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 Table of Contents  
Year : 2020  |  Volume : 14  |  Issue : 1  |  Page : 32-36

Factors affecting kinesiophobia in coronary artery disease patients

1 Department of Cardio-Respiratory Physiotherapy, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
2 Department of Cardiology, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
3 Sancheti Institute for Orthopedics and Rehabilitation, Pune, Maharashtra, India

Date of Submission13-Sep-2019
Date of Decision18-Oct-2019
Date of Acceptance17-Mar-2020
Date of Web Publication29-Jun-2020

Correspondence Address:
Prof. Razia K Nagarwala
Department of Cardiology, Sancheti Institute College of Physiotherapy, Shivaji Nagar, Pune - 411 005, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/PJIAP.PJIAP_29_19

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INTRODUCTION: Kinesiophobia may act as a barrier to physical activities. It is, therefore, an important domain to consider when assessing psychosocial characteristics in coronary artery disease (CAD) patients. Different factors may affect the occurrence of kinesiophobia in CAD patients, and hence it becomes important to study these factors so that proper psychological counseling can be included under patient education to have better rehabilitation.
OBJECTIVE: The objective was to find if factors such as socioeconomic status, addictions, age, gender, anxiety, and financial security (medical insurance) affect kinesiophobia in CAD patients so as to know how these factors are significant in predicting kinesiophobia and direct patients to proper psychological counseling in future.
METHODOLOGY: A cross-sectional study was done on 62 patients, diagnosed with CAD at government and private hospitals and clinics were included in the study. Tampa Scale for Kinesiophobia Heart was used to assess the kinesiophobia. Logistic regression analyses and Spearman correlation were done for factors taken with kinesiophobia as a dependent variable and considered factors as independent.
RESULTS: About 83.87% of population had high level of kinesiophobia. Gender (odds ratio >1) and anxiety (P < 0.05) were significant in predicting kinesiophobia whereas age (P > 0.05), financial security (odds ratio <1), socioeconomic status (P > 0.05), and presence of addictions (odds ratio <1) did not show any correlation with kinesiophobia.
CONCLUSION: Of six factors taken into consideration, gender and anxiety significantly affect kinesiophobia, whereas age, financial security, socioeconomic status, and presence of addictions do not significantly affect kinesiophobia.

Keywords: Coronary artery disease, kinesiophobia, Tampa Scale Heart

How to cite this article:
Tungare NN, Nagarwala RK, Shyam AK, Sancheti PK. Factors affecting kinesiophobia in coronary artery disease patients. Physiother - J Indian Assoc Physiother 2020;14:32-6

How to cite this URL:
Tungare NN, Nagarwala RK, Shyam AK, Sancheti PK. Factors affecting kinesiophobia in coronary artery disease patients. Physiother - J Indian Assoc Physiother [serial online] 2020 [cited 2022 May 21];14:32-6. Available from: https://www.pjiap.org/text.asp?2020/14/1/32/288361

  Introduction Top

Coronary artery disease (CAD) is blockage of one or more arteries that supply blood to the heart, usually due to atherosclerosis. Ischemic or chronic heart disease is another term for CAD. Myocardial infarction occurs in later stages (mostly chronic), eventually leading to cardiac failure. These diseases are caused mainly due to thrombosis in coronary arteries causing ischemia. Symptoms of the disease include pain in chest and arms, breathlessness, nausea, vomiting, syncope and anxiety, and fear of impending death.[1]

Kinesiophobia is defined as “an excessive, irrational, and debilitating fear of physical movement and activity, resulting from a feeling of vulnerability to painful injury or reinjury.”[2] Based on clinical experience, patients with CAD often have doubts that if physical activity can be performed safely due to the disease.[3] Despite strong evidence for the benefits of exercise-based cardiac rehabilitation, studies show poor attendance and adherence. There is a need to identify obstacles that prevent patients from participating in cardiac rehabilitation and increasing their levels of physical activity, including exercise. Daily activities and functional capacity may be reduced to avoid pain, leading to decreased physical activity, disuse, disability, and further chronicity of pain.[4] Epidemiological studies have provided convincing evidence about the importance of physical activity in the cardiac rehabilitation process.[5] Kinesiophobia may act as a barrier to physical activities.[6] Kinesiophobia is, therefore, an important domain to consider when assessing psychosocial characteristics in CAD patients.[7] India is a country with a diverse range of cultures, ethnicities, religions, and languages. Socioeconomic and financial security factors do play a role in Indian beliefs, and hence, may affect the perception toward healthcare. Hence, it becomes important to consider these factors.[8]

Tampa Scale for Kinesiophobia-Swedish version (TSK-SV Heart) is for patients with CAD. The validity and reliability of this scale is published. This scale consists of four-component model. The four components include “Perceived danger of heart problem,” “Avoidance of exercise,” “Fear of injury/reinjury,” and “Dysfunctional self.” Kinesiophobia: the TSK-SV heart comprises 17 statements that assess the subjective rating of kinesiophobia. The statements are rated from “strongly disagree” (score = 1) to “strongly agree” (score = 4) on a four-point Likert scale. The total score varies between 17 and 68. The higher the value, the greater is the degree of kinesiophobia.[7],[9],[10]

Demographic factors such as age, gender, and presence of addictions do affect the prevalence of cardiac disorders, and hence, it becomes necessary to find if these factors affect kinesiophobia also in CAD patients. Anxiety can hinder psychosocial adjustment to the chronicity of cardiovascular disease and physical recovery after an acute event. Higher anxiety is predictive of worse quality of life among patients with cardiovascular disease.[11],[12],[13]

  Methodology Top


The procedure followed for the study was in accordance with the ethical standards of the ethical committee. Informed consent was obtained from all the patients before handling them the questionnaires to answer, and we assure the confidentiality of the identity of patients. The institutional ethical committee has approved the study for publication.

Study design

It is a cross-sectional study done on 62 patients (39 males, 26 females: mean age: 57 ± 10) from government and private hospitals and clinics, diagnosed with CAD was taken. Convenient sampling technique was done. Inclusion criteria was mainly CAD diagnosed patients which consisted of ischemic heart disease (n = 25), myocardial infarction (n = 26), and cardiac failure patients (n = 11). The patients who were already operated for cardiac disease or had any recent injury or undergone any surgery were excluded from the study.


After the diagnosis of CAD, when patients were in stable condition, the questionnaire (scales) was filled by them. The scales used were also translated into local languages for patients who did not understand English. The face and content validation of these translated scales was done.


Personal factors

Age (mean age: 57 ± 10), gender, addictions, and financial security (medical insurance): these factors were obtained from the demographic data of CAD patients.

Socioeconomic status

Kuppuswamy scale (2018) is an updated version to calculate the socioeconomic class of the Indian citizens. This scale depends on the overall income of family or individual.[14]


Beck inventory anxiety scale was used. It is a self-report measure of anxiety. It have 21-items with scorings done on the LIKERT scale ranging from 0 to 3.[11]

Statistical analyses

Data were analyzed using SPSS version 20 software (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.). Descriptive statistics was used to find out the number of CAD patients having kinesiophobia and classifying them on the basis of gender, having/not having addictions, and having/not having insurance. Significance of prediction of kinesiophobia by gender, insurance, and addictions was found by Logistic regression, and Spearman correlation was done for age, socioeconomic status, and anxiety. The significance level was set at P ≤ 0.05.

  Results Top

Of 62 CAD patients, 52 patients that is 83.87% persists the high level of kinesiophobia [Table 1]. When considering gender, females were seen to have more kinesiophobia compared to males [Table 2]. It can be interpreted that gender significantly predicts kinesiophobia (odds ratio >1) [Table 3], whereas the presence of addictions and having medical insurance do not significantly predict kinesiophobia [Table 3]. It can be interpreted that anxiety significantly predicts kinesiophobia (P = 0.000) [Table 4]. Age (P = 0.506) and socioeconomic status (0.964) do not significantly affect kinesiophobia.
Table 1: Occurrence of kinesiophobia in coronary artery disease patients

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Table 2: Factors considered in coronary artery disease patients who had high/low level of kinesiophobia

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Table 3: Logistic regression for gender, insurance, and addiction factors

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Table 4: Spearman's correlation for age, socioeconomic status, and anxiety factors

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  Discussion Top

Kinesiophobia is seen in all CAD patients, and high kinesiophobia is seen in most of them because they have the fear of injury and perceived danger of heart problems.[9],[15] Kinesiophobia is also proven to be found in the study of low back pain.[10] Also a study which shows the relation between kinesiophobia and different factors such as pain, quality of life, depression proved that these factors do correlate significantly with kinesiophobia.[16] Kinesiophobia has a direct relation with chronic pain, and avoidance behavior is seen in such patients due to pain.[2],[3] Moreover, in CAD patients, chest pain can be one of the causes due to which kinesiophobia might be present. Due to kinesiophobia, CAD patients avoid doing exercises or physical activities.[6],[9] Few studies show that high level of kinesiophobia acts as a barrier in cardiac rehabilitation leading to hindrances in patient recovery, which further affects the quality of life of CAD patients.[4],[6],[9]

Some of the differences already known between kinesiophobia and factors such as age, presence of addictions (current smoking), and anxiety were confirmed by this study. When we consider gender, in the present study, the ratio of number of females is seen to have more kinesiophobia than that of males [Table 2], and the reason can be their worries of household burden and their responsibilities in Indian population. A study done on CAD patients, which has found out the impact of kinesiophobia on clinical variables, proves that gender does not significantly affect kinesiophobia in CAD patients.[9] Whereas another study done on population having chronic pain, males had more kinesiophobia and lower activity levels compared to that of females.[17],[18] These different results might be seen due to difference in region and disease population. People having addictions such as frequent smoking, alcohol, or tobacco consumption also seem to be concerned about the fear of movement but do not significantly predict kinesiophobia [Table 3], and a study also confirms the same.[9] Patients, who do not have medical insurance, have financial burden regarding huge medical expenses, and ways of compensating their loans. A study shows that there is rising expenditure among households for the treatment of chronic conditions such as CAD in India.[19] Moreover, the perception of middle as well as lower socioeconomic status highly gets affected due to their expenditures. The presence of financial security thus becomes a vital factor to know the perception of CAD patients with respect to kinesiophobia, due to their huge expenses on healthcare. However, in the current study, the presence of medical/health insurances in CAD patients does not significantly predict the presence of kinesiophobia [Table 3]. Furthermore, the levels of kinesiophobia do not significantly correlate with socioeconomic class of people [Table 4]. Studies show that cardiac patients do have anxiety which affects their physical activities, and hence, proves as a causative factor for kinesiophobia.[9],[20],[21],[22] Patients having high amount of anxiety, having high level of kinesiophobia due to fear of injury, and perception of the risk factors associated with heart disease. Two studies have shown significant anxiety and depression in patients suffering from myocardial infarction.[12],[13] Some studies have also shown kinesiophobia having its impact on psychological factors such as anxiety and depression in CAD patients.[9] Since age is not significantly predicting kinesiophobia [Table 4], CAD patients of any age, younger ones, or older can have a fear of movement. A study done on CAD patients, which has found out the impact of kinesiophobia on clinical variables, proves that age does not have significant affection over kinesiophobia.[9] Some studies do suggest that age has a significant affection over kinesiophobia but in other patient population.[22],[23]

Strengths and limitations of study

This study helps us to know the factors affecting kinesiophobia so that we can direct a proper psychological counseling to prevent kinesiophobia occurring in CAD patients so as to have a better physical rehabilitation. There were no limitations in this study.

Future scope of the study

Considering these factors, proper interventions can be carried out to treat or prevent kinesiophobia in CAD patients.

  Conclusion Top

Of the six factors taken into consideration, two factors which are gender and anxiety significantly affect kinesiophobia and four factors which are age, financial security, socioeconomic status, and presence of addictions do not significantly affect the kinesiophobia.


The authors would like to thank the patients who participated in this study, the hospitals and clinics who permitted to conduct this study, and the translators who helped in the translation of the scales used in this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Colledge NR, Walker BR, Davidson's Principles and Practice of Medicine. 21st ed. Churchill Livingstone Elsevier, 2010.  Back to cited text no. 1
Korri SH, Miller RP, Todd DD. Kinesiophobia: A new view of chronic pain behavior. Pain Manag 1990;3:35-43.  Back to cited text no. 2
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Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: Psychometric properties. J Consulting Clin Psychol 1988;56:893.  Back to cited text no. 11
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Oskay D, Tuna Z, Düzgün İ, Elbasan B, Yakut Y, Tufan A. Relationship between kinesiophobia and pain, quality of life, functional status, disease activity, mobility, and depression in patients with ankylosing spondylitis. Turkish J Med Sci 2017;47:1340-7.  Back to cited text no. 16
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Rovner GS, Sunnerhagen KS, Björkdahl A, Gerdle B, Borsbo B, Johansson F, et al. Chronic pain and sex-differences; women accept and move, while men feel blue. PloS One 2017;12:e0175737.  Back to cited text no. 18
Chauhan AS, Mukherjee K. Economic burden of coronary heart disease in North India. Int J Noncommun Dis 2016;1:18.  Back to cited text no. 19
Lüning Bergsten C, Lundberg M, Lindberg P, Elfving B. Change in kinesiophobia and its relation to activity limitation after multidisciplinary rehabilitation in patients with chronic back pain. Dis Rehabil 2012;34:852-8.  Back to cited text no. 20
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  [Table 1], [Table 2], [Table 3], [Table 4]


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