Kinesiophobia and physical activity: A systematic review and meta-analysis

Abstract

ObjectivePhysical activity is known to reduce the risk of disability, disease, and mortality. However, in some patients, an excessive, irrational, and debilitating fear of movement (i.e., kinesiophobia) is thought to induce avoidance behaviors, contributing to decreased engagement in physical activity. The aim of this study was to examine whether kinesiophobia is negatively associated with physical activity and what factors influence this relationship.MethodsThree databases were searched for articles including both a measure of kinesiophobia and physical activity. Two reviewers screened articles for inclusion, assessed risk of bias, and extracted data from each study. Pearson product-moment correlations were pooled from eligible studies using the generic inverse pooling and random effects method to examine the relationship between kinesiophobia and physical activity.ResultsForty-nine articles were included in the systematic review and 41 studies (n = 4,848) in the meta-analysis. Results showed a moderate negative correlation between kinesiophobia and physical activity (r = -0.31; 95% CI: -0.42 to -0.20; I2= 1.8%; p < 0.0001). Subgroup meta-analyses revealed that the correlation was statistically significant only in patients with a cardiovascular or arthritis condition and in studies using a self-reported measure of physical activity. There was no evidence of an effect of age, gender, or pain.ConclusionsHigher levels of kinesiophobia were moderately associated with lower levels of physical activity. However, between-study heterogeneity was considerable, and results showed no evidence of this association when physical activity was assessed with accelerometers or pedometers. Additional studies using device-based measures of physical activity are required to confirm these results and to understand the factors and mechanisms influencing this potential relationship.ImpactOur results suggest that kinesiophobia could be considered as a limiting factor when developing physical activity promotion strategies for inactive patients.