Content » Vol 45, Issue 10

Original report

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

Kristina Åhlund, Maria Bäck, Ninni Sernert
Department of Research and Development, NU-Hospital Organisation, (Institute of Neuroscience and Physiology, University of Gothenburg), SE-461 85 Trollhättan, Sweden. E-mail:
DOI: 10.2340/16501977-1219


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 futher 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.

Lay Abstract


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