Author:

Keywords:

Science & Technology, Life Sciences & Biomedicine, Critical Care Medicine, Respiratory System, General & Internal Medicine, QUALITY-OF-LIFE, AFFECTIVE DIMENSION, IMPACT, DISEASE, DEPRESSION, CONTRIBUTE, EMPHYSEMA, EMOTIONS, CYCLE, PAIN, Aged, Anxiety, Dyspnea, Exercise Test, Fear, Female, Humans, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive, Quality of Life, Surveys and Questionnaires, 1103 Clinical Sciences, 3201 Cardiovascular medicine and haematology, 3202 Clinical sciences

Abstract:

BACKGROUND: A growing body of research connects anxiety with poorer outcomes in COPD. However, more specific measures of dyspnea-related fear may be more closely related to critical processes involved in pulmonary rehabilitation (perception of dyspnea and avoidance of physical activity) and may have a predictive value for COPD outcome beyond general anxiety measures. METHODS: In this naturalistic outcome study, we investigated the effects of baseline anxiety and dyspnea-related fear on perceived dyspnea and other outcomes of a well-established pulmonary rehabilitation program for COPD. RESULTS: Seventy-three patients participated in the study. At baseline, higher dyspnea-related fear was associated with higher levels of dyspnea during ergometer exercise, but also with a steeper decrease of exercise dyspnea during the course of pulmonary rehabilitation, whereas lower dyspnea-related fear was associated with an increase in exercise dyspnea, even when controlling for anxiety, lung function, and exercise intensity. Furthermore, higher dyspnea-related fear was associated with reduced quality of life (mastery subscale) and maximal exercise capacity at baseline, but also with a steeper increase in quality of life (emotions and mastery subscale) and exercise capacity during rehabilitation. However, the association of dyspnea-related fear with worse 6-min walking distance and impairment in daily activities persisted throughout rehabilitation. CONCLUSIONS: Results indicate a mediating effect of dyspnea-related fear on the association between anxiety and exercise-related dyspnea. Exercise in pulmonary rehabilitation in people with higher baseline dyspnea-related fear may act as a correction of excessive symptom reports through exposure to dyspneic situations.