The influence of pain-related beliefs on physical activity and health attitudes in patients with claudication: A pilot study

Abstract

We examined how pain beliefs are related to symptom severity, expectations of risk/benefits, and baseline physical activity among claudicants. Eligible patients at the Michael E DeBakey Veterans Affairs Medical Center were administered questionnaires that measured: fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire [FABQ]), walking impairment, baseline physical activity, claudication type, and risk/benefit attitudes. Among 20 participants, the median age was 69 years (IQR: 66-75). In our efforts to understand how fear-avoidance beliefs influenced physical activity among people with claudication, we found that 12 out of 19 participants (63%) thought that the primary etiology of their pain was walking, while 18 (out of 20) (90%) people thought that walking would exacerbate their leg symptoms - suggesting that there was some confusion regarding the effects of walking on claudication. Those who expected that walking would benefit their symptoms more than surgery reported fewer fear-avoidance beliefs ( p=0.01), but those who believed that walking would make their leg pain worse expected greater benefit from surgery ( p=0.02). As symptom severity increased, fear-avoidance beliefs also increased ( p=0.001). The association between symptom severity and fear-avoidance beliefs indicates that as pain or impairment increases, the likelihood of avoiding behaviors that are thought to cause pain might also increase. Accounting for pain-related beliefs when recommending physical activity for claudication should be considered.

Preferred exercise modalities in patients with intermittent claudication

“…Additionally, leg pain was also mentioned as one of the biggest reasons or possibly "fears" for attending an exercise programme. Previous evidence supports our findings that pain or fear of pain may discourage patients from exercising (11). However, systematic reviews suggest that clinically relevant improvements in walking distance can be attained at a lower threshold, without inducing pain, which may increase participation rates (8,12).…”

Non-traditional exercises in rehabilitation programmes for symptomatic patients with peripheral artery disease

“…8 In the same way, adherence in home-based programmes is also small. 9 Some studies have shown that pain has psychological implications, reduces motivation and is a barrier to patients with IC performing exercise. 9 In fact, a percentage of patients believe that their pain is caused by or worsened by walking exercise.…”

“…9 In fact, a percentage of patients believe that their pain is caused by or worsened by walking exercise. 9 As both moderate-pain exercise and pain-free exercise provoke similar functional benefits, pain-free exercise, as well as alternative exercise modalities, could be an important strategy to encourage patients to begin an exercise programme. Moreover, an education programme about this issue could be included in the management of patients with IC.…”

Patient perspectives on claudication: An opportunity to improve the adoption and adherence of exercise therapy

“…In this issue of Vascular Medicine , Sharath and colleagues 4 provide the results of a pilot study assessing the influence of fear-avoidance beliefs related to physical activity among patients with PAD and claudication ( n =20) who were referred to a vascular surgery clinic. The fear-avoidance model 5 suggests that patients may fear a specific behavior due to negative beliefs and confusion, which ultimately leads to its corollary, avoidance of the behavior.…”

“…A majority of patients feared exercise was the cause of claudication ( n =12/19, 63%), and thought that physical activity would not only make their pain worse ( n =18/20, 90%), but would also harm their legs ( n =10/18, 56%). 4 Conversely, patients with lower fear-avoidance belief scores expected greater benefit from exercise, and were less likely to believe they should avoid physical activity due to their leg symptoms. While these results are intuitive, providing objective data of a potential psychological mechanism for why leg pain is a barrier to physical activity among patients with PAD is a key contribution of this study.…”