Measurement of Exercise Avoidance and False Safety Behaviors in Older Adults

老年人运动回避和错误安全行为的测量

• 批准号: 10728342
• 负责人: Mindy Michelle Kibbey
• 金额: $ 4.72万
• 依托单位: RUTGERS, THE STATE UNIV OF N.J.
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10728342
• 关键词: Acute; Adherence; Aerobic Exercise; Aging; Alzheimer' s Disease; Anxiety; Assessment tool; Awareness; Behavior; Behavioral; Belief; Benign; Cardiac rehabilitation; Cardiovascular Diseases; Cessation of life; Chest Pain; Clinical; Clinical Medicine; Code; Cognitive; Cognitive Therapy; Data; Dementia; Development; Dimensions; Dyspnea; Elderly; Enrollment; Esthesia; Event; Exercise; Exertion; Eye; Face; Factor Analysis; Failure; Focus Groups; Fright; Generations; Heart; Heart Diseases; Heart Rate; Independent Living; Individual; Intervention; Interview; Investigational Therapies; Learning; Life Style; Longevity; Measurement; Measures; Medical; Medicine; Methods; Monitor; Myocardial Infarction; Patient Self-Report; Patients; Physical Function; Physical activity; Physiologic pulse; Physiological; Process; Property; Psychometrics; Quality of life; Race; Reaction; Recommendation; Recurrence; Research; Review Literature; Risk; Risk Reduction; Safety; Sampling; Schedule; Shortness of Breath; Speed; Stroke; Structure; Symptoms; Testing; Therapeutic; Treatment Efficacy; United States National Institutes of Health; Validity and Reliability; Visit; Walking; Work; age related; anxiety reduction; behavior change; behavior observation; bodily sensation; cardiovascular disorder risk; clinically relevant; cognitive function; disability; exercise prescription; falls; frailty; healthy aging; heart function; human old age (65+); improved; mortality; mortality risk; novel; participant enrollment; physical conditioning; prevent; programs; prospective; psychologic; targeted treatment; therapy design; tool; treadmill; vigorous intensity

PROJECT SUMMARY/ABSTRACT Aging-related changes to the structure and function of the heart increase vulnerability to cardiovascular disease (e.g., heart disease, stroke), frailty, falls, dementia, and Alzheimer disease. Exercise-based cardiac rehabilitation (CR) slows these processes, reduces risk of mortality, and improves physical function and quality of life. However, most patients who enroll in CR fail to gain the full benefits of treatment due to poor attendance and adherence, and few maintain independent physical activity when CR treatment ends. Exercise anxiety is a novel mechanism related to non-adherence to exercise and lifestyle physical activity that is characterized by cognitive, behavioral, and physiological underpinnings. Exercise anxiety is particularly elevated in patients enrolled in CR given that physical sensations of exercise often feel similar to sensations attributed to cardiovascular disease (e.g., shortness of breath, racing heart). Heightened awareness of these bodily sensations can promote fear and worry about what could happen during exercise (e.g., “What if I have a heart attack?”), even though it is both safe and recommended for patients to engage in aerobic exercise. Patients may avoid exercise and/or rely on false safety behaviors to manage fears (e.g., checking pulse frequently, restricting speed on treadmill). While these behaviors relieve anxiety in the moment, they exacerbate and maintain anxiety long-term. Through repeated use, individuals learn to attribute “safety” to their avoidance and safety behaviors, developing false beliefs that safety is contingent upon certain actions (e.g., “It’s only safe for me to exercise when someone is monitoring my heart”), which maintain their fears and unnecessarily limits their activities (e.g., “I can’t go for a brisk walk unless someone is keeping an eye on me”). Despite theoretical and clinical relevance, there is currently no reliable and valid measure to identify and track these exercise avoidance and false safety behaviors for targeted treatment, which leaves patients vulnerable to the misperception that it is only safe to exercise under a restrictive set of circumstances and results in limited physical conditioning and functioning. This study will fill this critical assessment gap through the two following aims. Aim 1: To characterize exercise avoidance and safety behaviors in CR via comprehensive literature review, expert focus groups, and clinical behavioral observation for generation of an initial item bank to be used for development of a self-report scale. Aim 2: To refine and evaluate the psychometric properties of scale items in a sample of patients enrolled in CR through exploratory factor analysis and item reduction, followed by confirmatory factor analysis and tests of item reliability and validity in a subsequent sample. This study will have an immediate impact on efforts in promotion of CR adherence and fearless aging by developing a self- report measure of exercise avoidance and false safety behaviors for use in both research and intervention efforts. This measure will facilitate systematic identification and treatment of fear-avoidance and false safety behaviors that undermine CR adherence and active independent living.

项目总结/摘要 与年龄相关的心脏结构和功能变化增加了心血管疾病的易感性。 疾病（例如，心脏病、中风）、虚弱、福尔斯、痴呆和阿尔茨海默病。基于心脏起搏的 康复（CR）减缓了这些过程，降低了死亡风险，并改善了身体功能和质量 生命然而，大多数参加CR的患者由于出勤率低而未能获得治疗的全部益处 和依从性，并且当CR治疗结束时，很少有人保持独立的体力活动。运动焦虑是一种 与不坚持锻炼和生活方式体力活动相关的新机制，其特征在于 认知行为和生理基础运动焦虑在患者中尤其升高 考虑到运动的身体感觉通常与归因于运动的感觉相似， 心血管疾病（例如，呼吸急促，心跳加速）。提高对这些身体的认识 感觉可以促进对锻炼期间可能发生的事情的恐惧和担心（例如，“如果我有心 攻击？”），尽管它是安全的，并建议患者进行有氧运动。患者可能 避免锻炼和/或依赖错误的安全行为来管理恐惧（例如，经常检查脉搏， 限制跑步机上的速度）。虽然这些行为缓解了焦虑的时刻，他们加剧， 长期保持焦虑。通过反复使用，人们学会了将“安全”归因于他们的回避， 安全行为，形成安全取决于某些行为的错误信念（例如，“这是唯一安全的， 当有人监视我的心脏时，我就去锻炼”），这会维持他们的恐惧和不必要的限制。 他们的活动（例如，“我不能去轻快地散步，除非有人看着我”）。尽管理论上 和临床相关性，目前还没有可靠和有效的措施来识别和跟踪这些运动 针对性治疗的回避和虚假安全行为，使患者容易受到 错误地认为只有在一系列限制性的情况下才能安全地锻炼， 身体状况和功能。本研究将通过以下两个方面填补这一关键的评估空白 目标。目的1：通过综合文献描述CR中的运动回避和安全行为 评审、专家焦点小组和临床行为观察，以生成初始项目库， 用于开发自我报告量表。目的2：对量表的心理测量学特性进行改进和评价 通过探索性因素分析和项目减少，在入组CR的患者样本中获得项目，然后 验证性因素分析和测试项目的信度和效度在随后的样本。本研究将 通过发展自我，对促进CR依从性和无畏衰老的努力产生直接影响， 报告用于研究和干预的运动回避和虚假安全行为的测量 努力这一措施将有助于系统地识别和处理恐惧回避和虚假安全 破坏CR依从性和积极独立生活的行为。