Department of Nursing Science, Health Psychology, Trier University, Trier, Germany.
Department of Cardiology and Nephrology, Rhein-Maas-Klinikum, Würselen, Germany.
PLoS One. 2024 Sep 5;19(9):e0309952. doi: 10.1371/journal.pone.0309952. eCollection 2024.
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.
体力活动（PA）恐惧在心力衰竭（HF）患者中被认为是定期运动的障碍，但缺乏针对 HF 的特定理论概念。本研究调查了 PA 恐惧、心脏相关焦虑和特质焦虑与慢性 HF 门诊患者的临床特征和自我报告的 PA 之间的相关性。还研究了应对健康威胁的人格相关应对方式是否通过症状感知影响 PA 恐惧。
这项横断面研究纳入了来自五家医院的 185 名 HF 门诊患者（平均年龄 62±11 岁，平均射血分数 36.0±12%，24%为女性）。通过自我报告评估 PA 回避、运动/锻炼参与（是/否）和心理特征。通过《情境下心力衰竭活动恐惧量表》（FActS-HF15）评估 PA 恐惧。在多变量回归分析中，更高的纽约心脏协会（NYHA）分级（b=0.26，p=0.036）和更多的 HF 药物（包括抗抑郁药）（b=0.25，p=0.017）与更高的 PA 恐惧独立相关，但与心脏相关恐惧和特质焦虑无关。在这三个焦虑评分中，只有 PA 恐惧的增加与 PA 回避行为（b=0.45，SE=0.06，p<0.001）和运动/锻炼参与减少的可能性增加（OR=1.34，95%CI 1.03-1.74，p=0.028）独立相关。对心脏症状的关注和症状困扰与 PA 恐惧呈正相关（p<0.001），这解释了警惕（将注意力转向健康威胁）应对方式患者的 PA 恐惧更高（p=0.004）。
使用 FActS-HF15 评估的 PA 恐惧是 HF 患者的一种特定类型的焦虑。对 HF 症状的关注和困扰似乎在 PA 恐惧中起着核心作用，尤其是在习惯于将注意力转向健康威胁的警惕患者中。这些发现为减少 HF 患者的 PA 恐惧和增加 PA 提供了针对性干预的方法。
ClinicalTrials.gov ID：NCT02898246。
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