Actigraphy-Based Physical Activity Monitoring in Adolescents With Juvenile Primary Fibromyalgia Syndrome


      Juvenile primary fibromyalgia syndrome (JPFS) is a chronic pain condition associated with significant impairment in physical functioning, but no studies have used newer technologies such as actigraphy to document objective physical activity levels in JPFS. This is the first study to objectively describe physical activity in JPFS patients and examine the relationship of pain, perceived functional impairment, and depressive symptoms on physical activity. One hundred four clinically referred adolescents with JPFS (ages 11 to 18 years) wore a hip-mounted actigraph for 1 week. Data on pain intensity, functional disability, depressive symptoms, and psychiatric diagnoses were obtained using self- and parent-report measures and a standardized psychiatric interview. Results showed that younger patients were more active. Pain intensity was not significantly associated with physical activity levels overall, but the most highly active group of adolescents reported lower levels of pain and disability than the least active. Parent report of adolescents' physical functioning and depressive symptoms were significantly correlated with adolescents' physical activity levels. Actigraphy provides a unique source of information about physical functioning which is distinct from adolescents' self-report of physical functioning in JPFS. Preliminary findings suggest that further study of factors that predict perceived and actual physical functioning in JPFS is warranted.


      This study presents the results of physical activity monitoring in adolescents with JPFS using actigraphy. Results indicate that actigraphy provides a unique source of objective information that can advance our understanding of physical disability in JPFS and the factors associated with physical impairment.

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        • Anthony K.K.
        • Schanberg L.E.
        Juvenile primary fibromyalgia syndrome.
        Curr Rheumatol Rep. 2001; 3: 165-171
      1. Centers for Disease Control and Prevention: Physical activity levels among children aged 9-13 years-United States, 2002.
        Morb Mortal Weekly Rep. 2003; 52: 785-788
      2. Centers for Disease Control and Prevention: National Center for Health Statistics, National Health and Nutrition Examination Survey United States, 1995-2005.
        National Center for Health Statistics, Vital and Health Statistics, 2005
      3. Centers for Disease Control and Prevention: Physical Activity Guidelines For Americans, Division of Nutrition, Physical Activity and Obesity. Available at:, National Center for Chronic Disease Prevention and Health Promotion, 2008

      4. Centers for Disease Control and Prevention: Youth Risk Behavior Surveillance: United States, 2007.
        Morb Mortal Weekly Rep. 2008; 57: 1-131
        • Claar R.L.
        • Walker L.S.
        Functional assessment of pediatric pain patients: psychometric properties of the functional disability inventory.
        Pain. 2006; 121: 77-84
        • Degotardi P.J.
        • Klass E.S.
        • Rosenberg B.S.
        • Fox D.G.
        • Gallelli K.A.
        • Gottlieb B.S.
        Development and evaluation of a cognitive-behavioral intervention for juvenile fibromyalgia.
        J Pediat Psychol. 2006; 31: 714-723
        • Eccleston C.
        • Jordan A.L.
        • Crombez G.
        The impact of chronic pain on adolescents: A review of previously used measures.
        J Pediatr Psychol. 2006; 31: 684-697
        • Eccleston C.
        • Morley S.
        • Williams A.
        • Yorke L.
        • Mastroyannopoulou K.
        Systematic review of randomised controlled trials of psychological therapy for chronic pain in children and adolescents, with a subset meta-analysis of pain relief.
        Pain. 2002; 99: 157-165
        • Finley A.G.
        • McGrath P.J.
        Progress in Pain Research and Management. Vol 10. IASP Press, Seattle, Wash1998
        • Flowers S.R.
        • Kashikar-Zuck S.
        • Johnson M.
        • Verkamp E.
        • Lynch-Jordan A.
        • Ting T.
        • Graham B.
        • Schikler K.
        • Spalding S.
        • Hashkes P.
        • Richards M.
        • Banez G.
        Physical activity monitoring in children and adolescents with juvenile primary fibromyaglia syndrome.
        J Pain. 2009; 10: S62
        • Gadow K.
        • Sprafkin J.
        The Symptom Inventories: An Annotated Bibliography.
        Checkmate Plus, Stony Brook, NY2005
        • Gauntlett-Gilbert J.
        • Eccleston C.
        Disability in adolescents with chronic pain: Patterns and predictors across different domains of functioning.
        Pain. 2007; 131: 132-141
      5. Goldenberg DL: The interface of pain and mood disturbances in the rheumatic diseases. Semin Arthritis Rheum, 2009 Feb 12;[Epublication ahead of print]

      6. Actical Software Instruction Manual [computer program]. Version 2.0. Bend, Ore, 2002

        • Kashikar-Zuck S.
        • Goldschneider K.R.
        • Powers S.W.
        • Vaught M.H.
        • Hershey A.D.
        Depression and functional disability in chronic pediatric pain.
        Clin J Pain. 2001; 17: 341-349
        • Kashikar-Zuck S.
        • Lynch A.M.
        • Graham T.B.
        • Swain N.F.
        • Mullen S.M.
        • Noll R.B.
        Social functioning and peer relationships of adolescents with juvenile fibromyalgia syndrome.
        Arthritis Rheum. 2007; 57: 474-480
        • Kashikar-Zuck S.
        • Parkins I.S.
        • Graham T.B.
        • Lynch A.M.
        • Passo M.
        • Johnston M.
        • Schikler K.N.
        • Hashkes P.J.
        • Banez G.
        • Richards M.M.
        Anxiety, mood, and behavioral disorders among pediatric patients with juvenile fibromyalgia syndrome.
        Clin J Pain. 2008; 24: 620-626
        • Kashikar-Zuck S.
        • Swain N.F.
        • Jones B.A.
        • Graham T.B.
        Efficacy of cognitive-behavioral intervention for juvenile primary fibromyalgia syndrome.
        J Rheumatol. 2005; 32: 1594-1602
        • Kashikar-Zuck S.
        • Vaught M.H.
        • Goldschneider K.R.
        • Graham T.B.
        • Miller J.C.
        Depression, coping and functional disability in juvenile primary fibromyalgia syndrome.
        J Pain. 2002; 3: 412-419
        • Kaufman J.
        • Birmaher B.
        • Brent D.
        • Rao U.
        • Flynn C.
        • Moreci P.
        • Williamson D.
        • Ryan N.
        Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data.
        J Am Acad Child Adolesc Psychiatry. 1997; 36: 980-988
        • Kop W.J.
        • Lyden A.
        • Berlin A.A.
        • Ambrose K.
        • Olsen C.
        • Gracely R.H.
        • Williams D.A.
        • Clauw D.J.
        Ambulatory monitoring of physical activity and symptoms in fibromyalgia and chronic fatigue syndrome.
        Arthritis Rheum. 2005; 52: 296-303
        • Korszun A.
        • Young E.A.
        • Engleberg N.C.
        • Brucksch C.B.
        • Greden J.F.
        • Crofford L.A.
        Use of actigraphy for monitoring sleep and activity levels in patients with fibromyalgia and depression.
        J Psychosom Res. 2002; 52: 439-443
        • Kovacs M.
        Children's Depression Inventory.
        Multi-Health Systems, Inc, North Tonawanda, NY1992
        • Long A.C.
        • Palermo T.M.
        • Manees A.M.
        Brief report: Using actigraphy to compare physical activity levels in adolescents with chronic pain and healthy adolescents.
        J Pediatr Psychol. 2008; 33: 660-665
        • McGrath P.J.
        • Walco G.A.
        • Turk D.C.
        • Dworkin R.H.
        • Brown M.T.
        • Davidson K.
        • Eccleston C.
        • Finley G.A.
        • Goldschneider K.
        • Haverkos L.
        • Hertz S.H.
        • Ljungman G.
        • Palermo T.
        • Rappaport B.A.
        • Rhodes T.
        • Schechter N.
        • Scott J.
        • Sethna N.
        • Svensson O.K.
        • Stinson J.
        • von Baeyer C.L.
        • Walker L.
        • Weisman S.
        • White R.E.
        • Zajicek A.
        • Zeltzer L.
        Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations.
        J Pain. 2008; 9: 771-783
        • Puyau M.R.
        • Adolph A.L.
        • Vohra F.A.
        • Butte N.F.
        Validation and calibration of physical activity monitors in children.
        Obes Res. 2002; 10: 150-157
        • Reid G.J.
        • Lang B.A.
        • McGrath P.J.
        Primary juvenile fibromyalgia: Psychological adjustment, family functioning, coping, and functional disability.
        Arthritis Rheum. 1997; 40: 752-760
        • Rowlands A.V.
        • Pilgrim E.L.
        • Eston R.G.
        Patterns of habitual activity across weekdays and weekend days in 9-11-year-old children.
        Prev Med. 2008; 46: 317-324
        • Sallis J.F.
        • Saelens B.E.
        Assessment of physical activity by self-report: Status, limitations, and future directions.
        Res Q Exerc Sport. 2000; 71: S1-S14
        • Stone A.A.
        • Shiffman S.
        • Schwartz J.E.
        • Broderick J.E.
        • Hufford M.R.
        Patient compliance with paper and electronic diaries.
        Control Clin Trials. 2003; 24: 182-199
        • Stone A.A.
        • Turkkan J.S.
        • Bachrach C.A.
        • Jobe J.B.
        • Kurtzman H.S.
        Cain V.S. The Science of Self-Report: Implications for Research and Practice. Lawrence Earlbaum Associates, Mahwah, NY1999
        • Varni J.W.
        • Burwinkle T.M.
        • Limbers C.A.
        • Szer I.S.
        The PedsQL as a patient-reported outcome in children and adolescents with fibromyalgia: An analysis of OMERACT domains.
        Health Qual Life Outcomes. 2007; 5: 9
        • Walker L.S.
        • Greene J.W.
        The functional disability inventory: Measuring a neglected dimension of child health status.
        J Pediat Psychol. 1991; 16: 39-58
        • Yunus M.B.
        • Masi A.T.
        Juvenile primary fibromyalgia syndrome: A clinical study of thirty-three patients and matched normal controls.
        Arthritis Rheum. 1985; 28: 138-145