title: Kinesiophobia mediates the influences on attendance at exercise-based cardiac rehabilitation in patients with coronary artery disease.
abstract: OBJECTIVE
  To identify predictors of attendance at exercise-based cardiac rehabilitation (CR) and to test the hypothesis that kinesiophobia mediates the influence on attendance at CR in patients with coronary artery disease (CAD).
  
  
  METHODS
  In total, 332 patients (75 women; mean age 65 ± 9.1 years) with a diagnosis of CAD were recruited at Sahlgrenska University Hospital, Sweden.
  
  
  METHODS
  The patients were tested in terms of objective measurements, self-rated psychological measurements, and level of physical activity. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An exploratory selection of significant predictors was made.
  
  
  RESULTS
  A current incidence of coronary bypass grafting (p < 0.001) and a diagnosis of ST-elevation myocardial infarction (p = 0.004) increased the probability of attendance at CR, while kinesiophobia (p = 0.001) reduced attendance. As a mediator, kinesiophobia was influenced by four predictors and the following indirect effects were found. General health and muscle endurance increased the probability of attendance at CR, while self-rated anxiety and current incidence of heart failure had the opposite effect.
  
  
  CONCLUSIONS
  This study suggests that kinesiophobia has an influence on and a mediating role in attendance at CR. The results need to be further investigated in relation to clinical practice.
authors.affiliation: a Department of Occupational Therapy and Physiotherapy , Sahlgrenska University Hospital , Gothenburg , Sweden.|b Institute of Medicine, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden.|c Department of Medical and Health Sciences , Division of Physiotherapy, Linköping University , Linköping , Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Bäck
authors.affiliation: a Department of Occupational Therapy and Physiotherapy , Sahlgrenska University Hospital , Gothenburg , Sweden.|d Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Cider
authors.affiliation: e The Center of Preshospital Research Western Sweden , University of Borås , Borås , Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
authors.affiliation: f Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden.
authors.forename: Mari
authors.initials: M
authors.lastname: Lundberg
authors.affiliation: g Department of Psychology , University of Gothenburg , Gothenburg , Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Jansson
mesh_terms: D000368:Aged; D000072038:Cardiac Rehabilitation / Q000523:psychology*; D003324:Coronary Artery Disease / Q000534:rehabilitation*; D015444:Exercise / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010698:Phobic Disorders
keywords: Attendance; coronary artery disease; exercise-based cardiac rehabilitation; kinesiophobia; secondary prevention