Kinesiophobia and physical activity after spontaneous coronary artery dissection: a comparison with type 1 myocardial infarction

Background

Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic cause of acute coronary syndrome that predominantly affects young to middle-aged women. Although physical activity is central to secondary prevention, evidence guiding exercise advice and cardiac rehabilitation after SCAD remains limited. As SCAD is often discussed in relation to physical or emotional stress, patients may receive cautious or inconsistent advice, potentially contributing to kinesiophobia and altered physical activity behaviour.

Purpose

To compare kinesiophobia, self-reported physical activity, and sedentary behaviour between patients with SCAD and type 1 MI; to examine associations between kinesiophobia, physical activity, and perceived physical capacity; and to explore factors associated with high kinesiophobia among patients with SCAD.

Methods

In this cross-sectional case–control study, 178 patients with SCAD and 279 patients with type 1 MI completed questionnaires. SCAD cases were identified through national registries and university hospitals; controls were recruited from a national myocardial infarction registry and matched as closely as possible for age, geographic region, and time since infarction.

Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia–Heart (TSK-Heart; ≥37 indicating high kinesiophobia). Physical activity, fulfilment of guideline recommendations, habitual activity level, sedentary behaviour, and self-perceived physical capacity were assessed using registry-based instruments and a visual analogue scale. Group differences were analysed using appropriate statistical tests and multivariable regression adjusted for age, sex, and time since infarction; associations were examined using Spearman correlations.

Results

Patients with SCAD reported higher kinesiophobia than patients with type 1 MI (median TSK-Heart 31 vs. 26) and a higher prevalence of high kinesiophobia (25.7% vs. 11.7%). SCAD was independently associated with high kinesiophobia after adjustment (adjusted OR 2.35, 95% CI 1.33–4.18). Habitual physical activity and sedentary behaviour did not differ between groups; however, fewer patients with SCAD met guideline-based physical activity recommendations (44.9% vs. 65.0%). Higher kinesiophobia was associated with lower habitual physical activity (ρ = −0.31) and poorer self-perceived physical capacity (ρ = −0.28). No demographic or clinical predictors of high kinesiophobia were identified among patients with SCAD.

Conclusions

Compared with patients with type 1 MI, patients with SCAD report higher kinesiophobia and are less likely to meet recommended physical activity levels despite similar habitual activity and sedentary time. These findings suggest that fear of movement may influence recovery after SCAD and highlight the need for targeted behavioural and rehabilitative strategies.Baseline characteristics