Kinesiophobia, Physical Activity, and Physical-Activity Self-Efficacy in Adolescents with Congenital Heart Disease

Kinesiophobia-an excessive, often debilitating fear of movement or exercise-has emerged as an important moderator of physical activity (PA) and has been linked with quality of life (QoL), anxiety, and depression in adolescents with heart disease (HD). This study explores additional factors that may be related to cardiac-focused kinesiophobia, including self-efficacy, PA engagement, and QoL. Sixty-three adolescents (mean age = 15.5 years; 49% female) with congenital or acquired HD completed the TSK-Heart-A, the Physical Activity Questionnaire for Adolescents (PAQ-A), the Pediatric Quality of Life Inventory (PedsQL™) Generic Core and Cardiac Module, and the Domain-Specific Physical Activity Efficacy Questionnaire (DSPAEQ-A). Data were analyzed using Kendall's Tau correlations and bootstrapped partial correlations controlling for PA. Greater kinesiophobia correlated with lower PA across both PA measures (τ = - 0.248), lower PA self-efficacy across household, leisure-time, and ambulatory domains (τ = - 0.293 to - 0.356), and poorer QoL for both generic and cardiac scales (τ = - 0.403, - 0.400). When controlling for PA, kinesiophobia remained significantly related to lower self-efficacy (r = - 0.314 to - 0.368) and poorer QoL (r = - 0.558, - 0.520). Cardiac-focused kinesiophobia is a salient psychological factor in pediatric HD and is tied to lower self-reported PA, poorer QoL and is independently associated with reduced PA self-efficacy-a modifiable resilience construct. These findings support the development of interventions that target fear-avoidance mechanisms and build self-efficacy to improve everyday activity and psychosocial functioning in adolescent HD.