Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 1 , Pages 109-117 , January 2009

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

  • Rob J. Smeets, MD, PhD

      Affiliations

    • Rehabilitation Centre Blixembosch, Eindhoven, The Netherlands
    • School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
    • Rehabilitation Foundation Limburg, Hoensbroek, The Netherlands
    • Corresponding Author InformationReprint requests to Rob J. Smeets, MD, PhD, Rehabilitation Foundation Limburg, PO Box 88, 6430 AB Hoensbroek, The Netherlands
  • ,
  • Kees D. van Geel, PT

      Affiliations

    • Rehabilitation Centre Blixembosch, Eindhoven, The Netherlands
    • Fysiotherapie Beelen/Medisch trainings centrum Breukelen, Breukelen, The Netherlands
  • ,
  • Jeanine A. Verbunt, MD, PhD

      Affiliations

    • School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
    • Rehabilitation Foundation Limburg, Hoensbroek, The Netherlands
    • Department of Psychological Science, Maastricht University, Maastricht, The Netherlands

References 

  1. Picavet HS, Schouten JS. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups: the DMC(3)-study. Pain. 2003;102:167–178
  2. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85:317–332
  3. Verbunt JA, Seelen HA, Vlaeyen JW, et al. Disuse and deconditioning in chronic low back pain: concepts and hypothesis on contributing mechanisms. Eur J Pain. 2003;7:9–21
  4. Crombez G, Vlaeyen JW, Heuts PH, Lysens R. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999;80:329–339
  5. Rainville J, Ahern DK, Phalen L, Childs LA, Sutherland R. The association of pain with physical activities in chronic low back pain. Spine. 1992;17:1060–1064
  6. Smeets RJ, Wittink H. The deconditioning paradigm for chronic low back pain unmasked?. Pain. 2007;130:201–202
  7. Verbunt JA, Seelen HA, Vlaeyen JW, van der Heijden GJ, Knottnerus JA. Fear of injury and physical deconditioning in patients with chronic low back pain. Arch Phys Med Rehabil. 2003;84:1217–1232
  8. Smeets RJ, Wittink H, Hidding A, Knottnerus JA. Do patients with chronic low back pain have a lower level of aerobic fitness than healthy controls? (Are pain, disability, fear of injury, working status, or level of leisure time activity associated with the difference in aerobic fitness level?). Spine. 2006;31:90–97
  9. Roelofs J, Goubert L, Peters ML, Vlaeyen JW, Crombez G. The Tampa Scale for Kinesiophobia: further examination of psychometric properties in patients with chronic low back pain and fibromyalgia. Eur J Pain. 2004;8:495–502
  10. McArdle WD, Katch FI, Katch VL. Exercise physiology: energy, nutrition, and human performance. In: Baltimore: Lippincott, Williams and Wilkins; 2001;p. 22–248
  11. Smeets RJ, Vlaeyen JW, Hidding A, et al. Active rehabilitation for chronic low back pain: cognitive-behavioral, physical, or both? (First direct post-treatment results from a randomized controlled trial [ISRCTN22714229]). BMC Musculoskel Disord. 2006;7:5
  12. Avakian EV, Horvath SM, Michael ED, Jacobs S. Effect of marihuana on cardiorespiratory responses to submaximal exercise. Clin Pharmacol Ther. 1979;26:777–781
  13. Milani RV, Lavie CJ, Mehra MR, Ventura HO. Understanding the basics of cardiopulmonary exercise testing. Mayo Clin Proc. 2006;81:1603–1611
  14. Schotanus J. Het meten van belastbaarheid bij patiënten met chronische lage rugklachten. Groningen: Rijksuniversiteit Groningen; 1999;
  15. Hodselmans AP, Jaegers SM, Goeken LN. Short-term outcomes of a back school program for chronic low back pain. Arch Phys Med Rehabil. 2001;82:1099–1105
  16. Astrand P, Rohdahl K. Textbook of work physiology, physiological bases of exercise. In: 3rd ed.. New York: McGraw-Hill; 1986;p. 354–391
  17. Durnin JV, Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged 16 to 72 years. Br J Nutr. 1974;32:77–97
  18. Carlsson AM. Assessment of chronic pain, I: aspects of the reliability and validity of the visual analog scale. Pain. 1983;16:87–101
  19. Sriwatanakul K, Kelvie W, Lasagna L, Calimlim JF, Weis OF, Mehta G. Studies with different types of visual analog scales for measurement of pain. Clin Pharmacol Ther. 1983;34:234–239
  20. Roland M, Morris R. A study of the natural history of back pain, part I: development of a reliable and sensitive measure of disability in low-back pain. Spine. 1983;8:141–144
  21. Beurskens AJ, de Vet HC, Koke AJ. Responsiveness of functional status in low back pain: a comparison of different instruments. Pain. 1996;65:71–76
  22. Goubert L, Crombez G, Vlaeyen JW, Van Damme S, Van den Broeck A, van Houdenhove B. De Tampa schaal voor kinesiofobie: psychometrische karakteristieken en normering. Gedrag Gezond. 2000;28:54–62
  23. Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62:363–372
  24. Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982;36:936–942
  25. Jacob T, Baras M, Zeev A, Epstein L. Low back pain: reliability of a set of pain measurement tools. Arch Phys Med Rehabil. 2001;82:735–742
  26. Philippaerts RM, Westerterp KR, Lefevre J. Doubly labelled water validation of three physical activity questionnaires. Int J Sports Med. 1999;20:284–289
  27. Nielens H, Plaghki L. Evaluation of physical adaptation to exercise of chronic pain patients by step-test procedure. Pain Clin 199;4:21-5.
  28. Nielens H, Plaghki L. Perception of pain and exertion during exercise on a cycle ergometer in chronic pain patients. Clin J Pain. 1994;10:204–209
  29. Nielens H, Plaghki L. Cardiorespiratory fitness, physical activity level, and chronic pain: are men more affected than women?. Clin J Pain. 2001;17:129–137
  30. Sullivan MJ, Bishop SR, Pivik J. The Pain Catastrophizing Scale: development and validation. Psychol Assess. 1995;7:524–532
  31. Van Damme S, Crombez G, Vlaeyen JW, Goubert L, Van den Broeck A, Van Houdenhove B. De Pain Catastrophizing Scale: Psychometrische karakteristieken en normering/The Pain Catastrophizing Scale: psychometric characteristics and norms. Gedragstherapie. 2000;33:209–220
  32. Osman A, Barrios FX, Gutierrez PM, Kopper BA, Merrifield T, Grittmann L. The Pain Catastrophizing Scale: further psychometric evaluation with adult samples. J Behav Med. 2000;23:351–365
  33. Beck AT, Rush AJ, Shaw BF, Emmery G. Cognitive therapy of depression. New York: Wiley and Sons; 1979;
  34. Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988;8:77–100
  35. Zitman FG, Griez EJ, Hooijer C. Standaardisering depressievragenlijsten. Tijdschr Psychiatr. 1989;31:114–135
  36. Vos JA. Ergometrie en trainingsbegeleiding. Amersfoort: Nederlands Paramedisch Instituut; 2004;
  37. Dawson-Saunders B, Trapp RG. Basic and clinical biostatistics. In: Norwalk: Appleton & Lange; 1998;p. 207–229
  38. de Gier M, Peters ML, Vlaeyen JW. Fear of pain, physical performance, and attentional processes in patients with fibromyalgia. Pain. 2003;104:121–130
  39. Keller A, Hellesnes J, Brox JI. Reliability of the isokinetic trunk extensor test, Biering-Sorensen test, and Astrand bicycle test: assessment of intraclass correlation coefficient and critical difference in patients with chronic low back pain and healthy individuals. Spine. 2001;26:771–777
  40. Jacobs DR, Ainsworth BE, Hartman TJ, Leon AS. A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc. 1993;25:81–91
  41. American College of Sports Medicine. Position stand on the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in adults. Med Sci Sports Exerc. 1998;30:975–991
  42. Verbunt JA, Westerterp KR, van der Heijden GJ, Seelen HA, Vlaeyen JW, Knottnerus JA. Physical activity in daily life in patients with chronic low back pain. Arch Phys Med Rehabil. 2001;82:726–730
  43. van den Berg Emons RJ, Schasfoort FC, de Vos LA, Bussmann JB, Stam HJ. Impact of chronic pain on everyday physical activity. Eur J Pain. 2007;11:587–593
  44. Battié MC, Bigos SJ, Fisher LD, et al. A prospective study of the role of cardiovascular risk factors and fitness in industrial back pain complaints. Spine. 1989;14:141–147
  45. Picavet HS, Schuit AJ. Physical inactivity: a risk factor for low back pain in the general population?. J Epidemiol Community Health. 2003;57:517–518
  46. Westerterp KR. Assessment of physical activity level in relation to obesity: current evidence and research issues. Med Sci Sports Exerc. 1999;31:S522–S525
  47. Philippaerts RM, Westerterp KR, Lefevre J. Comparison of two questionnaires with a tri-axial accelerometer to assess physical activity patterns. Int J Sports Med. 2001;22:34–39

 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.

PII: S0003-9993(08)01506-2

doi: 10.1016/j.apmr.2008.07.009

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 1 , Pages 109-117 , January 2009