NEW YORK (Reuters Health) - Pessimistic people report more knee pain and worse functioning than those with similar knee problems who don't have such a negative outlook, according to researchers.

Outlook, especially one that is negative and expecting the worst, "really affects the physical health of a person," lead author Dr. Gretchen A. Brenes of Wake Forest University in Winston-Salem, North Carolina, told Reuters Health.

She and her colleagues measured physical pain, functioning and outlook in 480 patients at least 65 years old who were suffering from arthritis. All of the study participants experienced pain in their knees on most days, which caused a certain amount of disability.

The researchers measured physical functioning and disability from pain by surveying patients and watching them perform day-to-day activities. Outlook was measured by asking people to rate how much they agreed with optimistic statements such as "I always look on the bright side of things" or pessimistic statements such as "If something can go wrong for me, it will."

The investigators found that people who appeared to be pessimistic were less able than others to perform all of the measured daily activities, which included walking, lifting an object, climbing stairs and getting in and out of a car. Optimism, in contrast, appeared less connected to health, with people characterized by a more cheery outlook appearing no better able of performing most functions than others, the authors report in the June issue of the Journal of Behavioral Medicine.

In an interview with Reuters Health, Brenes explained that people who are pessimistic don't believe things will work out for them, and so they never try to achieve anything. "They don't get a chance to find out if they can or can't do it," she said.

As such, if pessimistic people don't even try to maintain certain health behaviors, such as exercise, they are less likely to keep up their physical conditioning, and so will feel more pain and function less well than their more upbeat peers, Brenes added.

And when negatively inclined people do try to exercise, Brenes said, they may be more likely to feel pain, which just reaffirms their expectation that nothing works in their favor, so they might as well stop trying. It becomes a type of "negative self-fulfilling prophecy," Brenes explained.

Optimistic people may be more likely to try to exercise, Brenes noted. Although their efforts might keep their condition from deteriorating, they still may not actually improve, she added. "I guess optimists are more likely to try, but they are not more likely to succeed," Brenes pointed out.

Doctors who are faced with patients who appear to be overly pessimistic should recognize the impact this attitude may have on their conditions, Brenes recommended, and try to encourage these patients to challenge the assumption that they can't succeed.

Get patients to set small goals for themselves, she advised, and encourage them even in their small achievements.

SOURCE: Journal of Behavioral Medicine 2002;25:219-231.

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