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Part III Fibromyalgia profiles 309 Chapter XI Adaptation profiles comprising objective and subjective 311 measures in fibromyalgia Chapter XII Summary and general discussion 347 Samenvatting (Dutch summary) 367 Resumen (Spanish summary) 377 Acknowledgments / Dankwoord / Agradecimientos 385 Curriculum Vitae 395

Fibromyalgia: breaking stereotypes!

Chapter I: General introduction I 9

Chapter I: General introduction 11

Fibromyalgia: breaking stereotypes! 12

Chapter II: Gender differences II 27

Chapter II: Gender differences 29

Chapter III: Factor structure of the PANAS III 65

Chapter III: Factor structure of the PANAS 67

Chapter III: Factor structure of the PANAS 1 As Tuccitto, Giacobbi and Leite [11] indicated, the items of the PANAS were taken from the mood subcategories [53]: attentive (e.g., interested, alert, attentive), excited (e.g., enthusiastic, inspired, excited), proud (e.g., determined, proud), strong (e.g., active, strong), distressed (e.g., upset, distressed), guilty (e.g., ashamed, guilty), angry (e.g., hostile, irritable), jittery (e.g., nervous, jittery), and fearful (e.g., scared, afraid). 73

Chapter IV: Associative learning IV 99

Chapter IV: Associative learning 101

Fibromyalgia: breaking stereotypes! 2 Contingency and evaluative judgments for pre-exposed CSs were very far from significantly differing from those of not pre-exposed ones. The absence of any preexposure effect will be briefly considered in the discussion. For the sake of parsimony, judgments for pre-exposed and not pre-exposed CSs will be collapsed in further analyses, and henceforth considered as equivalent. 106

Chapter V: The discordance V 133

Chapter V: The discordance 135

Chapter VI: Reproductive vs. productive work VI 167

Chapter VI: Reproductive vs. productive work 169

Chapter VI: Reproductive vs. productive work 500 Reproductive work Productive work 400 Physical activity (min/day) 300 200 100 0 Sedentary time Light PA Moderate PA Vigorous PA 183

Chapter VI: Reproductive vs. productive work 50 Reproductive work Cognitive performance (PASAT) 40 30 20 Productive work 10 0 Correct answers Incorrect answers Unanswered questions 185

Chapter VII: Bouted physical activity and symtpoms VII 187

Chapter VII: Bouted physical activity and symtpoms 189

Chapter VIII: Fitness, well-being, and fatigue VIII 215

Chapter VIII: Fitness, well-being, and fatigue 217

Chapter VIII: Fitness, well-being, and fatigue

Chapter IX: Fitness, well-being, and severity IX 249

Chapter IX: Fitness, well-being, and severity 251

Chapter IX: Fitness, well-being, and severity

Chapter X: Physical functioning and well-being X 281

Chapter X: Physical functioning and well-being 283

Fibromyalgia: breaking stereotypes! 304 Table 2. Results of univariate regression analyses examining the association of objective and subjective evaluations of physical activity, sedentary time and physical fitness with three components of subjective well-being, n = 375. Positive affect (PANAS) Negative affect (PANAS) Satisfaction with life (SWLS) Adj. R 2 change 95% CI β (lower to upper) Adj. R 2 B change 95% CI β (lower to upper) Adj. R 2 B change 95% CI Dependent variable B β (lower to upper) Physical activity Objective 0.00 (0.00 to 0.00) 0.22 *** 0.045 *** 0.00 (0.00 to 0.00) -0.08 0.003 0.00 (0.00 to 0.00) 0.16 ** 0.023 ** Subjective 0.00 (0.00 to 0.00) 0.14 ** 0.017 ** 0.00 (0.00 to 0.00) -0.05 <0.001 0.00 (0.00 to 0.00) 0.07 0.003 Sedentary behaviour - 0.007 0.10 <0.001 0.00 (0.00 to 0.00) -0.12 * 0.011 * 0.00 (0.00 to 0.00) 0.01 0.00 (0.00 to 0.00) Objective <0.00 1-0.02 <0.001 0.00 (0.00 to 0.00) -0.02 <0.001 0.00 (0.00 to 0.00) 0.01 0.00 (0.00 to 0.00) Subjective Physical fitness Objective 0.71 (0.49 to 0.93) 0.32 *** 0.095 *** -0.65 (-0.92 to -0.38) -0.24 *** 0.052 *** 0.35 (0.20 to 0.49) 0.24 *** 0.051 *** Subjective 2.65 (1.83 to 3.46) 0.31 *** 0.094 *** -2.83 (-3.83 to -1.83) -0.28 *** 0.072 *** 1.45 (0.91 to 1.99) 0.26 *** 0.065 *** Single regressions were performed using age, education level and marital status as covariates. B, unstandardised regression coefficient; β, standardised regression coefficient; CI, confidence interval; Adj R 2, adjusted R 2 with significance levels of F- change. p* 0.05, p** 0.01, p*** 0.001. PANAS, the Positive and Negative Affect Schedule; SWLS, the Satisfaction with Life Scale.

Chapter X: Physical functioning and well-being Objective physical activity and sedentary time (both, min/week) were measured with triaxial accelerometers GT3X+ (Actigraph, Pensacola, Florida, USA). Subjective physical activity was assessed with the Leisure Time Physical Activity Instrument and Physical Activity at Home and Work Instrument. Subjective sedentary was assessed with the Sedentary Behaviour Questionnaire. Objective (z-score) and subjective physical fitness was assessed with the Senior Fitness Test Battery and the International Fitness Scale, respectively. Several B values (95% CI) are 0.00 because the measure of physical activity and sedentary behaviour are large (measured in min/week). 305

Fibromyalgia: breaking stereotypes! Table 3. Results of multivariate regression analyses examining the mutually independent associations of objectively and subjectively measured physical activity, sedentary time and physical fitness with three components of subjective well-being, n = 375. Positive affect (PANAS) Negative affect (PANAS) Satisfaction with life (SWLS) 95% CI Steps B β (lower to upper Adj. R 2 B change 95% CI β (lower to upper Adj. R 2 B change 95% CI β (lower to upper Adj. R 2 change Physical activity Step 1 0.045 *** 0.023 ** Objective physical activity 0.00 ( 0.00 to 0.00 ) 0.22 *** 0.00 ( 0.00 to 0.00 ) 0.16 ** Step 2 0.002 <0.001 Subjective physical activity 0.00 ( 0.00 to 0.00 ) 0.07 0.00 ( 0.00 to 0.00 ) 0.02 Step 1 0.017 ** 0.003 Subjective physical activity 0.00 ( 0.00 to 0.00 ) 0.14 ** 0.00 ( 0.00 to 0.00 ) 0.07 Step 2 0.03 *** 0.017 ** Objective physical activity 0.00 ( 0.00 to 0.00 ) 0.19 *** 0.00 ( 0.00 to 0.00 ) 0.15 ** Sedentary behaviour Step 1 0.011 * Objective sedentary time 0.00 ( 0.00 to 0.00 ) -0.12 * Step 2 <0.001 Subjective sedentary time (SBQ) 0.00 ( 0.00 to 0.00 ) 0.02 Step 1 <0.001 Subjective sedentary time (SBQ) 0.00 ( 0.00 to 0.00 ) -0.02 Step 2 0.011 * Objective sedentary time 0.00 ( 0.00 to 0.00 ) -0.12 * 306

Chapter X: Physical functioning and well-being Physical fitness Step 1 0.095 *** 0.052 *** 0.051 *** Objective physical fitness 0.71 ( 0.49 to 0.93 ) 0.32 *** -0.65 (-0.92 to -0.38) -0.24 *** 0.34 ( 0.20 to 0.49 ) 0.24 *** Step 2 0.048 *** 0.042 *** 0.036 *** Subjective physical fitness 2.01 ( 1.18 to 2.84 ) 0.24 *** -2.29 (-3.33 to -1.25) -0.22 *** 1.15 ( 0.59 to 1.72 ) 0.21 *** Step 1 0.094 *** 0.072 *** 0.065 *** Subjective physical fitness 2.65 ( 1.83 to 3.46 ) 0.31 *** -2.83 (-3.83 to -1.83) -0.28 *** 1.44 ( 0.90 to 1.98 ) 0.26 *** Step 2 0.049 *** 0.022 ** 0.022 *** Objective physical fitness 0.54 ( 0.32 to 0.76 ) 0.25 *** -0.45 (-0.73 to -0.17) -0.17 ** 0.25 ( 0.10 to 0.40 ) 0.17 *** Hierarchical regressions were performed using age, education level and marital status as covariates. For every dependent variable of physical functioning, the objective component was first entered into the model (results are shown above the dashed line) and subjective component was first entered into the model (results shown below the dashed line). B, unstandardised regression coefficient; β, standardised regression coefficient; CI, confidence interval; Adj R 2, adjusted R 2 with significance levels of F- change. p* 0.05, p** 0.01, p*** 0.001. PANAS, the Positive and Negative Affect Schedule; SWLS, the Satisfaction with Life Scale. Objective physical activity and sedentary behaviour (both, min/week) were measured with triaxial accelerometers GT3X+ (Actigraph, Pensacola, Florida, USA). Subjective physical activity was assessed with the Leisure Time Physical Activity Instrument and Physical Activity at Home and Work Instrument. Subjective sedentary was assessed with the Sedentary Behaviour Questionnaire. Objective (z-score) and subjective physical fitness was assessed with the Senior Fitness Test Battery and the International Fitness Scale, respectively. Several B values (95% CI) are 0.00 given that the measure of physical activity and sedentary behaviour is provided in min/week. 307

Chapter XI: Adaptation profiles XI 311

Chapter XI: Adaptation profiles 313

Chapter XII: General discussion XII 347

Chapter XII: General discussion 349

Samenvatting (Dutch summary) DS 367

Samenvatting (Dutch summary) 369

Resumen (Spanish summary) SS 377

Resumen (Spanish summary) 379

Acknowledgments / Dankwoord / Agradecimientos A/D 385

Acknowledgments / Dankwoord / Agradecimientos 387

Curriculum Vitae CV 395

Curriculum Vitae 397