International Journal of Environmental Research and Public Health Article Impact of Reducing Sitting Time in Women with Fibromyalgia and Obesity: A Randomized Controlled Trial Beatriz Rodríguez-Roca 1, Fernando Urcola-Pardo 1,2 , Ana Anguas-Gracia 1,2,3, Ana Belén Subirón-Valera 1,2,4 , Ángel Gasch-Gallén 1,5,* , Isabel Antón-Solanas 1,5,* and Ana M. Gascón-Catalán 1 1 Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain; [email protected] (B.R.-R.); [email protected] (F.U.-P.); [email protected] (A.A.-G.); [email protected] (A.B.S.-V.); [email protected] (A.M.G.-C.) 2 Research Group Water and Environmental Health (B43_20R), University Institute of Research in Environmental Science of Aragón, University of Zaragoza, 50009 Zaragoza, Spain 3 Research Group Safety and Care (GIISA0021), Institute of Research of Aragón, 50009 Zaragoza, Spain 4 Research Group Sector III Healthcare (GIIS081), Institute of Research of Aragón, 50009 Zaragoza, Spain 5 Research Group Nursing Research in Primary Care in Aragón (GENIAPA) (GIIS094), Institute of Research of Aragón, 50009 Zaragoza, Spain * Correspondence: [email protected] (Á.G.-G.); [email protected] (I.A.-S.) Abstract: Background: Sitting time has negative effects on health, increasing the risk of obesity, osteoporosis, diabetes, and cancer. Thus, primary health care education interventions aimed to reduce sitting time and sedentary behavior could have beneficial effects on people’s health and well- Citation: Rodríguez-Roca, B.; being. The purpose of this study was to assess the effectiveness of an intervention based on reducing Urcola-Pardo, F.; Anguas-Gracia, A.; sitting time to decrease cardiometabolic risk on a sample of women diagnosed with fibromyal- Subirón-Valera, A.B.; gia and moderate obesity. Methods: Randomized controlled trial to evaluate the effectiveness of Gasch-Gallén, Á.; Antón-Solanas, I.; an intervention to decrease cardiometabolic risk in 84 participants. Sedentary behavior was moni- Gascón-Catalán, A.M. Impact of tored using an accelerometer before and at 3-month follow-up. Results: Compared with the control Reducing Sitting Time in Women group, body mass index decreased, and the number of steps taken increased, in the intervention with Fibromyalgia and Obesity: group 3 months after the intervention. No significant differences were found in the rest of the A Randomized Controlled Trial. Int. J. variables measured. Conclusion: The intervention group decreased sitting time after the intervention. Environ. Res. Public Health 2021, 18, Group activities and support from primary care may be useful to improve treatment adherence. RCT 6237. https://doi.org/10.3390/ registration: NCT01729936. ijerph18126237 Keywords: sitting time; sedentary behavior; fibromyalgia; obesity Academic Editor: Stuart Biddle Received: 26 April 2021 Accepted: 7 June 2021 Published: 9 June 2021 1. Introduction Fibromyalgia (FM) is a chronic disorder characterized by chronic widespread mus- Publisher’s Note: MDPI stays neutral culoskeletal pain [1] and accompanied by fatigue, cognitive disturbances, psychiatric, with regard to jurisdictional claims in and multiple somatic symptoms [2]. FM has an unknown etiology and uncertain patho- published maps and institutional affil- physiology. As suggested by ongoing research, FM is considered to be a pain regulation iations. disorder and often classifies as a form of central sensitization syndrome [3]. Due to the nature of its symptoms, as well as its chronic nature, patients diagnosed with FM tend to engage in sedentary behavior (SB) [4]. SB occurs when “the energy expended is less than or equal to 1.5 metabolic equivalents (MET), keeping the posture of sitting or lying Copyright: © 2021 by the authors. down” [5]. SB is considered one of the major public health problems and it is a risk factor Licensee MDPI, Basel, Switzerland. for the development of noncommunicable diseases [6] including obesity [7], diabetes [8], This article is an open access article certain types of cancer [9], and sleep disturbances [10]. According to van der Ploeg [11] and distributed under the terms and Pines [12], SB shortens life expectancy and increases the risk of mortality independently conditions of the Creative Commons of physical activity. However, according to other authors [13], the risk of death associated Attribution (CC BY) license (https:// with prolonged sitting time (ST) can be reduced by moderate physical activity for 60 to creativecommons.org/licenses/by/ 75 min a day. 4.0/). Int. J. Environ. Res. Public Health 2021, 18, 6237. https://doi.org/10.3390/ijerph18126237 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, 6237 2 of 11 There is no curative treatment for FM. Symptom management strategies include pharmacological and nonpharmacological treatments aimed at alleviating pain, increas- ing restorative sleep, improving physical function, and, ultimately, improving quality of life [14]. As demonstrated by previous research, physical activities including aerobic exer- cise [15], strength exercises [16], pool activities [17], and daily steps [18] have a beneficial effect on people with FM. Specifically, physical activity can reduce the perception of pain and depression, and can improve the quality of sleep and self-management in patients with FM [18,19]. However, despite the evidence, women with FM tend to spend less time engaging in moderate and high intensity physical activity [20]. Previous studies on SB in different population groups, namely office workers [21], patients with chronic conditions [22], and even children [23], have found an association between reduced SB and positive health outcomes. In the population of patients with FM, a positive correlation has been established between reduced SB and impact of the disease on quality of life [19], pain, and fatigue [24]. However, as outlined above, patients with FM are significantly less active than sedentary healthy controls. Whereas ST seems to be consistently associated with symptoms of FM [25], there is insufficient evidence about the effects of reducing ST on health outcomes of people with FM who are overweight or moderately obese. In Spain, people with FM are frequently managed in the community by primary care nurses and physicians [26,27]. Primary healthcare providers are responsible for imple- menting health promotion programs, which can have a significant impact on patients’ lifestyle [28]. To our knowledge, there are no previous studies on health promotion inter- ventions aimed at reducing ST in patients with FM in our context. Our initial hypothesis was that reducing sitting time through a primary care health education intervention would reduce cardiometabolic risk in women with FM who were overweight or moderately obese. Therefore, the aim of this study was to evaluate the impact of a primary care health educa- tion intervention to reduce ST on cardiometabolic risk in a sample of patients diagnosed with FM and who were overweight or moderately obese. 2. Materials and Methods 2.1. Design We present the results from a randomized controlled trial to reduce daily hours of ST in overweight and obese women with FM. 2.2. Participants The participants were recruited from two primary care centers in the city of Zaragoza (Spain) from September 2013 to September 2014. A total of 494 women who had a diag- nosis of FM and were moderately obese or overweight were contacted via telephone by a researcher and qualified nurse (B.R.-R.), who explained the purpose of the investigation and invited them to take part in the study. If they accepted, they were given an appointment with the same researcher at their primary care center, where the selection criteria were carefully reviewed, the aim and procedures of the investigation were clearly explained, the consent form was signed (if applicable), and the participants were given an accelerometer with the aim of assessing and recording SB. The inclusion criteria to participate in this study were: (1) being female, (2) having a formal diagnosis of FM, (3) being 25–65 years old, (4) having a body mass index (BMI) of 25–34.9 kg/m2, and (5) spending more than 6 h a day sitting, as measured by the Marshall Sitting Questionnaire (MSQ) in its Spanish version [29]. We excluded individuals with contraindications to regular physical activity including osteoarticular diseases, advanced heart disease, severe walking difficulties, cancer on treatment, individuals who were not able to communicate in Spanish, and those who had an unstable demographic situation. Our rejection rate was high, with 282 women refusing to take part in the study. In addition, 88 women could not be contacted (a researcher gave them a phone call three times at different times and there was no reply) and 37 were excluded due to not meeting Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 3 of 12 times at different times and there was no reply) and 37 were excluded due to not meeting Int. J. Environ. Res. Public Health 2021, 18, 6237 3 of 11 the selection criteria. A final sample of 84 participants was recruited to participate in the Int. J. Environ. Res. Public Health 2021, 18, xstudy; FOR PEER 46 REVIEW were randomized to the intervention group and 38 3 toof 12the control group following a single-blind randomization method. Unfortunately, only 31 women in the intervention group and 21 in the control group, and 19 in the intervention group and 15 the selection criteria. A final sample of 84 participants was recruited to participate in the timesin atthe different control times group and there attended was no repl they) and first 37 wereand excluded second due post-intervention to not meeting assessments, the selection criteria. A final sample of 84 participants was recruited to participate in the study;respectively. 46 were randomizedFigure 1 shows to thea flowchart intervention of the group recruitment and 38 toprocess the control and RCT group design; following astudy; single-blind 46 were randomized randomization to the intervention method.