Effect of Acceptance and Commitment Therapy Plus Exercise on Chronic Pain

Results of a randomized controlled trial found that Acceptance and Commitment Therapy (ACT) combined with supervised exercise was not effective for decreasing pain interference among adults with chronic pain. These findings were published in Pain.

The combined exercise and ACT trial was a single-center, 2-arm, parallel group, randomized controlled superiority trial conducted at Mater Misericordiae University Hospital in Ireland between 2017 and 2018. Adults (N=175) with noncancer-related chronic pain and a Brief Pain Inventory (BPI) interference subscale score of at least 2 were randomly assigned to undergo either a combination of exercise and ACT (n=87) or exercise alone (n=88). The primary outcome was the change in pain interference at 12 weeks.

The activity trackers were worn by participants during waking hours for 1 week before starting the interventions and for the full duration of the interventions (9 weeks in total).

The intervention included 8 sessions once weekly, comprising 2 hours of group psychotherapy therapy that focused on the promotion of psychologic flexibility and mindfulness, followed by 1.5 hours of supervised gymnasium- or hydrotherapy-based exercise. The exercise alone intervention included only 1.5 hours of supervised gymnasium- or hydrotherapy-based exercise.

Among participants who received a combination of exercise and ACT and those who received exercise alone, the mean age was 48.41±10.39 and 47.69±11.67 years, 69% and 72.7% were women, and the mean duration of pain was 8.83±7.52 and 10.07±8.29 years, respectively. In addition, participants in the combined intervention and exercise alone groups had pain at a similar number of sites (mean, 4.14±2.39 vs 4.44±2.34), and 78.2% and 70.1% were unemployed, respectively.

Compared with patients in the intervention group, the rates of absence at any treatment session (17% vs 11.5%) and study withdrawal (17% vs 13.8%) were increased among those who underwent exercise alone. Of the 8 total sessions, participants in the intervention group attended a mean of 4.94±2.73 sessions and those in the exercise alone group attended a mean of 4.42±2.71 sessions.

Compared with baseline, participants in the intervention group reported significant decreases in BPI interference subscale scores at the end of treatment (mean, 6.86 vs 6.4; P =.03), with scores remaining stable through week 12 (mean, 6.36; P =.03). No significant decrease in BPI interference subscale scores was observed among participants in the exercise alone group at the end of treatment (mean, 6.92 vs 6.62; P =.185), including for scores assessed at week 12 (mean, 6.59; P =.17).

Despite significant longitudinal patterns observed within the groups, no significant between-group differences in BPI interference subscale scores were observed after all sessions were completed (mean difference [MD], -0.17; 95% CI, -0.78 to 0.44; P =.58), or at week 12 (MD, -0.18; 95% CI, -0.84 to 0.48; P =.59).

This study was limited by the inability to blind participants to their respective group assignments, as well as the number of participants’ lost to follow-up.

The researchers noted that “further studies of participants with varying degrees of baseline pain severity are warranted.”


Casey M-B, Smart KM, Segurado R, et al. Exercise combined with Acceptance and Commitment Therapy compared with a standalone supervised exercise programme for adults with chronic pain: a randomised controlled trialPain. 2022;163(6):1158-1171. doi:10.1097/j.pain.0000000000002487