "high" trajectory. CONCLUSION Along with the number of pain sites and musculoskeletal diseases, attention to depressive symptoms, smoking, and overweight/obesity is needed to tackle SA related to musculoskeletal pain.

(1) Background: This prospective study aimed to identify predictors of falls and fall-related fractures in community-dwelling older people with pain; (2) Methods: Participants comprised 389 community-dwelling older people aged 70+ years who had musculoskeletal pain in the neck, back, hip, leg/knee and/or feet. Demographic, anthropometric, balance, mobility, cognitive function, psychological status and physical activity level measures were obtained at baseline. Falls were monitored with monthly falls calendars for 12 months. Logistic regression analyses were performed to identify predictors of falls and fall-related fractures during a 12-month follow-up; (3) Results: Of the 389 participants, 175 (45.0%) and 20 (5.1%) reported falls and fall-related fractures during the 12-month follow-up, respectively. Greater postural sway on foam, more depressive symptoms and lower physical activity levels at baseline were associated with falls during the 12-month follow-up. Slower walking speed at baseline was associated with fall-related fractures during the 12-month follow-up. These associations remained significant after adjusting for age, sex, body mass index, comorbidities and medication use; (4) Conclusions: This study suggests poor balance, low mood and a less active lifestyle are predictors of falls, and slower walking speed predicts fall-related fractures among community-dwelling older people with pain.

INTRODUCTION There is little research on identifying modifiable risk factors that predict future interference of pain with daily activity in people with joint pain, and the estimation of the corresponding population attributable risk (PAR). The present study therefore investigated modifiable predictors of pain interference and estimated maximum potential gain from intervention in adults with joint pain. METHODS A population-based cohort aged ≥50 years was recruited from eight general practices in North Staffordshire, UK. Participants (n = 1878) had joint pain at baseline lasting ≥3 months and indicated no pain interference. Adjusted associations of self-reported, potentially modifiable prognostic factors (body mass index, anxiety/depressive symptoms, widespread pain, inadequate joint pain control, physical inactivity, sleep problems, smoking and alcohol intake) with onset of pain interference 3 years later were estimated via Poisson regression, and corresponding PAR estimates were obtained. RESULTS Inadequate joint-specific pain control, insomnia and infrequent walking were found to be independently significantly associated with the onset of pain interference after 3 years, with associated PARs of 6.3% (95% confidence interval -0.3, 12.4), 7.6% (-0.4, 15.0) and 8.0% (0.1, 15.2), respectively, with only the PAR for infrequent walking deemed statistically significant. The PAR associated with insomnia, infrequent walking and inadequate control of joint pain simultaneously was 20.3% (8.6, 30.4). CONCLUSIONS There is potential to reduce moderately the onset of pain interference from joint pain in the over-50s if clinical and public health interventions targeted pain management and insomnia, and promoted an active lifestyle. However, most of the onset of significant pain interference in the over-50s, would not be prevented, even assuming that these factors could be eliminated.

People with chronic musculoskeletal pain (CMSP) often have low physical activity. Various factors can influence the activity level. The aim of this study was to monitor physical activity, assessed by the number of steps per day, over time in people with CMSP and identify factors that could be associated with this activity feature. This prospective study involved people undergoing rehabilitation following an orthopedic trauma that had led to CMSP. At entry, participants completed self-reported questionnaires assessing pain, anxiety, depression, catastrophyzing, kinesiophobia, and behavioural activity patterns (avoidance, pacing and overdoing). They also underwent functional tests, assessing walking endurance and physical fitness. To determine daily step counts, participants wore an accelerometer for 1 week during rehabilitation and 3 months post-rehabilitation. The number of steps per day was compared among three time points: weekend of rehabilitation (an estimate of pre-rehabilitation activity; T1), weekdays of rehabilitation (T2), and post-rehabilitation (T3). Linear regression models were used to analyze the association between daily steps at T2 and at T3 and self-reported and performance-based parameters. Data from 145 participants were analyzed. The mean number of steps was significantly higher during T2 than T1 and T3 (7323 [3047] vs. 4782 [2689], p < 0.001, Cohen’s d = 0.769, and 4757 [2680], p < 0.001, Cohen’s d = 0.693), whereas T1 and T3 results were similar (p = 0.92, Cohen’s d = 0.008). Correlations of number of steps per day among time points were low (r ≤ 0.4). Multivariable regression models revealed an association between daily steps at T2 and pain interfering with walking, anxiety and overdoing behaviour. Daily steps at T3 were associated with overdoing behaviour and physical fitness. Despite chronic pain, people in rehabilitation after an orthopedic trauma increased their physical activity if they were given incentives to do so. When these incentives disappeared, most people returned to their previous activity levels. A multimodal follow-up approach could include both therapeutic and environmental incentives to help maintain physical activity in this population.

Abstract Importance Arthritis is a chronic condition affecting hundreds of millions of people worldwide, often leading to pain and functional limitations. Objective This study aimed to investigate the direct and indirect effects of pain on functional dependence in individuals with arthritis. Depressive symptoms and physical activity were examined as potential mediators of this relationship. Design This study was a longitudinal cohort study. Setting The study setting included community-dwelling adults participating in the Canadian Longitudinal Study on Aging. Participants This study sample consisted of 6972 participants with arthritis, including 4930 with osteoarthritis and 694 with rheumatoid arthritis. Exposure The exposure was the usual presence of pain or discomfort at baseline, with depressive symptoms (CESD-10) and physical activity (PASE) tested as mediators. Main Outcome and Measure The main outcome was functional dependence in basic activities of daily living (ADL) and instrumental activities of daily living (IADL) at follow-up, measured with a modified version of the Older Americans’ Resources and Services Multidimensional Functional Assessment Questionnaire (OARS). Results Baseline pain was positively associated with depressive symptoms (b = 0.356 [95% CI = 0.310 to 0.402]) and negatively associated with physical activity (b = −0.083 [95% CI = −0.125 to −0.042]). Functional dependence at follow-up was significantly predicted by baseline pain (log OR = 0.607 [95% CI = 0.261 to 0.952]), depressive symptoms (log OR = 0.358 [95% CI = 0.184 to 0.533]), and physical activity (log OR = −0.598 [95% CI = −0.818 to −0.378]). Mediation analysis showed that 23.3% of the total effect of pain on functional dependence was accounted for by the indirect effect through depressive symptoms (16.2%), physical activity (6.3%), and their serial combination (0.8%). Conclusions The presence of pain at baseline was associated with higher odds of functional dependence in basic and instrumental activities of daily living after a mean follow-up period of 6.3 years, with depressive symptoms and lower physical activity acting as mediators. Relevance The findings highlight the need for arthritis care to extend beyond pain management by incorporating strategies that address depressive symptoms and promote physical activity to preserve functional independence.

Background: We analyzed the immediate effects of a Telerehabilitation Program (TP) based on aerobic exercise in women with fibromyalgia (FM) syndrome during the lockdown declared in Spain due to the COVID-19 pandemic. Methods: A single-blind randomized controlled trial was designed. Thirty-four women with FM were randomized into two groups: TP group and Control group. The intervention lasted 15 weeks, with 2 sessions per week. The TP based on aerobic exercise was guided by video and the intensity of each session was monitored using the Borg scale. Pain intensity (Visual Analogue Scale), mechanical pain sensitivity (algometer), number of tender points, FM impact (Revised Fibromyalgia Impact Questionnaire), pain catastrophizing (Pain Catastrophizing Scale), physiological distress (Hospital Anxiety and Depression Scale), upper (Arm Curl Test) and lower-limb physical function (6-min Walk Test) were measured at baseline and after the intervention. Results: The TP group improved pain intensity (p = 0.022), mechanical pain sensitivity (p < 0.05), and psychological distress (p = 0.005), compared to the Control group. The Control group showed no statistically significant changes in any variable (p > 0.05). Conclusions: A TP based on aerobic exercise achieved improvements on pain intensity, mechanical pain sensitivity, and psychological distress compared to a Control group during the lockdown declared in Spain due to COVID-19 pandemic.

Objectives This study aims to determine the effects of non-pharmacological therapies, namely balneotherapy, exercise, and the combined use of balneotherapy and exercise, on total myalgic score (TMS), sleep quality, health status, and signs of depression in patients with fibromyalgia syndrome, and to compare the efficacies of these treatment programs with respect to the above parameters. Patients and methods A total of 120 female subjects (mean age 37.21±12.45 years; range 18 to 63 years) diagnosed with fibromyalgia were enrolled. The patients were randomized into three groups with 40 patients in each (group 1: balneotherapy group, group 2: balneotherapy + exercise group, and group 3: exercise group). The patients underwent the treatment program for five days a week for a total of three weeks. Clinical parameters, Fibromyalgia Impact Questionnaire, Pittsburgh Sleep Quality Index, TMS, and Beck Depression Scale were evaluated at pre-treatment and post- treatment periods, and at the third-month control visit. Results There were no differences between the groups with respect to Fibromyalgia Impact Questionnaire, Pittsburgh Sleep Quality Index, TMS and Beck Depression Scale scores on pre-treatment evaluation, while the combined use of balneotherapy + aerobic exercise was more effective on TMS (p<0.001), health status (p=0.009), and level of depression (p<0.001) in post-treatment evaluation. A better state of well-being with respect to sleep quality was achieved by balneotherapy and balneotherapy + exercise groups. The third-month comparisons, on the other hand, demonstrated that the balneotherapy + exercise group had a greater state of well-being with respect to TMS (p<0.001) and general health status (p<0.001). Balneotherapy + exercise and exercise therapy benefited signs of depression to a better degree (p<0.001). Balneotherapy and combined balneotherapy + exercise therapy produced more effective results in terms of sleep quality (p<0.001). TMS regressed to near baseline levels (p=0.397), while Fibromyalgia Impact Questionnaire levels rose to near baseline levels at the third-month control in the exercise therapy group (p=0.070). Conclusion The combined application of balneotherapy + exercise therapy, which are two of the recommended non-pharmacological treatments, may have superior and more sustained effects than administering either therapy alone.

[Purpose] There are various treatment modalities for fibromyalgia syndrome (FMS), which is characterized by widespread pain and fatigue. The aim of this study was to investigate the effects of aquatic, aerobic and isometric strength-stretching exercises on the physical and psychological parameters of patients with FMS. [Subjects and Methods] Seventy five female patients with FMS were randomly selected and divided into three groups. Patients (18–50 years) were treated for 3 months using one of three methods: a home-based isometric strength and stretching exercise program (ISSEP), a gym-based aerobic exercise program (AEP), and a pool-based aquatic aerobic exercise program (AAEP). Items evaluated were: the number of tender points, Visual Analog Scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), the Six-Minute Walk Test (6MWT), SF-36 physical and mental health scores, and the Beck Depression Inventory (BDI). [Results] The results revealed that AAEP was the most effective treatment of the three. All of the groups showed significant improvements in all variables between pre-and post-test, except the mean values of VAS and BDI in ISSEP. [Conclusion] The results suggest that aquatic aerobic exercise program is more effective than AEP and ISSEP in the treatment of FMS.

Background and Objective. Most patients with fibromyalgia benefit from different forms of physical exercise. Studies show that exercise can help restore the body's neurochemical balance and that it triggers a positive emotional state. So, regular exercise can help reduce anxiety, stress, and depression. The aim of this study was to analyze the benefits of moderate aerobic exercise when walking in two types of forests, young and mature, and to assess anxiety, sleep, pain, and well-being in patients with fibromyalgia. Secondary objectives included assessing (i) whether there were differences in temperature, sound, and moisture, (ii) whether there was an improvement in emotional control, and (iii) whether there was an improvement in health (reduction in pain) and in physical and mental relaxation. Patients and Methods. A study involving walking through two types of forests (mature and young) was performed. A total of 30 patients were randomly assigned to two groups, mature and young forests. The participants were administered the following tests: the Spanish version of the Revised Fibromyalgia Impact Questionnaire (FIQR) at baseline and the end-point of the study, the State-Trait Anxiety Inventory (STAI) after each walk, and a series of questions regarding symptomatic evolution. Several physiological parameters were registered. Results. FIQR baseline and end-point scores indicated a significant decrease in the symptomatic subscale of the FIQ (SD = 21.7; z = −2.4; p = 0.041). The within-group analysis revealed that differences were significant with respect to days of intense pain, insomnia, and days of well-being only in the group assigned to the mature forest, not in the group assigned to the young forest. No differences were found with respect to anxiety. Conclusions. Although the main aim of this research was not achieved, as the results revealed no differences between the groups in the two forest types, authors could confirm that an aerobic exercise program consisting of walking through a mature forest can provide the subjective perception of having less days of pain and insomnia and more days of wellness, in patients with fibromyalgia.

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[Purpose] The aim of this study was to assess the effectiveness of a 6-week aerobic exercise program on pain, physical function, and psychological status, and to evaluate the personality characteristics of fibromyalgia syndrome (FMS) patients. [Subjects and Methods] Fourteen women with FMS were enrolled. They were trained for a 6-week home-based aerobic exercise program. The Fibromyalgia Impact Questionnaire, the Beck Depression Inventory, the visual analog scale of pain and sleep quality were measured at baseline and at the end of week 6. The personality profiles were evaluated using the Minnesota Multiphasic Personality Inventory (MMPI). [Results] After the exercise program, significant improvements were determined in pain, sleep quality, physical function, depression and FMS symptoms compared to baseline. In addition, the hysteria item (71.21±8.84) of the MMPI was significantly higher in FMS. [Conclusion] Our findings indicate that home-based aerobic exercise may be a useful treatment in the management of FMS. Personality characteristics should be considered during the planning process of the treatment of FMS. Personality is a filter between life events and psychological responses. It is defined to be the integration of effective and behavioral patterns. Long-term studies involving larger clinical samples are needed to define the role of personality characteristics in FMS.

Objectives This study aims to compare the efficacy of three different exercise types on pain, health-related quality of life (HRQoL), depression, and body composition in women with fibromyalgia (FM). Patients and methods Between June 2019 and December 2019, a total of 41 women with FM (mean age: 46.7+9.4 years; range, 24 to 62 years) were randomly allocated into Group 1 (n=13, supervised aerobic plus stretching), Group 2 (n=13, supervised resistance plus stretching), and Group 3 (n=15, home-based stretching). All exercises were performed three times per week for 12 weeks and were individualized by measuring the maximal oxygen consumption (VO2max) for aerobic exercise and one-repetition maximum (1-RM) test for resistance exercise. The main measures were pain intensity assessed by the Visual Analog Scale (VAS), severity by the Fibromyalgia Impact Questionnaire (FIQ), symptoms of depression by the Beck Depression Inventory, HRQoL by the Short-Form Health Questionnaire (SF-36), and body composition by bioelectrical impedance analysis. Results The mean VAS difference (95% confidence interval [CI]): -2.61 (-1.94, -3.29); -2.61 (-1.82, -3.42); -1.07 (-0.49, -1.64) for Group 1, Group 2, and Group 3, respectively (p<0.001); however, there was no significant difference between the combined exercise groups. The FIQ scores decreased significantly in all exercise groups after training (p<0.05). At 12 weeks, 21 (80.8%) patients from combined groups and six (40%) patients from the stretching alone group achieved a minimal clinically significant difference defined as a 14% change in baseline FIQ scores (p=0.008). Other outcome parameters did not differ significantly among the groups. Conclusion Supervised aerobics/muscle strengthening combined with stretching exercises reduced pain, and FM severity more than a home stretching exercise alone.

Fibromyalgia (FM) is characterized by chronic pain and associated comorbidities such as fatigue, anxiety, depression, and sleep disorders. There is a large amount of evidence regarding the benefits of physical exercise in controlling chronic pain. However, there is no consensus on which exercise modality is most suitable and the real benefits of this intervention to treat FM symptoms. The present study investigated the analgesic and antidepressant effects and morphophysiological responses induced by different physical exercise (aerobic and strength protocols) during the experimental model of FM. Spontaneous pain, mechanical hyperalgesia, thermal allodynia, depression-related behavior, and locomotor activity were evaluated weekly, as well as the morphological evaluation of the spinal cord and dorsal root ganglion. Aerobic and strength training protocols consistently abolished nociceptive behaviors, reducing spontaneous pain scores, cold allodynia, and frequency of response to mechanical hyperalgesia. The strength exercise could modulate the depressive-like behavior. Finally, our data demonstrated that physical exercise performed for two weeks increased the number of glial cells in the dorsal root horn. However, it was not sufficient to control the other deleterious effects of the reserpine model on the spinal cord and the dorsal root. Together, these results demonstrated that different physical exercise modalities, when performed regularly in mice, proved to be effective and safe non-pharmacological alternatives for the treatment of FM. However, some gaps have yet to be studied regarding the neuroadaptive effects of physical exercise.

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Fibromyalgia (FM) is defined as a chronic syndrome characterized by diffuse musculoskeletal pain and several symptoms that reflect on the functional capacity and quality of life of the affected patients. Different types of exercises are recommended in the treatment of FM. Pilates is a method of physical conditioning that has been frequently used in rehabilitation programs, due to the benefits perceived in musculoskeletal disorders, as well as in other conditions.To evaluate the efficacy of Pilates method compared to aerobic exercise in pain, quality of life related to the disease, depression, quality of life in general, functional capacity, kinesiophobia, catastrophizing, treatment satisfaction and reduction in the use of medication by women presenting FM.Sixty-six female patients diagnosed with FM were included, aging 18 to 65, presenting pain between 3 to 8 in numerical pain scale (NPS). Patients with inflammatory rheumatic diseases, neurological diseases, under psychiatric treatment, who have started or changed physical activities or medication in the last three months, patients with uncontrolled cardiorespiratory and cardiovascular diseases or any condition that may limit the practice of exercises, with non-diabetes mellitus controlled and other musculoskeletal diseases that could prevent the use of this method were excluded. The selected patients were randomized into two groups: Pilates and Control. The Pilates group (PG) had Pilates sessions three times a week for 12 weeks. The Control patients (CG) used a treadmill three times a week for 12 weeks. The treatment sessions in both groups lasted 50 minutes and the groups were instructed to use acetaminophen750 mg each 8 hours in case of pain, but the use was controlled. The evaluations were done by blind assessor at baseline (T0), 45 days (T45), 90 days (90) and 180 (T180) days after initiation of the study using the following instruments: for pain: NPS; Fibromyalgia Impact Questionnaire (FIQ), to evaluate the quality of life related to disease; Beck Depression Inventory (BDI) for depression; The short form 36 (SF-36) to evaluate the quality of life in general; the 6-minutes walking test (6MWT) to evaluate the functional capacity; kinesiophobia scale (Tampa) to evaluate the fear of movement; Fear Avoidance Beliefs Questionnaire (FABQ), to evaluate catastrophizing and the Likert scale to evaluate the patient satisfaction towards the treatment.Thirty four patients were randomized for the GP and 32 for the CG. The groups were homogeneous at baseline. In the comparison between groups over time, we found better results for PG with statistical differences when compared to CG for: pain (p<0,001), disease-related quality of life (p<0,001), psychological status (p=0,026), some domains of SF-36 – pain (p=0,014) and general health status (p<0,044), kinesiophobia scale (p<0,001), reduction in analgesic consumption (p=0,042) and on the Likert scale (p=0,003).Pilates method is effective in the treatment of women with FM, presenting pain improvement, quality of life related to the disease, psychological status, the SF-36 (pain, general health) domains, the kinesiophobia scale, the analgesic consumption reduction and satisfaction with treatment with better results when compared to walking.[1]Castel A, Fontova R, Montull S, et al. Efficacy of a multidisciplinary fibromyalgia treatment adapted for women with low educational levels: a randomized controlled trial. Arthritis Care Res (Hoboken). 2013 Mar;65(3):421-31.[2]Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, W Häuser, E Fluß, et al. EULAR revised recommendations for the management of fibromyalgia. BMJ Journals. 2017. Annals of the rheumatic disease. Vol. 76, Issue 2. Disponível em:https://ard.bmj.com/content/76/2/318.[3]Byrnes K, Wu Ping-Jung, Whillier S. Is Pilates an effective rehabilitation tool? A systematic review. J Bodyw Mov Ther. 2018 Jan;22(1):192-202.NIL.None Declared.

Objective: To investigate the effect of motion-controlled videogames on pain, functionality, cardiopulmonary capacity, and quality of life in women with fibromyalgia. Materials and Methods: Forty women with fibromyalgia were randomized into virtual reality group (VRG) and conventional training group (CTG). The CTG performed aerobic exercise (cycling, 3 days per week, 20 minutes per day) and conventional exercises (muscle strengthening, balance, and flexibility, 3 days per week, 15 minutes per day) for 4 weeks. The VRG performed virtual reality exercise (volleyball, Microsoft Xbox Kinect®, 3 days per week, 15 minutes per day) together with cycling exercise for 4 weeks. After the exercise program, both groups received the same home exercise program for 4 weeks. All patients were evaluated at baseline, fourth, and eighth weeks. Primary outcome measure was Fibromyalgia Impact Questionnaire. Visual Analogue Scale (VAS), Hospital Anxiety and Depression Scale, Fatigue Severity Scale (FSS), Symptom Severity Scale, EuroQol-Five Dimensions İndex Scale/Visual Analogue Scale (EQ-5D-index/VAS) and Six Minute Walk Test (6MWT) were used as secondary outcome measures. Results: Thirty-four patients (17 VRG, 17 CTG) were evaluated at the eighth week. After 4 weeks, all outcome measures improved significantly in both groups (P < 0.05). However, there was no statistically significant difference in all outcome measures between fourth and eighth weeks. Group and time interactions for 6MWT (P = 0.043), FSS (P = 0.026), EQ-5D-İndex Scale (P = 0.014), and EQ-5D-VAS (P = 0.049) were significant only for the VRG. In addition, median individual's satisfaction was significantly higher in the VRG (P < 0.001). Conclusion: Virtual reality exercises along with aerobic exercise increase cardiopulmonary capacity and quality of life in fibromyalgia syndrome. In addition, they increase patient satisfaction and may improve patient compliance to exercise.

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OBJECTIVE To assess the impact of a long-term exercise programme vs usual care on perceived health status, functional capacity and depression in patients with fibromyalgia. DESIGN Randomized controlled trial. SUBJECTS Forty-two women with fibromyalgia were allocated randomly to 1 of 2 groups: an experimental group that carried out aerobic, strength and flexibility exercises for 24 weeks and a usual care control group. METHODS Health status and functional capacity were evaluated using the Fibromyalgia Impact Questionnaire and the Short Form Health Survey 36. Depression was evaluated with the Beck Depression Inventory. RESULTS Significant improvements were observed in health status and functional capacity for the exercise group over the control group. The magnitude of the effect size of these improvements, expressed as Cohen's d, was medium. The effect size (95% confidence interval) for the Fibromyalgia Impact Questionnaire was 0.58 (-14.12, -2.35), for the Short Form Health Survey 36. global score 0.54 (1.28, 14.52), and in the mental health domain of the Short Form Health Survey 36. 0.51 (1.20, 16.26). There was a large effect size in vitality. All the aforementioned improvements can be considered as clinically important changes. CONCLUSION Results confirm that a long-term combination of aerobic exercise, strengthening and flexibility improves psychological health status and health-related quality of life in patients with fibromyalgia.

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Objectives This study aims to compare the effects of neural therapy and exercise on pain, quality of life, depression, anxiety, and functioning status in patients diagnosed with fibromyalgia syndrome (FMS). Patients and methods This multi-center study included a total of 72 patients (60 females, 12 males; mean age: 39.2±9.5 years; range, 22 to 53 years) who were diagnosed with FMS according to the 1990 American College of Rheumatology (ACR) criteria between January 2015 and June 2015. The patients were randomly divided into two groups: the first group (n=30) received an exercise program (strengthening, stretching, relaxation, and aerobic exercises, three days a week), and the second group (n=42) received a total of six sessions of neural therapy as one session a week in addition to the same exercise program. Pain severity was assessed with the Visual Analog Scale (VAS), emotional state with the Beck Depression Scale (BDS) and Beck Anxiety Inventory (BAI), quality of life with Short Form-36 (SF-36), and functioning status with the Fibromyalgia Impact Questionnaire (FIQ). The patients were evaluated at the end of treatment (week 6) and one month after the end of treatment. Results The mean disease duration was 34.3±9.3 months, the mean VAS score was 7.3±2.2, and the mean FIQ score was 58.4±13.2. There were significant improvements in the VAS, FIQ, SF-36, BDS, and BAI scores after the treatment in both groups (p<0.05). Post-treatment BDS and VAS scores were significantly lower in the neural therapy group (p=0.038; p=0.049; p<0.05). There was no significant difference in any parameter one month after the treatment between the groups (p>0.05). Conclusion When neural therapy is combined with exercise in FMS patients, it may be advantageous in terms of pain and depression, compared to exercise alone.

Background Improvements in multiple myeloma (MM) treatments have led patients and doctors to pursue strategies to promote long-term quality of life (QOL). Often, physicians do not recommend physical exercise (PE) because of MM-related bone disease. Nonetheless, our group and others have shown that patients with MM can safely perform PE, including resistance training (RT) and walking (W). The goal of this study was to examine the impact on QOL, including fatigue, pain, depression and anxiety, of 3 PE interventions in patients with MM. Methods Patients included in this analysis participated in either (1) a 6-month pilot intervention that had a supervised, in-person RT arm (n=24) and an unsupervised home-based W arm (n=18); or (2) an ongoing 6-month remotely supervised RT intervention (n=34). Questionnaires were administered at baseline before beginning the intervention, at the end of the intervention, and 6 months later. Fatigue, pain, depression, and anxiety were assessed with the European Organisation for Research and Treatment of Cancer Quality-of-Life Fatigue Questionnaire; a 100-point visual analog scale (VAS) for pain; the Patient Health Questionnaire-9 (PHQ-9) for depression; and the General Anxiety Disorder Questionnaire (GAD-7). Additionally, 9 questions drawn from the 39-item National Comprehensive Cancer Network Distress Thermometer supplemented the assessment of these states, bringing the total number of elements assessed to 40 (14 fatigue, 2 pain, 13 depression, 11 anxiety). Frequencies of individuals reporting “not at all” versus “any” for each issue and mean total scores for the VAS, PHQ-9, and GAD-7 were compared by timepoint. Patients were only included in comparisons if they had completed the questionnaires at both timepoints. Evidence of a change in each of the 4 states was concluded if the majority of the elements associated with each state changed in the same direction (favorably or unfavorably) and at least 1 element changed statistically significantly, with McNemar's tests of differences in dichotomous variables and paired samples t-tests for differences in continuous variables. In all comparisons, a value of p < 0.05 was considered significant. All analyses were performed using SAS 9.4 for Windows (SAS Institute, Cary, NC, USA). Results The combined sample (n=76) was 54.0% female, 93.4% White, and 94.7% non-Hispanic, with a mean age of 63.4 years, and no differences by study or arm. Fatigue improved from baseline to the end of the intervention in the combined sample and in both the RT groups, with 10 of 14 elements improving and significantly fewer people reporting any exhaustion (22.4%), discouragement (26.3%), and problems with sleep (12.7%). However, improvements in fatigue were lost after the intervention, with 12 of 14 elements getting worse and significant increases in people reporting lacking energy (15.9%), feeling slowed down (18.2%), and problems with sleep (18.6%). During the intervention, pain improved in the supervised, in-person RT group, with both elements improving and the reduction in the VAS score being significant (12 points); these improvements were not lost in follow-up. Depression did not change during or after the intervention in any of the groups. However, anxiety got worse during the intervention in the combined sample, with 7 of 11 elements getting worse and significantly more people reporting any dread (8.6%). Although not significant in any of the groups, the change in anxiety was apparent only in the W group, with 8 of 11 measures getting worse in that group, and no consistent trend in either RT group. It is unknown if the change in anxiety in the W group can be tied to the intervention or disease-related or other factors. Conclusions In the current analysis, 6-month supervised RT interventions are associated with improvements in fatigue and pain, but improvements in fatigue are lost after the intervention. These findings provide support for RT interventions in MM patients to promote physical QOL, as well as further research into how to help patients achieve sustained improvements.

Myotonic dystrophy type 1 (DM1) is a hereditary disease characterized by muscular impairments. Fundamental and clinical positive effects of strength training have been reported in men with DM1, but its impact on women remains unknown. We evaluated the effects of a 12-week supervised strength training on physical and neuropsychiatric health. Women with DM1 performed a twice-weekly supervised resistance training program (3 series of 6-8 repetitions of squat, leg press, plantar flexion, knee extension, and hip abduction). Lower limb muscle strength, physical function, apathy, anxiety and depression, fatigue and excessive somnolence, pain, and patient-reported outcomes were assessed before and after the intervention, as well as three and six months after completion of the training program. Muscle biopsies of the vastus lateralis were also taken before and after the training program to assess muscle fiber growth. Eleven participants completed the program (attendance: 98.5 %). Maximal hip and knee extension strength (p < 0.006), all One-Repetition Maximum strength measures (p < 0.001), apathy (p = 0.0005), depression (p = 0.02), pain interference (p = 0.01) and perception of the lower limb function (p = 0.003) were significantly improved by training. Some of these gains were maintained up to six months after the training program. Strength training is a good therapeutic strategy for women with DM1.

Background: Anxiety and depression are prevalent after spinal cord injury, impairing social participation and quality of life. Objective: This study aimed to investigate the effects of traditional resistance training (TRT), flywheel resistance training (FWRT), and high-velocity resistance training (HVRT) on the mental health and quality of life in individuals with spinal cord injury. Methods: Thirty-two participants were divided into TRT (n = 12), FWRT (n = 8), and HVRT (n = 12) groups, undergoing 8 weeks of upper-limb training twice weekly under super-vision. Training intensity and volume were progressively increased. The Hospital Anxiety and Depression Scale and SF-36 Questionnaire were used to assess outcomes. Results: Both the TRT and FWRT groups showed a reduction in HADS-D scores post-intervention (p < 0.001). The TRT group also presented a significant reduction in HADS-A scores post-intervention (p = 0.003). Concerning quality of life, after training, TRT showed improvements in social functioning (p = 0.013), FWRT improved scores in physical functioning (p = 0.002), bodily pain (p = 0.002), vitality (p = 0.046), and role emotional (p < 0.001), while HVRT enhanced role physical (p < 0.001), social functioning (p = 0.013), and role emotional (p < 0.001). Conclusion: Overall, TRT was the most effective in reducing anxiety and depression and enhancing quality of life, while FWRT showed notable gains in physical and functional capacity. HVRT demonstrated improvements primarily in role physical but was less effective in other domains.

Background Fibromyalgia guidelines indicate that exercise is critical in the management of fibromyalgia, and there is evidence that patients with fibromyalgia can perform resistance training at moderate and high intensities. However, despite the biological plausibility that progression of intensity provides greater benefit to individuals, no studies have compared different intensities (progressive versus constant intensities) of the same exercise in this population. Objective To compare the effect of 24 sessions of resistance training (progressive vs. constant intensity) on impact of fibromyalgia, sleep quality, anxiety, depression, pain, walking ability, and musculoskeletal capacity. Methods A protocol for a blinded randomized controlled trial. The sample will be randomized into three groups: group 1 (progressive intensity, experimental), group 2 (constant intensity, control A), and group 3 (walking, control B). Group 1 will perform resistance training at moderate intensity (50% of maximum dynamic strength), previously determined by the 1 repetition maximum (1-RM) test in the proposed exercises. The strength of each individual will be reassessed every 4 weeks (by 1-RM) and the intensity of each exercise will be positively adjusted by 20% of the value observed in kg (i.e., first month 50%; second month 70%; third month 90% of the maximum dynamic strength). Group 2 will perform the same procedure, but the intensity will be maintained at 50% of the maximum dynamic strength throughout the treatment (i.e., constant intensity from the first to the third month). Group 3 will perform a 40-minute treadmill walk at low intensity, defined by a walking speed corresponding to 60-70% of the maximum heart rate, which we will control with a heart rate monitor. All groups will receive a 45-minute pain education session prior to the exercise program, covering the pathophysiologic mechanisms of chronic pain, strategies for coping with pain, avoiding hypervigilance, and deconstructing beliefs and myths about chronic pain. Discussion The results of the present study may help health care professionals adjust the intensity of resistance training and thus plan the most effective intervention (progressive or constant intensity) to reduce the impact of fibromyalgia on patients’ lives. Trial registration Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-9pbq9fg, date of registration: October 06, 2022.

Low back pain (LBP), a prevalent disorder among middle-aged and older adults, imposes substantial medical and socioeconomic burdens on individuals and society. Worse still, comorbid depression is frequently present in chronic LBP, which aggravates the functional prognosis. It is of significance to identify relevant predictors associated with the occurrence of depression in LBP. Therefore, this study developed a risk prediction model to estimate depression risk in LBP patients, which may support its early detection and intervention. This study used representative data from the China Health and Retirement Longitudinal Study. Thirty-one candidate variables encompassing socio-demographic, pain-related, behavioral, health status, and psychological factors were analyzed. Participants were randomly split into the training and validation cohorts (7:3 ratio). LASSO regression with tenfold cross-validation was used to select predictors. A logistic regression model was constructed, and a nomogram was developed based on the final predictors. Model performance was evaluated by area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA). A total of 1,693 participants with LBP from 2018 to 2020 were included, with a depression incidence of 29.4%. Multivariable logistic regression identified predictors of depression in LBP, involving gender, education, sleep quality, chronic diseases, life satisfaction, cognitive function, pain severity, use of analgesics, and among others. The nomogram demonstrated good discrimination (AUC 0.736 and 0.718 in the training and validation set, respectively). Hosmer–Lemeshow tests indicated a good model fit (P > 0.05). DCA confirmed favorable clinical utility. The developed model provides a practical tool for assessing the risk of depression in middle-aged and older adults with LBP, supporting early identification and targeted preventive strategies in clinical practice.

Although Tai Chi has demonstrated efficacy in alleviating pain and improving functional mobility in people with chronic pain, the mechanisms underlying its pain-relieving effects remain poorly understood. We assessed the efficacy of a Tai Chi intervention on pain-related sensory, emotional, and cognitive indices in Japanese community-dwelling older adults with chronic pain. A non-randomized controlled trial was conducted for 12 weeks in the community of Itoshima City, Fukuoka, Japan. Adults aged ≥ 60 years with chronic pain were recruited and allocated to an intervention group or a control group. A total of 84 participants were allocated, with 44 in the intervention group and 40 in the control group. Chronic pain was defined as musculoskeletal pain lasting ≥ 3 months. Baseline characteristics of participants included age, sex, education, body mass index, comorbidities, current tobacco consumption, current alcohol consumption, and fall history. The control group received resistance training; the intervention group received resistance training and Tai Chi exercise. The main outcomes were assessed at baseline and after 12 weeks of intervention: a pain numeric rating scale (NRS), the pressure pain threshold (PPT), the Tampa Scale of Kinesiophobia (TSK), the Pain Catastrophizing Scale (PCS), and the Central Sensitization Inventory (CSI). As secondary outcomes, TSK and PCS subscales were evaluated with the same procedures. The statistical analyses used the t-test, χ2-test, Wilcoxon rank-sum test, and analysis of covariance with adjustment for baseline characteristics. No baseline characteristics differed significantly between the groups. At 12 weeks, the intervention group showed significant improvements in the NRS (p = 0.02, 95%CI: −2.20, − 0.18), PPT (p = 0.003, 95%CI: 0.22, 0.99), TSK (p = 0.004, 95%CI: −6.35, − 1.22), and PCS (p = 0.01, 95%CI: −10.18, − 1.43) versus the control group. There was no significant between-group difference in the CSI values. After adjustment for baseline characteristics, significant interactions were revealed between time and group for PPT (p = 0.02), TSK (p = 0.02), and PCS (p = 0.03) as well as the subscales TSK-Somatic Focus (p = 0.02) and PCS-Rumination (p = 0.01). Tai Chi intervention may serve as a potential treatment for chronic pain by addressing sensory, emotional, and cognitive aspects of pain. The University Hospital Medical Information Network Clinical Trials Registry, UMIN000052727, Date: 2023-11-13. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000058307.

Abstract Background Exercise is increasingly being recognized to counteract specific complications of Crohn’s disease (CD). The aim of this study was to explore exercise experiences and perceptions after engaging in a combined impact and resistance training program, involving both intervention and control group viewpoints. Methods Semistructured telephone interviews, involving a convenience sample of participants with CD (n = 41; aged 49.1 ± 12 years) were undertaken up to 6 weeks following completion of the program. Data were analyzed using thematic analysis. Results Four overarching themes emerged, along with 11 subthemes: (1) Lack of confidence and knowledge, fears surrounding physical ability and symptoms, coupled with issues not addressed as part of the healthcare pathway played a part in transitioning to inactivity; (2) Improvements in strength, mental well-being, physical fitness, fatigue, abdominal and joint pain, comorbidities, and self-management strategies were among the reported benefits of exercise participation; (3) Seeing progress, goal setting, enjoyment, and a peer-led program receiving support and advice increased motivation. Whereas work-related tiredness, other commitments, and self-directed exercise were reported as exercise barriers; (4) The intervention design was well received and the journey from start to finish was positively discussed, important considerations for future interventions and implementation strategies. Conclusions The study yielded novel perceptions on the transition to inactivity following receiving a diagnosis, physical and psychological benefits accruing from the intervention, and views on program design. Information that will provide an essential step in the development of implementing exercise guidelines into the clinical pathway and supporting individuals with self-management options.

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There is an increasing need for patient education in chronic low back pain with mental comorbidity. The present study was carried out in the setting of multidisciplinary inpatient rehabilitation and investigated the acceptance and feasibility of the Debora pain competence and depression prevention training comparing an intervention group with a control group. While patients of the intervention group took part in the pain competence and depression prevention training, patients of the control group only participated in pain competence training. METHOD A total of 3 partial studies were used for formative evaluation. The triangulative design consisted of problem-centered interviews and focus groups with rehabilitation patients as well as focus groups with experts. The interviews were transcribed, anonymized, and content analysis was performed. RESULTS The training was well accepted and feasible from the perspective of the patients and experts. The therapists had a significant influence on the participants' satisfaction. Suggestions for improvement focused on developing extensions of the pain and stress management aspects and on discussing individual problems. Compared to the intervention group and independent of depression, the control group assessed the training as being less satisfatory and showed poor group coherence. CONCLUSIONS Results of the formal evaluation support the combined implementation of the Debora pain competence and depression prevention training program and suggest its long-term establishment in multidisciplinary inpatient rehabilitation.

To improve long-term outcomes of therapies for chronic diseases, health promotion and lifestyle modifications are the most promising and sustainable strategies. In addition, advances in digital technologies provide new opportunities to address limitations of drug-based treatments, such as medication non-adherence, adverse effects, toxicity, drug resistance, drug shortages, affordability, and accessibility. Pharmaceutical drugs and biologics can be combined with digital health technologies, including mobile medical apps (digital therapeutics), which offer additional clinical benefits and cost-effectiveness. Promises of drug+digital combination therapies are recognized by pharmaceutical and digital health companies, opening opportunities for integrating pharmacotherapies with non-pharmacological interventions (metapharmacology). Herein we present unique features of digital health technologies which can deliver personalized self-care modalities such as breathing exercises, mindfulness meditation, yoga, physical activity, adequate sleep, listening to preferred music, forgiveness and gratitude. Clinical studies reveal how aforementioned complimentary practices may support treatments of epilepsy, chronic pain, depression, cancer, and other chronic diseases. This article also describes how digital therapies delivering “medicinal” self-care and other non-pharmacological interventions can also be personalized by accounting for: 1) genetic risks for comorbidities, 2) adverse childhood experiences, 3) increased risks for viral infections such as seasonal influenza, or COVID-19, and 4) just-in-time stressful and traumatic circumstances. Development and implementation of personalized pharmacological-behavioral combination therapies (precision metapharmacology) require aligning priorities of key stakeholders including patients, research communities, healthcare industry, regulatory and funding agencies. In conclusion, digital technologies enable integration of pharmacotherapies with self-care, lifestyle interventions and patient empowerment, while concurrently advancing patient-centered care, integrative medicine and digital health ecosystems.

BACKGROUND Exercise therapy is an effective component of fibromyalgia (FM) treatment. However, it is important to know the effects and specificities of the different types of exercise: muscle stretching and resistance training. AIM To verify and compare the effectiveness of muscle stretching exercise and resistance training for symptoms and quality of life in FM patients. DESIGN Randomized controlled trial. SETTING Physical therapy service, FM outpatient clinic. POPULATION Forty-four women with FM (79 screened). METHODS Patients were randomly allocated into a stretching group (N.=14), resistance group (N.=16), and control group (N.=14). Pain was assessed using the visual analog scale, pain threshold using a Fischer dolorimeter, FM symptoms using the Fibromyalgia Impact Questionnaire (FIQ), and quality of life using the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). The three intervention groups continued with usual medical treatment. In addition, the stretching and resistance groups performed two different exercise programs twice a week for 12 weeks. RESULTS After treatment, the stretching group showed the highest SF-36 physical functioning score (P=0.01) and the lowest bodily pain score (P=0.01). The resistance group had the lowest FIQ depression score (P=0.02). The control group had the highest score for FIQ morning tiredness and stiffness, and the lowest score for SF-36 vitality. In clinical analyses, the stretching group had significant improvement in quality of life for all SF-36 domains, and the resistance group had significant improvement in FM symptoms and in quality of life for SF-36 domains of physical functioning, vitality, social function, emotional role, and mental health. CONCLUSIONS Muscle stretching exercise was the most effective modality in improving quality of life, especially with regard to physical functioning and pain, and resistance training was the most effective modality in reducing depression. CLINICAL REHABILITATION IMPACT The trial included a control group and two intervention groups, both of which received exercise programs created specifically for patients with FM. In clinical practice, we suggest including both modalities in an exercise therapy program for FM.

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This study aimed to investigated the effect of a virtual exercise program on depression level during the COVID-19 pandemic in a patient who survived childhood cancer. An 8-year-old boy who was diagnosed with Acute Lymphoblastic Leukemia (ALL) about 4 years ago and survived after the treatment underwent a virtual aerobic exercise program tailered to face-to-face evaluations covering the lower and upper extremities and trunk under 5-week supervision. At the end of 5 weeks, his depression level did not decrease according to the Children's Depression Inventory (CDI), but the family was asked verbal questions about the effectiveness of this program. The family reported that despite the quarantine period during the COVID-19 pandemic, this exercise program increased the activity level of their children and that the program had positive effects on their children's emotional state. For future studies, inventories containing more detailed questions that measure parameters such as pain and depression level after aerobic exercises applied in surviving children are needed.

Osteoporosis (OP) is a progressive, age-related condition impacting approximately 3.8% of Australians. OP is associated with increased psychological distress, increased pain and decreased quality of life. Correlations exist between OP and psychological distress, with people living with OP three times more likely to experience very high levels of psychological distress compared to those without. Emerging evidence suggests a connection between bone loss and depressive symptoms. For people living with OP, depression and/or anxiety, increasing physical activity is recommended to improve overall health outcomes. Currently, no guidelines for exercise recommendations exist for people living with these co-occurring conditions. The aim of this systematic review is to identify the most effective physical activity intervention to improve mental and physical health, quality of life and pain in people with co-occurring OP and symptoms of depression and/or anxiety. The research question, eligibility criteria and search strategy were developed, and peer reviewed by the research team, and the search was registered through PROSPERO (CRD42023440020). A systematic search of the following databases was conducted using the Cochrane Highly Sensitive Search Strategy for identifying randomized trials and Polyglot search translator: PubMed, CINAHL, Embase, PsycInfo, Scopus & Web of Science. From 7,405 results, 2,372 were excluded as duplicates leaving 5,033. Covidence was used to screen by title and abstract, with a further 5,009 excluded based on study design, population and outcome measures. Full-text screening by two researchers (CF & KM) led to 19 studies included for data extraction, with 5 excluded based on population (OP diagnosis), questionnaire validity and availability of data. Data extraction and analysis is currently underway with results to be presented at the conference. Findings will be used to design and implement a tailored lifestyle intervention program for people living with OP and symptoms of anxiety and/or depression. This research has been generously funded by the Estate of the Late Faye Patricia Williams.

This study aimed to explore the influence of metaverse technology (MT) factors like presence, usability, and enjoyment on patients’ satisfaction, with a focus on examining potential mediating effects. In addition, it sought to assess whether the yoga practice as an intervention therapy in MT induces changes in the pain, anxiety, and depression levels of patients experiencing back pain. From the pool of 202 participants, this study chose participants who had reported enduring low back pain over 12 weeks, with a visual analogue scale (VAS) rating of 4 or higher. After completing the questionnaire, patients were randomly assigned to either the control group (COG, n=100) or the yoga exercise group (YEG, n=99). Results showed that the construct validity for questionnaires and a reasonable model fit were confirmed, and that presence showed a statistically significant effect on psychological satisfaction via the mediating path of enjoyment (β=0.592, P=0.001). Following 8 weeks of the yoga practice, the VAS increased for the COG, while it decreased significantly by ~29% for the YEG (P=0.001). YEG also exhibited a decrease in the Oswestry Disability Index by ~17%, anxiety by ~7%, and depression by ~10% (P=0.001). In conclusion, psychological satisfaction in a yoga practice using a metaverse cannot be achieved solely through the sense of presence; enjoyment is necessary for patients’ satisfaction. Moreover, it was verified that virtual yoga practice is effective in ameliorating psychological factors resulting from back pain.

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People with osteoarthritis often experience pain and depression. These meta-analyses examined and compared nonpharmacological randomized controlled trials (RCTs) for pain and symptoms of depression in people living with osteoarthritis. RCTs published up until April 2022 were sourced by searching electronic databases EMBASE, PUBMED & MEDLINE, Web of Science, CINAHL and PEDro. Random-effects meta-analyses were performed to calculate pooled effect sizes (ES) and 95% confidence intervals (CI) for pain and depression. Subgroup analyses examined intervention subtypes. For pain, 29 interventions (n = 4382; 65 ± 6.9 years; 70% female), revealed a significant effect on reducing pain (ES = 0.43, 95% CI [0.25, 0.61], p  < 0.001). Effect sizes were significant ( p  < 0.001) for movement meditation (ES = 0.52; 95% CI [0.35, 0.69]), multimodal approaches (ES = 0.37; 95% CI [0.22, 0.51]), and psychological therapy (ES = 0.21; 95% CI [0.11, 0.31]), and significant ( p  = 0.046) for resistance exercise (ES = 0.43, 95% CI [− 0.07, 0.94]. Aerobic exercise alone did not improve pain. For depression, 28 interventions (n = 3377; 63 ± 7.0 years; 69% female), revealed a significant effect on reducing depressive symptoms (ES = 0.29, 95% CI [0.08, 0.49], p  < 0.001). Effect sizes were significant for movement meditation (ES = 0.30; 95% CI [0.06, 0.55], p  = 0.008) and multimodal interventions (ES = 0.12; 95% CI [0.07, 0.18], p  < 0.001). Resistance/aerobic exercise or therapy alone did not improve depressive symptoms. Mind–body approaches were more effective than aerobic/resistance exercise or therapy alone for reducing pain and depression in people with osteoarthritis. Systematic review registration: PROSPERO CRD42022338051.

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Objectives In this study, we aimed to clarify the impact of a Pilates-based therapeutic exercise on disability, pain, mood, and sleep quality in patients with pregnancy-related lumbopelvic pain (LPP), Patients and methods In the single-blinded randomized controlled study conducted between January 2018 and June 2018, 34 pregnant women (mean age: 29.7±6.2 years; range, 18 to 40 years) in the second trimester (week 14-24) with LPP were randomly assigned to a control group and a Pilates group. All patients underwent usual prenatal care. In addition, the selected Pilates exercise was carried out twice a week for 60-min per session for 12 weeks in the Pilates group. The control group was not prescribed an exercise regimen; however, they were not discouraged from exercising. The primary outcome was disability; secondary outcomes were LPP, mood, and sleep quality. Disability [Roland-Morris Disability Questionnaire (RMDQ)], LPP [Visual Analog Scale (VAS)], mood [Hospital Anxiety and Depression Scale, Anxiety (HADS-A) and Depression (HADS-D) subscales], and sleep quality [Pittsburgh Sleep Quality Index (PSQI)] were measured before and after 12 weeks. Adverse effects and adherence were recorded to determine exercise safety and compliance. The intention-to-treat analysis was applied. Results The between-group effect sizes were moderate for the RMDQ and VAS scales (d=0.4 and d=0.7, respectively) and small for the HADS-A and HADS-D scales (both d=0.2). The intention-to-treat analysis demonstrated that there was a statistically significant difference in disability, pain, and mood in favor of the Pilates group (p0.05). Conclusion Adding Pilates to usual prenatal care should be considered a promising treatment option for pregnancy-related LPP.

Opioid addiction and overdose are at record levels in the United States. This is driven, in part, by their widespread prescription for the treatment of pain, which also increased opportunity for diversion by sensation-seeking users. Despite considerable research on the neurobiology of addiction, treatment options for opioid abuse remain limited. Mood disorders, particularly depression, are often comorbid with both pain disorders and opioid abuse. The endogenous opioid system, a complex neuromodulatory system, sits at the neurobiological convergence point of these three comorbid disease states. We review evidence for dysregulation of the endogenous opioid system as a mechanism for the development of opioid addiction and/or mood disorder. Specifically, individual differences in opioid system function may underlie differences in vulnerability to opioid addiction and mood disorders. We also review novel research, which promises to provide more detailed understanding of individual differences in endogenous opioid neurobiology and its contribution to opioid addiction susceptibility. Expected final online publication date for the Annual Review of Neuroscience, Volume 43 is July 8, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Chronic pain affects 20% of the global population and is incredibly complex to treat. The burden of chronic pain is physical, emotional and financial, and prevalence rates continue to rise. Current treatments are ineffective long-term against pain and common comorbidities, including anxiety and depression, mood and sleep disorders, and social isolation. While a large body of evidence supports regular physical exercise as an effective long-term treatment for chronic pain and its comorbidities, exercise-induced pain and kinesiophobia are significant barriers to participation and adherence. Immersive virtual reality is a powerful short-term pain reliever, that, when combined with exercise, can help overcome these barriers. This perspective argues for the use of combined exercise and virtual reality treatment techniques to mitigate chronic pain.

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Fibromyalgia (FM) is a chronic syndrome characterized by widespread pain and other physical and psychological features. In this study, we aimed to analyze the effect of a low-intensity physical exercise (PE) program, combining endurance training and coordination, on psychological aspects (i.e., pain catastrophizing, anxiety, depression, stress), pain perception (i.e., pain acceptance, pressure pain threshold (PPT), and quality of life and physical conditioning (i.e., self-perceived functional capacity, endurance and functional capacity, power and velocity) in women with FM. For this purpose, a randomized controlled trial was carried out. Thirty-two women with FM were randomly allocated to a PE group (PEG, n = 16), performing an eight-week low-intensity PE program and a control group (CG, n = 16). Pain catastrophizing, anxiety, depression, stress, pain acceptance, PPT, quality of life, self-perceived functional capacity, endurance and functional capacity, power, and velocity were assessed before and after the intervention. We observed a significant improvement in all studied variables in the PEG after the intervention (p < 0.05). In contrast, the CG showed no improvements in any variable, which further displayed poorer values for PPT (p < 0.05). In conclusion, a low-intensity combined PE program, including endurance training and coordination, improves psychological variables, pain perception, quality of life, and physical conditioning in women with FM.

A recent study (FIBROWALK) has supported the effectiveness of a multicomponent treatment based on pain neuroscience education (PNE), exercise therapy (TE), cognitive behavioral therapy (CBT), and mindfulness in patients with fibromyalgia. The aim of the present RCT was: (a) to analyze the effectiveness of a 12-week multicomponent treatment (nature activity therapy for fibromyalgia, NAT-FM) based on the same therapeutic components described above plus nature exposure to maximize improvements in functional impairment (primary outcome), as well as pain, fatigue, anxiety-depression, physical functioning, positive and negative affect, self-esteem, and perceived stress (secondary outcomes), and kinesiophobia, pain catastrophizing thoughts, personal perceived competence, and cognitive emotion regulation (process variables) compared with treatment as usual (TAU); (b) to preliminarily assess the effects of the nature-based activities included (yoga, Nordic walking, nature photography, and Shinrin Yoku); and (c) to examine whether the positive effects of TAU + NAT-FM on primary and secondary outcomes at post-treatment were mediated through baseline to six-week changes in process variables. A total of 169 FM patients were randomized into two study arms: TAU + NAT-FM vs. TAU alone. Data were collected at baseline, at six-week of treatment, at post-treatment, and throughout treatment by ecological momentary assessment (EMA). Using an intention to treat (ITT) approach, linear mixed-effects models and mediational models through path analyses were computed. Overall, TAU + NAT-FM was significantly more effective than TAU at posttreatment for the primary and secondary outcomes evaluated, as well as for the process variables. Moderate-to-large effect sizes were achieved at six-weeks for functional impairment, anxiety, kinesiophobia, perceived competence, and positive reappraisal. The number needed to treat (NNT) was 3 (95%CI = 1.6–3.2). The nature activities yielded an improvement in affective valence, arousal, dominance, fatigue, pain, stress, and self-efficacy. Kinesiophobia and perceived competence were the mediators that could explain a significant part of the improvements obtained with TAU + NAT-FM treatment. TAU + NAT-FM is an effective co-adjuvant multicomponent treatment for improving FM-related symptoms.

In early 2020, countries across the world imposed lockdown restrictions to curb the spread of the Covid-19 coronavirus. Lockdown conditions, including social and physical distancing measures and recommended self-isolation for clinically vulnerable groups, were proposed to disproportionately affect those living with chronic pain, who already report reduced access to social support and increased isolation. Yet, empirical evidence from longitudinal studies tracking effects of prolonged and fluctuating lockdown conditions, and potential psychological factors mediating effects of such restrictions on outcomes in chronic pain populations is lacking. Accordingly, in the present 13-wave longitudinal study, we surveyed pain intensity, pain interference, and tiredness in people with chronic pain over the course of 11 months of the Covid-19 pandemic (April 2020 - March 2021). Of N = 431 participants at baseline, average completion rate was ~50% of timepoints, and all available datapoints were included in linear mixed models. We examined the impact of varying levels of lockdown restrictions on these outcomes, and investigated whether psychological distress levels mediated effects. We found that full national lockdown was related to greater pain intensity, and these effects were partially mediated by depressive symptoms. No effects of lockdown level were found for pain interference and tiredness, which were instead predicted by higher levels of depression, anxiety, pain catastrophising, and reduced exercise. Our findings are relevant for improving patient care in current and future crises. Offering remote management options for low mood could be particularly beneficial for this vulnerable population in the event of future implementation of lockdown restrictions. PERSPECTIVE: This longitudinal study demonstrates the impact of Covid-19 lockdown restrictions on people with chronic pain. Findings suggest a complex interaction of psychosocial factors which impacted various aspects of pain experience in patients, which offer potential to inform clinical strategies for remote medicine and future crises.

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Purpose This cross-sectional study aimed to investigate whether psychosocial factors were predictive for exercise-induced hypoalgesia (EIH) in pain-free adults. Methods A sample of 38 pain-free nurses with a mean (SD) age of 26 (6) years were included in this study. Participants completed psychosocial questionnaires prior to physical tests. Pressure pain threshold (PPT) was assessed bilaterally at the calves (local), lower back (semi-local) and forearm (remote) before and immediately after a maximal graded cycling exercise test. Separate linear mixed effects models were used to determine change in PPT before and after cycling exercise (EIH). Multiple linear regression for all psychosocial variables and best subset regression was used to identify predictors of EIH at all locations. Results The relative mean increase in PPT at the forearm, lumbar, calf, and globally (all sites pooled) was 6.0% (p<0.001), 10.1% (p<0.001), 13.9% (p<0.001), and 10.2% (p=0.013), respectively. Separate best subset multiple linear regression models at the forearm (predictors; Multidimensional Scale of Perceived Social Support (MSPSS) total), lumbar (predictors; MSPSS total, Pain Catastrophizing Scale (PCS) total, Depression Anxiety Stress Scale (DASS) depression), calf (predictors; MSPSS friends, PCS total), and global (predictors; MSPSS friends, PCS total) accounted for 7.5% (p=0.053), 13% (p=0.052), 24% (p=0.003), and 17% (p=0.015) of the variance, respectively. Conclusion These findings confirm that cycling exercise produced EIH in young nurses and provided preliminary evidence to support the interaction between perceived social support, pain catastrophizing and EIH. Further investigation is required to better understand psychological and social factors that mediate EIH on a larger sample of adults at high risk of developing chronic musculoskeletal pain.

Objective: The aim of this study was to compare exercise, continuous short-wave diathermy (SWD) and intermittent SWD treatment modalities and to evaluate the effects of these treatments on chronic back pain and depression. Methods: This study is an intervention trial which evaluated patients who applied to our clinic due to chronic low back pain between 2008-2009. The study group consisted of 90 patients between the ages of 40-65 who had had low back pain for more than 6 months. The patients were randomized into three groups. The first group received placebo short-wave diathermy, the second group received continuous short-wave diathermy, and the third group received pulsed short-wave diathermy. Pain was evaluated by Visual Analog Scale (VAS) and the Pain Disability Index (PDI).The Modified Oswestry Low Back Pain Disability Questionnaire Form was used for the measurement of functional deficiency and the Beck Depression Inventory (BDI) was used for the evaluation of depression.All scales were performed before the treatment, immediately after treatment and 3 months after treatment. Results: Significant decreases in PDI and VAS scores were found in all groups (p<0.05 for each). Similarly, there was a significant improvement in all groups in terms of functional deficiency(p<0.001 for each), while no differences were found between groups (p = 0.895). In terms of BDI scores, there was no improvement in those receiving only exercise, while Group 2 and 3 had significant improvements (p <0.05). When groups were compared for BDI scores, no differences were found between any of the groups (p = 0.189). Conclusion: Continuous SWD treatment with exercise was found to be more effective in reducing pain in patients with chronic low back pain than other treatment modalities used in our study. Although there was no significant difference between the groups in terms of depressive mood, it was found that those receiving continuous and pulsed SWD treatment had significant improvements in depression as measured by the BDI.

ABSTRACT Endometriosis affects approximately 10 percent of women of reproductive age. Although physical activity has shown beneficial effects for managing endometriosis-related symptoms, women with this condition often engage in lower levels of activity. This study aimed to assess physical activity levels and identify perceived barriers to exercise among women diagnosed with endometriosis. A cross-sectional study was conducted using online questionnaires distributed through endometriosis associations in Spain. Participants (n = 154, mean age: 39 ± 7 years) completed the Barriers to Being Active Quiz (BBAQ) and the International Physical Activity Questionnaire – Short Form (IPAQ-SF). Sociodemographic and clinical data were also collected to explore potential associations between symptoms and activity patterns. The most prevalent barriers were lack of energy (68.2 percent) and lack of willpower (50.0 percent). Lack of energy was significantly associated with pain, dysmenorrhea, fatigue, and depression, and emerged as the primary limiting factor. Despite reporting moderate-to-high levels of physical activity, as defined by IPAQ criteria – moderate (≥600 MET-min/week) or high (≥1,500 MET-min/week with vigorous activity ≥ 3 days/week, or ≥ 3,000 MET-min/week with activity on ≥ 7 days/week) – symptoms such as pain (79.2 percent) and fatigue (79.9 percent) remained prevalent. Psychological and physical symptoms, especially fatigue and depression, significantly influence exercise participation among women with endometriosis. These findings underscore the need for tailored strategies to address perceived barriers and promote sustained physical activity in this population. Integrating psychological support and individualized exercise guidance, and pain management interventions, may enhance adherence and long-term outcomes.

OBJECTIVES: Although the practice of physical exercise in patients with intermittent claudication (IC) is often encouraged, adherence is low. The difficulty in performing physical training may be related to the psychological characteristics of patients with claudication. To verify the association between anxiety and depression symptoms and barriers to physical exercise and walking capacity in patients with IC. METHODS: One-hundred and thirteen patients with a clinical diagnosis of IC were included in the study. Patients underwent clinical evaluation by a vascular surgeon, answered the Beck Depression Inventory, and Beck Anxiety Inventory tests were applied by the psychologist. The patients performed the 6-minute test and reported their barriers to physical activity practice in a questionnaire. RESULTS: Patients with signs of depression had a shorter pain-free walking distance (p=0.015) and total walking distance (p=0.035) compared to patients with no signs of depression. Pain-free walking distance (p=0.29) and total walking distance (p=0.07) were similar between patients with and without signs of anxiety. Patients with symptoms of moderate to severe depression reported more barriers to physical activity practice compared to patients without signs of depression. CONCLUSION: Symptoms of anxiety and depression are prevalent among patients with peripheral arterial occlusive disease (PAD). Depression symptoms are associated with personal barriers to exercise, while anxiety symptoms are not. The main barriers to physical activity among patients with IC are exercise-induced pain and the presence of other diseases.

BACKGROUND Individuals with chronic musculoskeletal disorders (MSD) often avoid physical activity (PA) and exercise although these are the key factors in managing their condition and pain. OBJECTIVES To determine the PA levels of individuals with chronic MSD and their relationship with barriers and facilitators. DESIGN Three hundred and five subjects with five MSD groups; fibromyalgia, myofascial pain, osteoarthritis, periarticular regional pain and degenerative spine problems were included in the study. The visual analogue scale was used to assess pain, the Hospital Anxiety and Depression Scale to assess emotional impact, and the Nottingham Health Profile (NHP) to assess quality of life. PA levels were categorised by the International Physical Activity Questionnaire-Short Form. Perceived barriers and facilitators for PA/exercise were determined by questionnaire. RESULTS 66 (21.6%) were male, 239 (78.4%) were female. 196 (64.3%) of the subjects were physically inactive, 94 (31.1%) low-active, and 15 (4.6%) sufficiently active. The most frequently reported barriers for PA/exercise were fatigue/feeling too tired (72.1%), pain (66.2%), and lack of motivation/willingness (54.4%). The most frequently reported facilitators were the desire to be in good health (72.8%), enjoying exercise (59.7%), and the desire to keep fit and lose weight (59%). CONCLUSION The level of PA in individuals with MSD was quite low. Identifying the underlying causes of PA is important since PA/exercise is beneficial for musculoskeletal health. Yet, barriers and facilitators for PA were revealed for this study population. Identifying and understanding these barriers and facilitators would facilitate the individualised PA/exercise programs for both clinical practice and research.

Introduction: Regular physical activity (PA) has a beneficial effect on joint pain, stiffness, strength, flexibility, and aerobic capacity in patients with rheumatoid arthritis (RA). Objective: The aim of this study was to assess the level of PA in patients with rheumatoid arthritis and to identify potential barriers to this activity. Material and Methods: The study involved 132 patients with RA. Participants completed the International Physical Activity Questionnaire (IPAQ), the Functional Assessment of Chronic Illness Therapy—Fatigue Scale (FACIT-F), the Tampa Scale for kinesiophobia (TSK), Strength, Ambulation, Rising from a chair, Stair climbing and history of Falling questionnaire (SARC-F) for sarcopenia assessment, and the Patient Health Questionnaire-9 (PHQ-9) for depression. Basic socio-epidemiological data, disease activity score in 28 joints (DAS28), duration of disease, and therapy information were retrieved from electronic patient records. Latent class analysis (LCA) was used to identify subpopulations of patients. Results: The study included 109 women (82.6%) and 23 men (17.4%). Low levels of PA were observed in 16 patients (12%), moderate levels in 70 patients (53%), and high levels in 42 patients (35%). Symptoms of pronounced fatigue were significantly associated with low PA (28.5 ± 11.3 vs. 37 ± 7 vs. 37 ± 10; p = 0.002). The risk of sarcopenia was significantly higher in RA patients with low PA (p = 0.05). Kinesiophobia was present in all three groups (65.2%). LCA identified two classes. In the first class, patients were more likely to be non-exercisers compared to the second class. Patients in the first class were characterized by a higher probability of being female, obese, with lower education levels. Patients in the first class had pronounced fatigue, kinesiophobia and more frequent symptoms of depression. The second class (65% of the total population) included patients who exercised moderately to frequently (93%) and were middle-aged. They were less obese, highly educated, employed, and majority of them achieved low disease activity or remission. In addition, they had lower risks for sarcopenia, depression, fatigue, and kinesiophobia. Conclusions: This study showed that RA patients with moderate and high levels of PA have better disease control, fewer symptoms of fatigue and depression, and a lower risk of sarcopenia. However, kinesiophobia was significantly present in all three groups, indicating a need for further promotion of this non-pharmacological treatment.

Background In order to counteract fatigue, physical activity (PA) is recommended for all stages of cancer. However, only few advanced cancer patients (ACP) are physically active. Quantitative data with high numbers of ACP reporting barriers to PA are missing. This study aimed to identify barriers to PA in ACP with tiredness/weakness and investigate their motivation towards it. Methods Outpatients with metastatic cancer receiving cancer care at a German Cancer Center reporting moderate/severe tiredness/weakness during self-assessment (MIDOS II) were enrolled. We assessed Fatigue-(FACF-F) and Depression (PHQ8) Scores, demographics, cancer-specific parameters, motivation for PA, physical, psychological and social barriers. Results 141 of 440 eligible patients (32.0%) with different diagnoses agreed to participate. Patients frequently reported “I feel weakened due to my tumor therapy” ( n  = 108; 76.6%), physical symptoms (tiredness, weakness, dyspnea, joint-problems, pain, nausea [ n =  107; 75.9%]) and fatigue ( n  = 99; 70.2%) as barriers to PA. However, no significant group differences regarding these barriers were found between physically active and inactive patients. Social barriers were rarely chosen. Motivated patients were 5.6 times more likely to be physically active ( p <  0.001), also motivation turned out to be the strongest predictor for a physically active behavior (β = 1.044; p  = 0.005). Motivated attitude towards PA was predicted by fatigue (β = − 2.301; p  = 0.008), clinically relevant depression ( β = − 1.390, p =  0.039), knowledge about PA and quality of life (QoL) (β = 0.929; p =  0.002), PA before diagnosis (β = 0.688; p =  0.005 and Interest in exercise program (β = 0.635; p =  0.008). Conclusion “I feel weakened due to my tumor therapy” is the most reported barrier to PA among both, physically and inactive patients. Motivation for PA is the strongest predictor of performing PA. Interest in PA , knowledge about PA/QoL and PA before diagnosis are main predictors of a motivated attitude . Absence/presence of social barriers did not associate with motivation, fatigue and depression proved to be a negative predictor. Programs including information, motivational counseling and individualized training should be offered for ACP to overcome barriers and reduce fatigue. Trial registration German Register of Clinical Trials DRKS00012514 , registration date: 30.5.2017.

Background: During the coronavirus-19 (COVID-19) pandemic various containment strategies were employed. Their impact on individuals with neurological conditions, considered vulnerable to COVID-19 complications, remains to be determined. Objective: To investigate associations between physical activity and health-related quality of life outcomes in individuals with a neurological condition during government mandated COVID-19 restrictions. Methods: An e-survey assessing fear of COVID-19, physical activity level and health-related quality of life outcomes (functional disability and pain, anxiety and depression, loneliness, fatigue, and vitality) was distributed to individuals with a neurologically-related mobility disability living in the United Kingdom. Open-ended questions were also included to contextualize barriers and facilitators to engage in physical activity during the COVID-19 pandemic. Gamma-weighted generalized linear models and tree-structured regression models were employed to determine the associations between physical activity and health-related quality of life. Results: Of 199 responses, 69% reported performing less physical activity compared to pre-pandemic. Tree-structured regression models revealed that lower leisure-time physical activity was significantly associated (p ≤ 0.009) with higher depression and fatigue, but lower vitality. The closure of leisure facilities and organized sport (27%) was the most commonly cited barrier to engage in physical activity, while 31% of participants mentioned concerns around their physical and mental health as a facilitator. Conclusion: Our analysis identified homogenous subgroups for depression, fatigue, and vitality based specifically on leisure-time physical activity cut points, irrespective of additional demographic or situational characteristics. Findings highlight the importance of and need to safely promote leisure-time physical activity during the COVID-19 pandemic in this at-risk population to help support health-related quality of life.

Depression is common in patients with knee OA, and clinical guidelines do not advise treating both conditions simultaneously. However, recent research recommends combining interventions that address symptoms of both conditions to maximize efficacy. Exercise improves pain, disability, and mood, but chronic pain and depression are barriers to physical activity in this population. Duloxetine is indicated to treat neuropathic pain and depression among knee OA patients and could serve as a therapeutic complement to exercise.To assess the feasibility of a 24-week, center-based, aerobic exercise program, plus duloxetine to treat knee OA and depression.Participants were recruited between August 2021 and November 2022 from the University of Maryland and VA Maryland Health Care Systems and study advertisements. Inclusion criteria were: English speaking; age 40 years or older; symptomatic knee OA satisfying ACR criteria; major depression according to the SCID-5 (Structured Clinical Interview for DSM-V, ruling out history of bipolar disorder or psychotic symptoms; substance abuse disorder or suicidal ideation in the last year); no plans for knee surgery; and ability to walk on a treadmill. Exclusions included: exercising at least twice per week; taking duloxetine, antipsychotics, benzodiazepines, or opioid analgesics; cognitive impairment; comorbidity precluding exercise; and pregnant or lactating women. Participants began duloxetine (30 mg/day) as they started exercising, titrating up to a daily optimal dose of 60 mg/day. They were expected to complete 3 supervised treadmill walking sessions per week based on an individualized training plan defined by peak heart rate achieved during a graded exercise test. Data were collected at baseline and 12- and 24-weeks. Feasibility was evaluated via recruitment rates, reasons for drop out, and treatment adherence. Depression and pain severity were measured using the Hamilton Depression Rating Scale (HAM-D) and Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscale, respectively.Among 377 interested adults, 98 completed telephone pre-screening (Figure 1). Common reasons for not pre-screening included time commitment (n=39), no depression (n=27), concerns about medication (n=25), already on antidepressants (n=20), and knee surgery (n=12). There were 68 ineligible prescreened individuals who did not satisfy criteria for probable depression (n=45), medications (n=16), knee OA symptoms (n=5), or exercise (n=2). The 30 eligible candidates were invited to in-person screening visits, but 21 did not attend, and only 9 were enrolled. These 9 participants were older women (mean age=64.7 years), 8 identified as Black/African American, 7 attended and/or graduated from college, 3 were married, and 4 were retired. During the in-person screening process, 6 participants did not satisfy DSM-V criteria for major depression, 1 voluntarily withdrew from the study, and only 2 satisfied all eligibility criteria. One participant withdrew at baseline due to a non-study related adverse event and another completed the treatment protocol. The participant who completed the study was almost 100% adherent to duloxetine and experienced a reduction in depression severity from baseline to 24 weeks (HAM-D=25 to 1). By contrast, exercise compliance was low, with only 26% of planned sessions completed, and knee pain severity changed little from baseline (KOOS=41.7 to 44.4).Treating knee OA and depression with a center-based exercise program and duloxetine had low feasibility. Critical design challenges amenable to change included the time commitment of 3 weekly supervised exercise sessions among interested individuals and depressive symptoms not satisfying diagnostic criteria for major depression for persons who wanted treatment. A hybrid or home-based exercise program plus duloxetine may be more feasible, and knee OA patients with depressive symptoms who are at risk for major depression could benefit from preventive intervention.NIL.NIL.Alan Rathbun: None declared, Rhea Mehta: None declared, Alice Ryan: None declared, Yu Dong: None declared, Brock Beamer: None declared, Justine Golden: None declared, Joseph Gallo: None declared, Mark Luborsky: None declared, Michelle Shardell: None declared, Jason Peer: None declared, Marc Hochberg Consultant of: Marc Hochberg is the president of Rheumcon and receives consulting fees from Bone Therapeutics, Bristol-Myers Squibb, Eli Lilly, Galapagos, IBSA Insititut Biotechniq SA, Novartis Pharma AG,Pfizer, Samumed LLC, Theralogix LLC and Kolon TissueGene.

Many of the 1.3 million Russian-speaking immigrants in the US have chronic conditions such as cardiovascular disease, diabetes, obesity, and depression. They engage in physical activity less often than other groups, and little is known about their views of physical activity. This qualitative study explored physical activity attitudes, beliefs, motivators, and barriers among older Russian-speaking immigrants. In four focus group interviews, 23 participants discussed physical activity. “Movement is life” was a theme throughout all interviews. Walking was the most frequently mentioned activity. Increased energy and decreased pain were described as health benefits. Motivators for physical activity were maintaining function, improved health, and the support of God and family. Barriers included poor health and environmental safety concerns. Participants suggested community walking groups and church-supported programs as useful methods to promote physical activity. Future research includes developing culturally appropriate interventions that utilize physical activity to prevent and manage chronic illness with ethnic minority older adults.

Our goal was to test the effectiveness of collaborative care (CC) versus usual care (UC) to improve treatment of pain, depression, physical inactivity, and quality of life in outpatients with spinal cord injury (SCI). We conducted a single blind parallel group randomized controlled trial. The setting was two outpatient SCI rehabilitation clinics within a large academic medical center. Participants were 174 outpatients who were on average 47.7 years old, 76% male, 76% white, 8% Hispanic, 47% tetraplegic, 95% more than 1 year post-SCI, and 45% on Medicare. The intervention consisted of a mental health-trained collaborative care manager (CM) integrated into two SCI rehabilitation medicine clinics and supervised by content experts in pain and mental health treatment. The CM provided assessment, medical care coordination, adherence support, outcome monitoring, and decision support along with brief psychological interventions to the patients via up to 12 in-person or telephone sessions. Among all participants, 61% chose to focus on pain; 31% on physical activity and 8% on depression. The primary outcome was quality of life as measured by the World Health Organization Quality of Life-BREF at the end of treatment (4 months). Secondary outcomes were quality of life at 8 months and pain intensity and interference, depression severity, and minutes per week of moderate to vigorous physical activity at 4 and 8 months. A total of 174 participants were randomized 1:1 to CC (n = 89) versus UC (n = 85). The primary analysis, a mixed-effects linear regression adjusting for time since injury and sex, revealed a non-significant trend for greater improvement in quality of life in CC versus UC at 4 months (p = 0.083). Secondary analyses showed that those receiving CC reported significantly greater improvement in pain interference at 4- and 8-months and in depression at 4-months, but no significant effect on physical activity. We conclude that in an outpatient SCI care setting, CC is a promising model for delivering integrated medical and psychological care and improving management of common, chronic, disabling conditions such and pain and depression.

Knowledge of the factors affecting pain intensity and pain sensitivity can inform treatment targets and strategies aimed at personalizing the intervention, conceivably increasing its positive impact on patients. Therefore, this study aimed to investigate the association between demographic factors (sex and age), body mass index (BMI), psychological factors (anxiety and depression, kinesiophobia and catastrophizing), self‐reported physical activity, pain phenotype (symptoms of central sensitization, and nociceptive or neuropathic pain), history of COVID‐19 and pain intensity and sensitivity in patients with chronic non‐specific low back pain (LBP).

Introduction: Palliative care not only focuses on physical ailments associated with the disease, but also considers the psychological, social and spiritual needs of the patients. The aim of this study is to assess the impact of physical activity on palliative care patients, with special regard to the subjective assessment of severity of total pain and quality of life. Materials and methods: The study was conducted on 92 palliative care patients either in a hospice or at home. The tool used to assess the patients was an original questionnaire focusing on the area of their independence and motor abilities. The study attempted to understand whether an appropriate physical activity and the instruction of palliative care patients and their families in the field of independence would improve the quality of life and reduce the intensity of total pain in the patients. Results: All of the patients were at an advanced stage of cancer. The survey at time “0”, conducted before the start of the instructions for patients and their relatives, showed that a majority of patients (47, 51.09%) often experienced limitations during the performance of daily activities. In the fourth visit, conducted one week after the fourth educational session, there was a significant increase in patients who did not experience any limitations in performing their daily activities or experienced them just sometimes. Conclusions: The ultimate effect of the proposed educational program on physical activity was an increase in the quality of life, a reduction in pain and a mood improvement. These results would need confirmation with more extensive studies.

Objective To explore the associations between habitual self-reported physical activity, pain sensitivity and patient-reported outcomes (including pain intensity) in patients with chronic pain. Design Cross-sectional, experimental study. Subjects Patients (n = 78), age range 18–65 years, with different chronic pain conditions (> 3 months) were compared with age- and sex-matched healthy controls (n = 98). Methods Multivariate correlations between self-reported physical activity, pressure pain sensitivity, and patient-reported outcome measures were assessed. Results Lower perceived health status (p < 0.001, Cohen’s d = 2.34), higher levels of depression (p < 0.001, Cohen’s d = 1.77), and lower pain tolerance threshold (p < 0.001, Cohen’s d = 1.66) were the most prominent variables discriminating patients from controls. In patients, bivariate and multivariate analyses showed that higher pressure pain tolerance was associated with male sex, lower pain intensity and fewer painful regions, higher self-efficacy and more self-reported physical activity, but not with lower levels of anxiety and depression. Conclusion Pain tolerance thresholds, as well as degree of depression and perceived health status discriminated between patients and controls, and there was an association between pain tolerance thresholds and level of self-reported physical activity in patients. This study highlights the importance of further research into how increased physical activity may improve pain sensitivity in patients with chronic pain. LAY ABSTRACT Patients with chronic pain and healthy controls were included in this study of the relationships between self-reported physical activity, measurements of sensitivity to pressure pain, and questionnaire data. Pressure pain sensitivity was one of the most important factors discriminating between patients and controls, and there was a significant correlation between pain tolerance threshold and level of self-reported physical activity in patients (i.e. the lower pain thresholds the less physical activity). These results are relevant, as there are only a few previous studies examining the relationship between physical activity in patients with chronic pain and their sensitivity to pressure pain. More research is needed to explore how daily physical activity may improve chronic pain by, for example, increasing patient’s tolerance to pain.

There is clear evidence demonstrating the benefits of physical activity (PA) on pain and overall health, however, PA is challenging for many individuals living with chronic pain. Even non‐exercise specialists can (cost) effectively promote PA, but many health professionals report a number of barriers in providing guidance on PA, suggesting that it is not consistently promoted. This expert position paper summarizes the evidence and provides five recommendations for health professionals to assess, advise and support individuals living with any chronic pain condition with a long life expectancy in adopting and sustaining physically active lifestyles.

OBJECTIVE To investigate kinesiophobia, physical activity levels and barriers to physical activity in women with breast cancer and breast cancer survivors. METHODS The case-control study was conducted at the Breast Clinic of Acıbadem Maslak Hospital, and the Department of Physiotherapy and Rehabilitation at Acibadem Mehmet Ali Aydinlar University, Turkey, from October 2021 to July 2022, and comprised patients with breast cancer in group A, breast cancer survivors in group B and healthy controls in group C. The primary outcome measures were physical activity levels, barriers to physical activity and kinesiophobia levels, while the secondary outcome measures were levels of anxiety, depression, fatigue and quality of life. Data was collected using standard tools. Data was analysed using SPSS 22. RESULTS Of the 212 women, 70(33%) were in group A with mean age 50.71±11.30 years, 70(33%) in group B with mean age 47.64±9.85 years, and 72(34%) in group C with mean age 47.03±7.48 years. Group C had better physical activity levels, fatigue and quality of life scores than the other groups, but it had worse perceptions of physical activity and more individual, psychosocial and environmental barriers to physical activity compared to the other groups (p<0.05). Group A had more barriers to exercise related to fear of overall body pain, poor balance, fear of falling and fear of feeling worse post-exercise compared to the other groups (p<0.05). Group B subjects were more afraid that lymphoedema might be exacerbated if they exercised (p<0.05). CONCLUSIONS Women with breast cancer and breast cancer survivors had worse scores for physical activity levels, fatigue and quality of life compared to the healthy controls. All three groups had a variety of barriers to physical activity.

Abstract Purpose To explore experiences, barriers, and facilitators to participating in physical activity and exercise in adults living with chronic pain. Materials and methods An interpretive description qualitative study using semi-structured interviews was conducted. Participants included adults living with chronic pain (pain >3 months in duration). Transcripts were analyzed using thematic analysis. Results Sixteen participants (five men; 11 women) with a median age of 53 years (range: 28–87) were interviewed. Three major themes related to physical activity and exercise in adults living with chronic pain were conceptualized by the researchers: the challenge of staying active (decreased activity levels, discomfort during physical activity, and uncertain and fluctuating abilities); diverse factors influence participation (pain, fatigue, perceived risks, beliefs about physical activity, competing demands, social support, motivation, other health conditions, and access to supports for physical activity or exercise); and perceived outcomes (pain management, functional improvements, social participation, mental health, and overall well-being). Conclusions Participating in physical activity and exercise was a challenge for adults living with chronic pain, whereby participation was influenced by multiple factors. Rehabilitation providers should aim to reduce modifiable barriers to physical activity and exercise for adults living with chronic pain, with the goal of improving health outcomes for this population. Implications for rehabilitation Despite the perceived benefits, participation in physical activity and exercise is a challenge for adults living with chronic pain. Diverse factors can influence participation in physical activity and exercise from the perspective of adults living with chronic pain. Rehabilitation providers should aim to reduce modifiable barriers to physical activity and exercise for adults living with chronic pain. Results can be used to inform future person-oriented physical activity and exercise interventions for adults living with chronic pain.

Background For medical teams, one of the main objectives of rehabilitation for people with chronic low back pain is adherence to physical activity (PA). Objective The objective of this study was to identify PA barriers and facilitators in this population. Methods This qualitative study included 4 discussion groups and 16 semi-structured interviews conducted among people with non-specific chronic low back pain who were involved in a specific rehabilitation program or seen in primary care settings. Results Three main themes were identified: physical factors, psychological factors and socio-environmental factors. The main barrier to PA practice is pain. Psychological barriers were associated with the difficulty in integrating PA in the person’s daily life. Environmental barriers were dominated by lack of time. Facilitators identified associated the supervised nature of the physical activity (supervision by professionals) and group practice, which improved people’s adherence. Conclusion The results of this study will allow teams to target relevant educational objectives for these people and develop dedicated self-management programs.

Fibromyalgia is associated with widespread pain, depression, and declines in physical functioning. The purpose of this study was to examine the trajectory of these symptoms over time related to physical activity adoption and maintenance via motivational interviewing versus education, to increase physical activity. There were no treatment group differences; we divided the sample (n = 184) based on changes in physical activity. Repeated measures analyses demonstrated differential patterns in depression, pain, and physical functioning at 24 and 36 weeks. Findings suggest increased physical activity may serve as a multiple-target intervention that provides moderate to large, long-lasting benefits for individuals with fibromyalgia.

OBJECTIVE: This study aimed to evaluate the effectiveness of physical therapy (PT) on pain, functional status, depressive symptoms, and quality of life in patients with chronic neck pain (CNP). MATERIAL AND METHODS: The study was designed as a randomized controlled trial involving outpatient clinic patients at a tertiary care hospital and included 80 patients with CNP. The patients were randomly assigned to two groups. The treatment group (TG) received ten sessions of conventional PT (hot pack, ultrasound, and Transcutaneous Electrical Nerve Stimulation) and home-based exercises. The control group (CG) was only given a home-based exercise program. Both groups were informed about correct posture and daily life activities. Patients were assessed pre-treatment, at the end of treatment (2 weeks), and 12 weeks after the treatment using the Visual Analogue Scale (VAS pain), cervical range of motion (ROM), Beck Depression Index (BDI), and short form-36 (SF-36). RESULTS: Both groups showed significant improvements in VAS pain scores, ROM, SF-36, and BDI scores post-treatment (p<0.01 for all). At the three-month follow-up, the improvements in the TG continued, while the CG showed a regression compared to the levels observed two weeks after the treatment. The degree of improvement in VAS pain and BDI scores in the TG was significantly greater than in the CG (p<0.01). CONCLUSION: In the treatment of CNP, adding PT modalities to the home exercise resulted in greater reductions in pain, disability, and depressive symptoms, as well as improvements in quality of life compared to home exercise alone. It’s appropriate to recommend PT modalities as a beneficial treatment for CNP.

No abstract available

Background Depressive complications in chronic pain are detrimental to rehabilitation. This study was aimed at determining the influence of the presence of depressive symptoms on the efficacy of physical therapy among participants with chronic low back pain (CLBP). Methods Data was collected from a randomized controlled trial on 113 participants with CLBP. Participants were reallocated into the depressed or nondepressed groups based on the 50-cutoff point of the self-rating depression scale. All patients received 60 min sessions of physical therapy twice a week for 12 weeks. The primary outcome was back-related disability. Secondary outcomes included pain ratings, sleep quality, life quality, other psychological outcomes, and minimal clinically important differences. These outcomes were collected at baseline, 12, 26, and 52 weeks. Results 31 (27.4%) were accompanied by depressive symptoms. At 12 weeks, the initial depression score was only associated with anxiety score (β = 1.196 [0.531 to 1.860], P = 0.001) and depression score (β = 0.742 [0.200 to 1.284], P = 0.009) in the depressed group, but the initial depression score was associated with anxiety score (β = 0.409 [0.138 to 0.681], P = 0.004), depression score (β = 0.920 [0.658 to 1.184], P < 0.001), sleep quality (β = 0.108 [0.018 to 0.199], P = 0.020), and pain anxiety (β = 0.465 [0.034 to 0.897], P = 0.035) and negatively associated with life quality (β = −0.815 [−1.267 to −0.363], P = 0.001) in the nondepressed group. Conclusions Physical therapy is effective to CLBP with depressive symptoms. A higher initial depression score may weaken the efficacy of physical therapy in the nondepressed group. Depressive complications may adversely influence intervention efficacy for CLBP. This trial is registered with ChiCTR1800016396.

Isolated rib fractures are a non-trivial trauma burden associated with functional impairment and chronic pain. Distraction fractures of the VII-IX thoracic spine are one of the injuries that occur in the middle of the thoracic spine. Some common symptoms that occur are sharp or dull pain in the middle back between the shoulder blades and waist, limited movement, especially stiffness when bending or twisting the body, and respiratory distress. From the case of an 18-year-old male patient, a student, who came to the medical rehabilitation polyclinic in a wheelchair with his mother. The position of both legs is bent. His current physical condition is due to an accident. The patient experienced severe depression with symptoms of feeling sad, feeling weak, even though he had eaten enough, and losing interest in things that made the patient happy before. Physical Rehabilitation Therapy includes mobility exercise, occupational therapy 1 time a week: stimulation and facilitation of hand function, Activities of Daily Living (ADL) gradually. Combination of therapy with Psychiatry in the form of pharmacotherapy and psychotherapy. Multidisciplinary treatment, especially structured physical rehabilitation programs, psychiatry, and other fields, can improve symptoms of pain, and other symptoms, and symptoms of depression. 

BACKGROUND Finding effective, accessible treatment options such as professional-delivered cognitive behavioral therapy (CBT) for medically complex individuals is challenging in rural communities. PURPOSE We examined whether a CBT-based program intended to increase physical activity despite chronic pain in patients with diabetes delivered by community members trained as peer coaches also improved depressive symptoms and perceived stress. METHODS Participants in a cluster-randomized controlled trial received a 3-month telephonic lifestyle modification program with integrated CBT elements. Peer coaches assisted participants in developing skills related to adaptive coping, diabetes self-management goal-setting, stress reduction, and cognitive restructuring. Attention controls received general health advice with an equal number of contacts but no CBT elements. Depressive symptoms and stress were assessed using the Centers for Epidemiologic Studies Depression and Perceived Stress scales. Assessments occurred at baseline, 3 months, and 1 year. RESULTS Of 177 participants with follow-up data, 96% were African Americans, 79% women, and 74% reported annual income <$20,000. There was a significant reduction in perceived stress in intervention compared to control participants at 3-months (β = -2.79, p = .002 [95% CI -4.52, -1.07]) and 1 year (β = -2.59, p < .0001 [95% CI -3.30, -1.87]). Similarly, intervention participants reported significant decreases in depressive symptoms at 3-months (β = -2.48, p < .0001 [95% CI -2.48, -2.02]) and at 1 year (β = -1.62, p < .0001 [95% CI -2.37, -0.86]). CONCLUSIONS This peer-delivered CBT-based program improved depressive symptoms and stress in individuals with diabetes and chronic pain. Training community members may be a feasible strategy for offering CBT-based interventions in rural and under-resourced communities. CLINICAL TRIAL REGISTRATION NCT02538055.

ABSTRACT Objectives This retrospective analysis of real-world clinical data aimed to evaluate interdisciplinary, multimodal pain therapy (IMPT) delivered in an outpatient clinic for individuals with chronic musculoskeletal pain. The primary objectives were to assess improvements in pain intensity and pain-related disability, and to examine theory- and evidence-based correlates of these outcomes, including mental and physical health parameters. Methods A cohort of 308 patients underwent a four-week IMPT, which included exercise, manual therapy, and cognitive behavioural therapy. Pain intensity and disability (Chronic Pain Grade), habitual well-being (Marburg Questionnaire on Habitual Well-being), mental and physical health (Veterans RAND 12), depressive symptoms, anxiety, and stress (Depression Anxiety Stress Scale) were assessed with self-report questionnaires approximately two months before and six months after IMPT. Physical function was assessed with performance-based measures including the stair climb test, a stability, sensorimotor regulation and symmetry test and the prone bridge test at the beginning and end of the treatment. Data were analysed by dependent samples t-tests and multiple linear regressions. Results Six months post-treatment, patients showed reductions in pain intensity (d = .95) and disability (d = .75). Improvements in depression, anxiety, stress, habitual well-being, physical health, and physical function were observed, with effect sizes ranging from small to large. Regression analysis showed that improvements in self-reported habitual well-being and physical health were associated with changes in pain intensity and disability. However, this was not the case for changes in performance-based physical function or changes in psychological risk factors (i.e. depressive symptoms, stress). Discussion The results demonstrate that pain reductions after IMPT are more strongly associated with changes in subjective perceptions of health and habitual well-being than with performance-based indicators. However, further research is needed to draw conclusions about causality and to account for other potential contributing factors, such as treatment adherence, pain catastrophising, and self-efficacy.

The benefits of biophilic interior design have been recognized by healthcare facilities, but residential environments receive relatively less attention with respect to improving the health of people living with chronic diseases. Recent “stay-at-home” restrictions due to the COVID-19 pandemic further emphasized the importance of creating interior spaces that directly and indirectly support physical and mental health. In this viewpoint article, we discuss opportunities for combining biophilic interventions with interior design, fostering disease-specific self-care. We provide examples of designing residential spaces integrating biophilic interventions, light therapy, relaxation opportunities, mindfulness meditation, listening to music, physical activities, aromatherapy, and quality sleep. These modalities can provide the clinical benefits of reducing migraine headaches and chronic pain, as well as improving depressive symptoms. The disease-specific interior environment can be incorporated into residential homes, workplaces, assisted-living residences, hospitals and hospital at home programs. This work aims to promote a cross-disciplinary dialogue towards combining biophilic design and advances in lifestyle medicine to create therapeutic interior environments and to improve healthcare outcomes.

INTRODUCTION Torture is associated with adverse health consequences, with especially high rates of PTSD, depression and chronic pain. Despite increased awareness of the relationship between pain and posttraumaticsymptoms, and the accompanying need for effective treatment strategies, few studies have examined an integrated treatment of comorbid PTSD and pain. METHODS In this study, using an A-B case series design with three and six month follow-up, six refugee torture survivors with comorbid PTSD, depression and chronic pain received 20 sessions of Narrative Exposure Therapy (NET) and 10 sessions of physiotherapy. Outcome variables included symptoms of PTSD and depression, pain intensity, physical functioning and quality of life. Symptoms of PTSD and pain were also rated after each treatment session. RESULTS Two patients achieved clinically significant reduction in symptoms of PTSD. Only one patient achieved clinically significant change in depressive symptoms, and two experienced clinically significant reduction in pain intensity. Clinical descriptions of the course of treatment for all patients are provided. DISCUSSION AND CONCLUSIONS Despite its limitations, the study suggests that some torture survivors who suffer high symptom loads may benefit from a combined treatment of NET and physiotherapy. Appreciating individual differences and how they affect treatment can provide valuable insight and inform clinicians working with torture survivors. Directions for future researchregarding the improvement of rehabilitation strategies of torture survivors are discussed, and highlighted through descriptions from the six therapy cases.

Background and Purpose: Understanding prognosis is critical for clinical care and health policy initiatives. The purpose of this study was to determine whether distinct prognostic trajectories of physical function and disability exist in a cohort of 245 community-dwelling older adults with chronic low back pain (LBP), and to characterize the demographic, health, and pain-related profiles of each trajectory subgroup. Methods: All participants underwent standard clinic examinations at baseline, 3 months, 6 months, and 12 months. At each time point, the Late Life Function & Disability Instrument (LLFDI) was used to measure general physical function (LLFDI Function) and disability (LLFDI Disability-Limitation); the Quebec LBP Disability Questionnaire was used to measure disability due to pain. Growth mixture modeling (GMM) was performed on each outcome to identify distinct trajectory classes/subgroups; baseline demographic (eg, age and sex), health (eg, comorbidities, depressive symptoms, and physical activity level), and pain-related (eg, LBP intensity, pain-related fear, and pain catastrophizing) characteristic profiles were compared across subgroups. Results: GMM statistics revealed an optimal number of 3 to 4 trajectory subgroups, depending on the outcome examined. Subgroups differed across demographic, health, and pain-related characteristics; the classes with the most favorable prognoses had consistent profile patterns: fewer depressive symptoms, fewer comorbidities, higher physical activity levels, lower LBP intensities, less pain-related fear, and less pain catastrophizing. Conclusion: Our findings indicate that several distinct trajectory subgroups exist that would have been masked by observing mean cohort change alone. Furthermore, subgroup characteristic profiles may help clinicians identify likely prognostic trajectories for their patients. Future research should focus on identifying modifiable risk factors that best predict group membership, and tailoring interventions to mitigate the risk of poor prognosis.

OBJECTIVE Given the complex and unclear etiology of neck pain, it is important to understand the differences in central sensitization as well as psychosocial factors in individuals with chronic neck pain and healthy controls. The purpose of this study was to benchmark differences in central sensitization, psychosocial factors, and range of motion between people with nonspecific chronic neck pain and healthy controls and to analyze the correlation between pain intensity, neck disability, and psychosocial factors in people with chronic neck pain. METHODS Thirty individuals with chronic neck pain and 30 healthy controls were included in this case-control study. Outcome measures were as follows: central sensitization (pressure pain threshold, temporal summation, and conditioned pain modulation), psychosocial factors (depressive symptoms, pain catastrophizing, and quality of life), and active cervical range of motion. RESULTS People with neck pain had lower local pressure pain threshold, a decrease in conditioned pain modulation, more depressive symptoms, greater pain catastrophizing, lower quality of life, and reduced range of motion for neck rotation when compared with healthy controls. In people with neck pain, moderate correlations were observed between pain intensity and quality of life (ρ = -0.479), disability and pain catastrophizing (ρ = 0.379), and disability and quality of life (ρ = -0.456). CONCLUSIONS People with neck pain have local hyperalgesia, impaired conditioning pain modulation, depressive symptoms, pain catastrophizing, low quality of life, and reduced active range of motion during neck rotation, which should be taken into account during assessment and treatment. IMPACT This study shows that important outcomes, such as central sensitization and psychosocial factors, should be considered during assessment and treatment of individuals with nonspecific chronic neck pain. In addition, pain intensity and neck disability are correlated with psychosocial factors.

[Purpose] We compared the effectiveness of dry needling with a classical physiotherapy program in patients with chronic low-back pain caused by lumbar disc hernia (LHNP). [Subjects and Methods] In total, 34 subjects were allocated randomly to the study (n=18) and control groups (n=16). In the study group, dry needling was applied using acupuncture needles. The control group performed a home exercise program in addition to hot pack, TENS, and ultrasound applications. Pain was assessed with the short form of the McGill Pain Questionnaire. The number of trigger points and their pressure sensitivity were evaluated with a physical examination (palpation). The Beck Depression Inventory was used to assess depression. The Tampa Kinesiophobia Scale was used to assess fear of movement. [Results] In the study group, the calculated Cohen’s effect sizes were bigger than those in the control group in terms of pain, trigger point-related variables, and fear of movement. Effect sizes for reducing depressive symptoms were similar in both groups. [Conclusion] These results suggest that dry needling can be an effective treatment for reducing pain, number of trigger points, sensitivity, and kinesiophobia in patients with chronic low-back pain caused by lumbar disc hernia.

This comprehensive narrative review aims to investigate the impact of virtual reality (VR) and social gaming on the quality of life, depression, and dialysis tolerance in patients with chronic kidney disease (CKD), a growing global health concern affecting the quality of life and increasing mortality rates. Through a combination of exercise and video games, exergaming, and digital game therapy (DGT), sedentary risks can be mitigated and therapy adherence enhanced. Despite potential side effects such as exhaustion and nausea, research indicates that virtual therapeutic games improve motivation and dialysis tolerance, and even reduce brain activity in pain-associated regions during procedures. These methods are superior to traditional distraction techniques like music, movies, and toys. Exergaming, social gaming, and VR gaming can improve various health factors including depressive symptoms, functional capacity, muscle strength, fatigue, physical activity, mental health, motivation, engagement, cognition, and overall quality of life for CKD patients. Representing a novel approach to CKD management, these interventions promote physical activity, cognitive stimulation, and social interaction. Continued research and innovation will facilitate the integration of VR-based therapies into routine CKD care.

No abstract available

A 58-year-old woman with poor well-being and living with symptoms of severe chronic pain, mood swings, insomnia, depression, poor social life, poor autonomic function, negative thoughts, water retention has reported for the restoration of normal life. The patient was provisionally diagnosed with persistent depressive disorder. Patient was on pharmacological intervention from last twenty-ve years and on regular medications including serotonin reuptake inhibitors (SSRI's) and Triazolam for treating Insomnia. The patient was admitted in a psychiatric unit for one month of treatment and underwent cognitive behavior therapy along with pharmacological interventions. Due to lack of effectiveness of these medications, the patient became more aggressive and complains of low self-esteem and severe insomnia. She nally approached a physical therapy centre with the complains of severe fatigue and pain at different body sites. She was examined by the physical therapist, complete medical history, general assessment, physical examination was conducted. Patient was initially diagnosed with Generalized body aches but after few days of treatment and regular visits and in patient discussions, she was diagnosed with bromyalgia. The Visual Analogue Scale (VAS) was recorded to be 9 at the scale of 10, Pain pressure threshold (PPT) assessed with Digital algometer was 6.76 KPA and having trigger points at almost 13 different bodily sites. The Erythrocyte Segmentation rate was also reported higher than the normal limits. The patient was initially treated with Interferential therapy to release the inammation later followed by Myofascial Release Techniques (MRT) and generalized exercises were advised to be done at home by the patient herself. This treatment was given for one month regularly, later followed by three days per week for another two months respectively. The patient has responded well to this treatment and there were marked improvement in the symptoms. The signicant change was noticed in chronic pain, mood swings, social activities, and inammation and indirect improvement was observed in insomnia, and negative thoughts. The patient was advised to follow the exercise regimen at home for another three months and should visit the clinic for regular follow ups fortnightly. This six-month patient centric approach helped in restoration of the well-being of a patient and presented as the nal cure of bromyalgia. The patient was also guided to report back to the clinic if notice any prevailing symptoms. A further study has been proposed and planned to treat the patients with similar symptoms of chronic and widespread pain indicative of bromyalgia. The same protocol can be followed and to check the efcacy and to mask the effect of this therapeutic approach among similar patients. The efcacy in protocol can help to evaluate the condition and would help designing the clinical management of Fibromyalgia syndrome (FMS)

BACKGROUND Decreasing pain catastrophizing and improving self-efficacy to self-manage chronic pain symptoms are important treatment targets in the context of interdisciplinary cognitive behavioral therapy for chronic pain. Greater pain catastrophizing has been shown to be associated with greater impact of pain symptoms on functioning, while conversely, greater pain self-efficacy has been associated with lower pain intensity and lower levels of disability. OBJECTIVE To prospectively evaluate interdisciplinary cognitive behavioral therapy for pain outcomes, as well as to the mediating effects of both pain catastrophizing and pain self-efficacy on outcome. METHODS Participants were 315 patients with chronic pain between April 2017 and April 2018 who completed a three-week interdisciplinary pain rehabilitation program. Pain severity, pain interference, pain catastrophizing, pain self-efficacy, quality of life, and depressive symptom questionnaires, and measures of physical performance were assessed at pre- and posttreatment. Follow-up questionnaires were returned by 163 participants. Effect size and reliable change analyses were conducted from pre- to posttreatment and pretreatment to 6-month follow-up. Mediation analyses were conducted to determine the mediating effect of pain catastrophizing and pain self-efficacy on pain outcome. RESULTS Significant improvements from pre- to posttreatment in pain outcomes were observed, and over 80% evidenced reliable change in at least one pain-relevant measure. Pain catastrophizing and pain self-efficacy mediated the relationship between changes in pain outcomes. CONCLUSIONS Interdisciplinary pain rehabilitation is an effective treatment and decreasing pain catastrophizing and increasing pain self-efficacy can influence maintenance of treatment gains.

Purpose: Chronic pelvic pain (CPP) is a relatively common health problem, impacting around 25 million women globally. This study details the development of a multidisciplinary women's CPP clinic at a major U.S. academic medical center, and examines associations between mood, pain symptoms, and trauma history. Materials and Methods: Data were collected from 96 subjects, including self-report measures (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Brief Trauma Questionnaire), pain intensity ratings, psychiatric diagnoses, and relevant medical history. Results: Most subjects reported at least one traumatic experience. Nearly half of subjects met criteria for an anxiety disorder and/or a depressive disorder. Most subjects were diagnosed with pelvic floor dysfunction, and more than half were referred to physical therapy. Women with abdominal/pelvic surgery history reported more traumatic experiences than women without surgical history. Women with a history of sexual abuse reported trying more medications and seeking care from a greater number of providers. Many reported pain duration of >2 years. Conclusions: Study findings related to mental health and trauma support a multidisciplinary CPP approach that includes a clinical health psychology component. Future research may investigate the therapeutic processes that apply to this population to identify targeted efficacious interventions.

BACKGROUND Rumination and overgeneral autobiographical memory are dysfunctional cognitions commonly found in older adults with depression. The theoretical underpinnings of mindfulness-based cognitive therapy (MBCT) address the ruminative tendencies and the non-specific retrieval of autobiographical memories. This study aims to examine the efficacy and cognitive mechanisms of MBCT in older adults with active depressive symptoms. METHODS 57 older adults (mean age, 70 years) with normal cognition and mild to moderate depressive symptoms were randomly allocated to either the MBCT group or the active control group for 8 weeks. The MBCT group consisted of eight 2-hour weekly sessions and a 7-hour full-day retreat, with different themes for each class, guided mindfulness exercises, feedback and discussion, homework review, and psychoeducation. The active control group comprised a 1-hour physical exercise and a standardised health education of the specific theme with group discussion (eg fall prevention, chronic pain). Participants were assessed before and after the 8-week intervention for four outcome measures: the Hamilton Depression Rating Scale (HAMD), the Ruminative Response Scale (RRS), the Autobiographical Memory Test (AMT), and the Mindful Attention Awareness Scale (MAAS). RESULTS There was a significant reduction in severity of depressive symptoms (HAMD score) in both the MBCT group (F(1, 27) = 35.9, p < 0.001, η2 = 0.57) and the active control group (F(1, 28) = 9.29, p < 0.01, η2 = 0.24), but only the MBCT group showed substantial improvements in autobiographical memory specificity (AMT score), rumination (RRS score), and mindfulness (MAAS score). CONCLUSION Although both MBCT and active control programme decrease the severity of depressive symptoms in older adults, only MBCT improves AMS, rumination, and mindfulness. Our findings provide empirical support for the theoretical underpinnings of MBCT. Older adults with more severe depression and more severe dysfunctional cognition may benefit more from the specific therapeutic effects of MBCT.

Abstract Background and aims A targeted pain program may prevent the progression and subsequent occurrence of chronic pain in adolescents. This study tested the effectiveness of a new acceptance and commitment therapy -based pain management intervention, using physical and psychological functions as the outcomes. The objective was also to determine whether Pediatric Pain Screening Tool risk profiles function as outcome moderator in the current sample. A valid screening tool would enable the program development. Methods Thirty-two consecutive adolescent patients (13–17 years old) with idiopathic recurrent musculoskeletal pain completed the study. The intervention comprised acceptance and commitment therapy-oriented multidisciplinary treatment. Pediatric Pain Screening Tool, pain frequency, functional disability, school attendance, physical endurance, depressive symptoms, and catastrophizing coping style were measured before treatment (baseline) and again at 6 and 12 months after the initiation of treatment. To test the effectiveness of the new program, we also determined whether the original risk classification of each patient remained constant during the intervention. Results The intervention was effective for high-risk patients. In particular, the pain frequency decreased, and psychosocial measures improved. In post-intervention, the original risk classification of seven patients in the high-risk category changed to medium-risk. PPST classification acted as a moderator of the outcome of the current program. Conclusions The categorization highlighted the need to modify the program content for the medium-risk patients. The categorization is a good tool to screen adolescent patients with pain. Implications The results support using the Pediatric Pain Screening Tool in developing rehabilitation program for pediatric musculoskeletal pain patients. According to the result, for adolescent prolonged musculoskeletal pain patients the use of ACT-based intervention program is warranted.

: Background: Half of pregnant women frequently complain of lumpo-pelvic pain (LPP). It could have a detrimental impact on sleep, work capacity, physical, social, and psychological health that contribute to physical inactivity. The benefits of LPP prevention or remedy for pregnant women through specific exercises should therefore be further investigated. Thus, this trial aimed to evaluate the effect of a concurrent exercise program on pregnancy-related lumbo-pelvic pain. Methods: A randomized, controlled trial was conducted at the family health centers affiliated to Mansoura district as well as the antenatal clinics of Mansoura University hospital in El Dakahlia Governorate. A total sample size of 144 pregnant women was selected using a randomized sampling technique. Data collection tools were five: a structured interview schedule for assessing pregnant women's characteristics; the Numeric Rating Scale (NRS); the Roland-Morris Disability Questionnaire (RMDQ); an Arabic version of the Hospital Anxiety and Depression Scale (HADS); and an Arabic version of the Pittsburgh Sleep Quality Index (PSQI). Results: Before the exercise program, 70.8% of the pregnant women in study groups reported moderate pain level, while 58.3% of the pregnant women in control groups reported sever pain level. Compared to two-months after the program, this higher pain level improved in the study group to mild pain among 52.8%, but remained the severe pain level among 55.6% of the control group. Conclusion and recommendations: The concurrent exercises reduce the severity of lumbo-pelvic pain and its related symptoms in pregnant women. So, the researchers recommend including concurrent exercises in regular prenatal care as a viable therapeutic option for pregnancy-related LPP.

Background There is limited research on whether digital interventions can prevent acute or subacute pain from developing into chronic pain. This observational study’s primary objective examined whether chronic pain was more likely to be prevented in digital acute MSK program participants than nonparticipants. An exploratory objective was time to pain relief for program participants versus nonparticipants. Patients and Methods The intervention group participants conducted video visits with physical therapists and were recommended exercise therapies and educational articles delivered through an app dedicated to addressing musculoskeletal (MSK) needs. This study used a multidimensional approach incorporating pain, function, depression, and anxiety scores to determine whether chronic pain prevention was achieved at 12 weeks. Descriptive analyses, unadjusted, and adjusted logistic regression were conducted. Time-to-event analysis was performed to compare the time to pain relief between groups. Results A total of 171 participants (intervention: 75, nonparticipants: 96) with baseline and 3, 6, and 12 week follow-up data were included in the sample. Baseline mean (SD) age was 44.2 (11.8) years and mean VAS pain was 43.3 (22.9), out of 100. Results showed significantly higher odds of achieving chronic pain prevention at 12 weeks in the intervention participants versus nonparticipants. After adjusting for age, pain region, registration month, number of weeks of pain experienced, and healthcare service use at 12 weeks, 20.5% of the intervention group and 5.5% of the nonparticipant group achieved chronic pain prevention. At 91 days, the probability of developing chronic pain was 77.7% for nonparticipants and 46.5% for intervention participants (p<0.001; Log rank test). Conclusion A digital acute MSK program may help to prevent chronic pain from developing among those with acute and subacute MSK needs. Study results also suggest that program participants achieve chronic pain relief sooner compared to nonparticipants.

Objective: To compare three rehabilitation treatments, exercise therapy, acupuncture, and silicon oxide tablets (Stiper®), in women undergoing breast cancer surgery, assessing pain, depression, upper limb function, and range of motion parameters (ROM). Methods: Seventy-nine women with pain above 3 on the visual analog pain scale (VAS) were divided into three groups: exercise group was treated with exercise therapy, acupuncture group was treated with acupuncture, and Stiper® group was treated with silicon oxide tablets in place of needles. Results: Sixty-seven patients completed the treatment, 26 from exercise group, 23 from acupuncture group, and 18 from Stiper® group . There was an improvement of pain over time in all groups, the first session compared with the fifth (p < 0.001) and with the tenth (p < 0.001), but not between groups. There was a statistically significant difference in depressive symptoms using the Beck questionnaire over time in the three groups, between the first and tenth sessions (p = 0.001), between the first and fifth sessions (p = 0.052), but not between groups. Regarding the DASH questionnaire for shoulder function, there were significant differences over time at all evaluated moments (p<0.001), but not between groups. There was a statistically significant difference in ROM over time in the three groups, but not between groups. Conclusion: The rehabilitation of physical dysfunctions in women who survived breast cancer through exercise therapy, acupuncture, and silicon oxide tablets in pain, depression, upper limb function, and ROM, proved to be effective, without statistical difference between the groups.

Background: Sarcopenia is considered an independent prognostic factor for overall survival and performance status in head and neck cancer (HNC) receiving chemo-radiotherapy (CRT). CRT is known to cause sleep disturbances, increased pain perception, depression leading to reduced quality of life (QOL). Exercise-based rehabilitation has emerged as a promising strategy for improving outcomes in HNC. Our study aimed to evaluate effect of exercise on sarcopenia and QOL in patients with HNC receiving CRT. Methodology: Seventy HNC patients, aged 40-70 years TNM stage III- IVb receiving CRT, were randomized into two groups and received intervention for seven weeks. Intervention Group, IG (n=40) received combined aerobic and resistance training according to the ACSM guidelines. Control Group, CG (n=40) were advised to walk according to the NCCN guidelines. Sarcopenia was assessed using Bio Impedance Analyser (BIA), muscle strength using JAMAR hand dynamometer and QOL by FACT H&N on pre CRT day 1 and post 7 weeks. Wilcoxon signed-rank test and Mann-Whitney U test were used to assess within-group differences and between-group comparisons respectively. Results: 80 participants with a mean age of 58.44 ±3.75 years were included. IG showed a smaller decrease in total skeletal muscle mass compared to CG with IGs total skeletal muscle mass decreasing from 35 to 30 and CGs muscle mass decreasing from 40 to 21 (p<0.001). QOL showed significant improvement in CG from 66 to 61 (p < 0.001). In contrast, IGs quality of life saw a minor, non-significant change from 62 to 61. Conclusion: Sarcopenia was lesser in IG compared to CG, highlighting the favourable impact of resistance training and its inclusion in the HNC rehabilitation. However, CG demonstrated significant improvements in quality of life as compared to IG suggesting that quality of life is a multifaceted construct that may not be directly correlated with physical improvements alone.

Background. Two prophylactic papillomavirus (HPV) vaccines have been available for primary prevention of cervical cancer. Although serious adverse effects (AE) were rare, more than 230 women have been suffering from severe AEs such as persistent pain and headache in Japan. Our research group started to treat adolescent females suffering from the AEs. Objective. To survey the characteristics of and the effects of cognitive behavioral therapy on adolescent female suffering from the AEs in Japanese multidisciplinary pain centers. Methods. One hundred and forty-five patients suffering from the AEs were reviewed retrospectively and 105 patients of them were provided guidance on home exercise and activities of daily living based partially on a cognitive-behavioral approach. The intensity of pain was rated by the patients using a numerical rating scale (NRS). Furthermore, the Hospital Anxiety and Depression Scale (HADS) and the Pain Catastrophizing Scale (PCS) were used. Results. Eighty out of the 105 patients who received the guidance were followed up, 10 displayed a marked improvement, and 43 showed some improvement. Conclusions. Guidance on home exercise and activities of daily living based on a cognitive-behavioral approach alleviated the AEs that women suffered from after HPV vaccination in Japan.

This study compared the effectiveness of a 12-day stress-prevention program (SGS) supplemented by individualized, structured, four-session telephone-coaching to that of an SGS without telephone-coaching in entrepreneurs from the green professions presenting with increased stress levels. All participants went through the SGS before being randomized either to the telephone-coaching group (TC) or to the control group without telephone-coaching (noTC). SGS included four key therapeutic elements: stress-management intervention, relaxation, physical exercise, and balneotherapy. The primary outcome was the current degree of subjectively experienced stress assessed with the Perceived Stress Questionnaire (PSQ) at a 9-month follow-up. Secondary outcomes included burnout symptoms, well-being, health status, sleep disorders, expectation of self-efficacy, depression, anxiety, ability to work, pain, and days of sick leave. Assessments were conducted at baseline, 12 days (end of program), and 1 (start telephone-coaching), 3, 6 (end of telephone-coaching), and 9 months. Data from 103 adults (TC = 51; noTC = 52), mostly fulltime farmers, were available for analysis (mean age: 55.3; 49.1% female). Participants experienced significant immediate improvement in all outcome measurements, which declined somewhat during the first three months after the end of SGS and then remained stable for at least another six months. While within-group changes from baseline to 9 months showed significant improvements at medium to large effect sizes for all target variables (PSQ-total, TC: −13.38 (±14.98); 95%-CI: (−17.68; −9.07); noTC: −11.09 (±14.15); 95%-CI: (−15.11; −7.07)), no statistically significant differences were found between the groups at any time and for any target variable (between-group ANCOVA for PSQ-total at 9 months, parameter estimator for the group: −1.58; 95%-CI: (−7.29; 4.13)). The stress-prevention program SGS is a feasible, effective, and practical way to reduce perceived stress and improve participants’ resources. Four subsequent telephone-coaching sessions do not seem to contribute to a further improvement in the results.

BackgroundA physically active lifestyle contributes to the prevention of lifestyle diseases, promotion of physical health, and reduction of pain, among other benefits. Being physically active also promotes mental health for many individuals, in the form of improved mood, increased self-efficacy and reduced risk of depression. Alcohol-dependent individuals may experience a better quality of life when supplementing their treatment with physical exercise. This study aimed to evaluate the effect of exercise on Quality of Life among patients with alcohol use disorder in a large randomized controlled trial.MethodsThe study had three arms: Patients were allocated to (A) treatment as usual, (B) treatment as usual and supervised group exercise two days a week of one hour each, (C) treatment as usual and individual physical exercise minimum two days a week. Duration of the intervention was six months. Data on values of Quality of Life were collected at baseline (before treatment start and at time of enrollment in the study), and at follow-up (at six months after enrollment in the study) using the EQ-5D questionnaire and the EQ-VAS. The sample consisted of 117 consecutive patients, and the follow-up rate was 66.6%. Intention-to-treat analyses were conducted to evaluate the effect of exercise on quality of life.ResultsAlthough not statistically significant, a substantial portion of the participants in the individual exercise condition reported that they had no pain or discomfort (one of the five quality of life dimensions measured by EQ-5D questionnaire) compared to the controls at follow-up. No difference was found between the groups regarding the EQ-VAS.ConclusionThe exercise intervention had no effect on quality of life for patients with alcohol use disorder, nor was quality of life improved across the total sample. More research in how to improve quality of life for patients with alcohol use disorder is needed.Trial registrationISRCTN74889852 (retrospectively registered, date: 16/05/2013).

BACKGROUND Negative emotions are common in women with benign breast disease (BBD) and may influence breast cancer risk, but the relationship between these emotions, cancer development, and mitigating factors remain unclear. This study aimed to assess the impact of negative emotions on breast cancer risk and identify associated contributing factors. METHODS This prospective cohort enrolled 3,535 women with BBD from 12 Chinese hospitals. Negative emotions were assessed using the Irritability, Depression, and Anxiety (IDA) scale and breast pain was evaluated with the Breast Pain Score scale. Associations between negative emotions and breast cancer risk were analyzed using Cox regression models. Factors associated with negative emotions were identified with logistic regression, and mediation analysis was used to explore the roles of life satisfaction, sleep duration, and physical exercise. RESULTS Nearly half (47%) of participants had high negative emotions (IDA ≥19). During follow-up, 2% developed breast cancer. High negative emotion was associated with a 2.78-fold increased cancer risk (HR = 2.78, 95% CI: 1.34-5.76; P = 0.006), driven by depression and introverted irritability. Negative emotions correlated with physical inactivity, short sleep, life dissatisfaction, and severe breast pain. Life satisfaction (45%), sleep (7%) and exercise (19%) partially mediated the breast pain-negative emotion relationship. CONCLUSIONS Negative emotions significantly increase breast cancer risk in women with BBD. Addressing modifiable factors like exercise, sleep, and life satisfaction may reduce emotional distress and potentially lower cancer risk. IMPACT Integrating psychological assessment and lifestyle interventions into BBD management could improve emotional well-being and mitigate cancer risk.

Fibromyalgia syndrome (FMS) is characterized by pain referred to deep tissues. Diagnosis and treatment of FMS are complicated by a variable coexistence with regional pain, fatigue, sleep disruption, difficulty with mentation, and depression. The widespread, deep pain of FMS can be a consequence of chronic psychological stress with autonomic dysregulation. Stress acts centrally to facilitate pain and acts peripherally, via sympathetic vasoconstriction, to establish painful muscular ischemia. FMS pain, with or without a coexistent regional pain condition, is stressful, setting up a vicious circle of reciprocal interaction. Also, stress interacts reciprocally with systems of control over depression, mentation, and sleep, establishing FMS as a multiple-system disorder. Thus, stress and the ischemic pain it generates are fundamental to the multiple disorders of FMS, and a therapeutic procedure that attenuates stress and peripheral vasoconstriction should be highly beneficial for FMS. Physical exercise has been shown to counteract peripheral vasoconstriction and to attenuate stress, depression, and fatigue and improve mentation and sleep quality. Thus, exercise can interrupt the reciprocal interactions between psychological stress and each of the multiple-system disorders of FMS. The large literature supporting these conclusions indicates that exercise should be considered strongly as a first-line approach to FMS therapy.

Abstract This presentation focuses on the implementation and preliminary outcomes of an ongoing four-arm randomized controlled trial of short-term behavioral activation (BA) and multi-component falls prevention (FP) for homebound older adults, age 50 and older, with depression (24-item Hamilton Rating Scale for Depression [HAMD] >15). Both BA and FP are delivered by trained lay counselors via video-conferencing. iPads with a video-conferencing platform and an exercise app, “Keep on Keep up” are loaned to the participants. The study arms are BA only, FP only, combined BA and FP (TBF), and telephone support call which serves as attention control. BA is designed to increase engagement in value-based activities, and FP uses the CDC’s STEADI tool kits and the exercise app. The expected enrollment goal is 320 by March 1, 2026. We have used a variety of recruitment Methods referrals from Meals on Wheels case workers, distribution of the study fliers with Meals on Wheels, and presentations at local senior apartment complexes. Barriers to recruitment and retention included mental illness self-stigma and related denial of depression, lack of motivation, chronic pain, and physical health crises. Each study participant goes through baseline assessment, weekly sessions over nine weeks, and three follow-up assessments over nine months. The average age of the participants is 68 years; 70% female and 30% male; 55% Black or Hispanic and 45% non-Hispanic White; and the baseline HAMD scores of 23. We will present 12- and 24-week outcomes. Qualitative feedback from participants in BA, FP, and TBF have been highly positive.