Original article
Is the Fear Avoidance Model Associated With the Reduced Level of Aerobic Fitness in Patients With Chronic Low Back Pain?

https://doi.org/10.1016/j.apmr.2008.07.009Get rights and content

Abstract

Smeets RJ, van Geel KD, Verbunt JA. Is the fear avoidance model associated with the reduced level of aerobic fitness in patients with chronic low back pain?

Objectives

To compare aerobic fitness of patients with chronic low back pain (CLBP) against healthy controls and to assess whether variables of the fear avoidance model are associated with loss of aerobic fitness.

Design

A case-comparison study.

Participants

Patients with CLBP (n=223), and normative data from healthy subjects (n=18,082).

Interventions

Not applicable.

Main Outcome Measures

Maximal oxygen uptake (V̇o2max) was estimated on the basis of a modified submaximal Åstrand bicycle test performed by patients with CLBP (observed level of aerobic fitness) and compared with the normative data of healthy controls matched for age, sex, and level of sport activity (expected level of aerobic fitness). Pain (visual analog scale); disability (Roland Disability Questionnaire); pain-related fear (Tampa Scale for Kinesiophobia); depression (Beck Depression Inventory); catastrophizing (Pain Catastrophizing Scale); and the level of activity during sport, work/household, and leisure time (Baecke Physical Activity Questionnaire) were assessed. Multiple linear regression analysis was performed with the difference of the observed and expected level of aerobic fitness as dependent variable and putative influential factors including those of the fear avoidance model as independent variables.

Results

o2max could be calculated in 175 (78%) of the patients. Both men and women with CLBP had significant lower V̇o2max than expected (10.3mL/kg lean body mass (LBM)×min−1 and 6.5mL/kg LBM×min−1, respectively; P<.001). The levels of activity during leisure time and work/household were significantly associated with this reduced level of aerobic fitness. However, the variables of the fear avoidance model were not.

Conclusions

Most patients with CLBP-associated disability have a lower level of aerobic fitness, but this is not associated with fear avoidance.

Section snippets

Participants and Settings

This study is part of a research project on the evaluation of rehabilitation treatment in CLBP.11 In this project, 223 patients referred by their general practitioner or medical specialist between April 2002 and December 2004 agreed to participate in a randomized controlled trial to evaluate the effectiveness of different treatments for CLBP disability. Patients were treated in 3 rehabilitation centers in the province of Noord-Brabant in The Netherlands: rehabilitation centre Breda,

Sample Characteristics

Demographic data and complaint characteristics of the 223 participating patients and specified for men and women separately are shown in table 1. Men differed significantly from women regarding weight, LBM, length, duration of LBP, duration of LBP-associated disability, level of education, BPAQ work, hours of sports, and household activities. There were no further significant sex-related differences. Furthermore, about 70% of the patients were on partial sick leave because of LBP or were not

Discussion

Using the Åstrand submaximal bicycle test allowed estimation of the V̇o2max in 78% of the patients with CLBP, which is in agreement with our previous study.8 All patients had CLBP-associated disability and were referred for multidisciplinary treatment. Ninety-one percent of this specific sample had a lower level of aerobic fitness compared with healthy controls matched for age, sex, and level of sport activity during the preceding 6 months. Both men and women with CLBP had a significantly lower

Conclusions

Most patients with CLBP-associated disability have a lower level of aerobic fitness than healthy controls matched for age, sex, and level of sport activity in the preceding 6 months, but this is not associated with fear avoidance. To investigate further the development and impact of loss of the level of aerobic fitness, longitudinal studies should be performed in patients with acute LBP.

Acknowledgments

The authors would like to thank the rehabilitation centers Breda, Leijpark, and Blixembosch and the many people who contributed to the successful completion of this study, particularly the participating patients, the rehabilitation center contact persons, therapists, and research assistants.

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    Supported by Zorgonderzoek Nederland/Medische Wetenschappen (grant no. 014-32-007).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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