Accelerometer-Measured Daily Physical Activity in Adults With Chronic Heart Failure and Associations With Fear of...

Fear of physical activity (FoPA) has been discussed as a barrier to physical activity in chronic heart failure. We describe associations of FoPA with accelerometer-assessed daily physical activity indicators and examine the contribution of the 2 coping dispositions cognitive avoidance and vigilance to this relationship.

In this multisite study, FoPA, using the "Fear of Activity in Situations 15-Heart Failure" questionnaire, and coping dispositions were assessed in 87 stable outpatients with chronic heart failure (61.0 ± 11.0 years, 26% women). Participants wore an accelerometer for 7 days. Step count and minutes of moderate to vigorous intensity activity (MVPA) per day were computed, both using 10-minute bouts and total MVPA. Multiple linear regression was applied to test associations of FoPA with physical activity. Direct and indirect (via FoPA) associations of coping dispositions with activity were examined.

The 82 patients with valid accelerometer data had a median of 52 minutes of total MVPA per day (interquartile range 30.3-83.3) and 14.3 minutes of bouted MVPA per day (interquartile range 0-20.4). They walked a median of 5409 steps/d (interquartile range 3204-7944). Significant and independent associations of FoPA with reduced total MVPA per day ( b  = -10, SE = 2.85, P  < .001) and step count per day ( b  = -811, SE = 258, P  = .002) emerged. Cognitive avoidance contributed directly and independently to higher activity; vigilance had a small indirect effect on lower activity via increased FoPA.

In outpatients with chronic heart failure, FoPA constitutes a clinically relevant barrier to daily physical activity. Coping dispositions deserve further attention to deliver tailored fear-reducing interventions.