The Relationship between Self-Efficacy, Kinesiophobia, and Physical Activity in People with Heart Failure: A Systematic Review and Meta-Analysis

Authors

  • Thi Ngoc Anh Hoang Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
  • Siriphan Sasat Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand

DOI:

https://doi.org/10.55489/njcm.170520266417

Keywords:

Heart Failure, Kinesiophobia, Meta-Analyses, systematic review, physical activity, self-efficacy

Abstract

Background: In heart failure (HF), self-efficacy facilitates physical activity (PA), whereas kinesiophobia is known as a barrier to PA. Understanding their relationship with PA may support the effectiveness of interventions to enhance PA performance in HF patients. The objective was to investigate the strength of the relationship between self-efficacy, kinesiophobia, and PA in HF patients.

Method: Five databases were used to search for eligible articles, including PubMed, Scopus, ScienceDirect, ProQuest and CINAHL from 2015 to 2025. Six correlations were included in the meta-analysis between self-efficacy and PA, and the other five articles were analyzed in the kinesiophobia and PA meta-analysis.

Results: Self-efficacy was associated positively with PA (pooled r = 0.29, 95%CI: 0.22 to 0.36), while kinesiophobia was associated negatively with PA (pooled r = -0.33, 95%CI: -0.45 to -0.21). Exercise-task self-efficacy had a higher relationship to PA (pooled r = 0.31, 95%CI: 0.23 to 0.39). Kinesiophobia measured by FActS-HF had a higher relationship to PA compared to the other. pooled r = - 0.37 (95%CI: -0.59 to -0.15).

Conclusion: Both kinesiophobia and self-efficacy have a moderate relationship with PA in HF. These results highlight the significance of psychological factors, including self-efficacy and kinesiophobia in the PA of individuals with HF.

References

GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 Nov 10;392(10159):1789-1858. DOI: https://doi.org/10.1016/S0140-6736(18)32279-7. Erratum in: Lancet. 2019 Jun 22;393(10190):e44. DOI: https://doi.org/10.1016/S0140-6736(19)31047-5. PMID: 30496104; PMCID: PMC6227754.

Milinković I, Rosano G, Lopatin Y, Seferović PM. The Role of Ivabradine and Trimetazidine in the New ESC HF Guidelines. Card Fail Rev. 2016 Nov;2(2):123-129. DOI: https://doi.org/10.15420/cfr.2016:13:1 PMid:28785466 PMCid:PMC5490945

Butrous H, Hummel SL. Heart failure in older adults. Canadian Journal of Cardiology. 2016;32(9):1140-1147. DOI: https://doi.org/10.1016/j.cjca.2016.05.005 PMid:27476982 PMCid:PMC5503696

Bozkurt B, Fonarow GC, Goldberg LR, Guglin M, Josephson RA, Forman DE, et al. Cardiac Rehabilitation for Patients With Heart Failure: JACC Expert Panel. J Am Coll Cardiol. 2021 Mar 23;77(11):1454-1469. DOI: https://doi.org/10.1016/j.jacc.2021.01.030 PMid:33736829

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129-2200. DOI: https://doi.org/10.1093/eurheartj/ehw128. Erratum in: Eur Heart J. 2018 Mar 7;39(10):860. DOI: https://doi.org/10.1093/eurheartj/ehw383. PMID: 27206819.

World Health Organization. Physical activity [Internet]. Geneva: World Health Organization; 2021 [cited 2026 Feb 17]. Available from: https://www.who.int/news-room/fact-sheets/detail/physical-activity

Lee H, Boo S, Yu J, Suh SR, Chun KJ, Kim JH. Physical Functioning, Physical Activity, Exercise Self-Efficacy, and Quality of Life Among Individuals With Chronic Heart Failure in Korea: A Cross-Sectional Descriptive Study. J Nurs Res. 2017 Apr;25(2):131-139. DOI: https://doi.org/10.1097/JNR.0000000000000150 PMid:28277393

Meng, Zhang T, Ge X, Zheng Q, Feng T. Physical activity changes and related factors in chronic heart failure patients during the postdischarge transition period: a longitudinal study. BMC Cardiovasc Disord. 2024;24(1):232. DOI: https://doi.org/10.1186/s12872-024-03881-4 PMid:38684960 PMCid:PMC11059695

Bandura A. Self-efficacy. In V. S. Ramachaudran (Ed.), Encyclopedia of human behavior. 1994;4:71-81. New York: Academic Press. (Reprinted in H. Friedman [Ed.], Encyclopedia of mental health. San Diego: Academic Press, 1998). Available from: https://happyheartfamilies.citymax.com/f/Self_Efficacy.pdf

Ha FJ, Hare DL, Cameron JD, Toukhsati SR. Heart failure and exercise: a narrative review of the role of self-efficacy. Heart, Lung and Circulation. 2018;27(1):22-7. DOI: https://doi.org/10.1016/j.hlc.2017.08.012 PMid:28969981

Dontje ML, van der Wal MH, Stolk RP, Brügemann J, Jaarsma T, Wijtvliet PE, et al. Daily physical activity in stable heart failure patients. J Cardiovasc Nurs. 2014 May-Jun;29(3):218-226. DOI: https://doi.org/10.1097/JCN.0b013e318283ba14 PMid:23416939

Conraads VM, Deaton C, Piotrowicz E, Santaularia N, Tierney S, Piepoli MF, et al. Adherence of heart failure patients to exercise: barriers and possible solutions: a position statement of the Study Group on Exercise Training in Heart Failure of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2012 May;14(5):451-458. DOI: https://doi.org/10.1093/eurjhf/hfs048. Erratum in: Eur J Heart Fail. 2012 Jul;14(7):802. PMID: 22499542

Yang Z, Jia H, Wang A. Predictors of home-based cardiac rehabilitation exercise adherence among patients with chronic heart failure: a theory-driven cross-sectional study. BMC Nurs. 2023 Nov 6;22(1):415. DOI: https://doi.org/10.1186/s12912-023-01566-5 PMid:37926820 PMCid:PMC10626687

Kori SH MR, Todd DD. Kinesiophobia: a new view of chronic pain behavior. Pain Manage. 1990;3(1):35-43.

Spaderna H, Brandenburg VM, Lauterbach M, Partetzke TM, Schwab SU, Voss F, et al. Associations of fear of physical activity, coping style and self-reported exercise behavior in patients with chronic heart failure. PLoS One. 2024 Sep 5;19(9):e0309952. DOI: https://doi.org/10.1371/journal.pone.0309952 PMid:39236063 PMCid:PMC11376548

Lüke T, Brandenburg VM, Partetzke TM, Voss F, Spaderna H. Accelerometer-Measured Daily Physical Activity in Adults With Chronic Heart Failure and Associations With Fear of Physical Activity and Coping Dispositions. J Cardiovasc Nurs. 2026 May-Jun 01;41(3):165-173. DOI: https://doi.org/10.1097/JCN.0000000000001242. PMID: 40719556

Tierney S, Elwers H, Sange C, Mamas M, Rutter MK, Gibson M, et al. What influences physical activity in people with heart failure?: a qualitative study. Int J Nurs Stud. 2011 Oct;48(10):1234-1243. DOI: https://doi.org/10.1016/j.ijnurstu.2011.03.003 PMid:21459380

Goubran M, Farajzadeh A, Lahart IM, Bilodeau M, Boisgontier MP. Relationship Between Fear of Movement and Physical Activity in Patients With Cardiac, Rheumatologic, Neurologic, Pulmonary, or Pain Conditions: A Systematic Review and Meta-Analysis. Phys Ther. 2025 Jun 2;105(6):pzaf050. DOI: https://doi.org/10.1093/ptj/pzaf050 PMid:40188486 PMCid:PMC12207065

Selzler AM, Moore V, Habash R, Ellerton L, Lenton E, Goldstein R, Brooks D. The Relationship between Self-Efficacy, Functional Exercise Capacity and Physical Activity in People with COPD: A Systematic Review and Meta-Analyses. COPD. 2020 Aug;17(4):452-461. DOI: https://doi.org/10.1080/15412555.2020.1782866 PMid:32633148

Queensland Health. Physical activity, exercise and heart failure [Internet]. Brisbane: Queensland Government; 2022. Available from: https://www.health.qld.gov.au/__data/assets/pdf_file/0042/987774/Physical-activity-and-heart-failure-for-internet.pdf

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129-2200. DOI: https://doi.org/10.1093/eurheartj/ehw128. Erratum in: Eur Heart J. 2018 Mar 7;39(10):860. DOI: https://doi.org/10.1093/eurheartj/ehw383. PMID: 27206819

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372:n71. DOI: https://doi.org/10.1136/bmj.n71 PMid:33782057 PMCid:PMC8005924

Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985 Mar-Apr;100(2):126-131. PMID: 3920711; PMCID: PMC1424733.

Moola S, Munn Z, Sears K, Sfetcu R, Currie M, Lisy K, et al. Conducting systematic reviews of association (etiology): The Joanna Briggs Institute's approach. Int J Evid Based Healthc. 2015 Sep;13(3):163-169. DOI: https://doi.org/10.1097/XEB.0000000000000064. PMID: 26262566

Tang X, Zeng Z, Huang H, Symonds J. Quality Appraisal Tools for Quantitative, Qualitative, and Mixed-Methods Studies: A Review and a Brief New Checklist. ECNU Review of Education. 2025:20965311251371227. DOI: https://doi.org/10.1177/20965311251371227

Lüke T, Brandenburg VM, Partetzke TM, Voss F, Spaderna H. Accelerometer-Measured Daily Physical Activity in Adults With Chronic Heart Failure and Associations With Fear of Physical Activity and Coping Dispositions. J Cardiovasc Nurs. 2026 May-Jun 01;41(3):165-173. DOI: https://doi.org/10.1097/JCN.0000000000001242 PMid:40719556

Yifan T, Yanling H, Weiyun W, Xiaolin H, Zejuan G, Rong W, et al. Mediation analysis of activities of daily living and kinesiophobia in association between cardiac function and health status of patients with chronic heart failure. Clin Cardiol. 2023 Sep;46(9):1049-1058. DOI: https://doi.org/10.1002/clc.24147 PMid:37706605 PMCid:PMC10540005

Lobyaem C, Poungkaew A, Wattanakitkrileart D, Chirakarnjanakorn S. Factors Predicting Physical Activity in Patients with Heart Failure. J Thai Nurse Midwife Counc. 2023;38(01):112-128. DOI: https://doi.org/10.60099/jtnmc.v38i01.261296

Klompstra L, Jaarsma T, Strömberg A. Self-efficacy Mediates the Relationship between Motivation and Physical Activity in Patients with Heart Failure. J Cardiovasc Nurs. 2018;33(3):211-216. DOI: https://doi.org/10.1097/JCN.0000000000000456 PMid:29189427 PMCid:PMC5908261

Lee H, Boo S, Yu J, Suh SR, Chun KJ, Kim JH. Physical Functioning, Physical Activity, Exercise Self-Efficacy, and Quality of Life Among Individuals With Chronic Heart Failure in Korea: A Cross-Sectional Descriptive Study. J Nurs Res. 2017 Apr;25(2):131-139. DOI: https://doi.org/10.1097/JNR.0000000000000150 PMid:28277393

Klompstra L, Jaarsma T, Strömberg A. Physical activity in patients with heart failure: Barriers and motivations with special focus on sex differences. Patient Preference and Adherence. 2015;9:1603-1610. DOI: https://doi.org/10.2147/PPA.S90942 PMid:26635469 PMCid:PMC4646589

Deka P, Almenar L, Pathak D, Klompstra L, López-Vilella R, Marques-Sule E. Depression mediates physical activity readiness and physical activity in patients with heart failure. ESC Heart Fail. 2021;8(6):5259-5265. DOI: https://doi.org/10.1002/ehf2.13609 PMid:34523268 PMCid:PMC8712809

Marques-Sule E, Deka P, Almenar L, Pathak D, López-Vilella R, Klompstra L. Physical Activity Readiness in Patients with Heart Failure. Int J Environ Res Public Health. 2022 Dec 6;19(23):16332. DOI: https://doi.org/10.3390/ijerph192316332 PMid:36498402 PMCid:PMC9738390

Pozehl BJ, McGuire R, Duncan K, Hertzog M, Deka P, Norman J, et al. Accelerometer-Measured Daily Activity Levels and Related Factors in Patients With Heart Failure. J Cardiovasc Nurs. 2018;33(4):329-335. DOI: https://doi.org/10.1097/JCN.0000000000000464 PMid:29538050 PMCid:PMC5995599

Meng Y, Zhang T, Ge X, Zheng Q, Feng T. Physical activity changes and related factors in chronic heart failure patients during the postdischarge transition period: a longitudinal study. BMC Cardiovasc Disord. 2024 Apr 30;24(1):232. DOI: https://doi.org/10.1186/s12872-024-03881-4 PMid:38684960 PMCid:PMC11059695

Chen MF, Ke SR, Liu CL, Wu TC, Yu YM, Chiou AF. Associated factors and impacts of sedentary behaviour in patients with heart failure: A longitudinal study. Eur J Cardiovasc Nurs. 2020 Oct;19(7):609-618. DOI: https://doi.org/10.1177/1474515120912381 PMid:32338530

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj. 2003;327(7414):557-560. DOI: https://doi.org/10.1136/bmj.327.7414.557 PMid:12958120 PMCid:PMC192859

Teixeira JMM, Roever L, Ramasamy A, Pereira R, Carneiro I, Krustrup P, Póvoas SCA. Statistical heterogeneity in meta-analysis of hypertension and exercise training: A meta-review. J Sports Sci. 2023 Nov;41(22):2033-2044. DOI: https://doi.org/10.1080/02640414.2024.2309055. Erratum in: J Sports Sci. 2023 Dec;41(24):2251-2252. DOI: https://doi.org/10.1080/02640414.2024.2331892. PMID: 38341865.

Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629-634. DOI: https://doi.org/10.1136/bmj.315.7109.629 PMid:9310563 PMCid:PMC2127453

Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994 Dec;50(4):1088-1101. DOI: https://doi.org/10.2307/2533446 PMid:7786990

Bowman NA. Effect sizes and statistical methods for meta-analysis in higher education. Res High Educ. 2012;53(3):375-382. DOI: https://doi.org/10.1007/s11162-011-9232-5

Chinn S. A simple method for converting an odds ratio to effect size for use in meta-analysis. Stat Med. 2000 Nov 30;19(22):3127-3131. DOI: https://doi.org/10.1002/1097-0258(20001130)19:22<3127::AID-SIM784>3.0.CO;2-M PMid:11113947

Jurgens CY, Lee CS, Aycock DM, Masterson Creber R, Denfeld QE, DeVon HA, et al. State of the science: the relevance of symptoms in cardiovascular disease and research: a scientific statement from the American Heart Association. Circulation. 2022;146(12):e173-e84. DOI: https://doi.org/10.1161/CIR.0000000000001089 PMid:35979825

Qin J, Xiong J, Chen C, Wang X, Gao Y, Zhou Y, et al. Influencing factors of kinesiophobia in older patients with chronic heart failure: A structural equation model. Clinical cardiology. 2023;46(7):729-736. DOI: https://doi.org/10.1002/clc.24024 PMid:37114367 PMCid:PMC10352966

Daniali SS, Darani FM, Eslami AA, Mazaheri M. Relationship between Self-efficacy and Physical Activity, Medication Adherence in Chronic Disease Patients. Adv Biomed Res. 2017 May 29;6:63. DOI: https://doi.org/10.4103/2277-9175.190997 PMid:28603704 PMCid:PMC5458405

Du H, Everett B, Newton PJ, Salamonson Y, Davidson PM. Self-efficacy: a useful construct to promote physical activity in people with stable chronic heart failure. J Clin Nurs. 2012 Feb;21(3-4):301-310. DOI: https://doi.org/10.1111/j.1365-2702.2011.03983.x PMid:22175249

Mankar S, Rayas R, Ashok K, Parag K. Correlation between dyspnea-related kinesiophobia and activity limitation in patients with chronic respiratory diseases. Indian journal of respiratory care. 2022;11(1):20-23. DOI: https://doi.org/10.4103/ijrc.ijrc_77_21

Qin J, Xiong J, Wang X, Gao Y, Gong K. Kinesiophobia and its association with fatigue in CHF patients. Clin Nurs Res. 2022;31(7):1316-1324. DOI: https://doi.org/10.1177/10547738221081230 PMid:35249417

Cohen J. Statistical power analysis for the behavioral sciences: Routledge; 2013. DOI: https://doi.org/10.4324/9780203771587

Kubzansky LD, Huffman JC, Boehm JK, Hernandez R, Kim ES, Koga HK, et al. Positive psychological well-being and cardiovascular disease: JACC health promotion series. Journal of the American College of Cardiology. 2018;72(12):1382-1396. DOI: https://doi.org/10.1016/j.jacc.2018.07.042 PMid:30213332 PMCid:PMC6289282

Published

2026-05-01

How to Cite

1.
Hoang TNA, Sasat S. The Relationship between Self-Efficacy, Kinesiophobia, and Physical Activity in People with Heart Failure: A Systematic Review and Meta-Analysis. Natl J Community Med [Internet]. 2026 May 1 [cited 2026 May 1];17(05):326-3. Available from: https://www.njcmindia.com/index.php/file/article/view/6417

Issue

Section

Systematic Review/ Meta Analysis

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