Patients at risk include:
(1) history of myocardial infarction, stroke or other vascular event
(2) following surgery (back, cardiac, etc)
(3) following an accident or injury
Risk factors for fear of movement or reinjury include:
(1) depression
(2) anxiety
(3) catastrophizing
(4) post-traumatic stress disorder
Complications of persistent fear of movement or reinjury:
(1) deconditioning
(2) self-caused disability
(3) social isolation
Approach:
(1) Verify that the person has medical clearance to return to exercise.
(2) Determine any restrictions on participation.
(3) Start slow and proceed gradually.
(4) The initial setting should allow for close observation and immediate response in the event of a problem.
(5) For severe and persistent fear consider psychological counseling.
(6) Consider impact of any medications on sports performance and recovery.
(7) Provide encouragement and support.
(8) Educate on the hazards of not exercising.
(9) Obtain informed consent.
