This article is licensed under a Creative Commons Attribution 4.0 International LicenseĬited 8 times in Scopus. MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG) Accordingly, it is proposed that a loss of certainty or confidence in control predictions in response to persistent detection of prediction error features as a common foundation for the conscious experience of both pathological and nonpathological fatigue. In contrast to normal nonpathological fatigue, pathological fatigue is experienced in many people with chronic illness, and with a greater intensity and longer duration, causing severe impairments to an individual's functional activity and quality of life 2, 3. Here, drawing on the metacognitive theory of dyshomeostasis, we extend this account to offer an explicit description of the development of fatigue during extended periods of (physical) exertion. Although acute, transient subjective symptoms of exertional fatigue have also been associated with increasing interoceptive prediction error, the dynamic computations that underlie its development have not been clearly defined. The metacognitive theory of dyshomeostasis (Stephan et al., 2016) states that pathological fatigue emerges from the metacognitive mechanism in which the detection of persistent mismatches between prior interoceptive predictions and ascending sensory evidence (i.e., prediction error) signals low evidence for internal generative models, which undermine an agent’s feeling of mastery over the body and is thus experienced phenomenologically as fatigue. Within the clinical neurosciences, nascent frameworks position pathological fatigue as a product of inference derived through hierarchical predictive processing. Energy-related sensations such as fatigue are phenomena that, despite being researched in various fields, such as medicine, cognitive psychology, or exercise physiology, still lack consensus definitions and taxonomy (Pattyn et al., 2018 Skau et al., 2021).As Pattyn et al. Yet, pathological (i.e., prolonged or chronic) and transient (i.e., exertional) fatigue symptoms are traditionally considered distinct, compounding a separation between interested research fields within the study of fatigue. Defining Different Kinds of Energy-Related Sensations. Fatigue is a common experience in both health and disease.
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