Fear of movement in patients with heart failure - correlates and associations with accelerometry data

Abstract

Background: Guidelines recommend physical activity (PA) for patients with heart failure, yet PA levels in this group are low. Fear of movement might constitute a barrier to PA, but not much is known about its correlates and associations with objectively assessed PA. Methods: The newly developed Fear of Activity in Situations – Heart Diseases (FActS-HD) questionnaire was given to 132 patients (80% men, mean age 67 ± 12 years) with heart failure. The FActS-HD consists of 24 situational descriptions of physical activities with varying intensities (light, moderate, vigorous). Trait anxiety and depression, symptom burden, demographic and disease-related characteristics were assessed. Energy expenditure due to PA and frequency of activity types (e.g., walking, stair climbing) across 6 days were measured via accelerometry in 61 participants. Associations of FActS scores with potential correlates and PA were examined using multiple regression analyses. Findings: Fear of movement (total score/moderate intensity Cronbachs’ α = .98/.90) was correlated with higher anxiety and depression scores, higher symptom burden, not attending cardiac exercise groups, feeling less educated about heart failure, implanted defibrillator, comorbidities, and lower education (all p-values < .01). Controlling for age, gender, and BMI, both FActS-scores predicted fewer stair climbing (β = –.31/–.30, p < .01), whereas anxiety and depression did not. FActS-moderate tended to be associated with lower energy expenditure (β = –.18, p = .089). Discussion: Fear of movement, but not trait anxiety and depression, appear to impede physical activities in cardiac patients. Tailored interventions to decrease this fear and increase PA are warranted.