Fear-avoidance beliefs, exercise capacity, and activity-related dyspnea during pulmonary rehabilitation in patients with COPD

Abstract

Dyspnea-related fear-avoidance beliefs (FAB) have been suggested to be associated with worse exercise capacity, dyspnea, and depression in COPD. Pulmonary rehabilitation (PR) has been shown to improve these outcomes in patients with COPD, but research on the role of FAB on these outcomes during PR has been inconclusive. We therefore investigated associations of baseline FAB and changes in FAB with changes in exercise capacity, activity-related dyspnea, and depression during PR. Individuals with COPD (n=55) participated in a 3-week inpatient multidisciplinary PR program. At baseline and after PR, patients performed a 6 min walk test (6MWT), and filled out the Fear-Avoidance Questionnaire for COPD with its subscales measuring dyspnea-related fear beliefs (FB) and avoidance behavior (AB). Activity-related dyspnea and depressive symptoms were measured using the Baseline/Transition Dyspnea Index and Patient Health Questionnaire-9, respectively. After PR, patients showed improved 6MWT distance, and reported improvement in activity-related dyspnea, depression, FB, and AB. Improvement in AB was associated with better 6MWT distance after PR (schange=-.15, p=.044). Furthermore, lower baseline AB and improvement in AB were both associated with improved activity-related dyspnea (sbl=-.55, p=.003, schange=-.37, p=.02) and reduced depressive symptoms (sbl=.47, p=.001, schange=.51, p Dyspnea-related fear-avoidance beliefs are associated with multiple outcomes of pulmonary rehabilitation in patients with COPD. Explicitly targeting change in these beliefs may help to improve the effectiveness of PR.