The need for a coherent and universal framework for kinesiophobia for cardiovascular disease patients: A scoping review

Clinical guidelines recommend physical activity and exercise for patients with cardiovascular diseases (CVDs), yet adherence with exercise remains low. Kinesiophobia has gained attention as a barrier for physical activity among this population. Despite kinesiophobia being well-researched in chronic pain patients, it is currently unclear which conceptualizations exist to describe this phenomenon in patients with CVD.

This scoping review aimed to determine which terminology, definitions and theoretical constructs were conceptualized and applied to the fear measurements collected in patients with CVD. A description of the terminology and theoretical constructs applied might inform the development of a framework for cardiac kinesiophobia and help to identify research gaps.

Following the Joanna Briggs Institute methodology, 7 databases were searched. All study designs were included. Articles were assessed for kinesiophobia terminology and definitions, and the theoretical constructs applied for assessing kinesiophobia. Articles were also categorized according to their methodological approach and study aims regarding kinesiophobia.

Among 65 articles identified, in 51 kinesiophobia was used as either the primary term (40 articles) or the umbrella term (11 articles). Fourteen articles did not state kinesiophobia. Five additional terms were used, of which exercise sensitivity, fear of physical activity, and fear of exercise were explicitly introduced as unique terms to differentiate themselves from kinesiophobia/fear of movement. The fear avoidance model was cited as the theoretical construct in 25 articles (27%). Thirteen articles (14%) did not reference any theoretical basis, and 42 articles (46%) provided other theoretical reasonings. Twenty-three cross-sectional studies described correlates of kinesiophobia, 17 studies focused on questionnaire development, and 11 studies quantified associations with physical activity indicators.

There was no universally accepted terminology for defining kinesiophobia in cardiac patient populations. The fear avoidance model of pain was most frequently applied together with the Tampa Scale of Kinesiophobia for measuring fear levels in cardiac patients, but various other theoretical constructs and reasonings were also proposed. The majority of studies used cross-sectional designs to examine potential correlates of kinesiophobia. While these variations in terminology for kinesiophobia, nuances in definitions and constructs proposed were valid in their arguments, the lack of a universally accepted framework and theoretical reasoning for fear related to physical activity in the context of CVD constitutes an apparent gap. There is a need for an experimentally validated CVD-specific theory and a coherent and universal framework to assess this fear in patients with CVD in order to develop theory-based, patient-centered interventions.