Fear of physical activity relates to cardiac interoception and symptom distress in patients with chronic heart failure

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BackgroundPatients with chronic heart failure often experience symptoms during physical activity, such as shortness of breath and tachycardia, which may result in fear of physical activity (FoPA). This study tested whether interoception (i.e., the perception of body sensations) and symptom distress (i.e., negative appraisal of symptoms) are associated with FoPA in outpatients with chronic heart failure. MethodFoPA was assessed with the Fear of Activities in Situations (FActS) in patients with diagnosed heart failure and healthy controls. A heartbeat tracking task and self-reports were used to assess interoceptive accuracy and interoceptive attention in patients and controls. Heart failure-related distress was assessed using ratings of symptom and treatment burden in patients. Multiple regression models were calculated to determine associations with continuous FoPA scores. ResultsPatients with low FoPA perceived their heartbeats more accurately than patients with high FoPA and healthy controls. Interoceptive accuracy and symptom distress explained almost half of the variance in FoPA, after adjustments for sex and disease severity, in patients with heart failure. ConclusionsIn patients inaccurate interoception and symptom distress were associated with high FoPA, independent of heart failure severity. The perception and appraisal of cardiac arousal and symptoms during physical activity deserve further attention to develop interventions to reduce FoPA in patients with heart failure. ClinicalTrials.gov IdentifierNCT03119298.