Anxiety and Fear of Exercise in Cardiopulmonary Rehabilitation: PATIENT AND PRACTITIONER PERSPECTIVES.

J Cardiopulm Rehabil Prev

Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey (Dr Farris); Departments of Psychiatry and Human Behavior (Drs Abrantes and Bond) and Medicine (Dr Wu), Alpert Medical School of Brown University, Providence, Rhode Island; Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, Rhode Island (Dr Abrantes); Weight Control and Diabetes Research Center (Dr Bond) and Center for Cardiac Fitness (Ms Stabile and Dr Wu), The Miriam Hospital, Providence, Rhode Island; Lifespan Cardiovascular Institute, Providence, Rhode Island (Dr Wu); and Department of Cardiology, Providence VA Medical Center, Providence, Rhode Island (Dr Wu).

Published: March 2019

Purpose: One unexplored mechanism for poor outcomes in cardiovascular and pulmonary rehabilitation (CVPR) is fear about aerobic exercise. Patients in CVPR may tend to avoid aerobic exercise because of the fear of physical sensations associated with exertion. This study examined fear about exercise in patients enrolled in outpatient CVPR and practitioner beliefs and behaviors related to fear associated with exercise.

Methods: Survey data were collected from patients (n = 117) enrolled in cardiac rehabilitation (n = 69) and pulmonary rehabilitation (n = 48) and practitioners (n = 16) who were exercise physiologists and nurses working in CVPR.

Results: Fears about exercise and avoidance behaviors were common among patients. In pulmonary rehabilitation, fears and avoidance of exercise were correlated with higher levels of anxiety and depression (r values = 0.27-0.54), lower forced expiratory volume in the first second of expiration/forced vital capacity (r values = -0.13 to -0.39), lower health-related quality of life (r values = -0.13 to -0.62), and stronger beliefs about utility of anxiety treatment (r values = 0.21-0.36). In cardiac rehabilitation, fears about exercise were correlated with higher levels of anxiety (r values = 0.19-0.38), lower mental health quality of life (r values = -0.25 to -0.27), and stronger beliefs about utility of anxiety treatment (r values = 0.30-0.40), and avoidance of exercise was correlated with lower exercise tolerance and poorer physical health quality of life (r values = -0.22 to -0.24). Practitioners estimated that an average of 47 ± 20% of patients experience fear associated with exercise and reported low feelings of preparedness to address patient anxiety and fear.

Conclusions: It may be beneficial to provide practitioners with skills to recognize and address anxiety and fear in their patients as it relates to exercise.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6391737PMC
http://dx.doi.org/10.1097/HCR.0000000000000401DOI Listing

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