Kinesiophobia in Primary Caregivers of Patients with Chronic Heart Failure: A Scoping Review
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Keywords

Chronic heart failure
Caregivers
Kinesiophobia
Home based rehabilitation
Scoping review

DOI

10.26689/jcnr.v10i2.13577

Submitted : 2026-02-08
Accepted : 2026-02-23
Published : 2026-03-10

Abstract

Objective: To conduct a scoping review of kinesiophobia among primary caregivers of patients with chronic heart failure (CHF). Methods: Following a scoping review methodological framework, PubMed, Web of Science, Embase, Cochrane Library, CINAHL, CNKI, SinoMed, Wanfang, and VIP were searched from inception to 30 June 2025. Relevant studies on kinesiophobia in primary caregivers of CHF patients were identified, summarized, and analyzed. Results: A total of 24 studies were included. Caregivers generally showed insufficient exercise-related knowledge, particularly regarding appropriate exercise intensity and risk recognition. At the cognitive–affective level, caregivers exhibited a pronounced “substitutive” kinesiophobia, characterized by excessive worry about potential adverse events induced by patients’ physical activity. At the behavioral level, this was reflected in restricting patients’ activities and avoiding assisting with exercise, which in turn reduced patients’ adherence to cardiac rehabilitation. Conclusion: Kinesiophobia among primary caregivers of CHF patients arises mainly from cognitive deficits and protective psychological mechanisms. Individualized education and professional guidance are needed to enhance caregivers’ exercise management competence and thereby optimize patients’ rehabilitation outcomes.

References

Butler J, Yang M, Manzi M, et al., 2019, Clinical Course of Patients with Worsening Heart Failure with Reduced Ejection Fraction. Journal of the American College of Cardiology, 73(8): 935–944.

GBD 2017 Disease and Injury Incidence and Prevalence Collaborators, 2018, Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 354 Diseases and Injuries for 195 Countries and Territories, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017. Lancet, 392(10159).

Savarese G, Becher P, Lund L, et al., 2023, Global Burden of Heart Failure: A Comprehensive and Updated Review of Epidemiology. Cardiovascular Research, 118(17): 3272–3287.

Wang H, Li Y, 2022, Chinese Expert Consensus on the Comprehensive Management of Patients with Worsening Chronic Heart Failure 2022. Chinese Circulation Journal, 37(3): 215–225.

Zhao B, Liu Y, Yang H, et al., 2023, Meta-Analysis of Effects of Telerehabilitation on Patients with Chronic Heart Failure. Military Nursing, 40(12): 99–103.

Wang J, Sun G, Gao M, et al., 2023, Research Progress on Exercise Fear in Patients with Cardiovascular Diseases. Chinese Journal of Rehabilitation Medicine, 38(5): 712–715.[7] Hoffmann J, Hellwig S, Brandenburg V, et al., 2018, Measuring Fear of Physical Activity in Patients with Heart Failure. International Journal of Behavioral Medicine, 25(3): 294–303.

Qin J, Xiong J, Pan X, et al., 2022, Influencing Factors of Exercise Participation in Elderly Patients with Chronic Heart Failure: A Qualitative Study. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 30(5): 20–24.

Fox M, Butler J, Sidani S, et al., 2022, Family Caregivers’ Preparedness to Support Physical Activity of Patients at Risk for Hospital Readmission in Rural Communities: An Interpretive Descriptive Study. BMC Health Services Research, 22: 907.

Aromataris E, Lockwood C, Porritt K, et al., 2024, JBI Manual for Evidence Synthesis. JBI.

Molloy G, Johnston D, Gao C, et al., 2006, Effects of an Exercise Intervention for Older Heart Failure Patients on Caregiver Burden and Emotional Distress. European Journal of Cardiovascular Prevention and Rehabilitation, 13(3): 381–387.

Piamjariyakul U, Smith C, Werkowitch M, et al., 2012, Enhancing Heart Failure Home Management: Integrated Evidence for a New Family Caregiver Educational Plan. Applied Nursing Research, 25(4): 246–250.

Bahrami M, Etemadifar S, Shahriari M, et al., 2014, Informational Needs and Related Problems of Family Caregivers of Heart Failure Patients: A Qualitative Study. Journal of Education and Health Promotion, 3: 113.

Etemadifar S, Bahrami M, Shahriari M, et al., 2014, The Effectiveness of a Supportive Educative Group Intervention on Family Caregiver Burden of Patients with Heart Failure. Iranian Journal of Nursing and Midwifery Research, 19(3): 217–223.

Etemadifar S, Bahrami M, Shahriari M, et al., 2015, Family Caregivers’ Experiences of Caring for Patients with Heart Failure: A Descriptive Exploratory Qualitative Study. Journal of Nursing Research, 23(2): 153–161.

Wingham J, Frost J, Britten N, et al., 2015, Needs of Caregivers in Heart Failure Management: A Qualitative Study. Chronic Illness, 11(4): 304–319.

Cameron J, Rhodes K, Ski C, et al., 2016, Carers’ Views on Patient Self-Care in Chronic Heart Failure. Journal of Clinical Nursing, 25(1–2): 144–152.

He J, Jiang W, 2016, Qualitative Study of the Burden of Caregivers in Families of Stay-at-Home Patients with Chronic Heart Failure. Military Nursing, 33: 26–28 + 43.

Wingham J, Frost J, Britten N, 2017, Behind the Smile: Qualitative Study of Caregivers’ Anguish and Management Responses While Caring for Someone Living with Heart Failure. BMJ Open, 7(7): e014126.

Natasa S, Mitja L, Jerneja F, 2020, Living with Chronic Heart Failure: Exploring Patient, Informal Caregiver, and Healthcare Professional Perceptions. International Journal of Environmental Research and Public Health, 17(8): 2666.

Zhang Y, Li L, 2021, Current Status and Influencing Factors of Care Capacity of Patients with Chronic Heart Failure and Their Primary Caregivers. Journal of Dali University, 6(4): 71–79.

Schutz S, Walthall H, 2022, Needs and Experiences of Caregivers of People with Heart Failure: A Qualitative Study. Heart and Lung, 54: 42–48.

Birtwistle S, Jones I, Murphy R, et al., 2022, Lived Experiences of Physical Activity Post-Myocardial Infarction: A Longitudinal Study. Disability and Rehabilitation, 44(14): 3661–3670.

Najjar C, Dima D, Goldfarb M, 2021, Patient and Family Perspectives on Early Mobilization in Acute Cardiac Care. CJC Open, 4(2): 230.

Purcell C, Purvis A, Cleland J, et al., 2023, Home-Based Cardiac Rehabilitation for Heart Failure Patients and Caregivers: A Mixed-Methods Study. European Journal of Cardiovascular Nursing, 22(8): 804–813.

Linda C, Sk F, Ta L, et al., 2023, Improvement in Heart Failure Self-Care and Patient Readmissions with Caregiver Education. Western Journal of Nursing Research, 45(5): 402–415.

Li F, Zhang X, Chen J, 2024, Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 32(6): 112–116.

Marzban A, Akbari M, Moradi M, et al., 2024, Effect of Emotional Freedom Techniques on Anxiety and Caregiver Burden in Heart Failure. Journal of Education and Health Promotion, 13: 128.

Wu Q, Pei H, Zhang L, et al., 2024, Self-Care Challenges in Heart Failure: Perspectives of Patients and Caregivers. Geriatric Nursing, 58: 446–458.

Alaei A, Babaei S, Farzi S, et al., 2024, Effect of a Supportive-Educational Program Based on the COPE Model on Caregiver Burden. BMC Nursing, 23: 72.

Noonan M, Frost J, Dalal H, et al., 2024, Caregiver Presence in Home-Based Cardiac Rehabilitation Improves Quality of Life. European Journal of Cardiovascular Nursing, 23(1): 90–94.

Ao C, Hu S, Zhan L, 2025, Exercise Rehabilitation Based on Medical Care–Family Integration in Older Heart Failure Patients. World Journal of Psychiatry, 15(6): 105855.

Tsami A, Koutelekos I, Gerogianni G, et al., 2025, Quality of Life in Heart Failure Patients: Effects of Anxiety and Depression. Journal of Cardiovascular Development and Disease, 12(4): 137.

Kitko L, McIlvennan C, Bidwell J, et al., 2020, Family Caregiving for Individuals with Heart Failure: A Scientific Statement. Circulation, 141(22): e864–e878.

McHorney C, Mansukhani S, Anatchkova M, et al., 2021, Impact of Heart Failure on Patients and Caregivers: A Qualitative Study. PLOS One, 16(3): e0248240.

Zhai S, Chu F, Tan M, et al., 2023, Digital Health Interventions to Support Family Caregivers: A Systematic Review. Digital Health, 9: 20552076231171967.

Riffin C, Wolff J, Butterworth J, et al., 2021, Challenges and Approaches to Involving Family Caregivers in Primary Care. Patient Education and Counseling, 104(7): 1644–1651.

Longhini J, Gauthier K, Konradsen H, et al., 2025, Effectiveness of Nursing Interventions to Improve Self-Care in Heart Failure: A Meta-Analysis. BMC Nursing, 24(1): 286.

Thodi M, Bistola V, Lambrinou E, et al., 2023, Nurse-Led Educational Intervention in Heart Failure Patients and Caregivers. European Journal of Cardiovascular Nursing, 22(7): 709–718.

Li W, Tu H, Peng Y, et al., 2024, Meta-Synthesis of Psychological Experiences of Kinesiophobia in Cardiovascular Disease Patients. Military Nursing, 41(12): 95–99.

Wang C, Yu M, Liu C, et al., 2024, Status and Influencing Factors of Caregiver Readiness in Elderly Patients with Chronic Heart Failure. Chinese Journal of Nursing, 59(14): 1706.

Ahmad F, Bowles K, Alexander M, et al., 2015, Comparing Perspectives of Patients, Caregivers, and Clinicians on Heart Failure Management. Journal of Cardiac Failure, 22.

Kim E, Oh S, Son Y, 2020, Caring Experiences of Family Caregivers of Patients with Heart Failure: A Meta-Ethnographic Review. European Journal of Cardiovascular Nursing, 19(6): 473–485.

Coull A, Pugh G, 2021, Maintaining Physical Activity Following Myocardial Infarction: A Qualitative Study. BMC Cardiovascular Disorders, 21(1): 105.

Tierney S, Elwers H, Sange C, et al., 2011, Influences on Physical Activity in People with Heart Failure: A Qualitative Study. International Journal of Nursing Studies, 48(10): 1234–1243.

Polikandrioti M, Tsami A, Tsoulou V, et al., 2025, Quality of Life, Anxiety, and Depression in Caregivers of Heart Failure Patients. Health Care, 13(16): 1986.

Lv Q, Chang H, Wang Y, et al., 2025, Co-Occurring Self-Efficacy, Anxiety, and Depression in Heart Failure Caregivers. BMC Nursing, 24(1): 351.

Birtwistle S, Jones I, Murphy R, et al., 2021, Family Support for Physical Activity Post-Myocardial Infarction. Nursing and Health Sciences, 23(1): 227–236.

Liu J, Guo W, Gao W, et al., 2024, Meta-Synthesis of Qualitative Research on Kinesiophobia in Cardiac Rehabilitation Patients. Chinese Journal of Nursing, 59(4): 474–481.

Yu D, Qiu C, Li P, et al., 2024, Effects of Dyadic Care Interventions for Heart Failure: A Systematic Review and Meta-Analysis. International Journal of Nursing Studies, 157: 104829.

Saber S, Rahimian B, 2024, Enhancing Caregiver Resilience: A Systematic Review of Interventions for Chronic Disease Management. Biosocial Health Journal, 1(4): 179–187.

Kokorelias K, Chiu M, Paul S, et al., 2025, Use of Virtual and Augmented Reality to Support Caregiver Resilience: A Scoping Review. Cureus, 16(7): e64082.