## 6 Kinesiophobia in Chronic Diseases
### Cardiovascular Diseases  
[PERSON] et al. conducted a survey study among 135 patients with stable coronary artery disease, revealing that over 76% of participants exhibited a high level of kinesiophobia. The authors further emphasized that this finding was independent of age, body mass index (BMI), gender, disease duration, or the number of comorbidities. However, a significant association was observed with educational level, as patients with higher education demonstrated lower levels of kinesiophobia (\(p<0.01\)) and a slower decline in PA levels with age [63]. Similar findings were reported by [PERSON] et al. in a study involving 74 patients with acute coronary syndrome and 58 patients with acute heart failure, where an inverse correlation was found between kinesiophobia levels and education (r = \(-0.33\), \(p<0.0001\)) [64]. A higher prevalence of kinesiophobia was reported by [PERSON] et al. in a study conducted among 52 patients with newly or early diagnosed coronary artery disease. The findings indicated that 87.2% of patients exhibited a high level of kinesiophobia, with significantly higher kinesiophobia levels among those who had experienced a myocardial infarction compared to those without a history of heart attack (\(p\) = 0.031). Additionally, the study highlighted the role of angina pectoris in the course of coronary artery disease as a predictor of kinesiophobia (r = 0.424, \(p\) = 0.002). Regarding quality of life, the authors did not observe a strong correlation between kinesiophobia and overall quality of life (\(p<0.01\)). However, linear regression analysis demonstrated that as kinesiophobia levels increased, quality of life decreased among patients with coronary artery disease. This finding underscores the significance of kinesiophobia as a predictor of quality of life. It is worth noting that differences in the percentage of individuals presenting with high levels of kinesiophobia between studies may be attributed to variations in sample sizes, as acknowledged by the authors in the limitations of their study [65]. The significance of angina pectoris as a symptom influencing kinesiophobia in coronary artery disease was further examined in a study by [PERSON] et al., involving 251 patients across four cardiology departments. The study revealed that 75.7% of participants exhibited moderate or high levels of kinesiophobia. Moreover, an analysis of factors influencing kinesiophobia identified a positive correlation between age and kinesiophobia (r = 0.147, \(p<0.05\)), as well as low monthly income as an independent risk factor for higher kinesiophobia levels (\(p\) = 0.003) [66]. Another study assessing kinesiophobia levels and its association with gender, BMI, comorbidities, and disease duration was conducted by [PERSON] et al. among 217 hospitalized patients with coronary artery disease. Their findings indicated that 70% of participants exhibited high levels of kinesiophobia. However, similar to the study by [PERSON] et al., no significant correlations were observed between fear of movement and gender, BMI, comorbidities, or disease duration. Consistently, [PERSON] et al. also reported that gender was not a significant predictor of kinesiophobia. While the chi-square test (\(p\) = 0.002) suggested a significant association between gender and kinesiophobia, multivariate regression analysis revealed that female gender (\(p\) = 0.51) was not an independent predictor of kinesiophobia in this study. Additionally, no significant association between educational level and kinesiophobia was observed (\(p\) = 0.16), contradicting the findings of [PERSON] et al. [52,67]. The issue of kinesiophobia has also been explored in patients with chronic heart failure. This aspect was analyzed in a study by [PERSON] et al., involving 270 patients hospitalized in a cardiology department in Yangzhou.