Safety and effectiveness of exercise interventions for kinesiophobia in patients with cardiovascular disease: a systematic review and meta-analysis.

PURPOSE: To evaluate the effectiveness and safety of exercise interventions for kinesiophobia in patients with cardiovascular disease. METHODS: The system searched eight databases, covering periods from database creation to November 27, 2025. The RoB 2.0 and the ROBINS-I were used to assess the quality of the study. Meta-analysis was performed using Review Manager 5.4 software with random-effects models, supplemented by subgroup analyses and sensitivity analyses to explore sources of heterogeneity. RESULTS: Ten studies involving 1,505 cardiovascular disease patients were included pooled for meta-analysis. The pooled effect estimate indicated a numerical trend toward lower kinesiophobia scores with exercise interventions (SMD = -0.91; 95% CI [-1.33, -0.49]; I2 = 93%), although all included studies were rated as having moderate risk of bias. Based on the limited available data (2 of 10 studies), the existing dataset is inadequate to form robust, generalizable judgments about the safety profile of exercise interventions for this population. Exploratory subgroup analyses detected numerical differences in pooled effect sizes across different exercise parameters, yet these observational trends cannot support definitive exercise recommendations due to small sample sizes. CONCLUSION: Exercise to reduced kinesiophobia in cardiovascular patients, limited safety records and substantial heterogeneity across moderate-quality evidence restrict definitive inferences. REPORTING METHODOLOGY: PRISMA 2020 statement. PROSPERO REGISTRATION NUMBER: CRD42025646414.