## 4 Discussion
Thus, it seems plausible that those patients who are afraid of performing exercise because it will be uncomfortable or dangerous, are those who perceive they have a low capacity to achieve a desired goal related to physical exercise. This is supported by the relationship between the fear of movement and fatigue, disability, interference, and dissatisfaction with life [46]. In this way, if the therapist were to employ tools to make patients feel more secure in the practice of exercise, such as providing more detailed explanations of the exercises and offering corrective feedback to enhance the perception of security, the fear of movement could be reduced, along with their functional capacity. The avoidance of activity due to pain or other symptoms was explored as a mediator in the relationship between self-efficacy and physical activity [12]. In this regard, women with higher self-efficacy will show higher levels of physical activity, despite the usual fibromyalgia-related barriers, by preferring the achievement of the desired goals rather than pain avoidance goals. In other words, people who suffer from chronic pain must choose between pain avoidance goals and achievement goals, and this decision will be conditioned by self-efficacy. When the desired goal is physical activity, patients could prioritize doing exercise instead of choosing pain avoidance goals when they have higher levels of self-efficacy, and they know that it is going to be beneficial for them. Participants' adequate knowledge about the risks and benefits of physical exercise has been previously identified as a key determinant of adherence to exercise [47]. However, what happens when patients consider that physical exercise can be harmful to them? This is the case for patients with high levels of fear of movement, who may perceive that exercising is dangerous and could exacerbate their pain levels. In the framework of the fear-avoidance model, which links pain and cognitive-emotional factors, the fear of suffering pain during exercise may lead patients to focus their attention on potential somatic threat signals [48; 49]. Thus, these feelings may affect their self-efficacy, since a fear of movement would lead to unpleasant experiences while doing exercise, causing more pain and avoidance and, as a consequence, a vicious circle increasing both fear and avoidance [50]. The current study found that the fear of movement may be a variable to be considered in theoretical models explaining the levels of physical activity of women diagnosed with fibromyalgia. Therefore, interventions aimed at reducing this fear must be recommended. Although there are some examples of successful interventions based on tailored cognitive behavioral therapy, physical exercise, or multicomponent programs [51], involving professionals from different disciplines, including physicians, nurses, psychologists, physiotherapists, or physical exercise professionals, is recommended [47]. Furthermore, according to the health belief model, the involvement in a specific activity will be conditioned by the expected consequences [52]. Thus, patients must be informed about what exercise can do for them. However, patients must know more than only the benefits; the potential risks must also be explained, as well as the possibility of normal unpleasant and undangerous feelings, such as acute low levels of pain, fatigue, or frustration [53]. This information about risks and benefits may lead to larger engagement in exercise programs when it is provided by a physician or a nurse, rather than other non-healthcare professionals, such as physical trainers [47]. Therefore, it is recommended for healthcare professionals to be part of a multidisciplinary team, which includes exercise professionals, and also to effectively communicate to the patient the benefits of practicing regular exercise.