Kinesiophobia as a Problem in Adherence to Physical Activity Recommendations in Elderly Polish Patients with Coronary Artery Disease

Examination of the Relationship Between Sensory Processing Skills, Kinesiophobia and Fear of Falling in Older Adults with Hypertension and Normotension

OBJECTIVES

The aim of the study was to investigate fear of falling, kinesiophobia, and sensory processing in older adults with hypertension and normotension.

METHODS

Older adults, 62 with hypertension and 62 with normotension, aged 65-84 years were included in the study. The assessment of fear of falling was conducted using the Tinetti Falls Efficacy Scale, kinesiophobia was evaluated with the Tampa Kinesiophobia Scale, and sensory processing skills were analyzed with the Adolescent/Adult Sensory Profile.

RESULTS

Significant differences were found between the groups in terms of vestibular processing, visual processing and activity level, fear of falling and kinesiophobia (p < .05). No significant differences were found between the groups with respect to taste/smell, tactile, and auditory processing skills. The findings revealed that older adults with hypertension exhibited diminished vestibular and visual processing abilities, reduced activity levels, and heightened concerns about falling and a tendency to experience kinesiophobia. Fear of falling and kinesiophobia were found to increase with decreasing vestibular processing skills and activity levels in both groups (p < .05). Regression analysis revealed that age, kinesiophobia, vestibular processing, and activity levels were significant determinants of fear of falling (p < .05).

CONCLUSION

It is recommended that older adults with hypertension be assessed in terms of sensory, functional, and mental health, with the objective of planning appropriate intervention approaches.

Validity and reliability of the Turkish version of Exercise Benefits/ Barriers Scale: Perceived exercise benefits and barriers of patients with different axial spondyloarthritis subtypes

Objectives

The aim of this study was to translate the Exercise Benefits/Barriers Scale (EBBS) into Turkish and investigate the perceptions of Turkish-speaking patients with different axial spondyloarthritis (axSpA) subtypes regarding exercise benefits and barriers.

Patients and methods

This validation study was conducted between June 2018 and December 2021. Patients with axSpA were consecutively assessed regarding physical (age, sex and body mass index) and disease-related characteristics (disease activity, spinal mobility, functional status, quality of life, health status, emotional status, and kinesiophobia). Eligible participants were asked to complete the EBSS and other outcome measurements during their initial visits. EBBS was readministered 7 to 14 days later.

Results

One hundred forty-eight patients (89 males, 59 females; mean age: 44.3±11.8 years; range, 19 to 65 years) were included in the study. Of the patients, 108 had radiographic axSpA, and 40 had nonradiographic axSpA. EBBS-Barriers and EBBS-Benefits subscales demonstrated adequate internal consistency (Cronbach's alphas of 0.82 and 0.95, respectively) and test-retest reliability (intraclass correlation coefficients of 0.837 and 0.807, respectively). No significant differences were observed between axSpA subtypes regarding EBBS-Barriers (p=0.12) and EBBS-Benefits (p=0.10) subscales. Significant relationships were detected between kinesiophobia and EBBS-Barriers scores (r=-0.424, p<0.01), as well as EBBS-Benefits scores (r=-0.344, p<0.01) for all patients. EBBS-Benefits scores were correlated to health status (r=-0.412, p=0.08) and quality of life (r=-0.394, p=0.01) in patients with nonradiographic axSpA.

Conclusion

According to our results, the Turkish EBBS is a valid and reliable tool for patients with axSpA. Perceptions of the patients with axSpA regarding exercise barriers and benefits do not differ according to the disease subtype. It appears that kinesiophobia may be an important parameter regarding exercise perception in axSpA.

Exercise sensitivity, physical activity, and kinesiophobia in patients with chronic coronary syndrome: a cross-sectional study

Introduction

Cardiac risk factors and diseases exacerbate anxiety and may cause exercise sensitivity by increasing awareness of physical conditions. However, the extent to which exercise sensitivity influences the level of physical activity and kinesiophobia in CVD patients is unclear.

Aim

The current study aimed to determine exercise sensitivity and its associated kinesiophobia and physical activity levels in patients with chronic coronary syndrome (CCS).

Material and methods

This cross-sectional study involved 43 patients diagnosed with CCS and 45 age- and gender-matched healthy individuals. Exercise sensitivity (questionnaire created by researchers), physical activity levels (short form Physical Activity Questionnaire, IPAQ), and kinesiophobia (Tampa Kinesiophobia Scale Heart, TSK-H) were evaluated.

Results

The exercise sensitivity score (ESS, 37.40 ±7.38 and 33.65 ±5.83, p = 0.010) was higher in the CSS group. During exercise, feeling pain, depletion of energy fatigue, chest pain, chest tightness, dizziness, palpitations, dyspnoea, and fainting frightened the patients (p < 0.05). The TSK-H score was higher, and the difference was significant in CCS patients compared the healthy controls (p = 0.007). Tye physical activity level was lower in patients than in healthy controls (p < 0.001), and 58.1% of CCS patients were inactive. ESS was significantly associated with IPAQ score (r = -0.360; p = 0.018) and TKS-H score (r = 0.529; p < 0.001) in CCS patients. According to linear regression analyses, exercise sensitivity explains 25% of kinesiophobia and physical activity.

Conclusions

Patients with CCS exhibit fear and sensitivity towards exercise, and these fears contribute to high levels of kinesiophobia and low physical activity levels. Future studies should be designed based on exercise sensitivity to increase participation in exercise-based programs.

Fatigue and physical activity in post-CABG patients: the parallel mediation model of kinesiophobia and self-efficacy : a prospective multicentre and cross-sectional study in China

OBJECTIVES

The objective of this study was to investigate how kinesiophobia and self-efficacy explain the relationship between fatigue and physical activity (PA) in post-coronary artery bypass grafting (post-CABG) patients over the age of 45.

DESIGN

A prospective multicentre and cross-sectional study.

SETTING

The study was conducted in four public tertiary hospitals in China.

PARTICIPANTS

A total of 1278 patients who underwent CABG surgery were selected from the case pool, with their surgeries occurring between 3 and 19 months prior to selection. Out of 1038 patients who met the inclusion criteria and were invited to participate in the study, 759 patients agreed to participate and complete the questionnaire. Ultimately, 376 questionnaires were deemed eligible and included in the analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

The questionnaire included the following scales: the Chinese version of the Multidimensional Fatigue Inventory (MFI-20), the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Cardiac Exercise Self-Efficacy Instrument (CESEI) and the International Physical Activity Questionnaire-Long (IPAQ-L). A serial mediation model was used to test whether the association between fatigue and PA was mediated by kinesiophobia and self-efficacy, in the overall sample and subsamples defined by age.

RESULTS

The results confirmed that fatigue was directly (95% CI (-5.73 to -3.02)) associated with PA. Higher kinesiophobia (95% CI (-0.16 to -0.05)) or lower PA self-efficacy (95% CI (-0.11 to -0.02)) were parallel pathways through which higher fatigue impediment reduced PA levels. In both subgroups, the street pathways of kinesiophobia and self-efficacy were altered. In the age, 45-60 years group, kinesiophobia (Boot 95% CI (-0.19 to-0.05)) was a mediator of fatigue on PA levels, while in the 61-75 years age group, self-efficacy (Boot 95% CI (-0.17 to -0.04)) was a mediator of fatigue on PA levels.

CONCLUSIONS

A clear relationship between fatigue and PA was mediated by both kinesiophobia and self-efficacy. Furthermore, our findings highlight the importance of adapting the intervention according to the age of the patients, mainly by reducing patients' kinesiophobia in patients aged 45-60 years and increasing patients' self-efficacy in patients aged 61-75 years. It may be possible to improve PA levels in post-CABG patients over 45 years of age by eliminating kinesiophobia and increasing self-efficacy.

Influence of health education based on the transtheoretical model on kinesiophobia levels and rehabilitation outcomes in elderly patients undergoing total knee arthroplasty

Objective

In this study, we evaluated the effectiveness of health education based on the transtheoretical model in reducing symptoms of kinesiophobia and enhancing rehabilitation outcomes among elderly patients post-total knee arthroplasty.

Methods

Elderly patients post-knee replacement surgery were randomly divided into a control group, which received standard health education, and an experimental group, which received transtheoretical model-based health education. The intervention commenced on the day after surgery and continued for a duration of six months. Assessments of kinesiophobia scores, rehabilitation self-efficacy, and knee function were conducted before the intervention, and then at one, three, and six months postoperatively.

Results

Between January 2022 and December 2022, 130 elderly patients who met the eligibility criteria were enrolled and subsequently randomly assigned into two groups of equal size. Comparable baseline characteristics were observed between the two groups The experimental group demonstrated lower kinesiophobia scores and higher scores in rehabilitation self-efficacy and knee function at one, three, and six months following surgery, compared to the control group.

Conclusion

Health education based on a transtheoretical model reduces the symptoms of kinesiophobia and enhances rehabilitation self-efficacy and knee functions in elderly patients after knee replacement surgery.

Kinesiophobia and associated variables in patients with heart failure

AIMS

Patients with heart failure (HF) can exhibit kinesiophobia, an excessive, debilitating, and irrational fear of movement. This study aimed to enhance the understanding of kinesiophobia in patients with HF by analysing associations with the following variables: musculoskeletal pain, quality of life, quality of sleep, functional capacity, disability, frailty, sex, and age.

METHODS AND RESULTS

In this cross-sectional study, 107 participants were included, with ages ranging from 28 to 97 years (57% men, mean age 73.18 ± 12.68 years). Multiple regression analyses were performed with all variables, including polynomial regressions for variables with a non-linear relationship. Kinesiophobia was significantly correlated (P < 0.01) with musculoskeletal pain, quality of life, quality of sleep, functional capacity, disability, and being at risk of frailty, while age and sex were not statistically significant. Frailty disability and musculoskeletal pain intensity were variables linearly associated with kinesiophobia, while quality of sleep and disability had a non-linear relationship with kinesiophobia.

CONCLUSION

Kinesiophobia needs to be evaluated and better understood in patients with HF to improve physical activity and exercise adherence. This study found that musculoskeletal pain intensity, quality of sleep, disability, and frailty risk have a significant association with kinesiophobia in patients with HF. Our results suggest multi-dimensional associations of kinesiophobia in patients with HF, which require further examination and understanding.

Kinesophobia and its related factors in patients after percutaneous coronary intervention: A cross-sectional study

OBJECTIVES

To explore the postoperative kinesophobia of patients after percutaneous coronary intervention (PCI) and its related factors.

BACKGROUND

Percutaneous coronary intervention is an effective method to treat coronary heart disease (CHD), and cardiac rehabilitation is an important auxiliary method after PCI. However, the compliance of patients with cardiac rehabilitation after PCI is not good, among which kinesophobia is an important influencing factor.

DESIGN

A descriptive cross-sectional design was implemented, and the high-quality reporting of the study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology Statement.

METHODS

In total, 351 inpatients who underwent PCI in three tertiary grade-A hospitals in China were selected by convenient sampling method. We use one-way ANOVA and multiple linear regression analysis to determine the relevant related factors.

RESULTS

The kinesophobia of patients after PCI was negatively correlated with chronic illness resource utilization and sense of personal mastery, and positively correlated with illness perception. Education level, clinical classification of CHD, exercise habits, chronic illness resource utilization, illness perception and sense of personal mastery entered the regression equation, which could explain 78.1% of the total variation.

CONCLUSION

The level of kinesiophobia of patients after PCI is high. Education level, clinical classification of CHD, exercise habits, chronic illness resource utilization, illness perception and sense of personal mastery are the related factors of kinesiophobia of patients after PCI.

RELEVANCE TO CLINICAL PRACTICE

By reducing the level of exercise fear of patients after PCI, patients are more likely to accept and adhere to the cardiac rehabilitation plan, thus improving their prognosis and improving their quality of life.

PATIENT OR PUBLIC CONTRIBUTION

The patient underwent PCI in the research hospital. Researchers screen them according to the inclusion criteria and invite them to participate in this study. If they meet the requirements, participants will answer the research questionnaire face to face after signing the informed consent form.

Measurement properties of assessment tools of Kinesophobia in patients with cardiovascular disease: A systematic review

Objectives

This study aimed to evaluate the measurement properties and methodological quality of assessment tools for Kinesophobia among patients with cardiovascular disease and provide a reference for healthcare professionals in selecting high-quality assessment tools.

Methods

A systematic search was performed on specific databases: Embase, the Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang database, China Biological Medicine disc, CINAHL, and China Science and Technology Journal Database, from inception to April 1, 2023. The researchers retrieved studies on the measurement attributes of the exercise fear scale in patients with cardiovascular diseases. They also traced back the references of the included studies to supplement relevant literature. According to the inclusion and exclusion criteria, screening and data extraction were independently undertaken by two reviewers. Two researchers individually used the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) Risk of Bias Checklist to assess the methodological quality of the scale, applied the COSMIN criteria to evaluate the measurement properties of the scale, and used a modified Grading, Recommendations, Assessment, Development, and Evaluation system to assess the certainty of evidence.

Results

Seventeen studies were identified that reported the psychometric properties of six patient reported outcome measurement tools (included different languages version) The methodological quality of content validity was adequate in only two studies, the remaining patient-reported outcome measures demonstrated doubtful content validity. Limited information on cross-cultural validity/measurement invariance, measurement error, and responsiveness was retrieved. The Swedish version and the Chinese version of the Tampa Scale for Kinesiophobia Heart were graded "A." The remaining instruments were graded "B."

Conclusions

The methodological and measurement attributes of the Swedish and Chinese versions of the Tampa Scale for Kinesiophobia Heart are relatively high quality and can be tentatively recommended. The measurement properties of the remaining scales remain to be verified.

The relationship between kinesiophobia and adaptation to illness in different chronic illnesses

OBJECTIVES

The aim of this study was to determine the relationship between kinesiophobia and adaptation to chronic illness.

METHODS

The study was conducted with descriptive design. The questionnaire consists of three parts: a form including questions about socio-demographic characteristics and chronic diseases-related characteristics of the participants, Tampa Scale for Kinesiophobia, and Adaptation to Chronic Illness Scale.

RESULTS

A total of 217 patients participated in the study, consisting of 99 patients with diabetes, 74 with heart failure (HF), and 44 with chronic obstructive pulmonary disease (COPD). The general mean age of the patients participating in the study was 61.03 ± 11.99 years, and the mean duration of disease diagnosis was 9.83 ± 7.16 years. While age, physical adaptation, and psychological adaptation affected the level of kinesiophobia of the patients with COPD and HF by 44.3% and 47.7%, respectively, physical adaptation and psychological adaptation affected the level of kinesiophobia of the patients with DM by 29.6%.

DISCUSSION

While the level of kinesiophobia was found to be high in all disease groups, it was determined that the level of adaptation to the disease was limited. Psychological and physical adaptation to illness was correlated with kinesiophobia.

Cardiac rehabilitation engagement and associated factors among heart failure patients: a cross-sectional study

BACKGROUND

Chronic Heart Failure (CHF) still affects millions of people worldwide despite great advances in therapeutic approaches in the cardiovascular field. Cardiac rehabilitation (CR) is known to improve disease-related symptoms, quality of life and clinical outcomes, yet implementation is suboptimal, a frequently low engagement in rehabilitation programs has been found globally.

OBJECTIVE

To quantify diverse CR-engaged processes and elucidate associated factors of the various levels of CR engagement in CHF patients.

METHODS

Discharged patients admitted from cardiology departments between May 2022 to July 2022 were enrolled by mobile phone text messaging, CHF patients from same department between August 2022 to December 2022 were enrolled by face-to-face. Individuals who met the inclusion criteria filled the questionnaires, including the generalized anxiety disorders scale, patient health questionnaire, cardiac rehabilitation inventory, patient activation measure, Tampa scale for kinesiophobia heart, social frailty, Patient Health Engagement Scale (PHE-s®). We obtained sociodemographic characteristics and clinical data from medical records. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with CR engagement phases.

RESULTS

A total of 684 patients were included in the study. 52.49% patients were in the Adhesion phase. At the multivariate level, compared with the blackout phase process anxiety, monthly income (RMB yuan) equal to or more than 5,000 were the most important factor impacting CHF patients CR engagement. Compared with the Blackout phase, regular exercise or not, severe depression, previous cardiac-related hospitalizations 1 or 2 times, Age influenced patient CR engagement in the Arousal phase. Besides, compared with the Blackout phase, outcome anxiety and activation level were independent factors in the Eudaimonic Project phase.

CONCLUSION

This study characterized CR engagement, and explored demographic, medical, and psychological factors-with the most important being process anxiety, monthly income, patient activation, severe depression, and previous cardiac-related hospitalizations. The associated factors of CR engagement were not identical among different phases. Our findings suggested that factors could potentially be targeted in clinical practice to identify low CR engagement patients, and strategies implemented to strengthen or overcome these associations to address low CR engagement in CHF patients.

Mediation analysis of activities of daily living and kinesiophobia in association between cardiac function and health status of patients with chronic heart failure

AIMS

To explore the mediational effect of activities of daily living (ADL) and kinesiophobia on the cardiac function and health status of patients with chronic heart failure (CHF).

METHODS

From October 2021 to January 2022, a total of 244 CHF patients treated in the Department of Cardiology of general hospitals were recruited by the convenience sampling method. They were investigated with the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Barthel index for assessing ADL, and the EuroQol five-dimensional questionnaire (EQ-5D) for assessing the health status.

RESULTS

The cardiac function and kinesiophobia of CHF patients were both negatively correlated with their health status (r = -.390 and -0.410, respectively, both p < .01). Besides, the ADL of CHF patients was positively correlated with the health status (r = .320, p < .01). The cardiac function of CHF patients was negatively correlated with the ADL (r = -.412, p < .01), but positively correlated with kinesiophobia (r = .180, p < .01). The mediation proportion of ADL plus kinesiophobia between the cardiac function and health status of CHF patients was 43.48%. Both ADL and kinesiophobia partially mediated the effect of cardiac function on health status in CHF patients, but their mediational effects showed no significant difference (p = .777).

CONCLUSION

Both ADL and kinesiophobia exert obvious mediational effects between cardiac function and health status in CHF patients. Individualized cardiac rehabilitation (CR) programs based on the cardiac function, ADL and kinesiophobia of CHF patients may contribute to reduce the medical burden and improve the well-being of affected people.

Correlates of musculoskeletal pain and kinesiophobia in older adults with heart failure: A structural equation model

The study aimed to study the influence of musculoskeletal pain on kinesiophobia in patients with heart failure. This cross-sectional study recruited 107 heart failure patients aged 73.18±12.68 years (57% men) from an outpatient setting. Participants self-reported pain using the Musculoskeletal System Assessment Inventory and the Cornell Musculoskeletal Discomfort Questionnaire. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia-11. About 62% reported musculoskeletal pain, with knees (16.8%) and lower back (12.%) being the most painful locations. About 31% reported moderate levels and 24% indicated high levels of kinesiophobia. There were positive and significant associations between the indicators of pain and kinesiophobia. Results showed an adequate structural equation model fit to the data with musculoskeletal pain factors explaining 22.09% of the variance in kinesiophobia. Assessment of kinesiophobia in patients with heart failure with musculoskeletal pain is essential to improve self-care and overall quality of life.

Gender as a determinant of physical activity levels and mental health of medical students from Poland and Belarus in the context of the COVID-19 pandemic

Background

COVID-19 pandemic has brought about unfavourable changes regarding both physical activity (PA) levels and patterns of behaviour associated with mental health. The study sought to assess PA levels and kinesiophobia in medical students from Poland and Belarus taking account of gender.

Methods

A total of 779 students (405 students from University of Grodno (UG), Belarus, and 374 students from John Paul II University of Applied Sciences (ABNS) in Biala Podlaska, Poland) took part in the study. Women constituted 74.2% of the study population. A diagnostic survey as well as two research tools, i.e., the International Physical Activity Questionnaire (IPAQ)-short form, and the Tampa Scale for Kinesiophobia (TAMPA) were employed in the study.

Results

Students from ABNS manifested significantly higher levels of PA. Taking into account gender, male respondents displayed significantly higher levels of MET-min/week (MET-metabolic equivalent of task). As for kinesiophobia, significantly higher levels were demonstrated by students from UG. Its higher levels were also noted among women.

Conclusion

The findings of the study did not reveal strong correlations between kinesiophobia and PA levels in students from Poland and Belarus in the context of different approaches to the pandemic that both countries adopted. Students from ABNS proved to be more physically active. In turn, participants from UG exhibited significantly higher levels of kinesiophobia. Gender was the factor that significantly differentiated levels of kinesiophobia, with women displaying its higher levels.

Translation and psychometric evaluation of a scale to measure the fear of activity in Chinese patients with coronary artery disease

AIM

To translate and test the psychometric properties of a Chinese version scale to measure the Fear of Activity in patients with Coronary Artery Disease.

DESIGN

A cross-sectional design.

METHODS

The translation of the scale to measure Fear of Activity in Patients with Coronary Artery Disease included three steps, forward-back translation, expert discussion and pilot survey. The internal consistency and test-retest reliability were used to assess the reliability of the Chinese version scale of the Fear of Activity. Content, construct, criterion, and known-group validity of the scale were also evaluated.

DATA SOURCES

A total of 275 patients with Coronary Artery Disease were recruited from a university-affiliated hospital in Guangzhou, southern China.

RESULTS

The overall content validity index of the Chinese version scale of the Fear of Activity in Patients with Coronary Artery Disease was 0.90. Principal component analyses extracted four factors with a cumulative variance contribution of 57.5%. There is a strong correlation (r = 0.83) between this scale and Tampa Scale for Kinesiophobia Heart. The total scores of the Chinese version scale of the Fear of Activity in female patients were higher than those in male patients with Coronary Artery Disease, indicating that the scale was able to distinguish the differences between low and high score groups. The Internal consistency and test-retest reliability coefficients of the scale were 0.74 and 0.82, respectively.

CONCLUSION

The Chinese version scale of the Fear of Activity in Patients with Coronary Artery Disease, which consists of 21 items with four dimensions, is a reliable and valid instrument to evaluate the fear of activity in patients with Coronary Artery Disease.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The Chinese version scale of the Fear of Activity in Patients with Coronary Artery Disease can be used to assess the levels of fear of activity in patients with Coronary Artery Disease and explores the factors that influence fear of activity in the population.

IMPACT

This study translates and confirms the psychometric properties of the Chinese version scale of the Fear of Activity in Patients with Coronary Artery Disease in China. It is useful in both research and clinical fields to explore the fear of activity and its associated factors in patients with Coronary Artery Disease.

REPORTING METHOD

The study design followed the guideline of Strengthening the Reporting of Observational Studies in Epidemiology statement.

PATIENT OR PUBLIC CONTRIBUTION

Patients in a university-affiliated hospital participated in this study and contributed to data collection.

Kinesiophobia And Related Factors In Adult Patients With Familial Mediterranean Fever

Objective Kinesiophobia is a common problem in patients with rheumatic diseases and can cause physical inactivity, social isolation, disability, and poor quality of life. This study aimed to evaluate kinesiophobia and associated factors in patients with familial Mediterranean fever (FMF).

Methods A total of 38 patients diagnosed with FMF volunteered to participate in the study. All patients were assessed using the Tampa Kinesiophobia Scale (TKS), the International Physical Activity Questionnaire (IPAQ), the Fatigue Severity Scale (FSS), and the Hospital Anxiety and Depression Scale (HADS).

Results Thirty-three (86.8%) of the patients had TKS scores over 37, indicating high levels of kinesiophobia. The TKS score was positively correlated with the HADS depression score (r=0.530; p=0.001) and the FSS score (r=0.340; p=0.035) but was not significantly associated with age (r=0.102; p=0.543), disease duration (r=–0.110; p=0.511), body mass index (r=0.283; p=0.085), the HADS anxiety score (r=0.306; p=0.061), or the IPAQ score (r=–0.097; p=0.563).

Conclusions Our sample of adult FMF patients showed high levels of kinesiophobia associated with fatigue and depression. Treatments focusing on kinesiophobia in FMF patients could help to increase the effectiveness of rehabilitation.

Cognitive behavioural techniques reduce exercise anxiety and improve adherence to a resistance training program for people with anxiety-related disorders: A randomized controlled trial

Exercise is a cost-efficient alternative to other interventions for anxiety-related disorders (ARDs; e.g., psychotherapy, pharmaceutical) that is also associated with health benefits. Several exercise modalities, including resistance training (RT), have demonstrated efficacy at reducing symptoms of ARDs; however, there are challenges associated with effectively implementing such protocols, most notably, exercise avoidance or early discontinuation. Researchers have identified exercise anxiety as a contributor to exercise avoidance for people with ARDs. Exercise-based interventions for people with ARDs may need to include strategies for helping these individuals cope with exercise anxiety to facilitate long-term exercise engagement; however, research in this area is lacking. The primary purpose of this randomized controlled trial (RCT) was to examine the effects of combining cognitive behavioural techniques (CBT) with a RT program on changes in exercise anxiety, exercise frequency, disorder-specific anxiety symptoms, and physical activity for people with ARDs. A secondary purpose was to explore group differences in exercise motivation and exercise self-efficacy across time. A total of 59 physically inactive individuals with ARDs were randomized into either RT + CBT, RT, or waitlist (WL). Primary measures were assessed at baseline, weekly during the 4-week active phase, and at 1-week, 1-month, and 3-month follow-ups. Findings indicate both RT and RT + CBT can reduce exercise anxiety; however, the addition of CBT techniques may help facilitate improvements in exercise self-efficacy, reductions in disorder-specific anxiety, and increases in long-term exercise behaviour and vigorous physical activity. These techniques may be useful for researchers and clinicians alike in supporting individuals with ARDs interested in using exercise to cope with elevated anxiety.

Kinesiophobia in patients with angina pectoris of coronary artery disease: A cross-sectional survey

BACKGROUND

In the field of chronic pain research, kinesiophobia is defined as avoidance behavior due to fear of pain, but this perspective seems to be neglected in the field of coronary artery disease (CAD).

OBJECTIVE

To investigate the status quo of angina pectoris (AP) and kinesiophobia and factors associated with kinesiophobia in patients with AP of CAD.

METHODS

This was a cross-sectional study. Participants were recruited by convenience sampling, and patients with AP of CAD in four wards of the Cardiology Department of a hospital were enrolled in this study. Participants completed questionnaires and scales face-to-face with researchers.

RESULTS

Most patients with AP of CAD suffered from at least moderate pain episodes (60.2%) of at least 5 minutes per episode (53.8%), but less than 1/3 of patients reached 5 instances of pain per week (29.1%). The total score of kinesiophobia in patients was 40.80±6.65, and the vast majority of patients had moderate to high levels of kinesiophobia (75.7%). The results of multiple linear stepwise regression analysis showed that personal monthly income, New York Heart Function Assessment (NYHA) classification, pain intensity, and pain resilience were independent factors associated with kinesiophobia, and these factors explained 30.2% of the variation in total scores of kinesiophobia.

CONCLUSION

The symptoms of AP were prominent in terms of pain intensity and duration of pain. The level of kinesiophobia was moderate, and this was affected by multiple factors. Health care providers and researchers seldom pay attention to the kinesiophobia of patients with AP of CAD. This study refocused on the effect of "fear of pain" in kinesiophobia in patients with CAD. It opens up new horizons for the application of fear-avoidance models in CAD patients and helps to raise awareness of kinesiophobia in AP patients with CAD and provides guidance for reducing the level of kinesiophobia in the future.

Kinesiophobia Levels in Patients with Multiple Sclerosis: A Case-Control Investigation

Fear of movement or kinesiophobia is an irrational fear of physical movement and fatigue that causes a limitation of functional capacity and decreased physical activity. The purpose of this study was to ascertain the level of kinesiophobia in people with multiple sclerosis (pwMS) and compare it with a group of healthy people, through the Tampa Scale for Kinesiophobia with 11 items (TSK-11).

METHOD

A total of 116 subjects were recruited in a multicenter case-control study; 58 subjects suffered from MS and 58 were healthy subjects from different associations and the same locality. To assess the levels of fear of movement, the Spanish version of the TSK-11 self-questionnaire was used.

RESULTS

Most pwMS suffer from some degree of kinesiophobia (TSK-11 ≥ 18), and 60.3% had moderate to maximum kinesiophobia scores (TSK-11 ≥ 25). In contrast, healthy subjects presented a percentage of kinesiophobia from none to moderate (82.7%).

CONCLUSIONS

Kinesiophobia is higher in pwMS than in the healthy control group. Accordingly, individuals showing pwMS should be assessed and monitored in order to diagnosed initial kinesiophobia levels, to allow planning treatment and preventive care activities that may improve the foot health and overall health in this group of patients.

Kinesiophobia and associated factors among patients with chronic non-specific low back pain

PURPOSE

This study determined the association between kinesiophobia and age, body mass index, highest educational status, self-efficacy, pain intensity, and disability in chronic non-specific low back pain (CNSLBP) patients. Predictors of kinesiophobia were also assessed.

METHODS

This cross-sectional design utilised 224 CNSLBP patients in tertiary hospitals in Nigeria. The Tampa Scale of Kinesiophobia, Oswestry Disability Index, Pain Self-Efficacy Questionnaire, and Numerical Pain Rating Scale were used to assess kinesiophobia, disability, self-efficacy, and pain intensity respectively. Spearman's correlation and multiple regression analysis determined the association between the variables of interest and the predictors of kinesiophobia, respectively.

RESULTS

Most of the participants reported a high level of kinesiophobia (92%), low level of self-efficacy (68.8%), moderate pain intensity (58.0%), and moderate disability (57.1%). A significant positive weak correlation was observed between kinesiophobia and pain intensity (r = 0.138, p = 0.040). Gender, self-efficacy, pain intensity, and disability significantly predicted the extent of kinesiophobia (p < 0.05).

CONCLUSION

The increased levels of kinesiophobia are a cause for concern and highlight the need for kinesiophobia and related factors to be closely monitored and incorporated into preventive and curative rehabilitation programmes for CNSLBP patients to minimise the negative impact on rehabilitation outcomes.Implications for RehabilitationPatients with chronic non-specific low back pain (CNSLBP) have high levels of kinesiophobia, which could predispose them to avoidance behaviours, physical inactivity, and deterioration of health, all of which, if not addressed, may result in poor rehabilitation outcomes, setting off a viscious cycle.Regular kinesiophobia assessments could indicate areas of rehabilitation concern, allowing health care providers to better target rehabilitation programs and improve rehabilitation outcomes.Pain severity, self-efficacy, and disability should be frequently assessed and included when planning rehabilitation programs, to reduce the detrimental impact on kinesiophobia.In patients with CNSLBP, graded exposure therapy to movement is necessary to prevent and reduce kinesiophobia, thereby increasing compliance during rehabilitation programs.

Factors influencing kinesiophobia during the "blanking period" after radiofrequency catheter ablation in patients with atrial fibrillation by the fear-avoidance model

BACKGROUND

The influencing factors of kinesiophobia (fear of movement) in patients with atrial fibrillation(AF)during the post-operative "Blanking Period" are not known. The aims were to investigate the status of kinesiophobia in patients with AF during the post-operative "Blanking Period", then further describe the occurrence and analyze the influencing factors of patients' kinesiophobia by the Fear-Avoidance Model.

MATERIALS AND METHODS

In total,400 patients diagnosed with atrial fibrillation, during the post-operative "Blanking Period" from the selected hospital were included in this study. The Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Self-efficacy for Exercise (SEE) scale, and the Geriatric Locomotive Function Scale (GLFS) were used to assess kinesiophobia, exercise self-efficacy, and physical function. The study adopted a cross-sectional design.

RESULTS

The score of kinesiophobia during the "Blanking Period" after operation in patients with atrial fibrillation was (44.06 ± 10.77), and the rate of high kinesiophobia was 71.61%.Logistic regression results showed that age, education, household monthly income, resting heart rate, EHRA symptom classification, exercise self-efficacy, and physical function influenced the kinesiophobia of patients during the post-operative "Blanking Period"(p<0.05， p<0.01).

CONCLUSIONS

Kinesiophobia is common in patients with atrial fibrillation during the postoperative "Blanking Period", and the fear of movement is related to age, education, household monthly income, resting heart rate, EHRA symptom classification, exercise self-efficacy, and physical function. Clinical and nursing staff should pay close attention to the psychological problems in the post-operation "Blanking Period" of exercise rehabilitation in patients with atrial fibrillation, make timely interventions to reduce patients' fear of movement, and improve patients' compliance with exercise rehabilitation.

The effects of social isolation due to COVID‐19 on the fear of movement, falling, and physical activity in older people

Objective

This study investigates the interaction between fear of movement, fall risk, and physical activity levels in ageing individuals who experienced social isolation during the COVID‐19 pandemic.

Methods

In this descriptive and cross‐sectional study, 254 eligible participants used an online background survey. Individuals’ fear of movement was evaluated by the kinesiophobia causes scale, fall risk by the falls efficacy scale, and physical activity levels by the physical activity scale for the ageing.

Results

The fear of movement had a significant positive interaction on fall risk (β = 0.471, R² = 0.495, p < 0.001). The fall risk had a negative effect on physical activity (β = −1.686, R² = 0.161, p < 0.001). The fear of movement and fall risk explained 15.6% of the change in physical activity levels of ageing individuals (p < 0.001).

Conclusions

These results showed a significant interaction between physical activity levels and fear of movement, with a high fall risk in ageing individuals during the pandemic period.

Kinesiophobia in People with Multiple Sclerosis and Its Relationship with Physical Activity, Pain and Acceptance of Disease

Background and Objectives: Multiple sclerosis (MS) is the most common chronic demyelinating disease. Factors that reduce the occurrence of symptoms include physical activity (PA). However, the data indicate that PA levels among people with MS are lower than those of healthy peers. The cause may be kinesiophobia. The aim of the study was to determine the level of kinesiophobia among people with MS and its relationship with age, disease duration, functional status, PA, and degree of acceptance of the disease. Materials and Methods: Eighty people aged 35−69 were examined: 60 women (75%) and 20 men (25%). The Expanded Disability Status Scale (EDSS) was used to determine the level of disability (median: 3.50; min−max: 1−6). The research questionnaire consisted of a metric section, Visual Analogue Scale (VAS) for pain, Tampa Scale of Kinesiophobia (TSK), Acceptance of Illness Scale (AIS), and Modified Baecke Questionnaire for Older Adults for physical activity. Results: Of the respondents, 52.50% were characterized by a high level of kinesiophobia (>37 points). Correlation analysis: TSK and PA showed the following: r = −0.363 (p = 0.001). Regression explains kinesiophobia in 44% (R2 = 0.4364; p < 0.0000). The predictors of TSK were as follows: disability level: p < 0.01, ß = 0.33; disease acceptance: p < 0.01, ß = −0.34; PA: p < 0.05, ß < −0.05. Conclusions: The problem of kinesiophobia is significant in MS patients, and its predictors are the functional status of the patients, low degree of acceptance of the disease, and low level of physical activity. The age and duration of the disease do not determine the problem of fear of movement.

Kinesiophobia and Its Association With Fatigue in CHF Patients

Kinesiophobia is related with adverse outcomes in various diseases, but it hasn't been studied in chronic heart failure (CHF). Fatigue often causes movement avoidance in CHF patients by leading to a worse condition and server symptom burden. To explore kinesiophobia and its related factors and the relationship between the kinesiophobia and fatigue in CHF patients. We recruited total of 236 inpatients with CHF from October 2020 to March 2021 and administered a self-designed demographic questionnaire, the Chinese version of the Tampa Scale for Kinesiophobia Heart (TSK-Heart-C), and the Multidimensional Fatigue Inventory (MFI-20), and collected related electronic medical record data. The results showed that the incidence of kinesiophobia was 63.14% in hospitalized patients, and there was a moderate correlation between fatigue and kinesiophobia (r = .49, p < .01). Educational background, monthly family income, disease course, and fatigue explained 41% of the variation in kinesiophobia, of which fatigue independently accounted for 9%.

Association between Social Support and Physical Activity in Patients with Coronary Artery Disease: Multiple Mediating Roles of Self-Efficacy and Autonomous Motivation

Physical inactivity in patients with coronary artery disease is linked to recurrent cardiac events. Given that social support may be an enduring major factor for physical activity, the mechanism underlying the multiple mediating effects of self-efficacy and autonomous motivation on the relationship between social support and physical activity in patients with coronary artery disease has hardly been examined. Therefore, this study aimed to clarify the multiple mediating roles of social support and physical activity on the relationship between self-efficacy and autonomous motivation in patients with coronary artery disease. This descriptive cross-sectional study included 190 inpatients who were diagnosed with coronary artery disease and admitted to a cardiology ward university hospital in Korea. Parallel multiple mediated models were tested using the SPSS PROCESS macro. The direct effects of social support on physical activity and the indirect effects of self-efficacy and autonomous motivation on social support and physical activity were statistically significant. Thus, positive social support from health-care providers has an important role to play in promoting physical activity by increasing self-efficacy and autonomous motivation for physical activity in patients with coronary artery disease.

Heartbeat tracking task performance, an indicator of interoceptive accuracy, is associated with improvement of exercise tolerance in patients undergoing home-based cardiac rehabilitation

Aims

Interoception is the sensing function of physiological conditions and is crucial in self-regulation and decision-making. We examined the association of heartbeat tracking task performance, an indicator of interoceptive accuracy, with the degree of improvement in exercise tolerance in patients undergoing home-based cardiac rehabilitation.

Methods and results

Participants underwent baseline peak oxygen uptake (VO₂) measurements and a heartbeat tracking task. The heartbeat tracking task score varies between 0 and 1, with higher scores indicating a better heartbeat perception. After 6 months of home-based exercise training, peak VO₂ was measured again, and the percentage change (%Δ peak VO₂) relative to the peak VO₂ at baseline was calculated. Univariate regression analysis was performed to examine the association between %Δ peak VO₂ and the heartbeat tracking task score. Multiple regression analysis was performed to determine the predictors of %Δ peak VO₂. Of 120 participants, 100 patients (age 65.9 ± 11.9 years; 86% male) were included. There was a significant positive association between %Δ peak VO₂ and the heartbeat tracking task score at baseline (R ² = 0.236, P < 0.001). In multiple regression analysis, the percentage of measured peak VO₂ to the predicted value (%predicted peak VO₂) (β = -0.248, P = 0.002), exercise adherence (β = 0.364, P < 0.001), and heartbeat tracking task score at baseline (β = 0.372, P < 0.001) were significantly associated with %Δ peak VO₂.

Conclusions

Heartbeat tracking task performance, an indicator of interoceptive accuracy, at baseline is associated with the degree of improvement in exercise tolerance.

Kinesiophobia in Elderly Polish Patients After Ischemic Stroke, Including Frailty Syndrome

INTRODUCTION

In patients after stroke, the relationship between the occurrence of kinesiophobia and the accompanying frailty syndrome, as well as the acceptance of the disease and the level of mood, has not been recognized so far. The aim of this study was to determine the prevalence of kinesiophobia in elderly Polish people after ischemic stroke, including the frailty syndrome and the associations between the prevalence of kinesiophobia and feelings of anxiety and degree of the illness acceptance.

METHODS

A cross-sectional study was used to achieve the study objectives. The study involved 152 hospitalized patients aged of minimum 60 (mean age 63), qualified for post-stroke rehabilitation, including 76 women and 76 men. The patients were divided into two groups, with kinesiophobia (119 persons) and without kinesiophobia (33 persons). The Tampa Scale of Kinesiophobia (TSK), the Tilburg Frailty Indicator (TFI), the Hospital Anxiety Depression Scale (HADS) and the Acceptance of Illness Scale (AIS) were used. Study results were calculated using MedCalc Software.

RESULTS

Kinesiophobia has been demonstrated in 78% of people after ischemic stroke. The values of TFI and HADS were higher in the patients with kinesiophobia (p<0.001). In patients with ischemic stroke, it was shown that the level of kinesiophobia increased with higher anxiety (p<0.001), higher total TFI score, (p<0.05), and a lower level of illness acceptance (p<0.001).

CONCLUSION

The occurrence of kinesiophobia in elderly Polish people after ischemic stroke is common and the determinants of its development are the coexistence of the frailty syndrome, anxiety and a low level of illness acceptance. In post-stroke patients, the presence of kinesiophobia should be considered, especially in the situation of comorbid frailty syndrome. The issue of kinesiophobia in patients after stroke requires further in-depth research, especially in the field of cognitive-behavioral prevention aimed at ways to reduce this phenomenon.

Isolation Related to the COVID-19 Pandemic in People Suffering from Parkinson's Disease and Activity, Self-Assessment of Physical Fitness and the Level of Affective Disorders

Background: Staying at home for long periods and limiting various types of activities and social contacts due to the COVID-19 pandemic may have negative consequences for health. This is especially true for people suffering from chronic diseases, in whom an appropriate level of activity and social contacts delay the progress of the disease. This group includes people diagnosed with Parkinson’s disease—PD. Aim: It was decided to investigate the effect of COVID-19 isolation related to self-assessment of physical fitness, physical activity, and the level of anxiety and depression in people with PD. Methods: The study included 30 patients diagnosed with Parkinson’s disease. We compared the results of the pre-pandemic questionnaire and the telephone interview with the same questions—after the period of isolation due to COVID-19. The questionnaire included questions about physical activity and fitness self-assessment. The level of affective disorders was tested using HADS. Results: There was a statistically significant decrease in the physical activity of the respondents after isolation related to COVID-19 (p < 0.05). Self-assessment of physical fitness also decreased, but the differences were not statistically significant. In the post-isolation study, only 50% of the respondents had normative values for anxiety and only 40% for depression. The analysis showed that the level of physical activity—the independent variable, explains anxiety in 30% and depression in 27%. Conclusions: Pandemic isolation has significantly reduced physical activity in PD patients. There was a certain drop in the self-esteem of physical fitness in these people. Physical fitness is an important predictor of preventing the affective disorders of anxiety and depression. The effects of isolation due to COVID-19 require further research.

Influence of Frailty Syndrome on Kinesiophobia According to the Gender of Patients after Coronary Artery Bypass Surgery

(1) Background: Kinesiophobia is associated with fear of movement, general fitness exercises, and physical or mental discomfort. In patients with frailty syndrome, in addition to coexisting conditions, the postoperative recovery period may be longer than in patients without frailty; (2) Methods: The study included 108 people over 60 years of age, qualified for CABG (coronary artery bypass grafting). The Tilburg Frailty Index was used to assess frailty syndrome and the kinesiophobia scale was to assess fear of physical activity; (3) Results: Frailty syndrome was diagnosed among 19.44% of respondents. The social components of frailty were more intense in the group of women p = 0.009. The mean results for the biological and psychological domain on the scale of kinesiophobia were 1.94 and 1.6. The level of kinesiophobia was higher among women than among men taking into account the psychological domain (p = 0.006) and the subdomains: motor skills self-assessment (p = 0.042) and body care (p = 0.011); (4) Conclusions: Frailty syndrome does not affect kinesiophobia among patients after CABG. The level of kinesiophobia was higher among women than among men, taking into account the psychological domain. The greater the energy resources, the lower the level of frailty and its physical components in the group of women.

Effect of inspiratory muscle training on dyspnea-related kinesiophobia in chronic obstructive pulmonary disease: A randomized controlled trial

BACKGROUND

The major symptom of chronic obstructive pulmonary disease (COPD) is dyspnea, which causes dyspnea-related kinesiophobia resulting in avoidance of activities associated with dyspnea or compensation by reducing the rate of activity. The aim of this study was to assess dyspnea-related kinesiophobia and determine the effect of inspiratory muscle training (IMT) on dyspnea-related kinesiophobia in COPD.

METHODS

Forty COPD subjects were randomly allocated to either the IMT or sham group. Both groups' maximal inspiratory pressure (MIP) was assessed weekly. All patients were instructed to perform the training exercises for 15 min twice a day, 5 days a week for a total of 8 weeks. In the IMT group, intensity was set at 30% of MIP and adjusted according to weekly MIP value. In the sham group, intensity remained constant at 15% of initial MIP. Pulmonary function test (PFT), respiratory muscle strength, 6-min walk test (6 MWT), Breathlessness Beliefs Questionnaire (BBQ), Modified Medical Research Council scale (MMRC), modified Borg scale, Hospital Anxiety and Depression Scale (HADS), Saint George's Respiratory Questionnaire (SGRQ), and COPD Assessment Test (CAT) were assessed before and after the intervention.

RESULTS

BBQ scores ranged from 18 to 51, with mean values in the IMT and sham groups of 39.80 ± 7.62 and 43.00 ± 6.58, respectively. When between-group differences of all outcome scores were compared, there was a statistically significant improvement in the IMT group than in the sham group (p < 0.05). After IMT, statistically significant decreases in BBQ and modified Borg scores were observed in within groups (p ≤ 0.001). These decreases were significantly greater in the IMT group (p ≤ 0.001). MMRC decreased significantly only in the IMT group (p < 0.001). There was a statistically significant increase in PFT values in the IMT group (p = 0.007-0.045), but no difference in the sham group (p = 0.129-0.886). Both groups showed statistically significant improvement in respiratory muscle strength, 6 MWT distance, and CAT score after 8 weeks (p < 0.05). All HADS and SGRQ scores decreased significantly in the IMT group (p < 0.001), whereas only the SGRQ activity score decreased significantly in the sham group (p = 0.017).

CONCLUSIONS

Our study provides data on the presence and level of dyspnea-related kinesiophobia in COPD patients. All patients had BBQ scores higher than 11, indicating dyspnea-related kinesiophobia. IMT reduced BBQ score and improved respiratory function, and exercise capacity. Our results also support the other known benefits of IMT such as reduced dyspnea and symptom perception, decreased anxiety and depression, and improved quality of life.

Kinesiophobia in Stroke Patients, Multiple Sclerosis and Parkinson's Disesase

BACKGROUND

Stroke (S), multiple sclerosis (MS), Parkinson's disease (PD) are chronic neurological diseases that are a challange for public health and represent a real social problem. Physical activity (PA) improves functional performance, reduces various symptoms in PD and MS, in stroke- reduced neurological impairment of patients and provides a chance for independence. One of the main obstacles in successful rehabilitation is patients' movement passivity. The reason might be the psychological aspects, in particular fear of movement-kinesiophobia. Aim: To determine how many patients with S, MS, and PD suffer from kinsiophobia and what factors influence this process.

METHODS

Fifty patients after stroke, eighty one MS patients and sixty one PD patients were consecutively recruited from hospital and outpatients clinics. The sociodemographic data, self- assesment of fitness, Visual Analogue Scale (VAS) for pain, Tampa Scale of Kinesiophobia (TSK) and The Modified Baecke Questionnarie for Older Adults for physical activity were collected. A score >37 was considered to indicate a high level of kinesiophobia according to the TSK.

RESULTS

High level of kinesiophobia was shown in 66.67% of the subjects. TSK medians in particular illnesses were above the cut-off score and amounted: S-42.50 points; MS-38 points; PD-42.00 points. Regression showed 15% of fluctuation of variance (R2 = 0.1498; p < 0.0001), where regression factor showed: for mobility self-assessment: b = -0.2137 and for the age b = 0.0065.

CONCLUSIONS

Kinesiophobia among the patients suffering from S, MS and PD concerns most of the subjects. Predictors of kinesiophobia are: limitations connected with functioning and age. The meaning of kinesiophobia in neurological disorders requires further research.

Psychometric Features of the Polish Version of TSK Heart in Elderly Patients with Coronary Artery Disease

Background and objectives: Recommendations for the control of stable patients with coronary artery disease (CAD) related to an adequate level of physical activity (PA). Practical experience shows that the PA level in most people with CAD is definitely too low in relation to the guidelines. The cause may be psychological factors and among them the fear of movement-kinesiophobia. The aim of this project was to examine the evaluation of psychometric features of the Polish version of the Tampa Scale for Kinesiophobia Heart (TSK Heart), used in people with CAD. Materials and methods: The study involved 287 patients with stable CAD: 112 women and 175 men. Age: 63.50 (SD = 11.49) years. Kinesiophobia was assessed using TSK Heart, physical activity (PA)-using the International Physical Activity Questionnaire (IPAQ), and anxiety and depression was examined using the Hospital Anxiety and Depression Scale (HADS). The structure of TSK was examined using principal component analysis (PCA), internal cohesion (Cronbach's alpha, AC), and content validity was calculated by linear regression. Results: PCA showed a three-factor TSK structure. One-dimensionality and satisfactory reliability were found: TSK Heart: AC = 0.878. Kinesiophobia as a predictor of PA: R2 = 0.162 (p = 0.000000). Anxiety and depression-TSK: R2 = 0.093 (p = 0.00000). Conclusions: The Polish version of TSK Heart for cardiac patients is characterized by good psychometric features. The use of it can improve the cooperation of rehabilitation teams for patients with CAD.