Identifying kinesiophobia subgroups using latent profile analysis and persona development in frail older patients with cardiovascular disease: a mixed methods study

Kinesiophobia represents a major psychological barrier to exercise participation and engagement in cardiac rehabilitation among older patients with cardiovascular disease, and this barrier may be amplified in the presence of frailty. This study aimed to identify multidimensional kinesiophobia profiles, examine factors associated with profile membership, explore profile-specific exercise experiences and needs, and integrate these findings into clinically interpretable patient personas. This study was carried out from March to December 2025. In the quantitative phase, 238 patients completed assessments covering frailty, kinesiophobia, self-efficacy and physical activity. Latent profile analysis was used to identify distinct subgroups. In the qualitative phase, 23 semi-structured interviews were analyzed via content analysis. All findings were integrated for comprehensive analysis. Three profiles were identified: high fear–avoidance (25.2%), moderate fear–general (64.7%), and low fear–active (10.1%). Quantitatively, the profiles differed in kinesiophobia, exercise self-efficacy, physical activity, somatic symptoms, employment status, and income. Qualitative findings further differentiated exercise-related risk perceptions, behavioral patterns, experiences, and support needs. Notably, although the low fear–active profile showed the most favorable fear and self-efficacy pattern, 70.8% of this subgroup still had low physical activity. Kinesiophobia was heterogeneous in this sample of frail older patients with cardiovascular disease. The integrated personas provide a hypothesis-generating framework for developing and prospectively testing profile-informed rehabilitation approaches rather than a validated clinical decision rule.