Fear-avoidance beliefs and cardiac rehabilitation in patients with first-time myocardial infarction.

OBJECTIVE The aim of this study was to examine fear-avoidance beliefs in patients after first-time myocardial infarction and to determine how such beliefs change over time. A further aim was to analyse fear-avoidance beliefs and physical activity levels in patients attending exercise-based cardiac rehabilitation led by a registered physiotherapist, compared with a control group. DESIGN Prospective cohort study. PATIENTS A total of 62 patients after first-time myocardial infarction were consecutively included in the study, mean age 61 years (range 42-73). Thirty-four patients chose exercise-based cardiac rehabilitation and 28 carried out the exercise regime on their own (controls). At follow-up, 57 patients (n = 30 and n = 27, respectively) responded. METHODS The Fear-Avoidance Beliefs Questionnaire and the Exercise and Physical Activity questionnaires were completed at 1 and 4 months post-infarction. RESULTS Clinically relevant fear-avoidance beliefs were seen in 48% of all patients at baseline, compared with 21% at follow-up (p = 0.01). Corresponding baseline values were 62% for the cardiac rehabilitation group and 29% for controls (p = 0.02). At follow-up, 4 months post-infarction, the difference between the groups was no longer seen. The total amount of physical activity increased over time for the cardiac rehabilitation group (p = 0.03), and this was also significant compared with the control group (p = 0.02). CONCLUSION Compared with controls, patients attending exercise-based cardiac rehabilitation led by a registered physiotherapist, demonstrated higher levels of fear-avoidance beliefs at baseline, which decreased over time. Furthermore, attendees increased their level of physical activity and exercise over time. Participation in exercise-based cardiac rehabilitation is therefore strongly recommended for patients with myocardial infarction, especially for those with increased fear of movement.