Background & Aims

Exercise is an important part of managing chronic pain. Despite its benefits, people with chronic pain often do not exercise enough. Fear of pain and movement has been suggested as a barrier to exercise in people with pain. While some studies support the inverse fear-exercise link1,2, others provide conflicting results3,4. Studies that do not support this association included participants with high baseline physical activity or who sought to increase it. This suggests that the effect of fear of pain on exercise may be weaker in highly motivated people. Laboratory studies indicate that regardless of fear level, healthy people increase engagement in painful tasks when linked with rewards5,6, and goal preference may moderate this relationship. Despite these findings, research on the interplay of fear and motivation in the context of exercise and chronic pain is lacking. This study aims to pilot an experimental paradigm exploring the interaction between fear and motivation toward exercise.

Methods

Ten participants with non-oncologic chronic pain were recruited through purposive sampling (six women, mean age =41). Participants were exposed to a vignette experiment with two factors, fear and motivation, each with two levels (high and low). A cognitive interview was conducted to assess if stimuli and questions were interpreted in the way intended. For this pilot, we used a mixed design. First, participants rated their level of fear and enjoyment for various exercises. This information was used in the experimental phase, where participants were asked to imagine that they had been invited to an exercise program and were given a brief description. Some features of the program (e.g., exercise type) were modified to induce fear and motivation according to the assigned condition. Possible confounders, such as time availability and pain intensity, were held constant in the vignette. The study outcome was the likelihood of program attendance.

Results

Participants were able to imagine and differentiate how much fear and enjoyment they would feel when performing different exercises. Most participants did not show a clear association between fear and enjoyment ratings. Manipulation checks indicated that in the high motivation condition, participants perceived the program as more aligned with their preferences, felt more confident about meeting the physical demands, and anticipated better relations with other participants compared to the low motivation condition. Similarly, those in the low fear condition tended to report lower levels of fear of feeling pain or getting injured during the program than those in the high fear condition. However, the manipulation checks also revealed that strategies designed to affect fear impact motivational variables and vice versa. Notably, eight participants exhibited response patterns in line with the hypothesis that motivation might attenuate the effect of fear on exercise intentions.

Conclusions

Several characteristics of the vignette, questions, and instructions were modified as a result of the cognitive interviews. This initial pilot study offers insights into the feasibility of manipulating fear and motivation toward an exercise program by varying features of the program description. However, manipulation strategies need to be refined and retested in order to remove undesired variability.

References

1. Larsson, C., Ekvall Hansson, E., Sundquist, K., & Jakobsson, U. (2016). Impact of pain characteristics and fear-avoidance beliefs on physical activity levels among older adults with chronic pain: a population-based, longitudinal study. Geriatrics, 16(1), 1-8.
2. Taulaniemi, A., Kankaanpää, M., Rinne, M., Tokola, K., Parkkari, J., & Suni, J. (2020). Fear-avoidance beliefs are associated with exercise adherence: secondary analysis of a randomised controlled trial (RCT) among female healthcare workers with recurrent low back pain. Sports Science, Medicine and Rehabilitation, 12(1), 1-13.
3. Leonhardt, C., Lehr, D., Chenot, J. F., Keller, S., Luckmann, J., Basler, H., Baum, E., Donner-Banzhoff, N., Pfingsten, M., Hildebrandt, J., Kochen, M., & Becker, A. (2009). Are fear-avoidance beliefs in low back pain patients a risk factor for low physical activity or vice versa? A cross-lagged panel analysis. Psycho-Social Medicine, 6.
4. Pastor-Mira, M., López-Roig, S., Peñacoba, C., Sanz-Baños, Y., Lledó, A., & Velasco, L. (2019). Predicting walking as exercise in women with fibromyalgia from the perspective of the theory of planned behavior. Women & health, 60(4), 412-425.
5. Claes, N., Crombez, G., & Vlaeyen, J. (2015). Pain-avoidance versus reward-seeking: an experimental investigation. Pain, 156(8), 1449-1457.
6. Van Damme, S., Van Ryckeghem, D., Wyffels, F., Van Hulle, L., & Crombez, G. (2012). No pain no gain? Pursuing a competing goal inhibits avoidance behavior. PAIN, 153(4), 800-804.

Presenting Author

Camila Román

Poster Authors

Camila Román MSc

MSc

Pontificia Universidad Católica de Chile

Lead Author

Lydia Gómez-Pérez PhD.

Universidad de Málaga

Lead Author

Fernanda Mediano Stoltze PhD

Pontificia Universidad Católica de Chile

Lead Author

Luis E. Rodríguez MSc

Pontificia Universidad Católica de Chile

Lead Author

Patricio Cumsille PhD.

Pontificia Universidad Católica de Chile

Lead Author

Topics

  • Lifestyle Issues: Sleep/Diet/Exercise/Social Interactions