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Background and Aims Individuals with schizophrenia exhibit markedly low levels of physical activity and prolonged inactivity, contributing to increased cardiometabolic risk and reduced life expectancy. Fatigue is highly prevalent in schizophrenia and frequently reported as a major barrier to physical activity; however, its relationship with objectively measured activity remains poorly understood. In particular, the role of maladaptive cognitive appraisals of fatigue has not been examined. This exploratory study investigated associations between self-reported fatigue, fatigue catastrophizing, and objectively measured physical activity in individuals with schizophrenia compared with non-clinical controls.
Methods Sixty participants (27 individuals with schizophrenia and 33 non-clinical controls), matched on age, sex, and body mass index, wore a tri-axial wrist accelerometer continuously for seven days. Physical activity and inactivity were derived using standardized processing pipelines. Fatigue was assessed with the Multidimensional Fatigue Inventory and fatigue catastrophizing with the Fatigue Catastrophizing Scale. Associations between fatigue measures, physical activity, and clinical symptoms were examined.
Results Compared with controls, individuals with schizophrenia showed significantly lower levels of light, moderate, and vigorous physical activity, alongside higher fatigue, fatigue catastrophizing, and depressive symptoms. In the schizophrenia group, fatigue severity was not associated with objectively measured physical activity. In contrast, higher fatigue catastrophizing was associated with lower moderate physical activity and reduced step count. Fatigue severity was associated with depressive and negative symptoms, but not with physical activity.
Conclusion These findings suggest a dissociation between fatigue severity and actual physical activity behavior in schizophrenia and highlight fatigue catastrophizing as a key cognitive factor linked to reduced activity.
