This qualitative phenomenological study identified clear behavioral and emotional expressions of kinesiophobia among patients living with COPD. Participants described pervasive fears tied to physical activity: fear of breathlessness, fear of pain, fear of fatigue, and fear of falling. These fears were reported as immediate responses to attempts at exertion and as ongoing concerns that shaped daily choices about movement and exercise.
Fear of breathlessness was a dominant theme, with patients linking even mild exertion to the possibility of intolerable dyspnea. Pain and fatigue were also described as anticipated outcomes of activity, and fear of falling limited engagement in tasks perceived as unstable or risky. Together, these manifestations created a psychological and behavioral barrier to regular physical activity.
Interview analysis revealed a pattern of catastrophic symptom cognition. Many participants believed that undertaking exercise could trigger a range of adverse events or acute exacerbations. Normal physiological sensations that follow exertion—such as transient breathlessness or muscle fatigue—were sometimes interpreted as pathological or as signals of an impending acute attack. This confusion between expected post-exercise responses and clinical deterioration reinforced avoidance.
The authors report that these catastrophic appraisals were influential in shaping decisions to limit activity, as patients preferred to avoid any sensation they associated with risk. The misinterpretation of benign post-exercise discomfort as a sign of acute illness contributed to heightened anxiety around movement.
Risk perception was not confined to patients alone. Family members frequently shared or amplified concerns about the risks of activity. The study found that relatives’ attitudes and behaviours often reinforced patients’ fear, increasing protective or restrictive responses within the household and social context.
This social reinforcement altered the ambient expectations about activity, making avoidance more socially supported and, in some cases, encouraged. The interplay between patient beliefs and family behaviours was identified as a key factor maintaining the avoidance cycle.
Behavioral responses to fear and catastrophic cognition took two broad forms: active avoidance and passive avoidance. Active avoidance included deliberate restriction of walking, exercise, or household tasks to prevent perceived harm. Passive avoidance encompassed reliance on others to perform activities, withdrawal from previously routine tasks, and a tendency toward sedentary behaviours.
The study characterizes these avoidance strategies as both an immediate coping mechanism and a contributor to long-term decline in physical capability. Avoidant behaviour reduced opportunities to build or maintain physical endurance and introduced secondary psychosocial consequences, such as reduced autonomy.
Participants reported tangible, perceived consequences of sustained avoidance. Chief among these were decreased endurance during activities that previously could be managed, and an overall increase in daily sedentary time. These outcomes were framed by participants as both a result of and a perpetuator of their fear—creating a downward trajectory in physical function and confidence.
The study presents this pattern as evidence of a self-reinforcing cycle: fear leads to avoidance, avoidance leads to deconditioning, and deconditioning increases the intensity and legitimacy of fears about activity.
From the thematic analysis, the authors conclude that kinesiophobia in COPD is multifaceted, evolves over time, and is reinforced by social networks. They suggest that interrupting the observed cycle requires interventions that address cognitive misappraisals, behavioural avoidance, and family dynamics together. Multidimensional strategies—targeting patient beliefs about symptoms, providing graded activity exposure, and engaging family members—are presented as necessary components to reduce fear-driven inactivity.
Specific intervention details, protocols, or evaluated outcomes were not reported in this manuscript; the report provides experiential and thematic data intended to inform development of coping strategies by medical professionals.
The study used purposive sampling to recruit 21 patients with COPD from a tertiary hospital and an affiliated community health centre in China. Data collection consisted of semi-structured interviews. Interview transcripts were analyzed using Colaizzi’s seven-step method, a phenomenological analytic approach designed to extract themes from lived-experience data.
Recruitment sites, sample characteristics beyond the number of participants, interview guides, and verbatim quotations were reported in the source manuscript; readers should consult the full article for detailed methodological materials. The authors provide the manuscript as an unedited version noting that further editorial changes may occur prior to final publication.
The study received institutional ethics approval (NO.KYLL-2026-033). The authors declared no competing interests and acknowledged participants and supporting clinical and community staff. This article is published under an open-access Creative Commons licence and is presented as an unedited manuscript to provide early access to findings. The authors advise that further editing of the manuscript may affect content prior to final publication.
Overall, the study documents how kinesiophobia in COPD is not solely an individual-level phenomenon but is shaped by symptom interpretation and social context. The findings underscore the need for comprehensive clinical strategies that integrate cognitive, behavioural, and familial elements to break the observed fear–avoidance cycle and mitigate the functional decline associated with prolonged inactivity.