title: Dyspnea perception in COPD: association between anxiety, dyspnea-related fear, and dyspnea in a pulmonary rehabilitation program.
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.
authors.affiliation: Research Group Health Psychology, Department of Psychology, University of Leuven, Leuven, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Janssens
authors.affiliation: Research Group Health Psychology, Department of Psychology, University of Leuven, Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: De Peuter
authors.affiliation: Pneumology Department, University of Leuven, Leuven, Belgium.
authors.forename: Linda
authors.initials: L
authors.lastname: Stans
authors.affiliation: Pneumology Department, University of Leuven, Leuven, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Verleden
authors.affiliation: Pneumology Department, University of Leuven, Leuven, Belgium; Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven, Leuven, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Troosters
authors.affiliation: Pneumology Department, University of Leuven, Leuven, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Decramer
authors.affiliation: Research Group Health Psychology, Department of Psychology, University of Leuven, Leuven, Belgium. Electronic address: omer.vandenbergh@psy.kuleuven.be.
authors.forename: Omer
authors.initials: O
authors.lastname: Van den Bergh
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology*; D004417:Dyspnea / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D005080:Exercise Test; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology* / Q000534:rehabilitation; D011788:Quality of Life; D011795:Surveys and Questionnaires