Pain catastrophizing, kinesiophobia, and exercise adherence in postoperative cardiovascular surgery patients: the mediating role of exercise self-efficacy.

OBJECTIVE: To explore the mediating role of exercise self-efficacy in the relationship between pain catastrophizing, kinesiophobia, and exercise adherence in patients post-cardiovascular surgery. DESIGN: Cross-sectional study. SUBJECTS/PATIENTS: A total of 278 adult patients who underwent elective cardiovascular surgeries between March 2023 and February 2025 at a tertiary hospital in China. METHODS: Participants completed standardized instruments measuring pain catastrophizing, kinesiophobia, exercise self-efficacy, and exercise adherence. Statistical analysis was performed using SPSS 29.0, R 4.4.5, and Zstats 1.0, including mediation analysis. RESULTS: Pain catastrophizing significantly negatively correlated with exercise self-efficacy (r = -0.830, p<0.001) and adherence (r = -0.953, p < 0.001), while positively correlating with kinesiophobia (r = 0.295, p < 0.001). Kinesiophobia negatively correlated with self-efficacy (r = -0.252, p < 0.001) and adherence (r = -0.277, p<0.001). Exercise self-efficacy positively correlated with adherence (r = 0.699, p<0.001). Mediation analysis revealed that self-efficacy partially mediated the relationship between pain catastrophizing and adherence (β = -1.11, p<0.001) and between kinesiophobia and adherence (β = -0.30, p < 0.001). CONCLUSION: Exercise self-efficacy is a critical mediator in how psychological factors like pain catastrophizing and kinesiophobia influence exercise adherence post-cardiovascular surgery. Enhancing self-efficacy may improve rehabilitation outcomes.