Kinesiophobia and Physical Activity in Patients After Percutaneous Coronary Intervention: The Mediating role of Self-Efficacy and the Moderating Role of Type D Personality

PURPOSE: To investigate the interconnections among kinesiophobia, self-efficacy, Type D personality, and physical activity (PA) among patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). The explicit objective was to investigate whether self-efficacy mediated and Type D personality moderated the relationship between kinesiophobia and PA in this population. METHODS: Between November 2021 and October 2022, 328 patients who had undergone PCI were enrolled from cardiac wards at three different hospitals. The participants were instructed to finalize the International Physical Activity Questionnaire, the Tampa Scale of Kinesiophobia for Heart, the Cardiac Exercise Self-Efficacy Instrument, and the Type D Personality Scale. We used SPSS 22.0 (IBM Corp., Armonk, NY, USA) and the PROCESS macro for SPSS (developed by Andrew F. Hayes, The Ohio State University, Columbus, OH, USA) for the statistical analysis. RESULTS: (1) Mediation analysis revealed that self-efficacy partially mediated this relationship. (2) This study demonstrated that kinesiophobia was significantly associated with PA with Type D personality moderating the association between kinesiophobia and self-efficacy as well as the direct link between kinesiophobia and PA. However, kinesiophobia was associated with PA both directly and indirectly through self-efficacy. The simple slope graph revealed that patients with Type D personality exhibited substantially lower levels of PA than those with non-Type D personality as kinesiophobia increased. Patients with Type D personality had weaker self-efficacy than those without Type D personality when it came to strong kinesiophobia. CONCLUSION: Self-efficacy and Type D personality play important roles in the relationship between kinesiophobia and PA. Interventions after PCI should focus on reducing kinesiophobia and enhancing self-efficacy to improve PA. Personality assessment allows tailored strategies, with Type D patients requiring targeted approaches for fear and emotion regulation, while non-Type D patients may benefit more from self-efficacy enhancement.