Depression, fear-avoidance beliefs, and physical activity in patients with low back pain

The goal of this Study was to evaluate the impact of depression and fear-avoidance beliefs on the willingness to commence and continue physical activity in patients with low back pain. Data from a controlled, randomized intervention study of 1,378 German patients in primary care settings (58% female, mean age 49 years) suffering predominantly from acute back pain were subjected to a secondary analysis. Results showed that patients with high scores on both depression and fear-avoidance beliefs reported the lowest physical activity (kcal/week). The most important predictors for physical activity after 6 and 12 months were baseline activity and expected self-efficacy. Important predictors for relapse into inactivity were low self-efficacy and low perceived benefits of physical activity. Neither depression nor fear-avoidance beliefs were significant predictors of physical activity or relapse after 6 or 12 months. It is concluded that relatively stable constructs such as depression or fear-avoidance beliefs do not seem to be suitable for explaining either actual or intended physical activity in low back pain patients. Future research should focus more strongly on the impact of cognitive and affective aspects of situational decision-making processes on physical activity in everyday situations.