Journal Article

Associations of fear of physical activity, coping style and self-reported exercise behavior in patients with chronic heart failure

Schwab, Sandra U., Spaderna, Heike, Partetzke, Tara M., Brandenburg, Vincent M., Kindermann, Ingrid, Voss, Frederik, Lauterbach, Michael

2024

Overview

Fear of physical activity (PA) is discussed as a barrier to regular exercise in patients with heart failure (HF), but HF-specific theoretical concepts are lacking. This study examined associations of fear of PA, heart-focused anxiety and trait anxiety with clinical characteristics and self-reported PA in outpatients with chronic HF. It was also investigated whether personality-related coping styles for dealing with health threats impact fear of PA via symptom perception. This cross-sectional study enrolled 185 HF outpatients from five hospitals (mean age 62 ± 11 years, mean ejection fraction 36.0 ± 12%, 24% women). Avoidance of PA, sports/exercise participation (yes/no) and the psychological characteristics were assessed by self-reports. Fear of PA was assessed by the Fear of Activity in Situations-Heart Failure (FActS-HF15) questionnaire. In multivariable regression analyses higher NYHA class (b = 0.26, p = 0.036) and a higher number of HF drugs including antidepressants (b = 0.25, p = 0.017) were independently associated with higher fear of PA, but not with heart-focused fear and trait anxiety. Of the three anxiety scores only increased fear of PA was independently associated with more avoidance behavior regarding PA (b = 0.45, SE = 0.06, p < 0.001) and with increased odds of no sports/exercise participation (OR = 1.34, 95% CI 1.03-1.74, p = 0.028). Attention towards cardiac symptoms and symptom distress were positively associated with fear of PA (p < 0.001), which explained higher fear of PA in patients with a vigilant (directing attention towards health threats) coping style (p = 0.004). Fear of PA assessed by the FActS-HF15 is a specific type of anxiety in patients with HF. Attention towards and being distressed by HF symptoms appear to play a central role in fear of PA, particularly in vigilant patients who are used to direct their attention towards health threats. These findings provide approaches for tailored interventions to reduce fear of PA and to increase PA in patients with HF. ClinicalTrials.gov ID: NCT02898246.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adaptation, Psychological / Aged / Analysis / Angina pectoris / Antidepressants / Anxiety / Anxiety - psychology / Avoidance / Avoidance behavior / Biology and Life Sciences / Cardiac arrhythmia / Cardiac patients / Care and treatment / Chronic Disease / Congestive heart failure / Coping / Coping (Psychology) / Cross-Sectional Studies / Demographic aspects / Diagnosis / Disease / Ejection fraction / Exercise / Exercise - psychology / Fear / Fear & phobias / Fear - psychology / Female / Health aspects / Health risks / Heart failure / Heart Failure - physiopathology / Heart Failure - psychology / Humans / Male / Medicine and Health Sciences / Mental depression / Methods / Middle Aged / Patients / Personality / Physical activity / Physical fitness / Psychological aspects / Public opinion / Questionnaires / Regression analysis / Risk factors / Self Report / Social Sciences / Surveys and Questionnaires / Threat evaluation