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- Fibromyalgia-Related fatigue and the quality of life, depression, anxiety, self-esteem, life satisfaction and physical activity in patients with FibromyalgiaPublication . Alvarez, Marcos de Carvalho; Monteiro, Diogo Manuel Teixeira; Neiva, Henrique PereiraFibromyalgia (FM) is a chronic and persistent condition that causes physical and sensory changes. Its pathophysiology is still debated, but it is believed that the increase in symptoms is related to an imbalance of neurotransmitters or hyperexcitability of the central nervous system. Currently, 2% to 6% of the world's population has FM, with Portugal having 3% and Brazil having 2.5%. FM presents a variety of symptoms, including generalized muscle pain, excessive fatigue, anxiety and depression, reduced psychological components, and sleep problems. Due to its complexity, patients with FM often present a significant decrease in psychological components, leading to social isolation and avoidance of work responsibilities and physical activities. Therefore, this study aimed to analyze the relationship between FM-related fatigue and quality of life, anxiety, depression, self-esteem, and satisfaction with life and physical activity. The thesis was divided into three scientific studies, where the first investigated the potential role of physical activity as a mediator in the relationship between Fatigue and quality of life, and the second analyzed the direct and indirect relationships between Fatigue, anxiety, depression, self-esteem, and satisfaction with life. life and levels of physical activity and possible differences in these associations between two different cultures among patients, and the third was a comparison of symptom perceptions between two different cultures. The results of the three scientific studies included in this doctoral thesis show that: i) Although physical activity plays an extremely important role, it does not act as a mediator of the relationship between FM-related fatigue and the quality of life of its patients; ii) All associations proved to be significantly relevant, where there was also an absence of differences in terms of associations between these proposed variables in both cultures studied; iii) There were no significant differences in the perception of Fatigue, depression, anxiety, quality of life, self-esteem, satisfaction with life and physical activity between Brazilian and Portuguese patients. Combining these three studies, FM-related fatigue is an extremely relevant symptom that directly affects the psychological component of its patients, in which physical activity can have an important role in reducing and controlling negative symptoms and in increasing positive components (quality of life, self-esteem and satisfaction with life).