Catastrophic thinking reduced perceived benefits of physical activity in patients with fibromyalgia

According to a study published in International Journal of Environmental Research and Public Health.1 Intervention strategies that focus on reducing catastrophic thinking in addition to exercise may be beneficial for this patient population.

“Not all patients with fibromyalgia report seeing improvements in their physical health after performing the activity,” the researchers noted. “This discrepancy may be due to the severity of pain experienced by the patients, which has been shown in a previous study to predict functional disability. Taking into account that generalized chronic pain is the central symptom of fibromyalgia and that it leads to changes in the individual’s ability to function physically, it is possible that this mediates the relationship between gait behavior, improvements in functional impairment and the impact of the disease overall.”

Researchers assessed whether catastrophic thinking moderated the effects of perceived pain severity in patients with chronic pain using a sample of 491 adult women with a diagnosis of fibromyalgia according to American College of Rheumatology criteria. Participants participating in the cross-sectional study completed the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), the Pain Catastrophization Scale (PCS), the Brief Pain Inventory (to analyze the severity of pain), the Spanish version of the Hospital Anxiety and Depression Scale (HADS), and an ad hoc lifestyle item related to gait (regular walking). Gait pattern was defined as a minimum daily walking time of 30 minutes, at least 2 days per week, in part because of the highly sedentary target group and difficulty in maintaining physical activity in this patient population. A moderate mediation analysis analyzed the relationship between variables.

The mean age of the participants was 53.89 years (SD = 9.25), 75% were in a stable relationship, and 24% reported college-level education. Walking behavior was negatively correlated with catastrophic thinking, functional impairment, pain intensity and depression (p <0.001). Pain intensity was positively correlated with anxiety, depression, and catastrophizing.p <0.05). Catastrophizing was also associated with anxiety and depression (p <0.05). Sociodemographic and clinical variables, except age, were not associated with functional disability scores.

The association between performing the recommended gait and functional disability was mediated by pain severity (B = -5.19, SE = 1.59, t = -3.25, 95% CI = [-4.06, -0.28], p <0.001). In addition, the mediating effect of pain severity was moderated by catastrophizing (Index = -0.014, SE = 0.007, 95% CI [0.002, 0.030]).

The cross-sectional study design failed to derive cause-and-effect relationships between pain severity, catastrophic pain, gait behavior, and functional disability. Generalizability was limited because the sample consisted only of female patients with fibromyalgia. Bias in the answers is possible because evaluations were self-reported, which could influence the results. Finally, the study only included catastrophism as the main cognitive process. Other psychosocial factors, such as cognitive fusion, motivation and acceptance, should be included in future research.

“We can conclude that this study provides relevant results both for the clinical setting and for the field of the current research,” the researchers emphasized. “In particular, we found that gait adherence was significantly associated with functionality through pain. In addition, the positive effect of walking on disability, through the decrease in pain levels, is favored when patients have a low level of catastrophizing.”


Catalá P, Peñacoba C, López-Roig S, Pastor-Mira MA. Effects of walking as exercise on functional limitation from pain in patients with fibromyalgia: how does catastrophic thinking contribute? Int J Environ Res Public Health. 2022;20(1):190. Published December 23, 2022. doi:10.3390/ijerph20010190

Catastrophic thinking reduced perceived benefits of physical activity in patients with fibromyalgia

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