Women with fibromyalgia are more likely to adhere to their intentions to participate in walking programs if they perceive they have control, a study has found.
Therefore, to promote walking as an effective rehabilitation exercise, health providers should consider strategies to increase their patients’ perceived control in order to help them comply with their intentions, the researchers said.
The results of their study, “Predicting walking as exercise in women with fibromyalgia from the perspective of the theory of planned behavior,” were published in the journal Women & Health.
Fibromyalgia is a complex condition characterized by widespread chronic pain, fatigue, sleep disturbances, sexual dysfunction, and memory and mood issues.
Treatment for fibromyalgia is challenging, and normally consists of a combination of pharmacological therapies — antidepressants and anticonvulsants — and non-pharmacological approaches, such as physical exercise, cognitive‐behavioral therapy, and rehabilitation programs.
“In particular, exercise of low to moderate intensity has shown benefits in FM [fibromyalgia] health outcomes, and walking has been shown to decrease pain and improve mobility and function,” the investigators wrote. “However, adherence to walking programs is low, especially the ones of low intensity.”
The Theory of Planned Behavior (TPB) proposes that a person’s intention to perform a given behavior is the key factor that determines whether or not this behavior will be carried out. Based on this theory, women with fibromyalgia do not adhere to walking programs because they do not intend to participate, or because, despite their intentions, they are unable to follow through — a phenomenon known as the “intention-behavior gap.”
In this study, researchers from the Miguel Hernández University in Spain and their collaborators set out to identify the factors that affect a woman’s adherence to an unsupervised walking program.
The study involved 274 women from 18–70 years old and was part of a larger study (ISRCTN68584893) aimed at increasing the participation of women with fibromyalgia in unsupervised walking programs.
All participants were asked to complete a series of questionnaires to evaluate their pain intensity, level of distress, and physical disability.
A sub-group of 115 women received a pedometer (a monitoring device that counts the number of steps taken while walking or running) to wear only while walking as part of the unsupervised walking program. Participants were evaluated at the study’s start and seven weeks later.
From the 274 women initially enrolled in the study, 219 attended the last study visit.
Analyses indicated that, at baseline, a woman’s intention to adhere to the walking program was directly associated with their attitude and perceived behavioral control (PBC, the perception that participating in the walking program was completely under their control).
After seven weeks, self-reported adherence to the unsupervised walking program was only influenced by PBC, which in turn was associated with being a successful intender (women who not only intended, but also participated in the unsupervised walking program).
The data showed approximately a third of the study participants (33%) had “intention-behavior gap,” which the researchers attributed to the women’s perceived control.
“The women who perceived high control, in comparison to women with low control, increased their likelihood of walking about three-fold. This is a relevant finding, considering that 25% of sample scored below 4 on PBC, which is low perceived control,” the researchers said.
They also found that women who intended to walk according to the program held positive attitudes about the program, and felt some control and social pressure to comply.
“In spite of these findings, 33% of the participants did not behave according to their intentions,” the investigators wrote.
“The results of this study showed that between the two main reasons for not walking, intention was not the problem,” they said. “Our results suggest that to promote walking as a management strategy for women with FM (including all elements for performing it properly), health providers should help patients to comply with their intentions by increasing perceived control.”