Reduction in Fear of Physical Activity Among Older Persons With Coronary Artery Disease by Physical Therapist–Assisted Exercise: A Randomized Trial

Cardiovascular diseases remain the number one global concern for morbidity and mortality. Experience of angina with activity or at rest in patients with coronary artery disease (CAD) can induce kinesiophobia (fear of movement). 1 Knapik A. Dąbek J. Brzęk A. Kinesiophobia as a problem in adherence to physical activity recommendations in elderly Polish patients with coronary artery disease. Patient Prefer Adherence. 2019; 13: 2129-2135 Crossref PubMed Scopus (12) Google Scholar In this group of patients, kinesiophobia, often underestimated, may not be irrational but intricately connected with causing self-harm from an adverse cardiac event. 2 Dąbek J. Knapik A. Gallert-Kopyto W. et al. Fear of movement (kinesiophobia)—An underestimated problem in Polish patients at various stages of coronary artery disease. Ann Agric Environ Med. 2019; 27: 56-60 Crossref PubMed Scopus (4) Google Scholar Kinesiophobia, along with anxiety and depression, which are commonly reported in older adults with cardiovascular diseases, can negatively impact self-efficacy and engagement in physical activity and exercise. 3 Bäck M. Cider Å. Herlitz J. et al. Kinesiophobia mediates the influences on attendance at exercise-based cardiac rehabilitation in patients with coronary artery disease. Physiother Theory Pract. 2016; 32: 571-580 Crossref PubMed Scopus (20) Google Scholar ,4 Siow E. Leung D.Y.P. Wong E.M.L. et al. Do depressive symptoms moderate the effects of exercise self-efficacy on physical activity among patients with coronary heart disease?. J Cardiovasc Nurs. 2018; 33: E26-E34 Crossref PubMed Scopus (11) Google Scholar Guidelines on moderate-intensity exercise in patients with CAD are well established. 5 Piepoli M.F. Hoes A.W. Agewall S. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016; 37: 2315-2381 Crossref PubMed Scopus (4058) Google Scholar Research shows that high-intensity interval training as an alternative exercise modality is safe; however, more research is needed for its adoption into practice, especially in older adults with CAD. The purpose of this study was to investigate the effects of a physical therapist–assisted combined high-intensity interval training and resistance exercise program on kinesophobia in older adults with CAD. Additionally, we also examined if such a program can improve anxiety, depression, and overall physical activity in this population.