LAY ABSTRACTFear of movement (kinesiophobia) in common is patients with cardiac diseases. As a consequence, these patients have lower levels of adherence to cardiac rehabilitation. It would be useful to gain more insight into kinesiophobia in cardiac patients. In order to effectively screen for kinesiophobia and to evaluate treatment for these patients, an objective measurement tool would be useful. Secondly, in order to effectively treat patients, it would be useful to determine which subgroups of cardiac patients experience kinesiophobia. The aim of this study was to determine the reliability and validity of a questionnaire to measure kinesiophobia, and to determine the level of kinesiophobia in subgroups of patients. Objectives:To determine the psychometric properties of a questionnaire to assess fear of movement (kinesiophobia): the Tampa Scale for Kinesiophobia (TSK-NL Heart), and to investigate the prevalence of kinesiophobia in patients attending cardiac rehabilitation. Methods: A total of 152 patients were evaluated with the TSK-NL Heart during intake and 7 days later. Internal consistency, test-retest reliability and construct validity were assessed. For construct validity, the Cardiac Anxiety Questionnaire (CAQ) and the Hospital Anxiety and Depression Scale (HADS) were used. The factor structure of the TSK-NL Heart was determined by a principal component analysis (PCA). Results: After removal of 4 items due to low internal consistency, the TSK-NL Heart showed substantial reliability (intraclass correlation coefficient; ICC: 0.80). A strong positive correlation was found between the TSK-NL Heart and the CAQ (r s : 0.61). A strong negative correlation was found between the TSK-NL Heart and the HADS (Anxiety) (r s -0.51). The PCA revealed a 3-factor structure as most suitable (fear of injury, avoidance of physical activity, perception of risk). High levels of kinesiophobia were found in 45.4% of patients. Conclusion: The 13-item TSK-NL Heart has good psychometric properties, and we recommend using this version to assess kinesiophobia, which is present in a substantial proportion of patients referred for cardiac rehabilitation.
Objective The purpose of this study was to investigate the relationship between body mass index (BMI) class and physical activity and sedentary behavior in patients with acute coronary syndrome (ACS) during cardiac rehabilitation (CR). Methods This study was a secondary analysis of the OPTICARE trial. Physical activity and sedentary behavior were measured in patients with ACS (n = 359) using actigraphy at baseline, directly after completion of a multidisciplinary 12-week exercise-based CR program, and 9 months thereafter. Outcome measures were step count and duration of time (% of wear time) spent in light physical activity, moderate-to-vigorous physical activity, and sedentary behavior. Patients were classified as normal weight (BMI = 18.5–24.99 kg/m2; n = 82), overweight (BMI = 25.0–29.99 kg/m2; n = 182), or obese (BMI ≥ 30.0 kg/m2; n = 95). Linear mixed-effects models were applied to study the relationship between BMI class and physical activity and sedentary behavior. Results At the start of CR, compared with patients with normal weight, patients with obesity made on average 1.11 steps fewer per minute (952 steps/day), spent 2.9% (25 min/day) less time in light physical activity, and spent 3.31% (28 min/day) more time in sedentary behavior. Patients of all BMI classes improved their physical activity and sedentary behavior levels similarly during CR, and these improvements were maintained after completion of CR. Conclusion Patients with ACS who had obesity started CR with a less favorable physical activity and sedentary behavior profile than that of patients with normal weight. Because all BMI classes showed similar improvement during CR, this deficit was preserved. Impact This study indicates that reconsideration of the CR program in the Netherlands for patients with ACS and obesity is warranted, and development of more inclusive interventions for specific populations is needed. A new program for people with obesity should include added counseling on increasing physical activity and preventing sedentary behavior to facilitate weight loss and reduce mortality risk. Lay Summary People with ACS who have obesity are less active and sit more than patients with normal weight, both during and after CR. This study suggests that CR needs to be changed to help patients increase their physical activity to help them lose weight and reduce their risk of death.
To examine the strength of the association between exercise capacity and health-related quality of life (HRQOL) during and after cardiac rehabilitation (CR) in patients with acute coronary syndrome (ACS) who completed CR. Design: Prospective cohort study. Setting: Outpatient CR center. Participants: Patients (NZ607) with ACS who completed CR. Interventions: Multidisciplinary 12-week exercise-based CR program. Main Outcome Measures: At baseline (pre-CR), the 6-Minute Walk Test (6MWT) was performed to determine exercise capacity, and the MacNew Heart Disease Health-related Quality of Life questionnaire was used to assess HRQOL. Measurements were repeated immediately after completion of CR (post-CR): at 12 months and 18 months follow-up. Multivariable linear regression, including an interaction term for time and exercise capacity, was applied to study the association between exercise capacity and HRQOL at different time points relative to CR, whereas model parameters were estimated by methods that accounted for dependency of repeated observations within individuals. Results: Mean age in years AE SD was 58AE8.9 and 82% of participants were male. Baseline mean 6MWT distance in meters AE SD was 563AE77 and median (25th-75th percentile) global HRQOL was 5.5 (4.6-6.1) points. Mean 6MWT distance (P<.001) and the global (P<.001), physical (P<.001), emotional (P<.001) and social (P<.001) domains of HRQOL improved significantly during CR and continued to improve during follow-up post-CR. Independent of the timing relative to CR (ie, pre-CR, post-CR, or during follow-up), a difference of 10 m 6MWT distance was associated with a mean difference in the global HRQOL domain of 0.007 (95% confidence interval [CI], 0.001-0.014) points (PZ.029) and a mean difference in the physical domain of 0.009 (95% CI, 0.001-0.017) points (PZ.023). Conclusions: Better exercise capacity was significantly associated with higher scores on the global and physical domains of HRQOL, irrespective of the timing relative to CR, albeit these associations were weak. Hence, CR programs in secondary prevention should continue to aim at enhancing both HRQOL and exercise capacity.
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