Development and initial validation of the Exercise Sensitivity Questionnaire

Background: Aerobic exercise is essential for the primary and secondary prevention of cardiovascular disease and is a critical component of cardiac rehabilitation (CR). However, anxiety and avoidance of aerobic exercise is common in those with cardiac risk and disease as a result of heightened sensitivity to exercise sensations due to deconditioning or similarity in the physical sensations of exercise to health issues (e.g., shortness of breath, chest tightness, dizziness, fatigue, pain). Purpose: To develop and evaluate the initial psychometric properties of an instrument that measures exercise sensitivity (i.e., fear of aerobic exercise sensations), for use in individuals with elevated cardiovascular risk or with qualifying conditions for CR. Method: A large item pool was generated from existing measures of interoceptive sensitivity and evaluated for relevance to aerobic exercise by an initial sample of patients attending outpatient CR. Potential scale items, along with a set of validating questionnaires, were then administered through an online survey to adults (N = 252) with either a self-reported history of qualifying CR conditions or at least two cardiovascular risk factors. An exploratory factor analysis was used for item reduction and final item selection. Reliability and validity of the final scale items were examined in the online sample in addition to a clinical sample of patients attending CR (N = 50). Results: The exploratory factor analysis resulted in an 18-item scale, the Exercise Sensitivity Questionnaire (ESQ), which produced two factors characterized by anxiety about cardiopulmonary sensations and pain/weakness sensations during exercise. The ESQ and factor scores evidenced internal consistency, convergent and discriminant validity, in addition to predictive validity in relation to exercise participation. Conclusions: The findings suggest that the ESQ is a reliable, valid measure of exercise sensitivity that may be useful for clinical use and research in CR or for those with cardiovascular risk.