Background: Fibromyalgia (FM) is a rheumatological disease characterized by diffuse pain associated with physical and mental manifestations, which significantly compromise quality of life (QoL). Its diagnosis is challenging, usually involving a long period between the onset of symptoms and a correct diagnosis, resulting in delayed access to appropriate treatment. Prevalent symptoms include anxiety, mood and sleep disturbances, fatigue, cognitive dysfunction, and depression. Daily limitations (occupational, domestic, and personal) undermine autonomy and QoL, creating a cycle of poor physical and mental health. This condition often leads to high medication use, especially antidepressants. Literature suggests that factors such as a high body mass index (BMI) can be associated with increased symptom severity, whereas regular physical exercise can control symptoms and improve QoL. Because treatment is complex and leads to high demand for healthcare services, it is crucial to prioritize an active lifestyle in the management of FM.

Objectives: To analyze the influence of psychological, clinical, and exercise-related factors on the impact of FM on QoL.

Methods: This cross-sectional study was approved by the Human Research Ethics Committee of the State University of Santa Catarina (No. 40877420.0.0000.0118) and conducted between 2022 and 2025. Inclusion criteria consisted of women aged 18 years or older with a clinical diagnosis of FM who provided written informed consent. Instruments were administered to collect sociodemographic and clinical data, including weight, height, self-reported depression diagnosis, symptom duration, and physical exercise (including modality). Presence of symptoms was assessed using a list of 16 common manifestations. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), depressive symptoms with the Beck Depression Inventory (BDI), anxiety symptoms with the Beck Anxiety Inventory (BAI), and the impact of FM on QoL with the Revised Fibromyalgia Impact Questionnaire (FIQR). Statistical analysis was performed using multiple linear regression, with the total FIQR score as the dependent variable. Independent variables included age, symptom duration, number of symptoms, BMI, depression diagnosis, physical exercise (categorized as: no; yes, walking and stretching only; or yes, other modalities), and total scores from the PSQI, BDI, and BAI. Three models were proposed: Model 1 included only clinical characteristics; Model 2 focused on mental health questionnaires; and Model 3 integrated all variables.

Results: A total of 134 participants were included in the study, with a mean age of 55.2 ± 10.7 years. Regarding sample characteristics, the majority of participants were married (43.3%), retired (32.8%), and had a clinical diagnosis of depression (68.7%). Furthermore, 56% did not engage in physical exercise, while 13.4% practiced walking and/or stretching, and 30.6% performed other modalities. Among active participants, 30.5% engaged in combined exercise modalities, 22% practiced only walking, 16.9% only Pilates, and 11.9% only resistance training. Clinical characteristics revealed a mean BMI of 28.8 ± 6.0 kg/m ² , a mean symptom duration of 14 ± 10 years, and an average of 11.6 ± 3.0 symptoms (ranging from 2 to 16). The most frequent report was 15 symptoms (16.4% of participants). The most prevalent symptoms were tiredness (92.5%) and fatigue (91%), while the least prevalent were facial pain (50%), low mood (58.2%), and frequent headaches (59.7%). The sample exhibited high mean scores for total FIQR (66.8 ± 17.7), PSQI (12.5 ± 4.0), BDI (22.0 ± 11.4), and BAI (24.0 ± 13.2). Multiple linear regression analysis showed that in Model 1 (clinical variables only), the number of symptoms, a diagnosis of depression, and practicing exercise modalities other than walking or stretching significantly influenced the total FIQR. In Model 2 (mental health instruments), anxiety and depression were significant predictors, while sleep quality was not. In the final integrated model (Model 3), all previously significant variables remained influential, except for the clinical diagnosis of depression, which lost significance. These data are detailed in Table 1.

Conclusions: The FIQR questionnaire was developed to assess the impact of FM on patients, serving as a variable that is easily translated into clinical practice. This study highlights that among the characteristics analyzed, mental health (specifically anxiety and depression), the practice and modality of physical exercise, and the number of reported symptoms significantly influence the impact of the disease. These findings emphasize the relevance of mental health as a primary element in therapeutic approaches for FM. Furthermore, the results suggest that patients who engage only in modalities such as walking and stretching, often performed without professional guidance, may not obtain substantial health benefits, showing outcomes similar to those who do not exercise at all. This indicates a critical need for varied and supervised exercise modalities in this population.

REFERENCES: NIL.

Acknowledgments: NIL.

Disclosure of Interests: None declared.