冠心病患者运动恐惧的现状调查
Investigation of the current situation of exercise fear in patients with coronary heart disease

摘 要
Summary

目的 通过调查冠心病患者运动恐惧的现状，探索提高冠心病患者的心理护理
Objective To investigate the current situation of exercise fear in patients with coronary heart disease and to explore and improve the psychological care of patients with coronary heart disease

水平，促进其恢复和更好适应社会，提高生活质量，为医护人员的护理和治疗提供
level, promote their recovery and better adaptation to society, improve the quality of life, and provide care and treatment for healthcare workers

参考依据。方法 采用方便抽样的方法，选取广州市某三级甲等医院心内科200例冠心病患者作为研究对象，采用《心脏病患者运动恐惧量表》(TSK-SV)对冠心病患者进行调查分析。运用SPSS22.0对数据进行统计学分析。结果 患者的TSK- SV 得分为（43.76±7.01）分，其中危险感知得分为（12.52±0.85）分、运动回避得分为（10.54±1.44）分、运动恐惧得分为（10.78±3.32）分、功能紊乱得分为（9. 92±3.04）分。不同年龄、文化程度、职业状态、家庭月人均收入、是否锻炼、心 功能、病程的冠心病患者在运动恐惧得分方面存在差异，且差异具有统计学意义（P ＜0.01）。结论 此次调查冠心病患者运动恐惧处于较高水平，医护人员可根据不同人群的运动恐惧的特点进行及时干预，从而加强患者的健康运动管理。
References. Methods A total of 200 patients with coronary heart disease in the Department of Cardiology of a tertiary hospital in Guangzhou were selected as the research subjects by convenient sampling, and the Fear of Exercise Scale for Heart Disease Patients (TSK-SV) was used to investigate and analyze the patients with coronary heart disease. SPSS22.0 was used for statistical analysis. Results The TSK-SV score of the patients was (43.76±7.01), of which the risk perception score was (12.52±0.85), exercise avoidance score (10.54±1.44) points, motor fear score (10.78±3.32) points, dysfunction score (9. 92±3.04) points. There were statistically significant differences in the scores of exercise fear among patients with coronary heart disease of different ages, education levels, occupational status, monthly per capita household income, whether they exercised, cardiac function, and course of disease (P <0.01). Conclusion In this survey, the fear of exercise in patients with coronary heart disease is at a high level, and medical staff can intervene in time according to the characteristics of exercise fear in different populations, so as to strengthen the healthy exercise management of patients.

关键词 冠心病；运动恐惧；心理护理
Key words: coronary heart disease; Fear of movement; Psychological care

前 言
Foreword

冠状动脉粥样硬化性心脏病是心血管疾病中常见的疾病之一，其病因与不健康的饮食、吸烟、缺乏身体活动有关。研究表明，康复运动能够改善人的心肺功能，增加人体对血氧的摄取，同时血管收缩功能也会有所改善。我国专家共识指出心功能在Ⅲ级以下的稳定心脏病患者均应该考虑进行康复运动锻练^[1]，但很多患者害怕过度锻炼会导致病情反复，而产生运动恐惧^[2-3]。运动恐惧是对运动产生过度的、非理性惧怕的一种特殊的心理现象，又被称作恐动症^[4]，一开始用于疼痛患者，但随着心血管疾病发病率的上升，患者往往担心运动的不安全性，从而导致对锻炼运动产生回避态度。国外关于运动恐惧症的研究虽开始较早，但大多集中在慢性疼痛有关的领域，且不同疾病之间的运动恐惧症发生率也有一定的差异^[5]。现阶段我国对于冠心病患者运动恐惧的研究还处于初级阶段，故本文对冠心病患者的运动恐惧现状进行调查研究，旨在引起临床医护工作者重视冠心病患者出现运动恐惧的现象，能尽早识别并及时采取干预措施，从而改善心脏病患者的预后，提高其生活质量。
Coronary atherosclerotic heart disease is one of the common diseases in cardiovascular disease, and its causes are related to unhealthy diet, smoking, and lack of physical activity. Studies have shown that rehabilitation exercise can improve people's cardiopulmonary function, increase the body's blood oxygen uptake, and improve vasoconstriction。 According to the consensus of experts in China, patients with stable heart disease with cardiac function below grade III should consider rehabilitation ^exercise1, but many patients are afraid that excessive exercise will lead to recurrence of the disease and cause luckMoving Fear ²³. Kinesiophobia is a special psychological phenomenon that produces an excessive, irrational fear of movement, also known as kinesiophobia4It is initially used in patients with pain, but as the incidence of cardiovascular disease increases, patients often worry about the unsafety of exercise, which leads to an avoidance of exercise. Although foreign studies on kinesiophobia began earlier, most of them focused on chronic painand the incidence of kinesiophobia between different diseasesThere are also certain ^differences5. At present, the research on exercise fear in patients with coronary heart disease in China is still in its infancy, so this paper investigates and studies the current situation of exercise fear in patients with coronary heart disease, aiming to attract the attention of clinical medical workers The phenomenon of exercise phobia in patients with coronary heart disease can be identified early and timely intervention can be taken to improve the prognosis of patients with heart diseaseImprove their quality of life.

1 对象与方法
1 Objects and Methods

1.1 研究对象
1.1 Subject

本研究于2024年5月至10月选取广州市某三甲医院心内科的200例冠心病患者作为研究对象。纳入标准：①年龄为18岁以上；②神志清楚，言语沟通无障碍，能自行填写问卷；③同意参与研究调查；④确诊为冠心病患者，心功能分级≤Ⅲ级。排除标准：①有语言交流障碍和认知功能障碍患者；②入院前1个月出现出血性脑血管疾病，急性心肌梗死或不稳定心绞痛；③患者合并其他严重疾病或病情危急者；④经过解释后，仍不同意参与患者。
In this study, 2 00 patients with coronary heart disease from the Department of Cardiology of a tertiary hospital in Guangzhou were selected as the research subjects from May to October 2024. Inclusion criteria: (1) age 18 years or older; (2) Be conscious, have no barriers to verbal communication, and be able to fill in questionnaires by themselves; (3) agree to participate in research investigations; (4) Patients diagnosed with coronary heart disease, cardiac function grade ≤ grade III. Exclusion criteria: (1) Patients with language communication disorder and cognitive dysfunction; (2) Hemorrhagic cerebrovascular disease, acute myocardial infarction or unstable angina pectoris 1 month before admission; (3) Patients with other serious diseases or critical conditions; (4) After explanation, the patient still does not agree to participate.

1.2 研究方法
1.2 Research Methodology

1.2.1 问卷调查法
1.2.1 Questionnaire method

采用问卷调查的方法，共发放问卷204份，回收200份，回收率98%。问卷由两部分组成，①一般情况调查表是查阅参考相关文献的基础上自行编制，内容主要是对冠心病患者人口学资料的调查，包括患者的性别、年龄、文化程度、职业状态、心功能分级、家庭月收入、是否锻炼、病程等相关问题。②《心脏病患者运动恐惧量表》（TSK-SV Heart）是由国外 Bäck 博士^[6]改编，在2019年我国雷梦洁等^[3]将其翻译成中文版，以冠心病患者为研究对象，对量表进行了验证。量表分为4个维度包括危险感知、运动回避、运动恐惧、功能紊乱，其中危险感知包含条目3、8、11、16，运动回避包含条目2、4、12、14、17，运动恐惧包含条目1、7、9、13，功能紊乱包含条目5、6、10、15，共17个条目。总量表Cronbach'sα为0.859，各维度Cronbach'sα在0.743~0.824之间，信效度良好。量表采用Likert 4级评分法，分别记1~4分，由“非常不同意”“不同意”“同意”“非常同意”（条目4、8、12、16为反向计分），总分为17~68分，超过平均分即认定为运动恐惧处于较高水平，分数越高表明运动恐惧程度越高^[7]。
A total of 204 questionnaires were distributed and 200 were recovered, with a recovery rate of 98%. The questionnaire consists of two parts: (1) The general questionnaire is compiled on the basis of consulting relevant literature, and the content is mainly to investigate the demographic data of patients with coronary heart disease, including the gender, age, education level, occupational status, and cardiac function classification of patients, monthly family income, whether to exercise, course of illness and other related issues. (2) The "Exercise Fear Scale for Heart Disease Patients" (TSK-SV Heart) was adapted byDr. Bäck6 in China, and in 2019, Lei Mengjie et ^al.3 in ChinaIt was translated into Chinese, and the scale was validated with patients with coronary heart disease as the research object. The scale is divided into four dimensions, including risk perception, motor avoidance, motor fear, and dysfunction, among which risk perception includes items 3, 8, and 11, 16, exercise avoidance contains entries 2, 4, 12, 14, 17, and movement fear contains entries 1 and 7, 9, 13, Dysfunction contains entries 5, 6, 10, 15, a total of 17 items. The total scale of Cronbach'sα is 0859, Cronbach'sα in each dimension was between 0.743~0.824, and the reliability and validity were good. The scale adopts the Likert 4-level scoring method, which is scored 1~4 points respectively, and is scored by "strongly disagree", "disagree", "agree" and "strongly agree" (items 4, 8, 12, and 16 are scored in reverse), with a total score of 17~68 points⁷。

1.2.2 统计学方法
1.2.2 Statistical Methods

运用SPSS22.0统计软件对数据进行处理和分析，对计量数据用均数±标准差表示，计数数据采用频数（百分比）表示；一般资料差异进行了独立样本t检验/方差分析。
SPSS22.0 statistical software was used to process and analyze the data, and the measured data were expressed by mean ± standard deviation, and the counting data was expressed by frequency (percentage). Independent samples t-test/ANOVA were performed for general data differences.

2 结果
2 Results

2.1 冠心病患者运动恐惧得分情况
2.1 Exercise fear scores in patients with coronary heart disease

冠心病患者运动恐惧状况见表1，结果显示，200例冠心病患者运动恐惧的总均分为（43.76±7.01）分。从4个维度得分结果可以看出：危险感知的得分最高，运动恐惧次之，运动回避得分略低于运动恐惧，功能紊乱的得分最低。
Table 1 shows that the total mean score of 200 patients with coronary heart disease was (43.76±7.01). From the results of the four dimensions, it can be seen that the score of danger perception was the highest, followed by the fear of movement, the score of exercise avoidance was slightly lower than that of fear of movement, and the score of dysfunction was the lowest.

表1 冠心病患者运动恐惧得分状况（n＝200,`x±s）
Table 1 Exercise fear score in patients with coronary heart disease (n=20 0'x±s)

2.2 不同特征的冠心病患者运动恐惧情况
2.2 Kinesiophobia in patients with coronary heart disease with different characteristics

研究结果显示200例冠心病患者年龄为（69.68±12.41）岁。其中男性112人（56％），女性88人（44％）；初中及以下学历130人（65％），高中学历44人（22％），大学及以上学历26人（13％）；有工作41人（20.5%），退休136人（68%），无工作或下岗23人（11.5%）。其中性别没有统计学意义（P＞0.05），年龄、文化程度、职业状态、家庭月人均收入、是否锻炼、病程时长、心功能分级等这些变量具有统计学意义（P＜0.05）。
The results showed that the age of 200 patients with coronary heart disease was (69.68±12.41) years. Among them, 112 (56%) were males and 88 (44%) were females; 130 (65%) with junior high school education and below, 44 (22%) with high school education, university26 (13%) with or above education; 41 (20.5 per cent) were employed, 136 (68 per cent) were retired and 23 (11.5 per cent) were unemployed or laid off. There was no statistical significance for gender (P>0.05), but there were statistically significant variables such as age, education level, occupational status, monthly per capita household income, whether to exercise, duration of illness, and cardiac function grade (P＜0.05）。

表2 不同特征的冠心病患者运动恐惧情况
Table 2 Kinesiophobia in patients with coronary heart disease with different characteristics

3 讨论和分析
3 Discussion and analysis

3.1 冠心病患者运动恐惧的情况分析
3.1 Analysis of exercise fear in patients with coronary heart disease

从表1可知冠心病患者运动恐惧均分（43.76±7.01）分略高于Gołba 等^[8]（41.6±5.39）分，这可能与国外较早关注心脏病患者运动恐惧症，并积极进行干预有关。4个运动恐惧维度中均分最高的是危险感知（12.52±0.85）分，均分最低的是功能紊乱（9.92±3.04）分，但各条目均分（2.57±0.41）分均处于较高水平。这一结果与崔贵璞等^[2]和宋晓梅等^[9]研究结果相一致。
From Table 1, it can be seen that the mean score of exercise fear in patients with coronary heart disease (43.76±7.01) was slightly higher than that of Gołba et al. ⁸ (4, 1.6±5.39) points, which may be related to the earlier attention to the kinesiophobia of heart disease patients abroad and the active intervention. Among the four dimensions of fear of movement, the highest mean score was risk perception (12.52±0.85), and the lowest mean score was dysfunction (9.92±304), but the average score of each item (2.57±0.41) was at a high level. This result is consistent with the results of Cui Guipu et ^al.2 and Song Xiaomei et ^al.9.

3.1.1 危险感知
3.1.1 Hazard Perception

由表1可知冠心病患者普遍危险感知较高，由于疾病的因素，患者对于身体状况的感知格外敏感，常会产生焦虑。从张红伟等^[10]研究可知焦虑敏感性对运动恐惧有重要影响，当患者运动时感到不适，或者一旦认为运动可能会对自己的身体健康产生威胁时，患者的运动就会减少或者回避运动，这是患者产生运动恐惧的重要因素。对于冠心病患者而言，其运动恐惧，很大程度上是因为对自身疾病有一种悲观的预感^[11] ，这种悲观感知的形成，患者就会主动做出对自身更有利的措施，从而对自身进行一种保护性预防。
From Table 1, it can be seen that patients with coronary heart disease generally have a high risk perception, and due to the factors of the disease, patients are particularly sensitive to the perception of physical conditions, and often have anxiety. From Zhang Hongwei et ^al.10 it can be seen that anxiety sensitivity has an important impact on exercise fear, when patients feel uncomfortable when exercising, or once they think that exercise may pose a threat to their physical health, patients will reduce or avoid exercise, which is an important factor for patients to have exercise phobia. For patients with coronary heart disease, their fear of exercise is largely due to a pessimistic premonition about their own ^disease11, and the formation of this pessimistic perception will lead the patient to take more beneficial measures to himself, so as to carry out a protective prevention for himself.

3.1.2 运动恐惧
3.1.2 Fear of movement

由表1可得患者运动恐惧得分为（10.78±3.32）分，可能患者对心脏康复活动了解较少，由郑宇娟等^[11]研究可知，运动自我效能可调节活动行为的认知机制，可以提高患者的对运动的积极性。运动恐惧会影响冠心病患者的心脏康复，且对康复锻炼的依从性也会有所下降^[12]。降低运动恐惧水平对提高患者康复训练依从性具有重要意义。我国对于冠心病患者运动恐惧的研究相对较晚，冠心病患者产生运动恐惧的因素多种多样，对此研究还不够全面，对于改善冠心病患者运动恐惧现象的方法研究较少，且没有很好的管理方法和干预手段，病人康复结果较差。因此对于冠心病患者运动恐惧症状，可以进行相对应的健康教育以及对其进行认知行为疗法干预，有助于降低运动恐惧水平，提高患者运动积极性。建议从其他领域的运动恐惧研究进行探索，结合心脏病患者疾病特点及心理特点进行研究，推动心脏病患者运动恐惧的研究进展。
From Table 1, the score of exercise fear was (10.78±3.32), which may indicate that the patient had less understanding of cardiac rehabilitation activities, as shown by Zheng Yujuan et al.11Studies have shown that exercise self-efficacy can regulate the cognitive mechanism of activity behavior and improve patients' enthusiasm for exercise. Fear of exercise can affect cardiac rehabilitation in patients with coronary heart disease, and adherence to rehabilitation exercises can be ^reduced12. Reducing the level of exercise fear is of great significance for improving patients' compliance with rehabilitation training. The research on exercise fear in patients with coronary heart disease in China is relatively late, and there are various factors that cause exercise fear in patients with coronary heart disease, and the research on this is not comprehensive enough, and there are few studies on the methods to improve the phenomenon of exercise fear in patients with coronary heart disease, and there are no good management methods and intervention methods, and the recovery results of patients are poor. Therefore, for the symptoms of exercise phobia in patients with coronary heart disease, corresponding health education and cognitive behavioral therapy intervention can be carried out, which can help reduce the level of exercise phobia and improve the enthusiasm of patients. It is suggested that the research on sports fear in other fields should be explored, and the research should be carried out in combination with the disease characteristics and psychological characteristics of heart disease patients, so as to promote the research progress of sports fear in heart disease patients.

3.1.3 运动回避
3.1.3 Exercise avoidance

由表1可知运动回避得分（10.54±1.44）分，冠心病患者普遍认为当一个人的心脏有问题时应该避免进行体力活动或锻炼，可能是认为运动会加重心脏问题，错误的认知，会让患者回避正常运动，且患者对于一切会威胁到自身身体状况的危险因素也会产生回避心理。科学的心脏康复锻炼不但能增加心脏收缩功能^[9]，而且能够让患者感到愉悦舒适，从而让患者愿意坚持锻炼，形成一个良性循环。帮助患者提高认识，让患者能够积极面对康复运动，减少回避心理及行为。
From Table 1, it can be seen that the exercise avoidance score (10.54±1.44) points shows that patients with coronary heart disease generally believe that they should avoid physical activity or exercise when a person has heart problemsPatients also avoid all risk factors that threaten their physical condition. Scientific cardiac rehabilitation exercises can not only increase the systolic function of the ^heart9, but also make patients feel happy and comfortable, so that patients are willing to continue exercising, forming a virtuous circle. Help patients raise their awareness so that they can face rehabilitation exercise positively and reduce avoidance and behavior.

3.1.4 功能紊乱
3.1.4 Dysfunction

表1可看出，功能紊乱的得分是最低的，功能紊乱指的是生理、心理、社会等方面出现的失衡状态^[11]，由于冠心病是一种慢性病，可能在相当长的时间内患者都不会出现明显的机体功能障碍，即使当患者出现生理或心理失衡时如血压升高、心悸、焦虑、抑郁等情绪时，服用药、调整饮食或者进行心理调适就能很快缓解^[13]，且患者的社会功能基本不受限制，总的来说，患者发生功能紊乱率相对较低。
Table 1 shows that the score of functional disorder is the lowest, and functional disorder refers to the imbalance in physiological, psychological, and social ^aspects.11 Because coronary heart disease is a chronic disease, patients may not have obvious body dysfunction for a long time, even when patients have physiological or psychological imbalances such as elevated blood pressure, palpitations, anxiety, depression and other emotions, Dietary modification or psychological adjustment can be quickly ^relieved13, and the patient's social functioning is largely unlimited, and the rate of dysfunction is relatively low in general.

3.2 不同特征的冠心病患者运动恐惧情况的分析
3.2 Analysis of exercise phobia in patients with coronary heart disease with different characteristics

3.2.1 不同年龄冠心病患者运动恐惧差异的分析
3.2.1 Analysis of differences in exercise fear in patients with coronary heart disease at different ages

由表2可得知，不同人口学特征的冠心病患者的运动恐惧水平不同。由得分显示出在各年龄阶层中，随着年龄阶层的提高运动恐惧水平也不断提高，45岁以下的患者运动恐惧水平是四组中最低的，年龄≥77岁的患者的运动恐惧水平是最高的。患者的年龄与其运动恐惧水平的高低有关系，这个结果与崔贵璞等^[2]是相一致的。根据吴佳奇等^[14]研究显示，冠心病患者常会产生焦虑抑郁的心理现象，焦虑抑郁的患者对于运动锻炼积极性较差，运动频率明显下降，因此运动恐惧水平较高。年龄越大的患者这种不良的心理现象越明显。另一方面随着年龄的增长，人的生理机能逐渐衰弱，衰弱的冠心病患者运动能力较低，运动康复参与率低，患者对于运动的抗拒心理就越明显，因此年龄越大其运动恐惧水平越高。患者年龄越大，对于应激事件的发生就会越敏感，且身体机能的衰弱让老年人更加感到疲乏，因此对于运动的积极性下降。医护人员可以对老年病人制订个体化运动方案来改善健康状况。
As can be seen from Table 2, patients with coronary heart disease with different demographic characteristics have different levels of exercise phobia. The scores show that among all age groups, the level of exercise phobia increases with the age group, and the level of exercise phobia in patients under 4 and 5 years old is the lowest among the four groups, and the level of exercise phobia in patients aged ≥ 77 years is the highest。 The age of the patients is related to the level of exercise phobia, and this result is consistent with Cui Guipu et al.2. According to Wu Jiaqi et al.14 research, patients with coronary heart disease often have anxiety and depression, and patients with anxiety and depression are less motivated to exercise, and the frequency of exercise is significantly reduced, so the level of exercise fear is higher. The older the patient, the more pronounced this undesirable psychological phenomenon becomes. On the other hand, with the increase of age, people's physiological functions gradually weaken, and the weakened coronary heart disease patients have lower exercise ability and low participation rate in sports rehabilitation, and the more obvious the patient's resistance to exercise, so the older the age, the higher the level of exercise fear. The older the patient, the more sensitive they are to stressful events, and the weaker physical function makes older people feel more tired, so they are less motivated to exercise. Health care providers can develop individualized exercise programs for older patients to improve their health.

3.2.2 文化程度不同的冠心病患者运动恐惧差异的分析
3.2.2 Analysis of the differences in exercise fear in patients with coronary heart disease with different education levels

由表2可知，随着文化程度的提高，冠心病患者的运动恐惧水平是不断降低的，初中及以下的患者运动恐惧水平明显高于高中和大学及以下的患者。Ghisi等^[15]的研究发现文化程度低的患者心脏康复运动依从性低。可能是低文化水平患者对于疾病的认知低，不能更好的获得对疾病有利的信息容易做出错误的健康决策，且对于心脏康复锻炼的作用和效果存在质疑，进而心脏康复锻炼的积极性下降，因此运动恐惧水平也越高。受教育程度高的患者会获取更多关于疾病的知识，因此对于疾病的应对会更加积极主动，因此可减轻运动恐惧的症状。对于文化程度较低的患者，医护人员应注意做好健康宣教，让患者对疾病有更多的认识，同时让其了解疾病与康复锻炼之间的关系，解释运动对疾病发展的重要性，并进行相应的康复治疗，帮助其做出正确的健康决策。
As can be seen from Table 2, with the increase of education level, the level of exercise fear in patients with coronary heart disease is decreasing, and the level of exercise fear in patients with junior high school and below is significantly higher than that of patients with high school and college and below. Ghisi et al. ¹⁵Studies have found that patients with low literacy levels have low adherence to cardiac rehabilitation exercises. It may be that patients with low literacy level have low awareness of the disease, cannot obtain better information favorable to the disease, are prone to make wrong health decisions, and have doubts about the role and effect of cardiac rehabilitation exercises, and then the enthusiasm of cardiac rehabilitation exercises decreases, so the level of exercise fear is also higher. People with higher levels of education are more knowledgeable about the disease and are therefore more proactive in coping with the disease, thus reducing the symptoms of fear of movement. For patients with low education level, medical staff should pay attention to health education, so that patients can have more understanding of the disease, and at the same time let them understand the relationship between the disease and rehabilitation exercises, explain the importance of exercise to the development of the disease, and carry out corresponding rehabilitation treatment to help them make correct health decisions.

3.2.3 处于不同职业状态的冠心病患者运动恐惧差异的分析
3.2.3 Analysis of the differences in exercise fear in patients with coronary heart disease in different occupational states

由表2可知，职业状态分三组，有工作的患者运动恐惧水平相对于退休和无工作或下岗的患者较低，无工作或下岗的患者运动恐惧水平是最高的。崔贵璞等^[2] 认为退休患者运动恐惧水平较高是由于这类患者年龄相对较高，年龄较高的患者更容易发生运动恐惧。而无工作或下岗患者可能由于缺乏社会价值的体现，不能为家庭做出贡献，反而需要家人花费精力和钱财照顾从而更容易产生消极情绪，为减少运动带来的威胁，患者就会减少运动，所以运动恐惧水平较高。
As can be seen from Table 2, the occupational status is divided into three groups, and the level of exercise fear in working patients is lower than that of retired and unemployed or laid-off patients, and the level of exercise fear is the highest in unemployed or laid-off patients. Cui Guipu et ^al.2 suggested that the higher level of exercise fear in retired patients was due to the relatively high age of such patients, and older patients were more likely to develop exercise phobia. However, unemployed or laid-off patients may not be able to contribute to the family due to the lack of social value, but need the family to spend energy and money to take care of them, so they are more likely to have negative emotions, in order to reduce the threat of exercise, the patient will reduce exercise, so the level of exercise fear is higher.

3.2.4 不同家庭月人均收入的冠心病患者运动恐惧差异的分析
3.2.4 Analysis of the differences in the fear of exercise in patients with coronary heart disease in the monthly per capita income of different families

由表2可知，收入≤4000元的患者其运动恐惧水平明显高于4001~5000元、5001~6000元和收入＞6000元的患者，4001~5000元者次之，收入＞6000元的患者运动恐惧水平是最低的。家庭月收入较低的冠心病患者，运动恐惧相对更严重，可能与患者的经济负担等有关。这与宋晓梅等^[9]研究结果相一致但是高于其研究，其原因可能为研究对象所在地区消费水平和收入水平有差异等有关。低收入患者可能害怕由于运动导致病情加重，而使家庭的经济负担更重。
From Table 2, it can be seen that the level of exercise fear in patients with an income of ≤ 4000 yuan is significantly higher than that of 4001~5000 yuan5001~6000 yuan and patients with an income of >6000 yuan, 4001~5,000 yuan was the second, and patients with an income of > 6,000 yuan had the lowest level of exercise fear. Patients with coronary heart disease with a low monthly family income have a relatively more serious fear of exercise, which may be related to the patient's financial burden. This is consistent with the results of Song Xiaomei et ^al.9 but higher than their study, and may be related to the differences in consumption levels and income levels in the regions where the participants lived. Low-income patients may fear that exercise will exacerbate their illness, which will increase the financial burden on their families.

3.2.5 不同锻炼情况的冠心病患者运动恐惧差异的分析
3.2.5 Analysis of the differences in exercise fear in patients with coronary heart disease with different exercise conditions

由表2显示，参加锻炼的患者运动恐惧得分低于不参加锻炼的患者。黄蓉等^[16]研究显示早期运动干预可预防运动恐惧的发生，Knapik等^[17]和宋晓梅等^[18]研究可知，运动锻炼与运动恐惧症是呈负相关的。经常参加运动锻炼的患者了解运动对于疾病康复的益处，心脏健康不受日常活动影响，他们更愿意进行运动锻炼，因此运动恐惧水平较低。缺乏锻炼的患者加上主动回避运动，使运动恐惧更加严重，产生一个恶性循环，导致患者健康受到更多的威胁。中国心血管健康与疾病报告^[19]显示我国心血管疾病患病率逐年递增，心脏康复训练可改善冠心病患者长期预后，提高患者生存质量。
As shown in Table 2, patients who participated in exercise scored lower scores on exercise fear than those who did not. Huang et ^al.16 showed that early exercise intervention could prevent the occurrence of motor phobia, Knapik et ^al.17 and Song et ^al.18Studies have shown that exercise is negatively correlated with kinesiophobia. Patients who regularly participate in physical activity understand the benefits of exercise for recovery, their heart health is not affected by daily activities, they are more willing to exercise, and therefore have lower levels of fear of exercise. Patients who lack exercise and actively avoid exercise make the fear of exercise more severe, creating a vicious cycle that leads to more threats to the patient's health. The China Cardiovascular Health and Disease ^Report19 shows that the prevalence of cardiovascular diseases in China is increasing year by year, and cardiac rehabilitation training can improve the long-term prognosis and quality of life of patients with coronary heart disease.

3.2.6 不同病程（年）的冠心病患者运动恐惧差异的分析
3.2.6 Analysis of differences in exercise fear in patients with coronary heart disease with different disease durations (years).

由表2可知，病程≤1年的患者其运动恐惧程度是最低的，10年以上病程的患者,其运动恐惧水平高于其他三组。随着病程的延长，冠心病患者的运动恐惧症状越严重。可能由于随着病程的延长，患者年龄也越来越大，患者心理因素，生理因素等都会发生改变，常年疾病治疗一方面加重了家庭经济负担，患者会产生愧疚心理，另一方面患者心功能和体力都有所下降^[20]，这些变化影响着患者对疾病应对的方式，也加重了运动恐惧的症状。建议对患者进行积极的回访工作，对不同病程年龄的患者进行指导,针对各年龄病程阶段的病人及时调整康复锻炼计划。
As can be seen from Table 2, patients with a course of ≤ 1 year have the lowest level of kinesiophobia, 10The level of kinesiophobia was higher in patients with a disease duration of more than a year compared to the other three groups. As the course of the disease prolongs, the symptoms of kinesiophobia become more severe in patients with coronary heart disease. It may be that with the prolongation of the course of the disease, the patients are getting older, the psychological and physiological factors of the patients will change, and the treatment of perennial diseases will increase the financial burden of the family on the one hand, and the patients will feel guilty, and on the other hand, the patients' cardiac function and physical strength will decline ^[20], these changes affect the way the patients cope with the disease, and also aggravate the symptoms of exercise phobia. It is recommended to actively visit patients, guide patients of different age stages, and adjust the rehabilitation exercise plan in time for patients of all ages.

3.2.7 心功能分级不同的冠心病患者运动恐惧差异的分析
3.2.7 Analysis of the differences in exercise fear in patients with different levels of cardiac function in coronary heart disease

由表2可知，心功能分级越高，患者运动恐惧症状越严重。与崔贵璞等^[2]和宋晓梅等^[9]研究相一致，心功能分级越高，患者活动受限越明显，当患者在活动中获得不好的体验感时，在某种程度上会加重对运动康复的错误认知，因此患者对于运动回避就越明显，运动恐惧水平越高，王子安等^[21]研究也表明心功能与运动恐惧呈正相关，心功能越高患者在活动体验感越差。患者正常运动而发生较为明显的心悸、气促或疲劳等不适，这与心力衰竭复发时的症状非常相似，患者就会认为运动就会导致疾病发生，这种错误认知就会进一步导致运动恐惧^[20]。建议依据心功能的分级循序渐进进行运动康复治疗，同时也要对心功能分级较高的患者进行运动指导，提高认知，及时了解疾病发生和发展。
As can be seen from Table 2, the higher the cardiac function grade, the more severe the symptoms of kinesiophobia. Consistent with Cui Guipu et ^al.2 and Song Xiaomei et ^al.9 studies, the higher the cardiac function grade, the more obvious the patient's activity limitation, and when the patient gets a bad experience in the activity, it will aggravate the wrong perception of exercise rehabilitation to a certain extent, so the more obvious the patient's avoidance of exercise, the higher the level of exercise fearWang Zi'an et ^al.21 also showed that cardiac function was positively correlated with fear of movement, and the higher the cardiac function, the worse the activity experience in patients. When patients experience more pronounced discomfort such as palpitations, shortness of breath, or fatigue due to normal exercise, which is very similar to the symptoms of a recurrence of heart failure, the patient will assume that exercise will cause the disease, and this misconception will further lead to fear of ^movement20. It is recommended to carry out exercise rehabilitation treatment step by step according to the grading of cardiac function, and at the same time, exercise guidance should be given to patients with high cardiac function grading to improve cognition and keep abreast of the occurrence and development of the disease.

4 结论
4 Conclusion

综上，本次研究对象处于较高的运动恐惧水平，尤其是年龄大、文化程度低、低收入和心功能差的人群，主要体现在对危险的感知方面。医护人员应尽早意识到冠心病患者发生运动恐惧现象，根据不同人群特征进行指导，同时加强患者的健康运动管理，一旦发现患者出现明显运动恐惧现象及时采取干预措施，提高患者康复运动的依从性。
In summary, the subjects of this study were at a high level of exercise phobia, especially those who were older, less educated, low-income and had poor cardiac function, which was mainly reflected in the perception of danger. Medical staff should be aware of the phenomenon of exercise phobia in patients with coronary heart disease as soon as possible, provide guidance according to the characteristics of different populations, strengthen the healthy exercise management of patients, and take timely intervention measures once the patients are found to have obvious exercise phobia, so as to improve the compliance of patients with rehabilitation exercises.

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