Abstract Objectives: This study explored potential resilience factors that facilitate engagement in physical activity (PA) among adolescents with chronic musculoskeletal pain after completing intensive interdisciplinary pain treatment. Methods: Ten adolescents aged 13 to 17 years with a history of chronic musculoskeletal pain from a mid-western pediatric hospital in the United States participated in this qualitative study. Participants provided demographic information and completed semistructured virtual interviews. The interviews focused on their pain experiences, resilience, and engagement in PA. Transcripts were analyzed using primarily directed content analysis based on a pain resilience framework. Results: Participants highlighted several key resilience factors that influenced their PA engagement, including positive affect, motivation, acceptance, and self-efficacy. Positive affect and mood affected their willingness and enjoyment of PA. Motivation was enhanced by focusing on short-term and long-term gains and setting smaller, manageable goals. Acceptance of pain allowed participants to engage in PA even on bad pain days, using psychological flexibility skills. Social support and the ability to pair PA with other valued activities, such as spending time with friends and family, were also crucial in maintaining PA engagement. Conclusion: The study identified resilience factors relevant to PA interventions for pediatric chronic pain. Incorporating strategies that enhance positive affect, motivation, acceptance, and self-efficacy, along with fostering social support, may improve PA engagement and could enhance the effectiveness of PA programs, promoting better outcomes for adolescents with pain. Future research should explore and further validate the importance of these resilience factors in larger, more diverse populations and across different stages of pain treatment.
Black et al. (2026) studied this question.