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Tailored cognitive–behavioural therapy and exercise training improves the physical fitness of patients with fibromyalgia
  1. S van Koulil1,
  2. W van Lankveld2,
  3. F W Kraaimaat1,
  4. T van Helmond2,
  5. A Vedder2,
  6. H van Hoorn2,
  7. A R T Donders3,
  8. L Wirken1,
  9. H Cats2,
  10. P L C M van Riel4,
  11. A W M Evers1
  1. 1Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  2. 2Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
  3. 3Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  4. 4Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  1. Correspondence toS van Koulil, Department of Medical Psychology 840, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands; s.vankoulil{at}


Objectives Patients with fibromyalgia have diminished levels of physical fitness, which may lead to functional disability and exacerbating complaints. Multidisciplinary treatment comprising cognitive–behavioural therapy (CBT) and exercise training has been shown to be effective in improving physical fitness. However, due to the high drop-out rates and large variability in patients' functioning, it was proposed that a tailored treatment approach might yield more promising treatment outcomes.

Methods High-risk fibromyalgia patients were randomly assigned to a waiting list control group (WLC) or a treatment condition (TC), with the treatment consisting of 16 twice-weekly sessions of CBT and exercise training tailored to the patient's cognitive–behavioural pattern. Physical fitness was assessed with two physical tests before and 3 months after treatment and at corresponding intervals in the WLC. Treatment effects were evaluated using linear mixed models.

Results The level of physical fitness had improved significantly in the TC compared with the WLC. Attrition rates were low, effect sizes large and reliable change indices indicated a clinically relevant improvement among the TC.

Conclusions A tailored multidisciplinary treatment approach for fibromyalgia consisting of CBT and exercise training is well tolerated, yields clinically relevant changes, and appears a promising approach to improve patients' physical fitness. ID NCT00268606

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  • Funding This study was partly supported by grants from the Dutch Arthritis Association (‘Reumafonds’) and the Netherlands Organization for Health Research and Development (‘ZONMW’).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Commissie Mensgebonden Onderzoek (CMO) Regio Arnhem, Nijmegen.

  • Provenance and peer review Not commissioned; externally peer reviewed.