Relationship Between Fear of Movement and Physical Activity in Patients With Cardiac, Rheumatologic, Neurologic, Pulmonary, or Pain Conditions: A Systematic Review and Meta-Analysis.

The pooled relationship is small (r = −0.19), so fear of movement explains only a modest part of why people are inactive; many other factors are at work. The studies disagreed with each other a great deal (I² = 85.5%). The authors state that the range of results expected in future studies runs from −0.605 to 0.300, so a positive association cannot be ruled out. The funnel plot was asymmetrical (Egger test P = .0095), which the authors say may indicate publication bias, though they also attribute it to differences in study procedures and the large heterogeneity. Their own conclusion asks for caution about the relationship. Only 21 of the 98 authors contacted (21%) shared their estimates or raw data, so a substantial amount of relevant data is missing and could have changed the results. Fear of movement was measured with several different questionnaires (mainly different versions of the Tampa Scale and the Fear Avoidance Beliefs Questionnaire) and physical activity with many different questionnaires and devices, worn in different places and for different lengths of time. Fear of movement is a changing state, and the authors note that the time gap and context between the fear-of-movement assessment and the activity assessment may have influenced the results. Several conditions (cancer, surgery, postpartum, obstructive sleep apnea, fibromyalgia) rested on only one to five estimates; the authors say the lack of a significant finding there may simply reflect too few studies, so no association cannot be ruled out in those groups. All the included studies tested whether fear of movement and activity go together, not whether changing one changes the other, and the authors state that more evidence, particularly prospective studies, is needed before this affects therapeutic decisions.

The work was funded by the Natural Sciences and Engineering Research Council of Canada (NSERC). The authors state that the funders had no role in data collection, management, analysis or interpretation, in writing the report, or in the decision to submit it. The text supplied names no other conflicts of interest.

Do not read this as proof that reducing a patient's fear of movement will make them more active. The included studies measured fear of movement and physical activity together rather than following people forward, so they show the two go hand in hand, not that one causes the other, and the authors themselves say more evidence is needed before this should shape therapeutic decisions.