Measurement of Exercise Avoidance and False Safety Behaviors in Older Adults

项目摘要/摘要 心脏结构和功能的衰老相关变化增加了心血管疾病的易感性 疾病(如心脏病、中风)、虚弱、跌倒、痴呆症和阿尔茨海默病。运动性心脏 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 生活的一部分。然而，由于就诊情况较差，大多数登记参加CR的患者无法获得治疗的全部好处 和依从性，在CR治疗结束后，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有关的新机制，其特征是 认知、行为和生理基础。运动焦虑在患者中特别高 加入CR，因为锻炼的身体感觉通常与归因于 心血管疾病(例如，呼吸急促、心跳加速)。提高了对这些身体的认识 感觉会加剧对锻炼过程中可能发生的事情的恐惧和担忧(例如，如果我有一颗心怎么办 攻击？“)，即使这是安全的，并建议患者从事有氧运动。患者可能会 避免锻炼和/或依赖虚假的安全行为来管理恐惧(例如，频繁地检查脉搏， 限制跑步机的速度)。虽然这些行为在瞬间缓解了焦虑，但它们加剧了 长期保持焦虑。通过反复使用，个人学会将“安全”归因于他们的回避和 安全行为，形成错误的信念，认为安全取决于某些行动(例如，“只有 当有人在监测我的心脏时让我锻炼“)，这维持了他们的恐惧和不必要的限制 他们的活动(例如，“除非有人看着我，否则我不能快步走”)。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 靶向治疗的回避和虚假安全行为，使患者容易受到 误认为只有在一系列受限的情况下锻炼才是安全的，结果是有限的 身体条件作用和机能。这项研究将通过以下两项来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患者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，以生成初始题库 用于开发自我报告量表。目的2：提炼和评价量表的心理测量学特性 通过探索性因素分析和条目缩减，对纳入CR的患者样本中的条目进行分析，然后是 验证性因素分析和后续样本的项目信度和效度检验。这项研究将 通过发展一种自我意识，对促进CR遵守和无畏衰老的努力产生直接影响 在研究和干预中使用的运动避免和虚假安全行为的报告测量 努力。这一措施将有助于系统地识别和处理回避恐惧和虚假安全问题。 破坏CR坚持和积极独立生活的行为。

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.