Frail Older Heart Patients Fall Into Three Distinct Fear-of-Movement Profiles, Study Finds

For many older adults living with cardiovascular disease, the greatest obstacle to recovery is not the heart itself but the fear of moving. Researchers in China have now mapped that fear in unprecedented detail, showing that kinesiophobia—the excessive, irrational dread of physical activity—takes distinctly different forms in frail older cardiac patients, and that these forms cluster into three recognizable psychological profiles. The findings, published in BMC Geriatrics, combine statistical modeling with in-depth patient interviews to build clinically usable personas that could reshape how cardiac rehabilitation is prescribed for one of medicine’s most underserved populations.

Kinesiophobia is far more than simple reluctance to exercise. It is a fear-avoidance phenomenon in which patients catastrophize bodily sensations, interpreting breathlessness, palpitations, or muscle fatigue as signals of impending harm. In cardiac rehabilitation, this psychological barrier is a well-documented reason for non-participation and dropout, and the problem is amplified in frailty, a geriatric syndrome of diminished physiological reserve that leaves patients vulnerable to falls, exhaustion, and deconditioning. Paradoxically, the patients who most need structured movement to rebuild strength are often the ones most terrified of attempting it.

The research team, led by Huina Zou and Xinglin Zheng of the Xiamen Cardiovascular Hospital of Xiamen University, with Linjing Wu and Yuan Chen as corresponding authors, carried out the study between March and December 2025. In the quantitative phase, 238 frail older patients with cardiovascular disease completed assessments covering frailty, kinesiophobia, exercise self-efficacy, and physical activity. Rather than treating fear of movement as a single continuous score, the investigators applied latent profile analysis, a statistical technique that identifies hidden subgroups within a population based on patterns of responses across multiple dimensions. The approach recognizes that psychological states are heterogeneous: two patients with identical total scores may experience their fear in entirely different ways.

The analysis revealed three profiles. The largest, moderate fear–general, accounted for 64.7 percent of the sample and captured patients with intermediate levels of fear-avoidance across general dimensions. The second, high fear–avoidance, comprised 25.2 percent of participants and represented the most severely affected group, with pronounced catastrophic interpretations of bodily sensations and strong avoidance behavior. The smallest, low fear–active, made up 10.1 percent and showed the most favorable psychological pattern, with minimal fear and comparatively strong confidence in their ability to exercise. The profiles differed significantly not only in kinesiophobia itself but also in exercise self-efficacy, physical activity, somatic symptoms, employment status, and income—suggesting that fear of movement in this population is woven together with socioeconomic circumstances and the burden of physical symptoms.

One result stands out as particularly sobering. Although the low fear–active profile displayed the most favorable combination of low fear and high self-efficacy, 70.8 percent of patients in this subgroup still reported low physical activity. In other words, reducing fear alone does not guarantee that frail older cardiac patients will move more. Confidence and calm are necessary but insufficient; other barriers—perhaps environmental, social, or practical—continue to suppress activity even among patients psychologically primed for it. This finding challenges rehabilitation programs that focus exclusively on fear reduction as their mechanism of change.

To understand what the statistics meant in human terms, the team conducted an explanatory sequential qualitative phase, interviewing 23 patients using semi-structured interviews analyzed through content analysis. The interviews explored profile-specific exercise experiences, risk perceptions, behavioral patterns, and support needs. This mixed methods design allowed the researchers to explain and enrich the quantitative clusters: the numbers identified who belonged to each profile, while the interviews revealed how patients in each profile perceived the risks of movement, what patterns of behavior they had developed, and what kind of support they believed would help them. The joint display of quantitative and qualitative findings, provided in the study’s supplementary materials, integrates both strands of evidence for each profile.

From this integration, the researchers constructed patient personas—composite, clinically interpretable characters that embody each kinesiophobia profile. Personas are a tool borrowed from human-centered design, and their use in rehabilitation research is intended to make abstract statistical profiles tangible for clinicians, allowing nurses, physiotherapists, and cardiologists to recognize the psychological signature of a patient subgroup and tailor communication and exercise prescription accordingly. The authors are explicit that these personas provide a hypothesis-generating framework for developing and prospectively testing profile-informed rehabilitation approaches, not a validated clinical decision rule. They are a starting point for intervention design, not a diagnostic instrument.

The technical machinery behind the study deserves attention. Latent profile analysis, a person-centered alternative to variable-centered methods, estimates the probability that each patient belongs to an unobserved class based on their pattern of responses, and model fit is evaluated across candidate solutions to determine the optimal number of profiles. By combining this with somatic perception and self-efficacy measures, the study treats kinesiophobia as multidimensional—encompassing fear of harm, exercise avoidance, and confidence—rather than as a unitary phobia score. The qualitative content analysis then codes interview data into themes that map onto the quantitative dimensions, a joint-display logic central to contemporary mixed methods methodology.

The implications reach beyond the clinic. Cardiovascular disease remains the leading cause of death worldwide, and as populations age, the intersection of frailty and heart disease will grow. Cardiac rehabilitation is among the most effective interventions for secondary prevention, yet participation among older, frail patients remains persistently low, and psychological barriers such as kinesiophobia are a major reason. If rehabilitation programs can be matched to a patient’s fear profile—offering intensive fear-avoidance counseling to the high fear–avoidance quarter, general encouragement and practical support to the moderate majority, and activity-promoting strategies that go beyond fear reduction to the low fear–active tenth—the yield of rehabilitation could improve substantially. The study’s identification of somatic symptoms, employment, and income as factors associated with profile membership also hints that symptom management and socioeconomic support belong in the same conversation as exercise prescription.

The study was supported by the Xiamen Science and Technology Bureau’s Key Science and Technology Program Projects in Future Industries for 2024, with the funder having no role in study design, data collection, analysis, interpretation, or manuscript preparation. Ethical approval was obtained from the Ethics Committee of the Cardiovascular Hospital Affiliated with Xiamen University, and written informed consent was secured from all participants in both phases, with pseudonyms used throughout to protect privacy. The authors declare no competing interests. As the global population ages, understanding why the frailest heart patients fear the very movement that could save them—and recognizing that this fear comes in different shapes requiring different remedies—may prove one of the quiet but consequential advances in geriatric cardiology.

Subject of Research: Geriatrics

Article Title: Identifying kinesiophobia subgroups using latent profile analysis and persona development in frail older patients with cardiovascular disease: a mixed methods study

Article References: Zou, H., Zheng, X., Dong, P., Wu, L., Yang, M., Zhang, Q., Li, K., Tian, F., Chen, S., & Chen, Y. (2026). Identifying kinesiophobia subgroups using latent profile analysis and persona development in frail older patients with cardiovascular disease: a mixed methods study. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08338-1

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08338-1

Keywords: kinesiophobia, cardiovascular disease, frailty, cardiac rehabilitation, latent profile analysis, personas, mixed methods, geriatrics, Identifying, subgroups, latent, profile