## 5 Kinesiophobia and Physical Activity (PA)
\begin{table}
\begin{tabular}{c c c c c c c c} \hline \hline
**Tool Name** & **Language** & **Disease** & **Population Studied** & **Sample Size** & \multicolumn{2}{c}{**Internal**} & \multicolumn{1}{c}{**Retesi Reliability**} & \multicolumn{1}{c}{**References**} \\  & & & & & & (**Cronb's**) & \(\alpha\) & \(\tau\) = 0.75 (95\% CL: & \\ \multirow{4}{*}{TSK-11} & Swedish & Chronic pain & Patients aged 65+ & 433 & 0.74-0.87 & 0.64-0.82 & \multirow{4}{*}{[47]} \\  & English & Chronic pain & Mean age: 53.5 (SD = 15.75) & 933 & 0.71-0.79 & - & \multirow{4}{*}{[48]} \\  & Danish & Chronic pain & Mean age: 49.9 (SD = 14.4) & 77 & - & 0.81-0.92 & \multirow{4}{*}{[49]} \\ \hline TSK-13 & Danish & Chronic pain & Mean age: 49.9 (SD = 14.4) & 77 & - & 0.88 (95\% CL: & \\  & & & & & & 0.82-0.92) & \multirow{4}{*}{[49]} \\ \hline TSK-17 & Polish & Breast cancer & Mean age: 53.08 (SD = 14.35) & 100 & 0.74 & \multirow{4}{*}{[50]} \\  & Danish & Chronic pain & Mean age: 49.9 (SD = 14.4) & 77 & & 0.79-0.91) & \multirow{4}{*}{[49]} \\ \hline TSK Heart & Polish & Coronary disease & Mean age: 63.50 (SD = 11.49) & 287 & 0.878 & - & \multirow{4}{*}{[51]} \\  & Polish & Cardiovescalar & Mean age: 68.10 (SD = 6.96) & 217 & 0.77 & - & \multirow{4}{*}{[52]} \\ \hline TSK-SV Heart & Turkish & Pulmonary & & & & & \\  & &arterial & & & & & \\  & Hypertension, & Mean age: 53.6 (SD = 14.92) & 85 & 0.75 & \(\tau\) = 0.564 \(p<0.001\) & \multirow{4}{*}{[53]} \\  & Portuguese & Coronary Artery & & & 300 & & \\  & & Disease & & 28 (retest reliability) & 0.83 & \(\tau\) = 0.84 & \multirow{4}{*}{[54]} \\ \hline TSK-CV Heart & Chinese & Coronary Artery & - & 550 & >0.7 & Doubtrial & \multirow{4}{*}{[26]} \\  & & Disease & & & & & \\ \hline FACS & Spain & Breast cancer & Mean age: 51.34 (SD = 9.58) & 154 & 0.91 (w) (range: & - & \multirow{4}{*}{[55]} \\  & French & Chronic pain & Mean age: 51.15 (SD = 16.47) & 55 & 0.84 (95\% CL: & \\  & & & & & 0.91-0.96) & 0.82-0.94) & \multirow{4}{*}{[40]} \\ \hline \hline \end{tabular}  
* For some studies, McDonald’s Omega (\(\omega\)) is reported instead of Cronbach’s \(\alpha\).  
\end{table} 
Table 2: Overview of tools for assessing kinesiophobia: psychometric properties and sample characteristics. categorized barriers into five key domains: physiological factors (e.g., fatigue, joint pain, treatment-related side effects), psychosocial factors (e.g., fear of worsening symptoms, lack of motivation), cultural factors, economic constraints, and environmental barriers (e.g., lack of appropriate facilities or support). Among physiological barriers, 70-80% of participants in five cross-sectional studies reported that treatment-related side effects, such as fatigue and joint pain, significantly hindered their ability to engage in PA. A similar proportion cited lack of motivation as a key limiting factor. However, an interesting finding from the review was that group-based exercise interventions, involving other cancer patients and close family members, facilitated PA participation in 80-95% of cases [62]. Although existing studies provide compelling evidence on the role of kinesiophobia in PA reduction, it is important to acknowledge certain methodological limitations. Prior research has highlighted issues such as small sample sizes and variations in PA measurement tools, which may impact the generalizability of findings. Therefore, future research should focus on refining PA measurement methods, incorporating diverse assessment tools, and conducting controlled studies to minimize the risk of misinterpreting the underlying causes of PA reduction. Additionally, investigating interventions aimed at reducing kinesiophobia could provide valuable insights into improving PA adherence in both chronic disease and oncology populations.