نقش ترس از حرکت فیزیکی و فعالیت در سندرم خستگی مزمن

Objective: To examine beliefs in relation to avoidance of activity in chronic fatigue syndrome (CFS) patients. Methods: The first phase consisted of modifying an existing chronic pain measure of kinesiophobia—fear of physical movement and activity—and validating it on the CFS population [Tampa Scale of Kinesiophobia-Fatigue (TSK-F); n=129; test–retest: r=.89, P<.001; α=.68]. Subscales of Illness Beliefs (α=.78) and Beliefs about Activity (α=.70) were identified. The second phase consisted of evaluating whether behavioural persistence was predicted by the TSK-F (n=33). Participants were asked to ride an exercise bike for as long as they felt able. Results: Analyses indicated that behavioural persistence did not correlate with maximal heart rate or resting heart rate, level of tiredness, symptom severity, illness identity or emotional distress. However, the TSK-F did correlate highly with distance travelled and added a significant 15% of the variance in distance after adjustments for gender and physical functioning (PF). The TSK-F Beliefs about Activity subscale appears to be the predictive factor, explaining 12% of the variance in excise performance or rather 12% of the avoidance of exercise. Conclusion: Beliefs about Activity appear to be an important variable in predicting behaviour and avoidance of exercise. As avoidance has been suggested as a key to the maintenance of symptoms, disability and distress in CFS patients, this research has important theoretical, clinical and research implications.

Patients with chronic fatigue syndrome (CFS) have been shown to be less active and have longer rest periods after exercise than healthy controls [1]. Such behaviour has been hypothesised as central to both chronic pain and chronic fatigue [2], [3], [4], [5], [6], [7], [8] and [9]. Rest/avoidance of activity, while effective in the short-term, are maladaptive in the long-term, associated with deconditioning and a poorer outcome in both CFS [10], [11] and [12] and chronic pain [4]. In chronic pain, studies have examined such behaviour in terms of fear [2], [11] and [12]. The term “kinesiophobia” (kinesis=movement) describes “excessive, irrational and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or reinjury” [3]. These authors created the Tampa Scale of Kinesiophobia (TSK). Studies have shown that in pain patients the TSK is a main predictor of distress, disability [4] and [6] and persistence with behavioural tasks such as lifting weights and cardiovascular exercises [6]. It appears that pain-related fear is more disabling than pain itself [6]. A cognitive model has been developed using fear of movement as the determinant of the maintenance of pain (see Fig. 1) [4] and [6].

In conclusion, it appears that the findings show firstly that exercise can be anxiety provoking for this population. The TSK-F is a reliable predictor of the level of anxiety that individuals feel prior to completing physical exercise. Thirdly, the TSK-F is a powerful predictor of an individuals performance on a behavioural task. Although more work needs to be conducted in this area, this study provides the first experimental evidence that beliefs about activity and its consequences are important in predicting behavioural persistence and as such are important in our understanding and treatment of the maintenance of CFS.