Kinesiophobia and autonomous motivation for cardiac rehabilitation after cardiac surgery: sequential mediation by social support and psychological resilience.

Abstract

Objective To examine whether social support and psychological resilience sequentially mediate the relationship between kinesiophobia (fear of movement) and autonomous motivation for cardiac rehabilitation (CR) among patients following cardiac surgery. Methods A cross-sectional survey was conducted with 167 adult patients recruited via convenience sampling from the Department of Cardiac Surgery at a tertiary hospital in China between January 2024 and June 2025. Eligible participants completed validated Chinese versions of the Social Support Rating Scale (SSRS), Connor-Davidson Resilience Scale (CD-RISC), Tampa Scale for Kinesiophobia-Heart Version (TSK-SV Heart), and the autonomy subscale of the Cardiac Rehabilitation Inventory (CRI) 3 months after hospital discharge. Spearman correlation analyses were used to assess bivariate relationships, and a serial mediation model (kinesiophobia → social support → resilience → CR autonomy) was tested using Hayes' PROCESS macro (Model 6, 10,000 bootstrap samples). Results Participants reported mean scores of 27.49 ± 4.57 for social support, 57.84 ± 10.21 for resilience, 47.05 ± 4.69 for kinesiophobia, and 17.52 ± 3.00 for CR autonomy. Kinesiophobia was significantly negatively correlated with social support ( r = -0.339, p r = 0.531, p r = 0.509, p ab 1 = -0.0599) and the full serial path through both mediators (kinesiophobia → social support → resilience → CR autonomy; ab 3 = -0.0273) were statistically significant ( p Conclusion Social support and psychological resilience jointly and sequentially mediate the relationship between kinesiophobia and reduced autonomous motivation for CR after cardiac surgery. This provides empirical support for integrating fear, relatedness, and competence within a self-determination framework in post-surgical recovery. The results advance mechanistic understanding of health behavior by identifying modifiable psychological pathways that may inform future theory-driven interventions to promote sustained engagement in cardiac rehabilitation.