Physical activity and positive affect boost cognition in women with fibromyalgia despite pain

By Tarun Sai LomteReviewed by Susha Cheriyedath, M.Sc.Jul 29 2024

In a recent study published in the Journal of Clinical Medicine, researchers evaluated the effects of physical activity and positive affect on the relationship between cognitive performance and pain severity in fibromyalgia patients.

Fibromyalgia is characterized by widespread fatigue, pain, and diverse cognitive and physical symptoms. Cognitive deficits, i.e., fibrofog, include difficulties in executive function, attention, and memory, significantly impacting patients' quality of life. Further, chronic pain is linked to cognitive impairments, with evidence suggesting that pain interferes with working and attentional memory, reducing performance in cognitive tasks.

Study: The Influence of Physical Activity and Positive Affect on the Relationship between Pain Severity and Cognitive Performance in Women with Fibromyalgia. Image Credit: designium / Shutterstock

Besides, physical activity can effectively enhance cognitive function, even in people with chronic pain. Regular exercise can augment memory and attention in fibromyalgia patients. One study reported that the Stroop test scores, a measure of executive function, were significantly improved after a 12-month exercise program. In addition, positive affect, i.e., the degree of positive emotion experienced, can have a vital role in cognitive function.

Positive affective states can broaden thoughts and actions and improve cognitive flexibility. A more significant positive effect is associated with enhanced adaptation to pain. Furthermore, reports suggest that positive affect can be a facilitator and consequence of physical activity. The interactions between positive affect and physical activity and their impact on cognitive performance may be relevant for people with chronic pain, especially fibromyalgia patients.

About the study

In the present study, researchers investigated the influence of positive affect and physical activity on the relationship between cognitive performance and pain severity in fibromyalgia patients. They selected a sample comprising females with fibromyalgia because it is predominant in females. Eligible participants were aged > 18, met the American College of Rheumatology's fibromyalgia diagnostic criteria, and had a medical prescription for walking with no physical limitations that would hinder physical activity.

The study involved two phases of assessment. The first phase comprised an assessment of clinical and demographic characteristics, positive affect, anxiety, physical activity, pain severity, and depression. The Stroop test was administered in the second phase to evaluate participants' cognitive performance. Pain severity was determined using four items from the brief pain inventory – current pain intensity and average, highest, and lowest pain intensity over the past week.

A 10-item subscale of the positive and negative affect schedule measured positive affect. The international physical activity questionnaire assessed physical activity levels. The study primarily focused on moderate levels of physical activity. Anxiety and depression were measured using the hospital anxiety and depression scale.

A questionnaire was administered to collect demographic and clinical data, including age, residence, relationship status, education, occupation, and medications. Pearson correlation coefficients analyzed the relationships between the main variables. A moderated mediation analysis was performed to investigate whether positive affect alters the indirect effects of pain severity on cognitive performance through physical activity.

Findings

The sample comprised 231 females aged 56.9, on average. Over 55% were rural residents, 15% had higher education, 53% were married, and 76% were homemakers. The weekly average use of muscle relaxants, antidepressants, sleeping pills, and analgesics was 2.4, 4.6, 4.3, and 5.5, respectively. Pain severity was inversely related to cognitive performance and physical activity.

Conversely, moderate physical activity was inversely related to cognitive performance but directly with positive affect. Cognitive performance was inversely related to the number of weekly analgesics and muscle relaxants. Depression was directly related to anxiety and the number of sleeping pills and antidepressants taken weekly; it was inversely associated with positive affect.

Anxiety was related to the number of sleeping pills and antidepressants used weekly. The moderated mediation analysis showed significant interactions between positive affect and pain severity. However, the interactions between positive affect and moderate physical activity were insignificant. Further, pain severity had a direct effect on moderate physical activity.

Likewise, moderate physical activity had a direct effect on cognitive performance. Further, positive affect moderated the mediation effect of moderate physical activity in the relationship between cognitive performance and pain severity. Besides, the mediating effect of physical activity depended on the degree of positive affect.

Conclusions

The findings suggest that patients with greater pain severity are more likely to reduce physical activity and that physical activity may improve cognitive function. Notably, positive affect moderated the relationship between physical activity and pain severity. That is, high levels of positive affect can enhance patients' ability to perform physical activity despite pain. Overall, promoting positive affect and physical activity could effectively alleviate chronic pain's effects on cognition.