Kinesiophobia is a catastrophic fear of physical activity due to a patient’s overwhelming concerns and sense of vulnerability about cardiac consequences due to activities. However, there was a lack of information regarding kinesiophobia among patients with cardiac disease, particularly in low- and middle-income countries, including Ethiopia.

This study aimed to assess the prevalence of kinesiophobia and its associated factors among patients with cardiac disease attending cardiac units at hospitals in Addis Ababa, Ethiopia.

An institutional-based multicentre cross-sectional study was conducted.

The study was conducted through a systematic random sampling technique in six comprehensive specialised hospitals to select 405 study participants.

Kinesiophobia was assessed by the Tampa Scale Kinesiophobia-heart questionnaire. The collected data were analysed on SPSS V.25. Bivariate analysis was used to determine potential candidate variables. Finally, an adjusted OR (AOR) with a p value of <0.05 and a 95% CI was considered statistically significant.

The prevalence of kinesiophobia was 67.4% (95% CI: 62.6% to 72%). An older age group (AOR=3.84; 95% CI=1.663 to 8.864), cardiac function classification class II (AOR=2.639; 95% CI=1.090 to 6.388), class III (AOR=5.646; 95% CI=2.299 to 13.868), class IV (AOR=9.229; 95% CI=3.026 to 28.142), being physically inactive (AOR=2.642; 95% CI=1.490 to 4.685), being anxious (AOR=2.730; 95% CI=1.487 to 5.011) and moderate (AOR=2.172; 95% CI=1.063 to 4.437) and high perceived threat (AOR=6.146; 95% CI=2.955 to 12.786) were significantly associated with kinesiophobia.

The results of this research imply that kinesiophobia is a common health concern among patients with cardiac disease. Being above 50 years, advanced stage of cardiac disease, physical inactivity, anxiety and having higher threat illness perceptions were significantly associated with kinesiophobia among patients with cardiac disease.

Data are available upon reasonable request. The study contains all of the study data related to these findings. The data sets used and/or analysed during the current study are available from the corresponding author on reasonable formal request by generalising information or while maintaining confidentiality as it may needed for further analysis in accordance with ethical guidelines and the policies of the journal. We recommend the request should have a clear justification including the intended purpose of their analysis and how it relates to our findings, this will help us ensure that the data is used appropriately and in line with participant confidentiality.

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Cardiovascular diseases (CVDs) are among the types of diseases that involve the heart structure, the vessels and the conduction system abnormalities.1 They are highly increasing non-communicable diseases in Ethiopia, Africa and worldwide. CVDs are the leading causes of mortality and morbidity in the globe, accounting for 17.9 million fatalities annually, of which low- and middle-income nations account for more than three-quarters of all fatalities and result in significant medical costs. In Ethiopia, the prevalence of CVDs ranges from 7.2% to 24%, and the age-standardised CVD disability-adjusted life years were 3549.6 per 100 000 populations.2

Following cardiac disease (CD), a wide range of complications, including psychological and physiological issues, may manifest. Kinesiophobia is among the most common complications that happen to patients with CD; it happens when patients believe that exposure to movements can exacerbate pain and suffering, which is frequently accompanied by dread that is mediated by prior suffering.3 In patients with CD, kinesiophobia is an excessive and irrational fear of physical activity resulting from a feeling of vulnerability and excessive concerns about cardiac deterioration and other negative consequences of activities, including rhythm disorders, cardiac arrest and sudden death.4

Compared with patients with other diseases, patients with CD are more likely to experience kinesiophobia because fear and associated avoidance behaviours are common psychological reactions to an acute CD.5 Depending on the type of cardiac ailment and study population, different nations have different prevalence rates of kinesiophobia among patients with CD; based on an analysis done in 2024, the global prevalence of kinesiophobia is 61% among patients with CD, with a varied prevalence ranging from 20.0% to 87.2%.4

There are numerous reasons why patients referred for cardiac treatments and rehabilitation frequently experience kinesiophobia. These include sociodemographic factors, psychological factors, physical factors and factors related to heart function, which are the most important factors. These factors can all affect the prognosis of kinesiophobia among patients with CD during intervention and rehabilitation.6 7

Kinesiophobia can directly affect the prognosis of patients, and it is a significant obstacle to daily activities, which may lead to adverse outcomes in patients with CD, leading to long-term physical inactivity in patients, which can result in increased risk of cardiac events and psychological problems like solitude, hopelessness and a loss of self-worth.8 9

Exercise rehabilitation—such as resistance exercise, inspiratory muscle training and intermittent or continual aerobic training—and counselling, as cardiac rehabilitation’s principal method, can enhance physical well-being, including reducing fear of physical activity and improving quality of life.10 Among the cardioprotective components that exercise affects, the endothelium has been identified as a primary target; exercise has been shown to increase coronary endothelial function, endothelium-dependent vasodilation, myocardial perfusion and decrease the progression of cardiac symptoms.11

Most studies had been conducted in developed countries, and to the limit of the search result, this area was not focused on; the prevalence and associated factors of kinesiophobia among patients with CD remain unclear in Ethiopia and also in African countries. Therefore, the aim of this study was to determine the prevalence and associated factors of kinesiophobia among patients with CD in Addis Ababa, Ethiopia.

The purpose of this study was to determine the prevalence of kinesiophobia and its associated factors among patients with CD attending cardiac units at hospitals in Addis Ababa, Ethiopia. In this study, the prevalence of kinesiophobia among patients with CD attending cardiac units at hospitals in Addis Ababa, Ethiopia, was found to be 67.4% (95% CI 62.6% to 72%). The age group of patients, cardiac function classification, being physically inactive, being anxious and illness perception were significantly associated with kinesiophobia among patients with CD.

The prevalence of kinesiophobia in our study, 67.4%, was comparable with a study done in Turkey, 71.4%,25 Nanjing China, 69.5%,26 and Poland, 70%.27 Likewise, the studies done in Poland, Turkey and Nanjing, China found that most participants were men and that equal gender distributions may be attributed to a comparable rate of kinesiophobia with our study; this is because women have a high tendency to experience anxiety,28 which can influence the occurrence of kinesiophobia.

However, the prevalence of kinesiophobia in our study was lower than the findings of the previous studies; in two cross-sectional and one follow-up study in Turkey (87.2%, 85.3%, 74.5%), China (75.7%), Italy (83%), India (83.87%) and Poland (76%).6 25 29–33 Age group differences among the participants might be a possible reason for this discrepancy; relative to our study, in which the mean age of the participants was 44.06 years, three studies in Turkey, China, Italy, India and Poland had participants with a mean age greater than our study (58, 56.76, 58.1, 62.29, 60, 57, 71.8 years, respectively). As age increases, the physiological and psychological functions of the body deteriorate, which results in the overestimation of the dangers associated with physical activity,34 that might be one of the possible reasons for the discrepancy.

On the contrary, the prevalence of kinesiophobia in this study was higher than in cross-sectional studies conducted in China (58.4%),35 Sweden (20%)36 and the Netherlands (29%, 40.9%, 45.4%).37–39 It is also higher than study findings from Amsterdam-Netherlands, and another study done in Gothenburg, Sweden, aimed at assessing changes in fear of movement (40% pre-cardiac and 26% post-cardiac rehabilitation in the Netherlands and 25.4% at baseline and 21.1% after 4 months in the Sweden study).40 41 This difference might be due to different methodologies, study settings and better health access facilities in those countries. In the Netherlands’ studies,38 39 participants were recruited from rehabilitation centres, so they had a better understanding and awareness of physical activity and movement. Similarly, the discrepancy between our study and studies in Sweden could be that patients in Sweden have better access to physical activity and rehabilitation programmes.42 The likely rationale for the variations between our study and the studies done in China35 and another study in the Netherlands37 might be that unlike our study, in which most participants had class III cardiac function, more than half of the participants in the China and Netherlands study had class II and class I cardiac function, respectively. Patients with reduced cardiac function may overestimate the risks associated with physical activity. This cognitive appraisal can lead to an increased fear of the potential consequences of movement.26

In the present study, it was found that the age group was a significant predictor of kinesiophobia among patients with CD, where respondents above 50 years were 3.8 times more likely to have kinesiophobia than those aged 18–30 years. This result was in line with a study done in Italy and Turkey.7 32 The possible reason may be that an increasing age will result in a deteriorating sense of balance and an exaggerated perception of the potential danger, including fatigue and falls, that makes older people experience a greater sense of vulnerability43; these aspects of ageing may contribute to a high rate of kinesiophobia in patients above 50 years old.

According to our study, cardiac functions based on NYHA functional classification were significantly associated with kinesiophobia. Our study implies that participants who had a class II, class III and class IV cardiac function classification were 2.6, 5.6 and 9.2 times more likely to develop kinesiophobia as compared with those with a class I cardiac function classification, respectively. This direct relation was supported by two studies conducted in China and one study conducted in Turkey.26 33 44 As cardiac function decreases, primary symptoms of CDs, such as fatigue, dyspnoea and precordial pain, worsen, causing frustration in doing any activities,45 hence leading to kinesiophobia.

In the current study, physical inactivity was positively associated with kinesiophobia compared with those participants who were physically active, in which kinesiophobia was about 2.6 times more common among physically inactive participants than those who do regular physical activity. Studies done in Sweden and Turkey aligned with this study finding.41 46 A possible explanation for this is that physical inactivity may cease the recovery of cardiac symptoms that lead to refusal of performing any task,47 which eventually results in kinesiophobia.

Concerning the existence of psychological characteristics, our study found that those patients with anxiety symptoms were 2.7 times more likely to have kinesiophobia compared with those who did not experience anxiety. That is supported by a systematic review and meta-analysis conducted in China and a prospective cohort study conducted in the Netherlands.4 38 Cross-sectional studies done in Poland and Rhode Island, USA also suggest patients with CD who had anxiety were more likely to have kinesiophobia.48 49 This might be due to expecting the worst and being sensitive to physical cues and ordinary bodily sensations being among the faulty thought patterns that anxiety can cause. This kind of thinking might exacerbate kinesiophobia by making movement appear more dangerous than it actually is.50

In our study, it was found that those with moderate perceived threat were 2.2 times more likely to experience kinesiophobia, and those who had high perceived threats were 6.1 times more likely to have kinesiophobia than those with low perceived threats. This relation between illness perception and kinesiophobia was supported by studies carried out in China and the Netherlands.51 52 The possible reason may be that individuals with a high threat perception may doubt their ability to manage pain or engage in physical activity safely.53

As the study involves multiple institutions and used a random sample, the results of this research imply that kinesiophobia is emerging as a significant health concern among patients with CD. Key factors contributing to the occurrence of kinesiophobia among patients with CD include age (specifically those over 50 years), cardiac function classification class II, III and IV, physical inactivity, anxiety and higher threat perceptions of an illness.

Health bureaus and policymakers need to develop and implement preventative strategies and treatment guidelines for kinesiophobia to correct the misinterpretation of physical activity among patients, to be aware of the benefits of physical activity, as well as better to consider the early screening of kinesiophobia for beneficial intervention and prevent future impacts of kinesiophobia. Health professionals, including physiotherapists, should place more emphasis on physical activity participation and engage in the treatment of patients with CD by drawing attention to deteriorating aspects of age, incorporating exercise therapy, cognitive behavioural therapy and other management techniques based on those factors associated with kinesiophobia. In future studies, it might be interesting to conduct follow-up research that tracks changes over time in various variables, as well as qualitative research designed to address factors such as quality of life and awareness of physical activity.

Data are available upon reasonable request. The study contains all of the study data related to these findings. The data sets used and/or analysed during the current study are available from the corresponding author on reasonable formal request by generalising information or while maintaining confidentiality as it may needed for further analysis in accordance with ethical guidelines and the policies of the journal. We recommend the request should have a clear justification including the intended purpose of their analysis and how it relates to our findings, this will help us ensure that the data is used appropriately and in line with participant confidentiality.

The authors are grateful to Jimma University and the University of Gondar for providing the resources and support necessary for the research to be executed. The authors would like to extend special thanks to all study participants and data collectors.