Determinants of non-adherence to diabetes treatment among patients at Hawassa University Comprehensive Referral Hospital, Ethiopia.

Effort perception is a central construct in exercise physiology and neuroscience, yet the neural and cognitive mechanisms underlying its construction remain incompletely defined. Classical models have emphasized either peripheral feedback from group III/IV muscle afferents or central corollary discharge as primary determinants of perceived effort (; ; ). Although these frameworks have generated valuable mechanistic insights, they do not fully account for the context-dependent, what predictive processing accounts describe as precision-weighted, and multidimensional nature of effort perception observed across physiological, cognitive, and clinical settings. Blood flow restriction (BFR) provides a powerful experimental context for examining this complexity. Under BFR, ratings of perceived exertion (RPE) rise disproportionately relative to mechanical load, with responses varying according to cuff pressure, width, and exercise modality (). These distortions reveal that BFR alters the perception–action relationship in ways that cannot be explained by peripheral input alone. Unlike high-load exercise or systemic fatigue, BFR selectively manipulates metabolic stress while minimizing mechanical damage, allowing a clearer dissociation of peripheral and central contributions to effort perception and creating conditions of heightened sensory uncertainty that, within predictive processing frameworks, are interpreted as amplifying precision-weighting effects. The dissociation between mechanical load and perceived effort under BFR raises a fundamental question: rather than posing this as a rhetorical question, we now frame it as a testable hypothesis: effort perception escalates under BFR even when mechanical load is low because central inhibitory and predictive processes may reweight afferent input in a manner interpreted within precision-weighted integration frameworks under conditions of heightened sensory uncertainty. Evidence from pharmacological blockade and clinical conditions further challenges afferent-dominant interpretations. Perceived exertion persists when muscle afferent feedback is reduced (), and individuals with schizophrenia or proprioceptive deficits exhibit substantial distortions in effort awareness despite intact peripheral input (, ; ). These findings underscore that central processing plays an essential role and that effort perception reflects interpretations consistent with precision-weighted integration frameworks rather than a unitary physiological signal.