Do Cognitive Abilities Influence Physical and Mental Fatigue in Patients with Chronic Pain after Walking According to a Clinical Guideline for Physical Exercise?

Abstract

The objective of this study is to explore the mediator role of cognitive fusion and chronic pain acceptance on the effects that the walking pattern, following an established clinical guideline for physical exercise, can have on fatigue (physical and mental) in patients with chronic pain. The sample consisted of a total of 231 women with fibromyalgia with a mean age of 56.91 years (Standard Deviation SD = 9.58 years, range 30-78 years). The results show a significant indirect effect of the walking pattern on both physical and mental fatigue through cognitive fusion and chronic pain acceptance. Specifically, walking predicted less cognitive fusion, which predicted greater chronic pain acceptance, which, in turn, predicted less mental and physical fatigue (Beta-B- = -0.04, Standard Error SE = 0.02, 95% Confidence Interval 95% CI = [-0.09, -0.02]; B = -0.09, SE = 0.05, 95% CI = [-0.22, -0,15], respectively). It can be concluded that the walking pattern is linked to both physical and mental fatigue through cognitive defusion and chronic pain acceptance. These cognitive abilities would allow fibromyalgia patients to perceive an improvement in both physical and mental fatigue by carrying out the walking pattern. Emphasizing the training of cognitive defusion and pain acceptance would improve the adherence of these patients to walking.

Keywords: chronic pain; cognitive fusion; fibromyalgia; mental fatigue; pain acceptance; physical fatigue; walking.

Figure 1

Path diagram illustrating the direct effects and causal paths linking walking (for at least 30 minutes twice a week, over a minimum of six consecutive weeks) with mental fatigue. Notes: Serial multiple mediation analysis with walking as the independent variable, mental fatigue as the dependent variable, and cognitive fusion and acceptance as the first and second mediators. Values are unstandardized regression coefficients (SE in parentheses) and associated p values (** p < 0.01, *** p < 0.001). Bracketed association=direct effect (controlling for indirect effects). Solid lines indicate significant pathways, and dashed lines indicate nonsignificant pathways.

Figure 2

Path diagram illustrating the direct effects and causal paths linking walking (for at least 30 minutes twice a week, over a minimum of six consecutive weeks) with physical fatigue. Notes: Serial multiple mediation analysis with walking as the independent variable, physical fatigue as the dependent variable, and cognitive fusion and acceptance as the first and second mediators. Values are unstandardized regression coefficients (SE in parentheses) and associated p values (** p < 0.01, *** p < 0.001). Bracketed association=direct effect (controlling for indirect effects). Solid lines indicate significant pathways, and dashed lines indicate nonsignificant pathways.