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

Objective Physical activity contributes to the primary, secondary, and tertiary prevention of multiple diseases. 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 in several health conditions and what factors may influence this relationship. Methods Five databases were searched for studies 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. Results Seventy-four studies were included in the systematic review and 63 studies (83 estimates, 12,278 participants) in the main meta-analysis. Results showed a small-to-moderate negative correlation between kinesiophobia and physical activity (r = −0.19; 95% confidence interval: −0.26 to −0.13; I 2 = 85.5%; p < 0.0001). Funnel plot analysis showed evidence of publication bias, but p-curve analysis suggested that our results could not be caused by selective reporting. A subgroup meta-analysis showed that the correlation was statistically significant in patients with cardiac, rheumatologic, neurologic, or pulmonary conditions, but not in patients with chronic or acute pain. Conclusion Our results suggest that higher levels of kinesiophobia are associated with lower levels of physical activity in several health conditions that are not necessarily painful. Impact Kinesiophobia should be dissociated from pain and considered in relation to specific health conditions when implementing exercise therapy. Kinesiophobia may have prognostic implications in patients for whom physical activity contributes to prevent recurrence or worsening of their condition.