Anxiety and Fear of Exercise in Cardiopulmonary Rehabilitation

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: It may be beneficial to provide practitioners with skills to recognize and address anxiety and fear in their patients as it relates to exercise.