Exercise + CBT for Chronic Pain

(SLEEPFIT Trial)

This trial aims to determine which non-medication treatment is most effective for individuals with chronic musculoskeletal pain, such as back pain or arthritis, who also experience sleep difficulties. Participants will join one of three groups to engage in aerobic physical activity (exercise), cognitive behavioral therapy for insomnia (CBT-I), or a combination of both. The trial includes online sessions with a physiotherapist and guidance on managing pain and sleep. It seeks individuals who have experienced significant pain and sleep issues, have not been very active recently, and can access online consultations. The goal is to improve pain management and sleep quality without relying on medication. As an unphased trial, this study offers the opportunity to explore innovative treatments that could enhance participants' quality of life.

The trial information does not specify whether you need to stop taking your current medications. It focuses on non-medication treatments for pain and sleep problems.

Research has shown that both aerobic exercise and cognitive behavioral therapy for insomnia (CBT-I) are generally safe and well-tolerated. Aerobic exercise, such as walking or cycling, can reduce pain and enhance physical abilities in individuals with chronic pain. Problems rarely occur when exercises are performed at a low-to-moderate level, such as 50-60% of maximum heart rate.

Similarly, CBT-I can improve sleep quality for those with insomnia and chronic pain. Studies have found it helps with sleep issues and can slightly reduce pain, with few side effects. Researchers have also studied the combination of CBT-I with exercise. This combination is safe and can lead to small to moderate improvements in pain relief and daily activities.

Researchers are excited about the treatments being tested for chronic pain because they combine physical and mental health strategies in unique ways. Unlike typical pain management options like medication or standard physical therapy, these treatments explore the use of aerobic physical activity and cognitive behavior therapy for insomnia (CBT-I) individually and together. Aerobic exercise is known to boost overall physical health and release endorphins, which can naturally alleviate pain. Meanwhile, CBT-I targets sleep-related issues, which often exacerbate chronic pain. The combination of physical activity with CBT-I is particularly promising because it simultaneously tackles physical discomfort and mental stressors that contribute to pain, potentially offering a more holistic approach to managing chronic pain.

This trial will evaluate the effects of different treatments for chronic pain. Studies have shown that regular aerobic exercise, which participants in one arm of this trial will receive, can help reduce long-term pain and improve physical abilities. Research suggests that exercising 3–6 times a week provides the best pain relief. Another arm of this trial will involve Cognitive Behavioral Therapy for Insomnia (CBT-I), which has been proven to greatly improve sleep quality and reduce pain and disability for those with sleep problems. The trial also includes a combined treatment arm, where participants will receive both aerobic exercise and CBT-I. Combining these treatments may improve overall health, although it might not be significantly more effective for pain relief than using each method separately. Together, these treatments could help manage ongoing muscle and joint pain and sleep issues.¹³⁶⁷⁸