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Current behavioral interventions for weight loss in overweight and obesity present problems in maintaining long-term weight loss results. Acceptance and commitment therapy (ACT) could be a suitable approach to promote long-term weight loss. The aim of this pilot study is to evaluate the efficacy of an ACT-based intervention on body weight change at the end of the intervention and after a 9-month follow-up, in addition to analyzing the effects of the intervention on several variables of interest. Nine women (Mage= 44.11 years; SD= 5.82) attended a group intervention of 10 weekly sessions, addressing contents of eating habits, physical activity, and ACT. At the end of the intervention, the average weight loss was 2.8%, and after a 9-month follow-up, it was 3.9%. Based on the results, it can be concluded that the study provides evidence in favor of the suitability of ACT to help promote weight loss.

Resumen Introduccion En Espana el ictus es la sexta causa de discapacidad. Sus secuelas producen alteraciones motoras, sensoriales y cognitivas, que pueden minimizarse con una actuacion terapeutica temprana. Por ello se necesitan instrumentos de evaluacion rapida que detecten deficits en estas areas. El Oxford Cognitive Screen Test (OCS) es un test breve disenado para la valoracion de funciones cognitivas en pacientes con ictus. Nuestro objetivo fue generar una version espanola (OCS-E) realizando una adaptacion linguistica y cultural. Material y metodos Diseno de validacion linguistica con doble traduccion y 10 reuniones de consenso del equipo investigador multidisciplinar. Tres estudios piloto administrando el test respectivamente a 5 usuarios potenciales, 23 personas sanas y 23 diagnosticadas de ictus isquemico (61%) o hemorragico, con edades entre 31-88 anos. Resultados El OCS-E mantiene las 10 tareas originales, la codificacion de respuestas y el sistema de puntuacion. Se modificaron y ampliaron las instrucciones de administracion, lo que asegura la fiabilidad del contenido y de su aplicacion. En 5 tareas se han modificado imagenes, numeros y frases. La tarea praxia se amplio para evaluar ambos miembros superiores. Los estudios piloto confirmaron que las personas de la poblacion diana comprendian de forma adecuada las tareas, con independencia de la existencia de problemas cognitivos. Conclusiones La adaptacion cultural ha generado una version linguistica y conceptualmente equivalente, permitiendo su estudio psicometrico y posterior aplicacion en poblacion espanola. El OCS-E puede ser un instrumento de cribado util para evaluacion rapida de funciones cognitivas postictus.

Background: Aerobic exercise has a beneficial impact on physical and mental health. However, patients with fibromyalgia do not always report perceiving these improvements. Objective: The aim of this study was to examine whether catastrophic thinking moderated the effects of perceived pain severity once an active and regular lifestyle had been established on functional limitation in chronic pain patients, in particular in fibromyalgia patients. Methods: The sample consisted of a total of 491 women with fibromyalgia diagnosed according to the criteria of the American College of Rheumatology. Participants completed an ad-hoc item about lifestyle related to walking pattern, the Brief Pain Inventory, the Pain Catastrophization Scale, and the Fibromyalgia Impact Questionnaire-Revised. To examine the relationship between the variables, a moderate mediation analysis was performed through the macro PROCESS (model 14). Results: The relationship between the performance of the recommended walking pattern and functional limitation was mediated by the severity of pain (B = −5.19, SE = 1.59, t = −3.25, 95% CI = [−4.06, −0.28], p < 0.001). Furthermore, it was found that the mediating effect of pain severity was moderated by catastrophic thinking (Index = −0.014, SE = 0.007, 95% CI [0.002, 0.030]). Conclusions: The positive effect of walking on functionality through the reduction of pain levels is favored when patients present low catastrophizing, which affects the relevance of including interventions focused on the reduction of catastrophizing in the prescription of physical exercise in patients with fibromyalgia as the treatment of choice.

Objectives Avoidance, persistence, and pacing are activity patterns that have different adaptive effects in chronic pain patients. Some inconsistent findings have been explained from a contextual perspective that underlines the purpose of the activity. In this way, avoidance, persistence, and pacing are multidimensional constructs, nuanced by their goals. This multidimensionality has been supported with a new instrument, the Activity Patterns Scale, in heterogeneous chronic pain samples. Owing to the clinical implications of this conceptualization, the complexity of the activity patterns and their relationships with health outcomes in fibromyalgia (FM), our aim was to explore the construct validity of this scale in this pain problem, testing its internal structure and the relationships with other constructs. Materials and methods The sample included 702 women with diagnosis of FM from tertiary (53.3%) and community settings (46.7%). Confirmatory factor analysis was conducted to test different factor structures of the activity patterns and Pearson correlation to explore the relationships with health outcomes and psychosocial variables. Results A 6-factor structure showed acceptable fit indices (standardized root mean square residual=0.062; root mean-square error of approximation=0.066; comparative fit index=0.908). The highest significant relationships for health outcomes was between activity avoidance and FM impact (r=0.36) and excessive persistence and negative affect (r=0.41). Discussion Avoidance and persistence activity patterns are shown as multidimensional constructs but not pacing. The ongoing pain in these women may make it difficult to regulate their activity taking into account other goals not contingent on pain fluctuations.

Pain catastrophizing and pain acceptance have been associated with functioning in fibromyalgia. In relation to activity patterns, pacing has been defined as a helpful pattern to regulate activities in the context of value-based goals, but results regarding whether it is adaptive or not are controversial. This study analyzes the moderating role of pain acceptance between pain catastrophizing and pacing in 231 women with fibromyalgia. Moderation analyses were conducted with model 1 from the PROCESS Macro version 3.4. The results showed a clear moderating effect of pain acceptance. At low levels of pain acceptance, catastrophizing and pacing patterns maintained significant and positive associations. However, at high levels of pain acceptance, pacing was independent of catastrophizing. Far from considering pacing patterns as functional or dysfunctional per se, our results suggest that women with low pain acceptance carry out pacing influenced by catastrophizing independently of their goal pursuit, while patients who accept their pain may use pacing as a regulatory mechanism according to their goals.

This study analyzes the degree of agreement between three self-report measures (Walking Behavior, WALK questionnaire and logbooks) assessing adherence to walking programs through reporting their components (minutes, rests, times a week, consecutive weeks) and their concordance with a standard self-report of physical activity (IPAQ-S questionnaire) and an objective, namely number of steps (pedometer), in 275 women with fibromyalgia. Regularized partial correlation networks were selected as the analytic framework. Three network models based on two different times of assessment, namely T1 and T2, including 6 weeks between both, were used. WALK and the logbook were connected with Walking Behavior and also with the IPAQ-S. The logbook was associated with the pedometers (Z-score > 1 in absolute value). When the behavior was assessed specifically and in a detailed manner, participants’ results for the different self-report measures were in agreement. Specific self-report methods provide detailed information that is consistent with validated self-report measures (IPAQ-S) and objective measures (pedometers). The self-report measures that assess the behavioral components of physical activity are useful when studying the implementation of walking as physical exercise.

The objective of this study is to test the efficacy of a group motivational plus implementation intentions intervention in promoting adherence to an unsupervised walking program recommended for fibromyalgia, compared to an implementation intentions condition and to an active control condition. A triple-blind, randomized, longitudinal study with measures at baseline, short (seven weeks post-intervention), mid (12 weeks) and long-term (36 weeks) is performed. Data are analyzed using multilevel longitudinal growth curve two-level modelling. Participants are 157 women with fibromyalgia. In the short-term, adherence to the minimum and to the standard walking program (primary outcome measures) is explained by time (both

Physical activity and exercise are relevant behaviors for fibromyalgia health outcomes; however, patients have difficulties undertaking and maintaining an active lifestyle. With a cross-sectional design, this study explored the role of pain-related worrying and goal preferences in the walking persistence of women with fibromyalgia. The sample included 111 women who attended a tertiary health setting. We adapted the Six-Minute Walk Test where participants decided either to stop or continue walking in five voluntary 6 min bouts. Women who were categorized higher in pain-related worrying reported higher preference for pain avoidance goals (t = −2.44, p = 0.02) and performed worse in the walking task (LongRank = 4.21; p = 0.04). Pain avoidance goal preference increased the likelihood of stopping after the first (OR = 1.443), second (OR = 1.493), and third (OR = 1.540) 6 min walking bout, and the risk of ending the walking activity during the 30 min task (HR = 1.02, [1.0–1.03]). Influence of pain-related worrying on total walking distance was mediated by goal preferences (ab = −3.25). In interventions targeting adherence in physical activity and exercise, special attention is needed for women who are particularly worried about pain to help decrease their preference for short-term pain avoidance goals relative to long-term goals such as being active through walking.

(1) Background: Partner violence prevention programmes do not produce the expected behavioural changes. Accordingly, experts suggest applying evidence-based behavioural models to identify the determinants of abusive behaviours. In this research, we applied the reasoned action approach (RAA) to predict the performance (boys) and acceptance (girls) of abusive behaviours in adolescents. (2) Method: We designed a questionnaire based on the RAA and performed a cross-sectional study. We analysed the predictive capacity of the RAA constructs on intentions with the sample of single adolescents (n = 1112). We replicated the analysis only with those who were in a relationship (n = 587) and in addition analysed the predictive capacity of intention on future behaviour (3 months later). (3) Results: The hierarchical regression analysis performed with the sample of single adolescents showed that the model explained 56% and 47% of the variance of boys’ intentions to perform the controlling and devaluing behaviours, respectively; and 62% and 33% of girls’ intention to accept them. With those in a relationship, the model explained 60% and 53% of the variance of boys’ intentions to perform the controlling and devaluating behaviour, respectively, and 70% and 38% of girls’ intention to accept them. Intention exerted direct effects on boys’ performance of controlling and devaluing behaviours (31% and 34% of explained variance, respectively) and on girls’ acceptance (30% and 7%, respectively). (4) Conclusions: The RAA seems useful to identify the motivational determinants of abusive behaviours, regardless of adolescents´ relationship status, and for their prediction. Perceived social norms emerge as a relevant predictor on which to intervene to produce behavioural changes with both sexes.

Background: The Food Craving Acceptance and Action Questionnaire (FAAQ) was developed to measure food craving acceptance, but has not yet been adapted to Spanish. The aim of this study was to validate the FAAQ to the Spanish population and to analyze its psychometric properties.Method: Two studies were conducted. In the first study, the sample consisted of 224 undergraduate students who participated in the comprehension of the Spanish version and the Confirmatory Factor Analysis (CFA). The second sample consisted of 378 participants from a community sample who completed the refined version of the FAAQ and similar and dissimilar measures.Results: Study (1) The CFA was conducted, showing an inadequate fit of the model (CFI = 0.74, RMSEA = 0.18). Therefore, FAAQ was refined and it was administered to the community sample. Study (2) After an exploratory factor analysis, two factors were obtained as in the original FAAQ, Acceptance (30.92% variance explained) and Willingness (36.05%). The internal consistency was adequate for both subscales (ω = 0.88 and ω = 0.87, respectively). Correlation between the factors was r = 0.07, which provides evidence that Acceptance and Willingness are different constructs. Correlations of Acceptance with similar variables (r between −0.30 and −0.52) were stronger than the dissimilar measures (r between −0.26 and 0.24). This did not occur for the Willingness subscale, since correlations were low in all cases (r between −0.22 and 0.25).Conclusions: Spanish version of the FAAQ showed evidence of its reliability and validity, and may be a measure to provide a better understanding of how acceptance of thoughts and emotions concerning food and willingness impact eating management behaviors.

Intimate partner violence against adolescent girls is of increasing political and social concern. This paper presents formative research on the reasoned action approach (RAA) to the prediction of boys’ perpetration and girls’ acceptance of four psychologically abusive behaviors. Our objectives were: (1) to identify the behavioral and normative modal beliefs behind males’ performance and girls’ acceptance of the behaviors and (2) to explore the relationship between attitudes, perceived social norm, intention and behavior. A total of 479 adolescents between 14 and 18 years of age completed questionnaires on the performance (boys) or acceptance (girls) of a specific behavior. We used a grouping process to identify modal beliefs and carried out eight exploratory multiple regression analysis (one per behavior) to study attitude and social norm as predictors of intention and behavior. Positive and negative behavioral beliefs coexist in boys’ and girls’ minds, which can reflect an unclear positioning against abusive behaviors. Positive outcomes seem to be influenced by socialization processes and love myths. Peers can be a risk factor whereas parents are a protective factor against the performance and acceptance of these behaviors. Results showed significant relationships between the constructs in the sense specified by the model. Prevention programs could benefit by: managing participants’ individual behavior, intervening separately with boys and girls, overcoming adolescents’ confusion regarding these behaviors, and targeting parents as a means of discouraging their performance and acceptance. The RAA appears a useful tool for explaining and predicting the performance and acceptance of abusive behaviors.

espanolLa fibromialgia es una enfermedad cronica con dolor musculo-esqueletico como sintoma principal. El ejercicio fisico es una herramienta optima para la mejora de los sintomas. Las pacientes asocian empeoramientos a la ejecucion de actividad fisica, por lo que acaban por evitarla. Los objetivos fueron: (1) Evaluar y describir la preferencia por metas de logro relacionadas con ejercicio fisico frente a metas de evitacion del dolor y su perfil sociodemografico y clinico y (2) establecer la asociacion entre esa preferencia de metas y diferentes patrones de actividad fisica. Metodo: se utilizo un diseno correlacional y transversal, evaluando a 260 mujeres con fibromialgia en preferencia de metas respecto a ejercicio fisico, patrones de actividad y estado emocional. Resultados: Las mujeres con preferencia por metas de ejercicio fisico no puntuaron significativamente diferente a las mujeres que mostraron la preferencia contraria en ninguna de las variables sociodemograficas y clinicas estudiadas. La preferencia por evitar el dolor se asocio significativamente a patrones de actividad fisica de evitacion y de menor persistencia. Conclusiones: Las pacientes suelen preferir metas relacionadas con la evitacion del dolor. Esta preferencia no se asocia a ningun perfil sociodemografico o clinico, pero si a diferentes patrones de actividad. Dada la relevancia del ejercicio fisico en el tratamiento, intervenir para que sea una meta relevante se configura como una meta terapeutica. EnglishFibromyalgia is a chronic disease with musculoskeletal pain as main symptom. Physical exercise is an optimal strategy for the improvement of the symptoms. Patients associate deteriorate physical activity, so they end up avoiding it. The objectives were: (1) Evaluate and describe the preference for achievement goals related to physical exercise versus avoidance goals pain and sociodemographic and clinical profile, and (2) establish the association between that setting goals and different patterns of physical activity. Method: A correlational design was used, evaluating 260 women with fibromyalgia in preference to goals regarding physical exercise, activity patterns and emotional state. Results: Women with preferences for physical exercise goals did not score significantly differently than women who showed the opposite preference in the sociodemographic and clinical variables studied. The preference to avoid pain was significantly associated with patterns of avoidance of physical activity and less persistence. Conclusions: Patients generally prefer goals related to pain avoidance. This preference is not associated with any sociodemographic or clinical profile, but with different activity patterns. Given the relevance of physical exercise in the treatment, intervening to be a relevant goal is configured as a therapeutic goal.

Introducción: La fibromialgia es un trastorno crónico que cursa con dolor músculo-esquelético generalizado, con frecuencia acompañado de numerosa comorbilidad. Dentro de la necesidad de un abordaje multidisciplinar, el ejercicio físico aeróbico se recomienda como tratamiento de primera elección. Objetivo: Analizar las creencias, bajo el modelo de la Teoría de la Acción Planeada, asociadas a la intención de “caminar 2-4 veces por semana, un mínimo de 30 minutos, intercalando un pequeño descanso, durante al menos 6 semanas consecutivas”. Método: se utilizó un diseño longitudinal con dos medidas (T1-T2) con una diferencia de 6 semanas, con 275 (T1) y 219 (T2) mujeres con fibromialgia. Resultados: Existe una tendencia a la significación en la relación entre intención y conducta de caminar (x2= 3.336, p=.068). Se observan diferencias estadísticamente significativas en las creencias comportamentales positivas (p=.004), en las creencias comportamentales negativas (p=.008) y en las creencias normativas prescriptivas (p=.002) entre las pacientes con alta y baja intención.La recomendación medica de caminar y la intensidad de dolor percibida se asocian significativamente con las creencias comportamentales positivas y con las creencias de control inhibidoras. Conclusiones: La intención de caminar según la pauta establecida se relaciona con creencias comportamentales positivas relativas a consecuencias generales de salud, y no a la mejora específica de la sintomatología relacionada con la fibromialgia.

Objective This study aimed to examine the relationship between cognitive factors (cognitive fusion and catastrophizing) and functional limitation experienced by patients with fibromyalgia across different levels of pain severity (i.e., moderation). Methods The sample comprised 226 women with fibromyalgia. Their mean age was 56.91 years (standard deviation = 8.94; range = 30 to 78 years). Results Pain severity, cognitive fusion, and all components of catastrophizing (i.e., rumination, magnification, and helplessness) contributed to greater fibromyalgia impact on functioning in the multivariate analyses (all P Conclusions The results suggest that in interventions to improve functioning in people with fibromyalgia, some maladaptive forms of thought management (i.e., cognitive fusion and magnification) preferably should be challenged at milder levels of pain severity. According to our findings, cognitive fusion and magnification might have less room to impact functioning at higher levels of pain severity; therefore, rumination and helplessness, which had comparable associations with functioning irrespective of pain levels, would be preferable targets in psychological interventions in patients with fibromyalgia experiencing more severe pain levels.

The intrinsically adaptive or maladaptive nature of certain activity patterns in fibromyalgia (FM) has been put into question. The role of contextual factors related to their influence on functional limitation is required. Perfectionism complicates the ability to cope of these patients. The aim of the study has been to analyze the moderating role of perfectionism between activity patterns and functional limitation. The sample were 228 women with FM. Moderation analyses were conducted with the PROCESS Macro. Activity avoidance and excessive persistence were associated with poorer functionality, regardless of perfectionism. Pain avoidance and task persistence were more strongly associated with FM impact in women with high or moderate levels of perfectionism. In a clinical setting adapting the recommendations given to patients according to their level of perfectionism would be justified. Pain avoidance might be inadvisable at high levels of perfectionism, and task persistence is recommendable especially when perfectionism is high.

Although fatigue usually goes unnoticed, it is a symptom that poses great challenges to patients with fibromyalgia and is a strong limitation. The aim of this study is to identify and describe the variables involved in fatigue in nine different situations of the Goal Pursuit Questionnaire (GPQ) that may occur in the daily lives of women with fibromyalgia, according to an ABC (Antecedents–Behaviors–Consequences) model. This study followed a qualitative descriptive research method and a deductive–inductive hybrid approach based on a phenomenological paradigm. Twenty-six women with fibromyalgia participated in focus group discussions between February and March of 2018. Thematic content analysis was carried out from transcribed verbatim interviews. We identified nine major themes that emerged from the participants’ conversations: self-imposed duties, muscle fatigue, overwhelming feeling of tiredness, difficulty thinking, difficulty concentrating, negative emotions, lifestyle changes, affected everyday activities, and lack of motivation for daily activities and social interactions. We conclude that the ABC model allowed certain elements to emerge regarding the fatigue experience, highlighting its importance as a symptom in fibromyalgia. This additional analysis of the ABC model showed that fatigue can be described through the 4 U’s Rule, which is integrated by these four adjectives: (1) Unpredictable, (2) Uncontrollable, (3) Unseen, and (4) Unintelligible. Identifying these characteristics can contribute to a better understanding of fibromyalgia in addition to better treatment for these patients.

Fibromyalgia (FM) is a highly disabling condition characterized by widespread chronic pain. Physical exercise, such as walking, has been recommended as the treatment of choice for FM. However, adherence to physical exercise tends to be poor. Pain is one of the main inhibitors to adhere to walking in FM patients. The main objective of this study has been to determine whether there is a clinical and psychosocial profile to help predict individual differences in adherence to walking in a sample of patients with FM with severe pain levels. In this cross-sectional study, the sample was composed of 172 women with FM and severe pain levels (> 7 in an 11-point numerical scale). Women were classified into two groups: (1) those who walked regularly and (2) patients who rarely or never walked. Group differences regarding clinical outcomes (e.g., FM impact, anxiety, depression, cognitive fusion, catastrophizing, affect, and personality), sociodemographic variables, and medical history were analyzed. Patients who walked despite pain significantly reported less impact of FM, anxiety, depression, catastrophizing, cognitive fusion, negative affect, openness to experience, agreeableness, and conscientiousness. The unique predictors of group membership (walking versus no walking) in a binary regression were FM impact and negative affect. The results show that adherence to exercise might be influenced and predicted by the clinical profile of the patient, which suggests that personalized motivational interventions should be addressed to this at-risk subgroup.

Background Exercise and physical activity are an evidence-based practice for chronic pain. Health professionals need instruments to assess self-efficacy for this practice taking into account the specific barriers of patients with these health problems. Purpose To develop and test the psychometric properties of a new self-efficacy scale for physical activity and walking exercise in patients with fibromyalgia. Design A cross-sectional and prospective study was conducted in a Spanish Fibromyalgia Unit. Two hundred and eleven new patients signed the informed consent and participated in the study. All of them were women, referred to by either Primary or Specialized Health Care. In addition to the new scale, they filled out several self-reported and validated instruments to collect the data present in this study. Results Exploratory factor analysis showed a three-factor model (GFI = .99; RMSR = .06) that explained 74.2% of the total variance. They assessed how confident patients felt about walking quickly in both 30- and 60-minute sessions, (Factor I: 10 items; α = .97), to perform daily physical activities (Factor II: 10 items; α = .93) and to undertake moderate physical activity (Factor III: 5 items; α = .95). The total score of the scale and the three-factor scores showed good criterion validity and adequate validity based on the relationships with other constructs. Conclusions The scale showed adequate psychometric properties and can be a useful tool to help health professionals monitor patients’ self-efficacy perception and customize both physical activity and walking exercise intervention goals and their implementation.

Monitoring/controlling behaviours can be present in the early stages of an abusive relationship. Because of the need for evidence-based interventions grounded on behavioural models that identify th...

Being physically active has positive effects on fibromyalgia functioning. However, promoting an active lifestyle in these patients continues to be a relevant clinical challenge. Our aim was to test a motivational model to explain light (LPA) and moderate-vigorous physical activity (MVPA). A cross-sectional prospective study was conducted at a tertiary level of care. Participants completed sociodemographic, clinical, motivational (physical activity self-efficacy and goal preferences) and behavioral measures (activity avoidance). LPA and MVPA were measured with triaxial accelerometers, starting the same day of the aforementioned assessment. Out of 211 women, 183 completed this measure. Structural models were performed. Our results show that the best fit indices (CFI = 0.97, SRMR = 0.04) showed a model with direct influence of PA self-efficacy on MVPA (p < 0.01) and indirect influence on LPA (p < 0.001). LPA received the influence of PA self-efficacy mainly through activity avoidance (p < 0.01). Clinical variables did not have any effect on PA intensities. Thus, the motivational variables showed different paths to explain two PA intensities. Targeting PA self-efficacy in rehabilitation settings is needed to enhance both daily LPA and MVPA intensities.

Occupational balance (OB) may be a major determinant of health outcomes due to its role in bringing a sense of purpose in the occupations that are personally experienced as a process of getting health and wellness. The Occupational Balance Questionnaire (OBQ) is a reliable instrument for measuring OB, although it has not been adapted and validated in Spain so far, therefore, this study had a double aim: (1) to translate and cross-culturally adapt the original OBQ version into Spanish (OBQ-E), (2) to analyze the psychometric properties for its use in the Spanish population. Standard procedures were used for the cross-adaptation process and pilot testing was carried out using three different samples to extend the applicability of the OBQ-E. Validation measures of the final version of the OBQ-E were conducted in a sample of 219 participants. The OBQ-E showed that items and instructions were culturally appropriate and written clearly. Psychometric testing showed excellent internal consistency (Cronbach’s alpha = 0.87, Guttman split-half coefficient = 0.85), good test–retest reliability (rs (Spearman rho) = 0.73), and acceptable convergent validity (overall status, rs = 0.37, Related Quality of Life, rs = 0.42, Satisfaction with Life Scale, rs = 0.54). The findings suggest that the OBQ-E may be a suitable instrument for assessing OB in the Spanish population, hence, it is a promising tool for epidemiological research that will significantly contribute to the understanding of OB as a health-related factor. Nevertheless, further investigation is also warranted to explore the potentiality of this instrument for clinical purposes.

The fear-avoidance model provides an explanation for the development of chronic pain, including the role of perception (i.e. pain catastrophism) as an explanatory variable. Recent research has shown that the relationship between pain catastrophism and avoidance is influenced in turn by different psychological and contextual variables, highlighting the affective-motivational ones. From this perspective, the Goal Pursuit Questionnaire (GPQ) was developed to measure the preference for hedonic goals (mood-management or pain-avoidance goals) over achievement goals in musculoskeletal pain patients. Recently, the Spanish version of the GPQ in fibromyalgia patients has been validated. Our aim has been to adapt the Spanish version of GPQ from pain to fatigue symptoms and to validate this new questionnaire (GPQ-F) in fibromyalgia. Despite the recognition of fibromyalgia as a complex disorder and the need for a differential study of its symptoms, fatigue, despite its high prevalence and limiting nature, remains the forgotten symptom. We conducted a cross-sectional study with 231 women with fibromyalgia. Previously, we adapted the Spanish GPQ for fatigue symptoms with three sub-studies (group structured interview, self-administration questionnaire and thinking-aloud; n = 15–27 patients). We explored the GPQ structure and performed path analyses to test conditional mediation relationships. Exploratory factor analysis showed two factors: ‘Fatigue-avoidance goal’ and ‘Mood-management goal’ (39.3% and 13.9% of explained variance, respectively). The activity avoidance pattern fully mediated the relation between both catastrophizing and fatigue-avoidance goals with fatigue. The study shows initial findings about the usefulness of the GPQ-F as a tool to analyze goal preferences related to fatigue in fibromyalgia. The results supported the mediational role of activity avoidance patterns in the relationship between preference for fatigue-avoidance goals and fatigue.

Background: The psychological flexibility model states that activity patterns are not deemed to be intrinsically functional or dysfunctional, it is considered that underlying factors, such as personal goals and contextual factors, are what will determine their effects on disability. Pain catastrophizing has frequently been associated with several important pain-related outcomes. Despite its recent conceptualization within affective–motivational approaches, its moderating role between activity patterns and dysfunction has not been analyzed. Methods: This study analyzes the moderating role of pain catastrophizing and its dimensions (Pain Catastrophizing Scale) between activity patterns (Activity Patterns Scale) and disease impact (Fibromyalgia Impact Questionnaire—Revised) in 491 women with fibromyalgia. Results: Activity avoidance (p &lt, 0.001), excessive persistence (p &lt, 0.001) and pacing (p &lt, 0.01) patterns were positively associated with fibromyalgia impact. Helplessness shows a moderating role between pain avoidance (B = 0.100, t =2.30, p = 0.021, [0.01, 0.18]), excessive persistence (B = −0.09, t = −2.24, p = 0.02, [−0.18, −0.01]), pain persistence (B = −0.10, t = −2.04, p = 0.04, [−0.19, −0.004]) and functioning. Conclusion: Helplessness (within pain catastrophizing) is a relevant variable within psychological flexibility models applied to activity patterns. Specifically, pain avoidance is especially dysfunctional in patients with high helplessness. To improve excessive persistence and pain persistence, it is necessary to reduce helplessness before regulating activity patterns.

Resumen Antecedentes y objetivo La evaluacion funcional es relevante en pacientes con deterioro cognitivo (DC). La escala Disability Assessment for Dementia (DAD) mide la capacidad funcional y su uso esta cada vez mas extendido. El objetivo es realizar una traduccion y adaptacion cultural de la escala DAD para generar una version espanola: DAD-E. Pacientes y metodo Se ha desarrollado un proceso de doble traduccion y traduccion inversa, un estudio piloto con 14 cuidadores de pacientes con deterioro cognitivo y 3 reuniones de consenso. Resultados El DAD-E mantiene los 40 items originales. Se han anadido a la codificacion de respuestas y puntuaciones originales 4 opciones de respuesta y 8 puntuaciones con el objetivo de detectar la discapacidad funcional exclusivamente causada por DC. Se han modificado y ampliado las instrucciones de administracion para mejorar la fiabilidad del contenido. Conclusiones La version DAD-E supone una adaptacion linguistica y cultural equivalente de la escala original, lo que permite su uso en nuestro contexto espanol. Puede ser un instrumento de gran utilidad clinica, ya que proporciona una evaluacion mas precisa de la discapacidad funcional causada por DC.

Some motivational models understand health behavior as a result of the interaction between goal preferences and mood. However, this perspective has not been explored in fibromyalgia. Furthermore, in chronic pain, it has only been explored with regard to negative affect. Thus, our aims were: (1) to develop a Spanish version of the Goal Pursuit Questionnaire (GPQ); (2) to explore the relationships between goal preferences and health outcomes, testing the moderator role of affect and the mediating role of chronic pain activity patterns. We conducted two cross-sectional studies. In Study 1, after a double translation/back-translation process, we interviewed 94 women attending the Fibromyalgia Unit of the Community of Valencia in order to identify the cultural feasibility and the content validity of the GPQ. Study 2 comprised 260 women. We explored the GPQ structure and performed path analyses to test conditional mediation relationships. Eight activities from the original GPQ were changed while maintaining the conceptual equivalence. Exploratory factor analysis showed two factors: ‘Pain-avoidance goal’ and ‘Mood-management goal’ (37 and 13% of explained variance, respectively). These factors refer to patients’ preference for hedonic goals (pain avoidance or mood-management) over achievement goals. Robust RMSEA fit index of the final models ranged from 0.039 for pain to 0.000 for disability and fibromyalgia impact. Pain avoidance goals and negative affect influenced pain mediated by task-contingent persistence. They also affected disability mediated by task and excessive persistence. Pain avoidance goals and positive affect influenced fibromyalgia impact mediated by activity avoidance. We also found a direct effect of negative and positive affect on health outcomes. Preference for pain avoidance goals was always related to pain, disability and fibromyalgia impact through activity patterns. Affect did not moderate these relationships and showed direct and indirect paths on health outcomes, mainly by increasing persistence and showing positive affect as an asset and not a risk factor. Intervention targets should include flexible reinforcement of achievement goals relative to pain avoidance goals and positive affect in order to promote task-persistence adaptive activity patterns and decreased activity avoidance.

PURPOSE The aim of the study was to analyze the profile of fibromyalgia patients receiving medical advice to walk and who complied with the advice according to a specific clinical pattern. A further aim has been to analyze the elements that increase adherence to walking. DESIGN A cross-sectional study with 920 women with fibromyalgia. METHODS Sociodemographic and clinical variables, walking behavior, and medical advice to walk were assessed. FINDINGS AND CONCLUSIONS Patients who adhere to walking have a lower likelihood of being tired. Regular walkers (patients who walk according to a specific clinical pattern) have a lower likelihood of comorbidity. Patients who receive medical advice to walk are more likely to walk more than 30 minutes and to take a break between bouts. CLINICAL RELEVANCE Nurses caring for people with fibromyalgia should include strategies to promote walking, especially in patients with low adherence profiles, paying attention to all elements of behavior.

The main objective of this study is to identify fibromyalgia syndrome (FMS) clusters using the Revised Fibromyalgia Impact Questionnaire (FIQR), and to examine whether the clusters differ in sociodemographic characteristics, clinical measures, direct and indirect costs, levels of inflammatory markers, and brain morphometry. A hierarchical cluster analysis was performed to classify a large, pooled Spanish sample of patients with FMS (N = 947) using the FIQR as clustering variable. A latent profile analysis was subsequently conducted to confirm the optimal number of FMS clusters. To examine external validity, a battery of clinical measures, economic costs, inflammatory markers, and gray matter volumes of relevant cortical and subcortical areas were analyzed. We also compared the discriminant validity of the clusters with the original FIQR severity categories. To promote the implementation in real-world clinical practice, we built a free online cluster calculator. Our findings indicated that a four-cluster solution more clearly captured the heterogeneity of FIQR data and provided the best fit. This cluster solution allowed for detection of differences for most clinical outcomes and economic costs. Regarding the inflammatory and brain-based biomarkers, differences were found in C-reactive protein, and tendencies were found in the right medial prefrontal cortex, the right parahippocampal gyrus, and the right middle cingulate cortex; brain regions associated with executive functions and pain processing. The original FIQR categories presented similar results, although their precision in discriminating among the nonextreme categories (ie, moderate and severe) was not sound. These findings are discussed in relation to previous research on FMS clustering.

Objective: The aim of this study is to examine the psychometric properties of the Spanish version of the Oxford Cognitive Screen in a subacute stroke population. Participants and setting: Fifty-seven subacute stroke outpatients and 54 healthy individuals were recruited in Alicante province, Spain. Main measure: The Oxford Cognitive Screen. Other measures: The Montreal Cognitive Assessment, the Barcelona test, and the Barthel Index. Design: A validation study was conducted to analyze the inter-rater, intra-rater, test–retest, and internal consistency of the Spanish version of the Oxford Cognitive Screen. Concurrent validity was assessed using the Montreal Cognitive Assessment and the Barcelona test, and divergent validity using the Barthel index. Discriminant indices such as the sensitivity, specificity, predictive values, and optimal cut-offs were also estimated. Results: The subtests of the Spanish version of the Oxford Cognitive Screen showed excellent estimates for the inter-reliability (intraclass correlation coefficient (ICC) = 0.790 to 1.000; rs = 0.693 to 1.000), and acceptable-good for intra-reliability (ICC = 0.181 to 0.990) and test–retest reliability ( rs = 0.173 to 0.971). Internal consistency was also excellent (standardized Cronbach’s α = 0.907). Spearman correlations for the concurrent validity were low-strong ( rs = −0.193 to 0.95) and low-moderate ( rs = −0.091 to 0.443) for divergent validity. The optimal cut-offs estimated for the subtests of the Spanish version of the Oxford Cognitive Screen showed good-high specificity (66.7%–100%) and positive predictive value (67.9%–100%), and low-good sensitivity (14.8%–83.3%) and moderate-good negative predictive value (53.5%–76.6%). Discriminant power as measured by the area under the curve indicated acceptable-good values (0.397 to 0.894). Conclusion: Our findings support that the Spanish version of the Oxford Cognitive Screen is a reliable and valid tool for screening cognitive impairments in subacute stroke patients.

Physical exercise is recognized as a component of the evidence-based guidelines for treatment of fibromyalgia. Walking is a low-moderate intensity exercise easily adaptable to a fibromyalgia patient's situation. The present study aims to estimate the prevalence of unsupervised walking for exercise in women with fibromyalgia, to describe their level of physical activity and to identify their predictors among socio-demographic, symptom perception and medical advice to walk. A cross-sectional survey with 920 women (all members of fibromyalgia associations) completed the International Physical Activity Questionnaire-Short Form and self-reported scales to assess symptom perception, walking, medical advice to walk and physical comorbidity. The prevalence of reported walking regularly as physical exercise was 30.8 % and it was predicted by medical advice (odds ratio, OR 1.876), age (OR 1.021) and fatigue intensity (OR 0.912). The prevalence of physical activity was 16 % for high-intensity activity, 40 % for moderate activity and 44 % for low activity. Predictors of low versus moderate and high physical activity were pain intensity (OR 1.171) and fatigue impact perception (OR 1.076). Evidence shows a low percentage of women with fibromyalgia walking regularly for physical exercise. Most reported low or moderate physical activity. The results indicate the importance of doctors' advice in promoting walking. Symptom perception and socio-demographic characteristics were weak predictors. Further work is required to examine other determinants of these low levels.

Although exercise is essential for the treatment of fibromyalgia, adherence is low. Walking, as a form of physical exercise, has significant advantages. The aim of this article is to describe, in 920 women with fibromyalgia, the prevalence of certain walking beliefs and analyze their effects both on the walking behavior itself and on the associated symptoms when patients walk according to a clinically recommended way. The results highlight the high prevalence of beliefs related to pain and fatigue as walking-inhibitors. In the whole sample, beliefs are associated with an increased perception that comorbidity prevents walking, and with higher levels of pain and fatigue. In patients who walk regularly, beliefs are only associated with the perception that comorbidity prevents them from walking. It is necessary to promote walking according to the established way (including breaks to prevent fatigue) and to implement interventions on the most prevalent beliefs that inhibit walking.

Background and objective Functional assessment is especially relevant in patients with cognitive impairment (CI). The Disability Assessment for Dementia (DAD) scale assesses functional ability and its use is becoming increasingly popular. This study aims to perform the translation and cultural adaptation of the DAD scale in order to create a Spanish version: DAD-E. Patients and method A double translation/back-translation process was developed, as well as a pilot study with 14 caregivers of patients with CI, and 3 review meetings to achieve general agreement. Results The DAD-E includes the 40 original items. Four response options and 8 scores were added in order to detect functional disability induced by CI independently of other possible causes. More detailed instructions for administration and scoring of the scale have been provided in order to improve the reliability of the content. Conclusions The DAD-E was shown to be a cultural and linguistic adaptation equivalent of the original scale, which allows it to be applied to the Spanish population. It may be a useful instrument in clinical practice since it provides a more accurate assessment of functional disability due to cognitive impairment.

Walking improves health outcomes in fibromyalgia; however, there is low adherence to this practice. The aim of this research was to explore the beliefs of women suffering from fibromyalgia toward walking, and the meaning that they attribute to the behavior of walking as part of their fibromyalgia treatment. This study is a qualitative description research. Forty-six (46) women suffering from fibromyalgia and associated with local fibromyalgia associations located in four different Spanish cities (Elche, Alicante, Madrid, and Talavera de la Reina) participated in focus group discussions in the summer 2012. Thematic content analysis was performed in transcribed verbatim from interviews. Participants perceived several inhibitors for walking even when they had positive beliefs toward its therapeutic value. Whereas participants believed that walking can generate improvement in their disease and their health in general, they did not feel able to actually do so given their many physical impediments. Furthermore, participants struggled with social isolation and stigma, which was lessened through the conscious support of family. Advice from family doctors was also a very important facilitator to participants. In a health care delivery context that favors person-centered care, and in order to foster adherence to walking-based fibromyalgia treatments, it is recommended that therapeutic walking programs be tailored to each woman' individual circumstances, and developed in close collaboration with them to help them increase control over their health and their condition.

OBJECTIVE: Over the last decade, family medicine has been progressively rejected by medical students as a career choice in many Western countries. Our objective is to contribute to a better understanding of this phenomenon by examining the reputation of and identification processes with family medicine by medical students. DESIGN: A qualitative case study. METHODS: Focus groups and document analysis were used for generating empirical material. Focus groups (n=6) were conducted (2008–2009). Thematic analysis was adopted as the technique for analyzing data gathered. SETTING: A faculty of medicine of a Spanish university. PARTICIPANTS: Second and sixth year undergraduate medical students (N=48). RESULTS: Family medicine appears to be largely devalued as a professional activity, among medical students, being viewed as a monotonous and non-technological medical practice with no intellectual challenge. Such a negative view, which already appears in early stages of medical training, leads to a lack of identification with this medical practice by students. CONCLUSION: Misconceptions about the practice of family medicine, created and reproduced in health care system and societal contexts, encourage the practice of specialized medicine. In addition, the academic environment appears to promote organ- and disease-based medical knowledge, which goes against the holistic and patient-centered approach characteristic of the practice of family medicine. In order to improve the reputation of family medicine and for it to be considered as an attractive career path by medical students, it is recommended that family medicine is developed as an academic medical field, and that improvements are made in the conditions and status of this medical practice within the health care system.

Vaglum, Wiers-Jensen, & Ekeberg (1999) developed an instrument to assess motivation to study medicine. This instrument has been applied in different countries but it has not been studied cross-culturally. Our aims were to develop a Motivation to do Medicine Scale for use in international studies and to compare motivations of UK and Spanish medical students (UK: n= 375; Spain: n= 149). A cross-sectional and cross-cultural study was conducted. The Vaglum et al. (1999) Motivation to do Medicine Scale (MMS) was used. The original MMS factor structure was not supported by the Confirmatory Factor Analysis. Exploratory Factor Analyses within each country identified four factors: “People”, “Status”, “Natural Science” and “Research”. Students scored higher on the “People” and “Natural Science” than on the other factors. The UK sample scored higher than the Spanish sample on the “Research” factor and there were greater difference between genders in Spain for both “People” and “Research” factors. The scale is suitable for use in cross-cultural studies of medical students’ motivation. It can be used to investigate differences between countries and may be used to examine changes in motivation over time or over medical disciplines.

The aim of this study was to compare clinical symptoms, perceived health status, health resource use and psychosocial features in fibromyalgia (FM) patients at different health care levels. A total of 315 participants were recruited from primary care (PC) (n = 101) and rheumatology settings (RS) (n = 214). Subjects completed a protocol of clinical features and health resource use, hospital anxiety and depression scale, sickness impact profile, chronic pain self-efficacy scale, multidimensional pain locus of control scale, perceived health competence scale and chronic pain coping inventory. Student’s t test, effect size, and contrast and power test were performed to examine differences between samples. FM patients treated in PC and RS were similar in most variables assessed and only differed significantly in tender points, sleep disturbance, wellness-focused coping strategies and in self-efficacy beliefs. The similarities do not support patient selection through care levels and thus, in the Spanish health care system at least, endorse PC as a reference unit for treatment and questioning the benefits of referring patients to RS.

Este estudio corresponde a la primera fase de investigación formativa recomendada en la teoría de la Acción Planeada para desarrollar una intervención. Nuestros objetivos son identificar las creencias modales sobre la realización de una pauta de ejercicio en personas con fibromialgia, probar los ítems para la evaluación directa de los constructos predictivos y explorar sus relaciones con la conducta. Evaluamos a 46 mujeres con fibromialgia. El análisis de contenido mostró un mayor número de consecuencias positivas que negativas asociadas a la ejecución de la pauta de ejercicio (creencias comportamentales); la familia y los amigos son los referentes importantes (creencias normativas) y se detectaron factores facilitadores e inhibidores de la ejecución de la conducta de ejercicio, relacionados con aspectos de la fibromialgia (creencias de control) como el dolor, la fatiga y el estado de ánimo. El índice de consistencia interna más bajo fue el de la escala de norma subjetiva (α= .78). Los resultados confirman el sedentarismo de la muestra (conducta previa: Media=3.67; rango=1-7) aunque también sugieren que estas personas tienen intención de realizar la conducta (Media= 5.67). Las relaciones obtenidas entre los constructos son las esperadas desde la teoría, apoyando la pertinencia de aplicarla en la conducta y población seleccionada. This study is the first phase of the formative research recommended in the Theory of Planned Behavior for the development of an intervention. Our aims are to identify modal beliefs about the performance of an exercise pattern in people with fibromyalgia, to test the items designed for direct evaluation of the predictive constructs and to explore their relationships with the behavior. We assessed 46 women with fibromyalgia. Content analysis showed more positive than negative consequences related to the performance of exercise guidelines (behavioral beliefs). Families and friends are the important referents (normative beliefs) and we identified facilitating and inhibiting factors in the performance of exercise behavior related to aspects of fibromyalgia (control beliefs) such as pain, fatigue and emotional state. The subjective norm scale showed the lowest internal consistency (α= .78). The results confirmed the sedentary lifestyle of the participants (previous behavior: Mean=3.67; rank=1-7) although they also suggested that participants intended to perform the behavior (Mean=5.67). The relationships between constructs are coherent with the theory, and support the relevance of applying it to the selected behavior and population.

International audience; Purpose To understand the influence of academic discourses about family medicine on medical students' professional identity construction during undergraduate training. Method The authors used a multiple case study research design involving international medical schools, one each from Canada, France, Spain, and the United Kingdom (UK). The authors completed the fieldwork between 2007 and 2009 by conducting 18 focus groups (with 132 students) and 67 semistructured interviews with educators and by gathering pertinent institutional documents. They carried out discursive thematic analyses of the verbatim transcripts and then performed within- and cross-case analyses. Results The most striking finding was the diverging responses between those at the UK school and those at the other schools. In the UK case, family medicine was recognized as a prestigious academic discipline; students and faculty praised the knowledge and skills of family physicians, and students more often indicated their intent to pursue family medicine. In the other cases, family medicine was not well regarded by students or faculty. This was expressed overtly or through a paradoxical academic discourse that stressed the importance of family medicine to the health care system while decrying its lack of innovative technology and the large workload-to-income ratio. Students at these schools were less likely to consider family medicine. Conclusions These results stress the influence of academic discourses on medical students' ability to identify with the practice of family medicine. Educators must consider processes of professional identity formation during undergraduate medical training as they develop and reform medical education. (R.A.)

Background Despite significant differences in terms of medical training and health care context, the phenomenon of medical students’ declining interest in family medicine has been well documented in North America and in many other developed countries as well. As part of a research program on family physicians’ professional identity formation initiated in 2007, the purpose of the present investigation is to examine in-depth how family physicians construct their professional image in academic contexts; in other words, this study will allow us to identify and understand the processes whereby family physicians with an academic appointment seek to control the ideas others form about them as a professional group, i.e. impression management. Methods/Design The methodology consists of a multiple case study embedded in the perspective of institutional theory. Four international cases from Canada, France, Ireland and Spain will be conducted; the "case" is the medical school. Four levels of analysis will be considered: individual family physicians, interpersonal relationships, family physician professional group, and organization (medical school). Individual interviews and focus groups with academic family physicians will constitute the main technique for data generation, which will be complemented with a variety of documentary sources. Discourse techniques, more particularly rhetorical analysis, will be used to analyze the data gathered. Within- and cross-case analysis will then be performed. Discussion This empirical study is strongly grounded in theory and will contribute to the scant body of literature on family physicians’ professional identity formation processes in medical schools. Findings will potentially have important implications for the practice of family medicine, medical education and health and educational policies. Electronic supplementary material The online version of this article (doi:10.1186/1472-6920-14-184) contains supplementary material, which is available to authorized users.

Identifying which warning signs (WS) of intimate partner violence against girls (IPV) must be included in prevention programs is essential, since there is not an explicit consensus. Our first aim was identifying the most frequent WS included in the reviewed Spanish prevention guides by means of a content analysis performed independently by three judges. Our second aim was subjecting these to a sample of adolescents (n=60) to know: (1) if they identify them as abusive behaviours; (2) how frequently do they consider they have to occur to be WS, and; (3) how frequently they observe them in their peer environment. Among the 23 identified WS, controlling (n=11) and devaluating behaviours (n=6) are the most frequent in the reviewed literature and the formers´ the most observed in the adolescents’ environment (rank: 52.5% - 90%). The majority labelled the 23 behaviours as abusive. Four controlling and 3 devaluating behaviours had to occur very often to be an IPV warning sign. Therefore their tolerance to these WS is high. The outcomes are valuable for the development of prevention programs and suggest the need of investigating on the explanatory factors of such tolerance.

Objetivo: Estudiar las relaciones y capacidad predictiva de la Autoeficacia, el Catastrofismo y el Miedo al Movimiento, sobre la experiencia de dolor en la Fibromialgia, además de identificar el papel de la Autoeficacia en el conjunto de estas relaciones. Método: Sesenta y un pacientes de la Unidad de Atención Integral a la Fibromialgia (Hospital San Vicente del Raspeig) cumplimentaron diferentes cuestionarios para evaluar las variables objeto de este estudio. Se utilizó el análisis de correlación de Pearson y el análisis de regresión múltiple. Resultados: No se encontraron relaciones significativas entre el Miedo al Movimiento y el resto de variables; solo la percepción del impacto global de la fibromialgia y del distrés presentó relaciones significativas tanto con el Catastrofismo como con la Autoeficacia. Esta última, no moduló la relación entre Catastrofismo y los resultados de salud. Sin embargo, además de su efecto directo en los mismos, mostró un efecto mediado por el Catastrofismo. Conclusión: La Autoeficacia aparece como la variable más relevante en la explicación de la experiencia de dolor de estos pacientes, constituyendo un objetivo terapéutico imprescindible también en el último nivel asistencial.

Background Fibromyalgia patients are often advised to engage in regular low- to moderate-intensity physical exercise. The need of fibromyalgia patients to walk has been stressed in previous research. Behavioral self-regulation theories suggest that a combination of motivational aspects (to develop or strengthen a behavioral intention: Theory of Planned Behavior) and volitional aspects (engagement of intention in behavior: implementation intentions) is more effective than a single intervention. In this paper, we describe a protocol for identifying the motivational processes (using the Theory of Planned Behavior) involved in the practice of walking (phase I) and for studying the efficacy of an intervention that combines motivational and volitional contents to enhance the acquisition and continuation of this exercise behavior (phase II). The paper also shows the characteristics of eligible individuals (women who do not walk) and ineligible populations (women who walk or do not walk because of comorbidity without medical recommendation to walk). Both groups consist of members of any of four patients’ associations in Spain who are between 18 and 70 years of age and meet the London Fibromyalgia Epidemiology Study Screening Questionnaire criteria for fibromyalgia. Furthermore, using this study protocol, we will explore the characteristics of participants (eligible women who agreed to participate in the study) and nonparticipants (eligible women who refused to participate). Methods/design Two studies will be conducted: Phase I will be a cross-sectional study, and phase II will be a triple-blind, randomized longitudinal study with two treatment groups and one active control group. The questionnaires were sent to a total of 2,227 members of four patients’ associations in Spain. A total of 920 participants with fibromyalgia returned the questionnaires, and 582 were ultimately selected to participate. Discussion The first data gathered have allowed us to identify the characteristics of the study population and they support the appropriateness of the inclusion criteria.. When the study is complete, the results will enable us to establish whether this kind of intervention can be used as a self-regulation tool for increasing and maintaining walking as unsupervised physical exercise of low to moderate intensity in fibromyalgia patients. Trial registration Trial registration number: ISRCTN68584893

Presently it is proposed that an alteration of autonomic nervous system (ANS) functioning may be involved in the chronicity of fibromyalgia (FM) symptoms. The aim of this study is to compare ANS activity by assessing the heart rate variability (HRV) between women with FM and healthy ones, and analyze its relationship with different dimensions of perceived health. The results confirm that women with FM have a more diminished parasympathetic, hormonal and thermoregulatory activity than healthy women at rest; and the existing relationship of ANS imbalance (analyzed with HRV) with the most common FM symptoms, while its relationship with perceived health needs more development.