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  1. Baas, Linda S. RN, PhD, ACNP
  2. Beery, Theresa A. RN, PhD, CCRN
  3. Allen, Gordon PhD
  4. Wizer, Michael PsyD
  5. Wagoner, Lynne E. MD, FACC


Heart failure is a chronic disabling problem afflicting a growing number of adults. These individuals experience episodes of exacerbation demonstrated by increasing shortness of breath, fatigue, and fluid retention. The symptoms often develop in a slow and insidious manner making perception of worsening difficult to determine. Theoretically, an increase in body awareness may help individuals recognize symptoms of worsening heart failure earlier, but it is not known whether increased body awareness leads to somatization, an abnormal dwelling on body symptoms. This study was conducted to describe body awareness in 90 persons with heart failure or after transplant. We found that the Body Awareness Quesionnaire was a reliable measure of this concept in this sample. When body awareness was examined for age, gender, and treatment (HF or transplant) group were examined, no significant differences were found. Furthermore, there were no significant relationships between body awarenss and negative moods such as anxiety, depression, or anger. Interventions to enhance body awareness may be a fruitful new direction that will improve symptom recognition without increasing somatization in persons with heart failure.


Heart failure is the only cardiac problem that continues to increase in incidence and prevalence in western countries. As more people survive ischemic and valvular heart problems, they live long enough to develop heart failure. Over 5 million Americans have heart failure, a major cause of hospitalizations in adults. 1-4 Dyspnea, fatigue, and edema are the hallmark symptoms of heart failure. 3-5 Unfortunately, these symptoms begin as subtle sensations that gradually increase in a manner that makes recognition and discrimination of severity difficult unless specific attention is directed to the cues. 5 Patient education is often aimed at describing what to do when symptoms occur, but the focus of this education is usually on what the symptom means and how it is treated. Little attention is given to the experience of subtle physiological cues that precede symptoms or occur as symptoms worsen. 5-7


Most patients present to the emergency department with symptoms not recognized as worsening heart failure by the patient, until the symptoms became overwhelming. 5,6 However, some individuals have the ability to perceive less intense changes in body functions and/or symptoms. The ability to recognize subtle body cues and identify the physiological manifestations is referred to as body awareness. 7,8 Efforts to use body awareness, and even enhance it, have been applied in many areas of health care. The use of perceived exertion in exercise has long been encouraged as a way to monitor intensity of work rather than relying on counting the pulse, especially in persons with altered heart rate variability. 9-12 Stress reduction programs focus on recognizing and intervening when tension-related physical cues are recognized. 13-18


Despite the potential benefits of body awareness, there is a concern that efforts to enhance body awareness may lead to an obsession or undue dwelling on bodily functions. 19 Perhaps, excess body awareness would result in anxiety, depression, or somatization (the propensity to magnify and fixate on benign body sensations). 7 Some clinicians have warned of creating "cripples" by encouraging patients to focus on body symptoms. 20


This study was undertaken as an initial exploration of body awareness in persons with heart failure (HF) who were treated medically and those who had undergone a heart transplant (TX). These subjects were already participating in 2 longitudinal studies of quality of life, and so they served as a convenience sample for this investigation. Although the specific symptoms experienced by the groups might differ, we were interested in the concept of body awareness, which is the ability to recognize physiological body cues, not specific symptoms of a disorder. Specifically, we were interested in the following: (1) evaluating a body awareness tool; (2) looking for age, sex, or treatment differences in body awareness; (3) examining the stability of the concept; and (4) evaluating whether the concept of body awareness was independent of positive and/or negative moods. From this information, we will be able to identify whether we should or should not promote increasing body awareness as a mechanism to improve self-management in persons with HF.