Measuring Fear of Physical Activity in Patients with Heart Failure
- 332 Downloads
Fear of physical activity (FoPA) has been suggested as a psychological barrier to exercise-based cardiac rehabilitation and everyday physical activity (PA) in patients with heart failure (HF). We evaluated the recently developed Fear of Activity in Situations-Heart Failure (FActS-HF) questionnaire that assesses affective/cognitive fear reactions to situations of varying PA intensities.
The FActS-HF was given to 132 ambulatory patients with stable HF (67 ± 12 years, 80% men). In 121 participants with valid FActS-HF data, the questionnaire’s dimensionality was investigated. Psychometric properties were determined in terms of reliability and validity. We assessed convergent and discriminant correlations of FoPA with anxiety, kinesiophobia, and depression. External validation criteria encompassed clinical variables and objectively assessed accelerometer measures of everyday PA in a subsample of 61 participants.
The FActS-HF measures a unidimensional construct (i.e., FoPA) based on items presenting varying PA intensities (i.e., the more intense the PA, the stronger the fear response). The scale demonstrated good 2-week stability (r tt = 0.82) and excellent internal consistency reliability (α = 0.97). FoPA was moderately to strongly associated with anxiety and kinesiophobia, and weakly to moderately associated with state/trait depression, supporting convergent and discriminant validity, respectively. High FoPA was associated with feeling uninformed about HF, comorbidities, non participitation to cardio fitness groups, and less stair climbing, as measured by accelerometry.
The FActS-HF is a reliable and valid instrument to measure FoPA in patients with HF and provides a promising tool for further research and practice.
KeywordsHeart failure Physical activity Kinesiophobia Psychometrics Accelerometry
The authors thank PD Dr. Ralf Westenfeld (Medical Faculty, University of Düsseldorf), Dr. Armin Jansen (Cardiowell Wuppertal), Diane Hennig, Bianca Liebrand, Lisa Morck, Olena Shyshova, and Züleya Abanoz (all University of Wuppertal) for participant recruitment, and Dr. Stefan Hey and Panagiota Anastasopoulou (Karlsruhe Institute of Technology) for their assistance in analyzing the accelerometer data.
Compliance with Ethical Standards
Approval of the Institutional Review Board of the University of Wuppertal was obtained.
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.Piepoli MF, Conraads V, Corra U, Dickstein K, Francis DP, Jaarsma T, et al. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011;13(4):347–57. https://doi.org/10.1093/eurjhf/hfr017.CrossRefPubMedGoogle Scholar
- 2.Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37(27):1–85. https://doi.org/10.1093/eurheartj/ehw128.
- 3.Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice guidelines. J Am Coll Cardiol. 2013;62(16):e147–239. https://doi.org/10.1016/j.jacc.2013.05.019.CrossRefPubMedGoogle Scholar
- 7.Coats AJ, Adamopoulos S, Radaelli A, McCance A, Meyer TE, Bernardi L, et al. Controlled trial of physical training in chronic heart failure. Exercise performance, hemodynamics, ventilation, and autonomic function. Circulation. 1992;85(6):2119–31. https://doi.org/10.1161/01.CIR.85.6.2119.
- 8.Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJS, Dalal H, et al. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev. 2014; https://doi.org/10.1002/14651858.CD003331.pub4.
- 9.European Heart Failure Training Group. Experience from controlled trials of physical training in chronic heart failure. Protocol and patient factors in effectiveness in the improvement in exercise tolerance. Eur Heart J. 1998;19(3):466–75. https://doi.org/10.1053/euhj.1997.0736.CrossRefGoogle Scholar
- 10.Piña IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha BD, et al. Exercise and heart failure. A statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation. 2003;107(8):1210–25. https://doi.org/10.1161/01.CIR.0000055013.92097.40.
- 11.O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, et al. Efficacy and safety of exercise training in patients with chronic heart failure: Hf-action randomized controlled trial. JAMA. 2009;301(14):1439–50. https://doi.org/10.1001/jama.2009.454.
- 12.Willenheimer R, Rydberg E, Cline C, Broms K, Hillberger B, Öberg L, et al. Effects on quality of life, symptoms and daily activity 6 months after termination of an exercise training programme in heart failure patients. Int J Cardiol. 2001;77(1):25–31. https://doi.org/10.1016/S0167-5273(00)00383-1.
- 14.Gerhardt A, Weidner G, Grassmann M, Spaderna H. Everyday physical activity in ambulatory heart transplant candidates: the role of expected health benefits, social support, and potential barriers. Int J Behav Med. 2014;21(2):248–57. https://doi.org/10.1007/s12529-013-9304-3.CrossRefPubMedGoogle Scholar
- 16.Tierney S, Elwers H, Sange C, Mamas M, Rutter MK, Gibson M, et al. What influences physical activity in people with heart failure? A qualitative study. Int J Nurs Stud. 2011;48(10):1234–43. https://doi.org/10.1016/j.ijnurstu.2011.03.003.
- 17.Tierney S, Mamas M, Skelton D, Woods S, Rutter MK, Gibson M, et al. What can we learn from patients with heart failure about exercise adherence? A systematic review of qualitative papers. Health Psychol. 2011;30(4):401–10. https://doi.org/10.1037/a0022848.
- 20.Gimeno-Santos E, Frei A, Dobbels F, Rüdell K, Puhan MA, Garcia-Aymerich J. Validity of instruments to measure physical activity may be questionable due to a lack of conceptual frameworks: a systematic review. Health Qual Life Outcomes. 2011;9(1):86. https://doi.org/10.1186/1477-7525-9-86.CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Strath SJ, Kaminsky LA, Ainsworth BE, Ekelund U, Freedson PS, Gary RA, et al. Guide to the assessment of physical activity: clinical and research applications. A scientific statement from the American Heart Association. Circulation. 2013;128(20):2259–79. https://doi.org/10.1161/01.cir.0000435708.67487.da.
- 23.Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(9):498–504.Google Scholar
- 24.Krohne HW. Psychologie der Angst. Stuttgart: Kohlhammer; 2010.Google Scholar
- 26.Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines: developed in collaboration with the international society for heart and lung transplantation. Circulation. 2009;119(14):e391–479. https://doi.org/10.1161/circulationaha.109.192065.CrossRefPubMedGoogle Scholar
- 28.Spaderna H, Weidner G, Zahn D, Smits J. Psychological characteristics and social integration of patients with ischemic and non-ischemic heart failure newly listed for heart transplantation: the waiting for a new heart study. Appl Psychol Health Well Being. 2009;1(2):188–210. https://doi.org/10.1111/j.1758-0854.2008.01006.x.CrossRefGoogle Scholar
- 29.Kemper CJ, Lutz J, Neuser J. Konstruktion und Validierung einer Kurzform der Skala Angst vor negativer Bewertung (SANB-5). Klin Diagn Eval. 2012;4:343–60.Google Scholar
- 32.Herrmann-Lingen C, Buss U, Snaith RP. Hospital Anxiety and Depression Scale—Deutsche version (HADS-D). Bern: Huber; 2011.Google Scholar
- 33.Brown TA. Confirmatory factor analysis for applied research. New York: Guilford; 2015.Google Scholar
- 35.Leonhardt C, Lehr D, Chenot J-F, Keller S, Luckmann J, Basler H-D, et al. Are fear-avoidance beliefs in low back pain patients a risk factor for low physical activity or vice versa? A cross-lagged panel analysis. GMS Psycho-Social-Medicine. 2009;6. https://doi.org/10.3205/psm000057.
- 37.Keteyian SJ, Leifer ES, Houston-Miller N, Kraus WE, Brawner CA, O'Connor CM, et al. Relation between volume of exercise and clinical outcomes in patients with heart failure. J Am Coll Cardiol. 2012;60(19):1899–905. https://doi.org/10.1016/j.jacc.2012.08.958.
- 39.Brunetti ND, Guerra A, Ieva R, Correale M, Santoro F, Tarantino N, et al. Scared for the scar: fearsome impact of acute cardiovascular disease on perceived kinesiophobia (fear of movement). Clin Cardiol. 2017;40(7):480–4. https://doi.org/10.1002/clc.22682.
- 41.Bäck M, Cider Å, Herlitz J, Lundberg M, Jansson B. Kinesiophobia mediates the influences on attendance at exercise-based cardiac rehabilitation in patients with coronary artery disease. Physiother Theory Pract. 2016;32(8):571–80. https://doi.org/10.1080/09593985.2016.1229828.