Kinesiophobia is negatively associated with physical activity: What factors influence this relationship?

By Tarun Sai LomteAug 23 2023Reviewed by Lily Ramsey, LLM

In a recent study posted to medRxiv*, researchers examined the association between physical activity and kinesiophobia.

Study: Kinesiophobia and Physical Activity: A Systematic Review and Meta-Analysis. Image Credit: GP PIXSTOCK/Shutterstock.com

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Background

The health benefits of physical activity have been well documented in the literature, including lower risks of disease, disability, and death. In particular, increased physical activity reduces the risk of obesity, cardiovascular disease, cancer, hypertension, dementia, and depression.

Kinesiophobia is the irrational, debilitating, and excessive fear of movement and activity due to a sense of vulnerability to a medical condition, injury, or pain.

The perception of physical activity-related cues automatically activates the physical activity concept and associated pleasant or unpleasant affective memories, leading to an impulsive tendency to approach or avoid physical activity.

Likewise, aversive fear of injury, pain, or worsening of a medical condition associated with the concept of movement may lead to automatic avoidance behaviors contributing to this fear. It may result in a phobic state (kinesiophobia).

About the study

In the present study, researchers systematically reviewed and meta-analyzed the relationship between physical activity and kinesiophobia. Medline, Cumulative Index to Allied and Nursing Health Literature (CINAHL), and PsycINFO databases were searched for potential studies using relevant keywords.

Studies were eligible if they reported original data from human participants, included at least one measure of physical activity and kinesiophobia, and evaluated their association.

Conference abstracts, study protocols, book chapters, and studies incorporating physical fitness measures were excluded. Duplicates were removed, and titles/abstracts were reviewed.

The team extracted data on participant characteristics, body mass index, pain intensity, health status, type and level of kinesiophobia, type of physical activity measure, and statistical estimates.

The risk of bias was estimated using the appraisal tool for cross-sectional studies. In the meta-analysis, Pearson product-moment correlations were pooled from studies to analyze the relationship between physical activity and kinesiophobia.

The heterogeneity variance (Tau-squared) was calculated using the restricted maximum likelihood estimator. Besides, the I-squared statistic was used to quantify between-study heterogeneity.

Publication bias was assessed using Egger’s regression test and p-curve analysis. Several sub-group analyses were performed. In addition, a secondary meta-analysis was performed to assess the relationship between device-measured physical activity and kinesiophobia.

A sensitivity analysis examined whether the quality of studies influenced results.

Findings

The authors identified 395 potential hits from the primary search. After exclusions, 49 studies with 6,084 participants were selected for the systematic review. The studies evaluated healthy individuals and those with pain, arthritis, cancer, surgery, and cardiovascular, neurological, and pulmonary conditions. Most studies used the Tampa scale of kinesiophobia to assess kinesiophobia.

Studies reporting the highest kinesiophobia levels involved individuals with a cardiovascular condition, arthritis, chronic pain, or pulmonary condition. Kinesiophobia levels were lower in healthy individuals and those with neurological or surgical conditions.

Thirty-four studies assessed physical activity using self-reported questionnaires. Accelerometers and pedometers were used in others.

The meta-analysis, which included 41 studies, revealed a significant moderate negative correlation between physical activity and kinesiophobia. Nevertheless, there was substantial between-study heterogeneity and publication bias.

The association between physical activity and kinesiophobia was significant only in patients with arthritis or cardiovascular disease. Heterogeneity was higher in studies with arthritis populations than those comprising cardiovascular disease patients.

Moreover, only self-reported physical activity measures correlated with physical activity and kinesiophobia. The secondary meta-analysis revealed no evidence of an association between accelerometer-based physical activity measures and kinesiophobia. Finally, the sensitivity analysis revealed that the quality of studies did not impact the correlation.

Conclusions

The findings reveal a moderate negative correlation between physical activity and kinesiophobia, suggesting that the fear of movement induces an impulse to avoid physical activity. Moreover, arthritis or cardiovascular disease patients may be at an elevated risk than others.

Although there was no association between kinesiophobia and physical activity in other health conditions (cancer, surgery, acute pain, and neurological or pulmonary disorders), the effects of kinesiophobia cannot be ruled out.

Notably, the association was statistically significant only in studies incorporating self-reported measures of physical activity, with the secondary meta-analysis supporting this finding.

This raises the question of the robustness of the association, given the higher reliability and validity of device-based measures than self-reports. Thus, future studies using device-based measures of physical activity are required to corroborate the findings.

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.