From ‘Disability and Rehabilitation’, 12 February 2012
Kinesiophobia, catastrophizing and anticipated symptoms before stair climbing in chronic fatigue syndrome: an experimental study
Jo Nijs(1,2,3), Mira Meeus(1,2), Marianne Heins(4), Hans Knoop(4), Greta Moorkens(5), Gijs Bleijenberg(4)
(1) Department of Human Physiology, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
(2) Division of Musculoskeletal Physiotherapy, Department of Health Care Sciences, Artesis University College Antwerp,Antwerp, Belgium
(3) Department of Physical Medicine and Physiotherapy, University Hospital Brussels,
(4) Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre,
Nijmegen. The Netherlands
(5) Reference Centre for Chronic Fatigue Syndrome, Department of Internal Medicine, University Hospital Antwerp, Belgium
Correspondence: Jo Nijs, Vrije Universiteit Brussel, MFYS-LK Building L, Pleinlaan 2, BE-1050 Brussels , Belgium. Tel: +32 26291154. Fax: +32 26292876. E-mail: Jo.Nijs@vub.ac.be
PURPOSE: Kinesiophobia and catastrophizing are frequent among people with chronic fatigue syndrome (CFS). This study was aimed at examining (1) whether kinesiophobia, anticipated symptoms and fatigue catastrophizing are related to stair climbing performance in people with CFS; and (2) whether kinesiophobia and fatigue catastrophizing are related to daily physical activity in CFS.
METHOD: Patients with CFS filled in a set of questionnaires, performed a physical demanding task (two floors stair of climbing and descending) with pre-test and post-test heart rate monitoring and immediate post-stair climbing symptom assessment. Real-time activity monitoring was used between the baseline and second assessment day (7 days later). Results: Kinesiophobia and fatigue catastrophizing were strongly related (ρ = 0.62 and 0.67, respectively) to poorer stair climbing performance (i.e. more time required to complete the threatening activity). Kinesiophobia and fatigue catastrophizing were unrelated to the amount of physical activity on the first day following stair climbing or during the seven subsequent days.
CONCLUSION: These findings underscore the importance of kinesiophobia and fatigue catastrophizing for performing physical demanding tasks in everyday life of people with CFS, but refute a cardinal role for kinesiophobia and fatigue catastrophizing in determining daily physical activity level in these patients.
Implications for Rehabilitation
* People with chronic fatigue syndrome (CFS) can easily perform stair climbing, a daily physical activity perceived by themselves as threatening, without triggering symptom flares. This is important as it can be used clinically to convince people with CFS of undertaking such a threatening task during treatment programs such as graded activity or graded exposure.
* The finding that kinesiophobia and fatigue catastrophizing are strongly related to stair climbing performance in CFS underscores the importance of restructuring the beliefs of these patients about the relationship between activity and symptoms. This should be a key component of the early stages of rehabilitation for people with CFS.
* In rehabilitation practice, diminishing kinesiophobia and fatigue catastrophizing in patients with CFS appears only relevant for targeting physical activities that are perceived as threatening (e.g. stair climbing), and not for increasing work-related or social (physical) activities.
* Clinicians can use the Tampa Scale Kinesiophobia version CFS for assessing the fear of patients with CFS to exacerbate their symptoms (including pain, fatigue and brain fog) due to physical activities.
* Clinicians can use the Tampa Scale fatigue for assessing the fear of patients with CFS to exacerbate their fatigue level due to physical activities.