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).
J Cardiopulm Rehabil Prev. 2019 Mar;39(2):E9-E13. doi: 10.1097/HCR.0000000000000401.
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.
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.
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.
It may be beneficial to provide practitioners with skills to recognize and address anxiety and fear in their patients as it relates to exercise.
心血管和肺康复（CVPR）中预后不良的一个未被探索的机制是对有氧运动的恐惧。CVPR 中的患者可能因为担心与用力相关的身体感觉而倾向于避免有氧运动。本研究调查了在门诊 CVPR 中接受治疗的患者的运动恐惧，以及与运动相关的恐惧相关的从业者信念和行为。
从参加心脏康复（n = 69）和肺康复（n = 48）的患者（n = 117）以及从事 CVPR 的运动生理学家和护士的从业者（n = 16）中收集了调查数据。
患者中普遍存在对运动的恐惧和回避行为。在肺康复中，运动恐惧和回避与更高水平的焦虑和抑郁（r 值为 0.27-0.54）、较低的第一秒用力呼气量/用力肺活量（r 值为-0.13 至-0.39）、较低的健康相关生活质量（r 值为-0.13 至-0.62）以及对焦虑治疗有效性的更强信念（r 值为 0.21-0.36）相关。在心脏康复中，对运动的恐惧与更高水平的焦虑（r 值为 0.19-0.38）、较低的心理健康生活质量（r 值为-0.25 至-0.27）以及对焦虑治疗有效性的更强信念（r 值为 0.30-0.40）相关，而回避运动与较低的运动耐量和较差的身体健康生活质量（r 值为-0.22 至-0.24）相关。从业者估计，平均有 47±20%的患者经历与运动相关的恐惧，并报告对处理患者焦虑和恐惧的准备程度较低。
为从业者提供识别和处理与运动相关的焦虑和恐惧的技能可能会有所帮助，因为这与运动有关。
