Positive Thinking and Moderate Exercise Boost Cognitive Function in Fibromyalgia

Lorena Gutiérrez, PhD

Credit: ResearchGate

Positive effect—defined as the degree of positive emotion a person experiences—can influence the impact of moderate physical activity on cognitive function among women with fibromyalgia, according to research published in Journal of Clinical Medicine.¹

“The experience of chronic pain, considered a main symptom of fibromyalgia, is strongly linked to impairments in cognitive performance,” wrote a group of investigators led by Lorena Gutiérrez, PhD, contracted doctoral professor in the Department of Psychology at the Rey Juan Carlos University, Madrid, Spain. “Previous research has shown that pain can interfere with attentional and working memory processes, resulting in lower performance in cognitive tasks. This phenomenon can be explained by the ‘limited workspace’ theory, where pain processing consumes cognitive resources that would otherwise be available for other tasks.”

Prior studies have touted physical exercise as an effective strategy to improve cognitive performance in patients with chronic pain disorders, such as fibromyalgia, due to reductions in inflammation and stress and increases in cerebral circulation. Positive effect has also been shown to improve cognitive flexibility and problem-solving skills by expanding the range of thoughts and actions. Therefore, patients with chronic pain who have greater positive affect are more likely to better adapt to pain and less likely to have pain impact daily life.²

To understand the relationship between pain severity and cognitive function through moderate physical activity, while considering the effects of positive affect, investigators conducted a prospective study of 231 women with fibromyalgia recruited from patient associations in Spain. The study was performed in 2 phases, the first of which involved evaluating anxiety, depression, pain severity, positive affect, and time spent exercising, as well as collecting demographics and clinical characteristics. In the second phase, a psychologist from the team conducted a cognitive performance test.

Positive affect was assessed using the Positive Affect subscale of the Positive and Negative Affect Schedule (PANAS), while physical activity was measured using the Spanish version of the International Physical Activity Questionnaire (IPAQ), a tool used to quantify physical activity performed during the last 7 days.

The average age of participants was approximately 57 years, approximately half (53%) were either married or in stable relationships, and most (76%) were housewives. Anxiety and depression were directly related to the number of antidepressants and sleeping pills taken per week and depressed patients were less likely to have higher positive affect.

Unsurprisingly, patients with greater pain severity had reduced levels of moderate physical activity, which was consistent with previous research.³ However, moderate physical activity showed a positive impact on cognitive function. Therefore, investigators encourage employing pain management strategies to ensure adequate physical activity.

Results of the moderation mediation model revealed the effect of physical activity on the relationship between cognitive function and pain severity was significant for low levels—but not moderate or high levels—of positive affect. Essentially, physical activity was able to mediate the relationship between pain severity and cognitive function, which was dependent on the level of positive affect. Investigators believe exercise may work by distracting patients and thus reducing pain perception, which allows cognitive resources to be freed up for other tasks. When positive affect levels are high, benefits of exercise may not be as obvious because the positive emotions are already providing a significant shield against pain on cognitive function. These patients are more likely to remain active despite pain.

“Promoting positive affect along with physical activity may be an effective strategy to mitigate the effects of chronic pain on cognition, thereby improving the quality of life of these patients,” investigators concluded.

References

1. ^{Catalá P, Gutiérrez L, Écija C, Peñacoba C. The Influence of Physical Activity and Positive Affect on the Relationship between Pain Severity and Cognitive Performance in Women with Fibromyalgia. J Clin Med. 2024;13(15):4419. Published 2024 Jul 28. doi:10.3390/jcm13154419}
2. ^{Zautra, A.J.; Johnson, L.M.; Davis, M.C. Positive Affect as a Source of Resilience for Women in Chronic Pain. J. Consult. Clin. Psychol. 2005, 73, 212–220.}
3. ^{Berryman, N.; Bherer, L.; Nadeau, S.; Lauzière, S.; Lehr, L.; Bobeuf, F.; Kergoat, M.J.; Vu, T.T.M.; Bosquet, L. Executive functions, physical fitness and mobility in well-functioning older adults. Exp. Gerontol. 2013, 48, 1402–1409.}