Resistance to Exercise and Psychological Factors that Affect

Resistance to Exercise and Psychological Factors that Affect Functional Recovery in Chronic Disorders SHRUTI MUTALIK, MD

Disclosure I have no financial relationships with any commercial interests related to the content of this activity

Pain �Pain : Solitary, consuming �Pain : Multimodal, not merely sensory �Nociceptive, and emotional/sensory processing �Pain and psychopathology : Bidirectional correlation

Pain : Psychopathology �Depression: link with functional outcomes, disability �Anxiety �Personality Disorders �Comorbid anxiety and depression : link with severity of pain �PTSD �Somatic Symptom Disorders �Substance abuse/dependence �Phantom limb pain �Complex regional pain syndromes

Screening for psychiatric disorders �Depression, anxiety screening, questionnaires �Recognition of need for focused psychiatric treatment �Antidepressants in chronic pain �Multidisciplinary approach

Functional outcomes �Impact on functional recovery �Impact on participation in exercise �Link between psychopathology and functional outcomes

Exercise �Evidence for mood and cognitive benefits �Meta-analysis of cohort studies : improved physical and physiological function in patients with chronic lower back pain �Exercise and functional outcomes

Coping with pain �Health locus of control �Pain related self efficacy �Pain acceptance �Predictors of treatment benefit?

Understanding Resistance �Barriers to physical activity �Patient perceptions, participatory social support (Heart failure patients) �Motivation to exercise and mood/anxiety/cognition

Motivating patients to exercise �Cognitive behavioral framework for conceptualizing resistance- CBT group therapy in chronic back pain to improve pain tolerance , lower disability �Interpersonal Therapy framework �Psychodynamic framework: Unconscious conflicts �Motivational interviewing, ambivalence

Motivational Interviewing: Evidence Base �Motivational Interviewing to increase physical activity in people with chronic health conditions: meta-analysis of ten trials, small effect in increasing physical activity levels in chronic health conditions �Improvement of exercise experience in MS �Motivational Interviewing and Exercise Programme for Community Dwelling older persons with Chronic Pain : improvements in mobility, pain intensity, anxiety

Motivational Interviewing A collaborative, person-centered form of guiding to elicit and strengthen motivation for change

Motivational Interviewing • Collaboration • Evocation • Autonomy • 1980 s: William Miller , Stephen Rolnick • Non- judgemental • Client Centered • Ambivalence

Prochaska & Diclemente Stages of Change

Motivational Interviewing

Motivational Interviewing �Avoid Arguing �Roll with Resistance �Express Empathy �Develop Discrepancy �Support Self-Efficacy

Summary �Heterogeneous psychopathology �Identification of psychiatric syndromes �Barriers to exercise �Collaborative approach to overcoming barriers �CBT, Motivational Interviewing

Thank you all!!

References � A Patient-Centered Approach to Addressing Physical Inactivity in Older Adults : Motivational Interviewing K, Goodman JH. J Gerontol Nurs. 2014 � Randomised controlled trial on the effectiveness of cognitive behavior group therapy in chronic back pain patients M, Scherbe S, Cicholas B. J Back Musculoskelet Rehabil. 2014 Aug 5 � Psychiatric aspects of pain. Curr Opinion Psychiatry 2007 Jan; 20(1): 42 -6. � Pain and depression: an integrative review of neurobiological and psychological factors. Goesling J, Clauw DJ, Hassett AL Psychiatry Rep. 2013 Dec; 15(12): 421. doi: 10. 1007/s 11920 -013 -0421 -0. � www. motivationalinterview. org � Motivational Interviewing to Increase Physical Activity in people with chronic health conditions : a systematic review and meta-analysis PD, Blackstock F, Shields N, Holland A, Iles R, Kingsley M, Bernhardt J, Lannin N, Morris ME, Taylor NF. Clin Rehabil. 2014 Jun 18. � Motivational interviewing and exercise programme for community-dwelling older persons with chronic pain : a randomized controlled study MM, Vong SK, Tang SK. J Clin Nurs. 2013 � Effect of Aerobic Exercise for Treatment of Chronic Lower Back Pain : A Metaanalysis Meng XG, Yue SW. Am J Phys Med Rehabil. 2014 Oct 8.