Coronary heart disease (CHD), caused by coronary artery atherosclerosis leading to myocardial ischemia, hypoxia, or necrosis, is the leading cause of death globally (Timmis et al., 2020). Patients often face recurrent episodes, frequent hospitalizations, and repeated interventions like coronary angiograms and revascularizations. CHD poses a serious threat to life, health, and imposes a heavy economic burden on individuals and healthcare systems worldwide (Roth et al., 2020; Timmis et al., 2020; Virani et al., 2021). Currently, 423 million people suffer from CHD, accounting for 31% of all deaths annually (Lum et al., 2020). The World Heart Association projects global cardiovascular costs to rise from $863 billion in 2010 to $1,044 billion by 2030 (Virani et al., 2021).

Cardiac rehabilitation (CR) plays a crucial role in secondary prevention for CHD, helping to stabilize, slow, or even reverse atherosclerosis progression. It reduces overall mortality by 13 to 24% and readmission rates by 31% within a year (Resurrección et al., 2019). This comprehensive program spans the acute, stabilized, and lifelong phases of CHD and includes medication, exercise, nutrition, psychosocial support, risk factor management, education, and lifestyle guidance (Knuuti et al., 2020). Exercise rehabilitation, the cornerstone of cardiac rehabilitation, improves myocardial circulation, lowers mortality and readmission rates, reduces functional impairments, and enhances quality of life (Fu et al., 2019; Dibben et al., 2021). However, global participation in exercise rehabilitation remains low at 20–50%, with even lower rates in developing countries (Bäck et al., 2016). A major barrier is kinesiophobia, which affects participation and adherence, negatively impacting patients’ quality of life (Bäck et al., 2016; Knapik et al., 2019; Baykal Sahin et al., 2021; Yang et al., 2023a; Yang et al., 2023d). Studies have shown that 25.4% of patients with CHD have kinesiophobia throughout the course of the disease (Keessen et al., 2020a). Therefore, the identification and intervention of kinesiophobia in patients with CHD is an important topic and challenge.

The term “fear of movement” originated in chronic pain research and refers to avoidance behaviors driven by fear of pain (Lethem et al., 1983). It has since been studied in post-surgery (Masuy et al., 2022), stroke (Wasiuk-Zowada et al., 2021), and heart failure patients (Sentandreu-Mañó et al., 2024). While kinesiophobia is common across patient groups, its triggers and nature vary, making generalization inappropriate. For example, chronic pain patients fear pain-related movements due to catastrophic perceptions of pain (Vlaeyen and Linton, 2012). In contrast, angina in CHD patients is often sudden, brief, and triggered by factors like cold, diet, emotions, or exercise. This pain may signal myocardial ischemia, raising serious concerns about vital organs and death (Bäck et al., 2018). Additionally, Bäck et al. (2012) patients diagnosed with CHD may experience existential fears related to exertion and adverse events due to the specificity of their symptoms. These fears may include a fear of death, concerns about stent dislodgement or displacement during exercise, and anxiety about experiencing another cardiac event. Although kinesiophobia has evolved in coronary heart disease (CHD) patients, its unique characteristics remain underexplored, and despite the focus on exercise interventions, the lack of a conceptual analysis limits the development of targeted interventions and assessment tools, making a clear understanding essential for improving rehabilitation outcomes. Conceptual analysis is essential to address this gap and guide the creation of more precise and effective strategies for managing kinesiophobia in this patient group.

Concept analysis is an effective method for clarifying ambiguous terms widely used across disciplines. Rodgers’ Evolutionary Concept Analysis emphasizes that concepts are dynamic and evolve over time (Rodgers, 1989). To refine their current usage, this approach redefines context, attributes, surrogate and related terms, antecedents, model cases, and consequences, providing a structured foundation for research and practice (Tofthagen and Fagerstrøm, 2010). Unlike traditional methods, evolutionary concept analysis traces a concept’s historical development, examines its key components, explores diverse interpretations, and analyzes its real-world applications (Rodgers et al., 2018). By emphasizing conceptual fluidity and multidimensionality, this method is particularly suitable for studying evolving, cross-disciplinary concepts, offering valuable insights into their theoretical development and practical implications.

This study aims to analyze kinesiophobia in CHD patients using Rodgers’ evolutionary approach, hypothesizing that it is a complex phenomenon influenced by cognitive distortions, emotional responses, and individual personality traits, rather than merely a psychological condition. By examining its core characteristics, this research seeks to provide a clearer theoretical framework to support early identification and the development of effective interventions for kinesiophobia in CHD patients.

In this section, we present the results of the concept analysis, organized into several key components: study characteristics, the evolving definition and use of the concept, surrogate terms and related concepts, attributes, antecedents, consequences, model case, and the final definition of kinesiophobia in patients with CHD. Additionally, we discuss the measurement tool used to assess this concept.

Clear conceptual frameworks are crucial for advancing nursing knowledge (Tofthagen and Fagerstrøm, 2010). In previous research, kinesiophobia is generally defined as a psychological state where chronic pain patients fear movement due to pain (Kori, 1990). Currently, research on kinesiophobia in CHD patients has mainly addressed prevalence and influencing factors, with less focus on its underlying attributes and mechanisms (Wang et al., 2023; Yakut Ozdemir et al., 2023; Zhu et al., 2024). This article is the first to specifically describe unique characteristics of kinesiophobia in CHD patients, aiming to differentiate it from similar concepts like “exercise anxiety” and other diseases. We concluded that kinesiophobia in CHD is a subjective avoidance behavior driven by personality traits, complex emotional reactions, and misperceptions related to symptoms, resulting in excessive and irrational fear of movement. Unlike other diseases, kinesiophobia in CHD has two dimensions: “fear of pain or weakness” and “fear of cardiac events,” with the latter being more prevalent (Bäck et al., 2013; Shen et al., 2023). Adverse events, such as chest tightness and pain, exacerbate this fear, causing patients to avoid physical activity due to the fear of triggering similar discomfort (Çakal et al., 2022; Yakut Ozdemir et al., 2023). While “exercise anxiety” is a relevant term, it only represents one emotional component of kinesiophobia (Çakal et al., 2022; Liu et al., 2024). Anxiety involves a tendency to act, driven by the desire for success, whereas fear involves avoidance and a flight response. Understanding these distinctions can help healthcare professionals identify kinesiophobia in CHD patients early and develop targeted interventions.

This article defines kinesiophobia in CHD patients across four dimensions: physiological, psychological, cognitive, and behavioral. Key attributes include self-symptomatic distress, complex emotional responses, subjective avoidance behavior with personality tendencies, misperceptions and negative reactions. CHD patients are highly sensitive to bodily signals, with exercise-related sensations often resembling heart attack symptoms, leading to excessive fear (Bäck et al., 2017; Guo et al., 2022; Demirci et al., 2023). Patients’ uncertainty and fear of cardiac tolerance leads to excessive concern about adverse cardiac events (Knapik et al., 2019; Li L. et al., 2024). Therefore, the most important thing for patients with CHD is to strengthen the control and management of disease symptoms. The most direct and effective way to do this is through pharmacologic intervention and interventional therapy, but it is also critical to enhance patient education and awareness of the disease (Shen et al., 2023). Kinesiophobia in CHD patients reflects both a state and a trait, driven by personality and misconceptions about exercise (Wang et al., 2023; Zhu et al., 2024). Misconceptions and outdated beliefs about exercise lead to avoidance and negative attitudes (Demirci et al., 2023; Zhu et al., 2024). Improving patient education through videos, WeChat groups, and articles can enhance understanding and reduce fear (Piao et al., 2022; Yakut Ozdemir et al., 2023). Encouraging peer support and tailored exercise plans, along with professional guidance, can help patients overcome initial fears and promote a positive view of exercise (Bäck et al., 2020).

kinesiophobia in CHD patients is influenced by socio-demographic, disease-related, and psychological factors, leading to reduced participation in cardiac rehabilitation, lower functional capacity, higher rates of cardiovascular events and mortality, and decreased quality of life (Çakal et al., 2022; Yakut Ozdemir et al., 2023). Early identification of risk factors and targeted prevention are essential. Specific tools can identify high-risk patients, but specific scales for assessing kinesiophobia in CHD are scarce (Ozyemisci-Taskiran et al., 2020). Current scales also underexplore the behavioral aspects of kinesiophobia, which involve complex physiological, psychological, cognitive, and behavioral factors. Future research should incorporate a “behavioral dimension” to improve these scales. Moreover, as existing tools rely on subjective self-reports, objective scales from healthcare professionals’ perspectives are needed for greater accuracy. Recent studies have developed validated tools to assess self-management behavior in home-based cardiac rehabilitation, emphasizing the need for structured and comprehensive evaluation methods in cardiac patients (Yang et al., 2023c; Yang et al., 2024a). While some risk prediction tools identify high-risk patients with subacromial pain syndrome (SAPS) and chronic back pain, no such models exist for CHD patients (Panken et al., 2020; Karartı et al., 2023). This reflects a lack of awareness among healthcare professionals regarding early screening for kinesiophobia in CHD, likely due to the late start of research in this area, an unclear definition, and limited exploration of its mechanisms (Bäck et al., 2012). In the future, healthcare professionals must enhance their risk awareness, and consider developing a precise, targeted risk prediction tool using machine learning algorithms to identify high-risk CHD patients with kinesiophobia early, enabling timely, tailored interventions.

Kinesiophobia in CHD patients primarily stems from symptom distress and misperception. After heart-related events, patients become more sensitive to life-threatening situations and develop a heightened fear of death (Bäck et al., 2020; Shen et al., 2023). Cognitive biases make it difficult for them to distinguish between disease-related symptoms and those triggered by exercise, leading them to avoid physical activity out of fear (Bäck et al., 2013; Piao et al., 2022). Early recognition of symptoms, timely psychological intervention, and safe exercise guidance are essential to reducing kinesiophobia. Cognitive-behavioral therapy (CBT) has shown potential in addressing kinesiophobia (Ploutarchou et al., 2023). Guo et al. (2022) applied CBT in 49 patients post-myocardial infarction and found improvements in daily activity performance, reduced kinesiophobia, and alleviated anxiety and depression. However, some studies suggest that CBT may not have short-term effects on kinesiophobia, indicating a need for further investigation (Vergeld et al., 2021). Moreover, as highlighted by Yang et al. (2023b), it is essential to appropriately monitor both objective indicators and subjective status during patients’ physical activity to ensure exercise safety, while also providing essential technical support and education. Additionally, multidisciplinary team rehabilitation may be a promising approach, though it has not been studied in CHD patients. Its effectiveness has been demonstrated in chronic pain management (Monticone et al., 2014). A proposed team could include doctors, nurses, psychologists, and rehabilitation therapists, providing personalized interventions based on patient needs. In this context, establishing an effective social support network becomes a crucial strategy to enhance exercise participation among patients with chronic heart disease (Yang et al., 2024b). It can play a significant role in alleviating kinesiophobia and promoting long-term rehabilitation.

In conclusion, this study conducts a conceptual analysis of kinesiophobia in CHD patients, exploring its core characteristics and unique attributes to provide a clearer theoretical framework for clinical practice. Our findings emphasize that kinesiophobia is a subjective avoidance behavior influenced by individual traits, emotional responses, and cognitive distortions, beyond being merely a psychological condition. This understanding highlights the need for refined assessment tools and the development of targeted interventions. Integrating psychological support, cognitive-behavioral therapy, and multidisciplinary rehabilitation may improve patient outcomes, while structured patient education can correct misconceptions, promote safe exercise participation, and reduce avoidance behaviors. By addressing kinesiophobia comprehensively, healthcare providers can optimize rehabilitation strategies, enhance adherence to exercise programs, and improve long-term cardiovascular health.

As research on kinesiophobia in CHD advances, there remains insufficient evidence on its conceptual content. This study analyzed the attributes, antecedents, and consequences of kinesiophobia in these patients, identifying its unique characteristics. Kinesiophobia in CHD patients is a subjective avoidance behavior that includes both “fear of pain or weakness” and “fear of cardiac events” based on personality tendencies, driven by complex emotional responses and misperceptions based on their own symptomatic disturbances, and presents an excessive and irrational fear of movement. This analysis supports the development of specific assessment tools and helps healthcare professionals design individualized intervention plans for patients.