Kinesiophobia and physical activity participation in axial spondyloarthritis: a cross-sectional study during the COVID-19 pandemic

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Abstract
Objective To examine the independent association of kinesiophobia with meeting physical activity (PA) guideline recommendations in individuals with axial spondyloarthritis (axSpA). Methods This cross-sectional study recruited U.S.-based adults with axSpA via online platforms and support groups between October and December 2020, during the COVID-19 pandemic. Participants completed a digital survey including demographic and clinical information and validated outcome measures for kinesiophobia (TSK-11), disease activity (BASDAI), function (BASFI), quality of life (ASQoL), and PA participation. PA participation was categorized as meeting American College of Sports Medicine (ACSM) guidelines for moderate, vigorous, and strengthening activity. Logistic regression models assessed the association of TSK-11 scores with meeting ACSM PA recommendations, adjusting for age, sex, disease duration, and disease activity. Results 180 participants completed the survey. Overall, 31%, 26%, and 34% met ACSM guidelines for moderate, vigorous, and strengthening activity, respectively. Higher kinesiophobia was significantly associated with reduced odds of meeting PA guidelines across all activity types. In adjusted models, sample sizes ranged from 141 to 142 participants across activity outcomes due to incomplete data; each one-point increase in TSK-11 was associated with 11% lower odds of meeting strengthening activity guidelines (OR = 0.89, 95% CI: 0.83–0.96), 8% lower odds for meeting moderate activity guidelines (OR = 0.92, 95% CI: 0.86–0.99), and 9% lower odds for meeting vigorous activity guidelines (OR = 0.91, 95% CI: 0.84–0.98). No covariates included in the adjusted models (age, sex, disease duration, BASDAI) were significant predictors. Conclusion Kinesiophobia was independently associated with lower odds of meeting PA guidelines among individuals with axSpA, beyond demographic and disease-related factors. These findings underscore the need for routine assessment and targeted intervention strategies to address fear-avoidant behaviors in activity and exercise counseling for axSpA. Key Points • Higher levels of kinesiophobia were independently associated with lower odds of meeting moderate, vigorous, and strengthening physical activity recommendations among adults with axial spondyloarthritis. • Most participants did not meet recommended levels of physical activity, with a substantial proportion reporting no participation in vigorous or strengthening activities. • Kinesiophobia may represent a clinically meaningful barrier to physical activity participation and a potential target for intervention in axial spondyloarthritis.

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