Welcome back to SpineIQ’s Back Blog! This week we will discuss a study with clinically relevant results by Kaleth et al. titled “Does increasing steps per day predict improvement in physical function and pain interference in adults with fibromyalgia?”1 Spinal pain is one of the most common symptoms of people with fibromyalgia2 therefore, the study provides some intriguing and pragmatic results for clinicians that treat patients with fibromyalgia with accompanying spinal pain.


Fibromyalgia commonly presents with chronic widespread musculoskeletal pain, commonly spinal pain, in addition to fatigue and poor sleep.3 Patients that experience fibromyalgia are less likely to be physically active and report poor functional ability.4 Medication is the first line treatment for patients with fibromyalgia however, there is an increased emphasis on non-pharmacological interventions that may increase physical activity and subsequently improve pain and function.5,6 This led the authors to conduct a randomized controlled trial to evaluate if motivational interviewing can increase physical activity in patients with fibromyalgia.7 The study we are discussing on this blog is a secondary data analysis of that trial. The purpose of the secondary analysis was to evaluate if a change in the number of steps per day was associated with decreased pain and improved function.


The original randomized controlled trial randomized 199 adults (18-65 years old) with fibromyalgia into a motivational interviewing or control group. Motivational interviewing has been defined as an approach to interacting with someone in order to enhance the person’s motivation to change.8 Each group received two supervised exercise sessions and an individualized exercise plan to continue long term. After the two exercise sessions, the intervention group received six motivational interviewing phone calls focusing on self-motivational statements about intent to exercise, optimism that exercise can help, committing to exercise, and preventing relapse to inactivity. The handbook that was used in the motivational interviewing group was published and is accessible.9  The control group also attended to exercise sessions and then received six phone calls discussing fibromyalgia related health content focusing on living well with pain, fatigue, sleep, and stress. All 199 adults in the original study were included in this secondary analysis. The number of steps taken was measured objectively using an accelerometer, which is a valid and reliable tool to evaluate physical activity, including step count. Patient reported outcomes were measured with the Fibromyalgia Impact Questionnaire to evaluate function and Brief Pain Inventory to evaluate pain intensity and interference. Function evaluates the impact that fibromyalgia has on daily tasks, pain intensity evaluates the numerical level of pain currently and in the last week, and pain interference evaluates the impact that pain has on daily tasks (e.g., activity, walking, work, sleep etc.). The patient reported outcomes were taken at 12, 24, and 36 weeks.


As we often see in the pain literature, most patients experienced some improvement over time. However, patients who averaged a higher number of steps per day experienced significantly more improvement in physical function and pain interference. In fact, even 1000 more steps per day made a difference in these two outcomes. Interestingly, pain intensity was not impacted by number of steps per day.


This study indicates that increasing physical activity even a little (1000 more steps per day) can have a significant impact on some patient reported outcomes. In fact, if a sedentary patient increases his or her physical activity to meet public health recommendations of walking 7000 steps per day, the likelihood of achieving 30% or better improvements in function and pain interference, an improvement thought to be clinically important to patients, increases significantly. In our blog last week we discussed the concept of minimal clinically important differences more in depth. While more steps were not significantly associated with pain intensity, it is important to note that walking more steps did not increase pain intensity. From a clinical standpoint, the results of this study indicate that if you educate your patients regarding why and how to increase their physical activity levels (when indicated), even a minimal increase can have significant impact.


  1. Kaleth AS, Slaven JE, Ang DC. Does increasing steps per day predict improvement in physical function and pain interference in adults with fibromyalgia? Arthritis Care Res. 2014;66(12):1887-1894. doi:10.1002/acr.22398
  2. Lachaine J, Beauchemin C, Landry P-A. Clinical and economic characteristics of patients with fibromyalgia syndrome. Clin J Pain. 2010;26(4):284-290. doi:10.1097/AJP.0b013e3181cf599f
  3. Borchers AT, Gershwin ME. Fibromyalgia: A Critical and Comprehensive Review. Clin Rev Allergy Immunol. 2015;49(2):100-151. doi:10.1007/s12016-015-8509-4
  4. McLoughlin MJ, Colbert LH, Stegner AJ, Cook DB. Are women with fibromyalgia less physically active than healthy women? Med Sci Sports Exerc. 2011;43(5):905-912. doi:10.1249/MSS.0b013e3181fca1ea
  5. Carville SF, Arendt-Nielsen L, Arendt-Nielsen S, et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. 2008;67(4):536-541. doi:10.1136/ard.2007.071522
  6. Ablin J, Fitzcharles M-A, Buskila D, Shir Y, Sommer C, Häuser W. Treatment of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines with Special Emphasis on Complementary and Alternative Therapies. Evid-Based Complement Altern Med ECAM. 2013;2013:485272. doi:10.1155/2013/485272
  7. Ang DC, Kaleth AS, Bigatti S, et al. Research to encourage exercise for fibromyalgia (REEF): use of motivational interviewing, outcomes from a randomized-controlled trial. Clin J Pain. 2013;29(4):296-304. doi:10.1097/AJP.0b013e318254ac76
  8. Resnicow K, McMaster F. Motivational Interviewing: moving from why to how with autonomy support. Int J Behav Nutr Phys Act. 2012;9:19. doi:10.1186/1479-5868-9-19
  9. Ang D, Kesavalu R, Lydon JR, Lane KA, Bigatti S. Exercise-based motivational interviewing for female patients with fibromyalgia: a case series. Clin Rheumatol. 2007;26(11):1843-1849. doi:10.1007/s10067-007-0587-0