Trajectories of Fear-Avoidance Beliefs on Physical Activity Over Two Years in People With Rheumatoid Arthritis

To identify and describe 2-year trajectories of fear-avoidance beliefs on physical activity and to identify predictors of these trajectories in people with rheumatoid arthritis (RA).

We included 2,569 persons with RA (77% women, mean age 58 years). Data on fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire physical activity subscale [FABQ-PA]; range 0-24), sociodemographics, disease-related variables, self-efficacy, and health-enhancing physical activity (HEPA) were collected from registers and by questionnaires at baseline, 14, and 26 months. K-means cluster analysis was used to identify fear-avoidance trajectories, and multinomial logistic regression was used to identify predictors of trajectory membership.

Three trajectories of fear-avoidance beliefs were identified: low (n = 1,060, mean FABQ-PA = 3), moderate (n = 1,043, mean FABQ-PA = 9), and high (n = 466, mean FABQ-PA = 15). Consistent predictors of being in the high fear-avoidance trajectory versus the other 2 trajectories were high activity limitation, male sex, income below average, not performing current HEPA, and elevated anxiety/depression. In addition, less consistent predictors such as shorter education, more pain, and low exercise self-efficacy were also identified.

Stable trajectories of fear-avoidance beliefs on physical activity exist among people with RA. Fear-avoidance may be targeted more effectively by tailoring physical activity promotion to vulnerable socioeconomic groups, men, and those with high activity limitation and anxiety/depression.