Network analysis of kinesiophobia and fear of progression and their association with cardiac rehabilitation adherence in post-CABG patients

Background Coronary heart disease is the major disease burden of cardiovascular diseases in China, and coronary artery bypass grafting (CABG) is the preferred surgical procedure for complex coronary artery lesions. Postoperative cardiac rehabilitation can improve patient outcomes; however, kinesiophobia and fear of progression are associated with lower adherence to rehabilitation. This study aimed to identify core symptoms within the fear network, explore hypothesized directional relationships among symptoms, and analyze the associations between the two types of fear symptoms and adherence to cardiac rehabilitation. Methods We conducted a cross-sectional survey of 294 patients who underwent their first CABG at three tertiary hospitals in Urumqi, Xinjiang, between October 2025 and February 2026. Participants were assessed using the scale of adherence to cardiac rehabilitation, the scale to measure fear of activity in patients with coronary artery disease, and the fear of progression questionnaire-short form. R software was employed to construct the symptom network. Bayesian network analysis was used to construct a directed acyclic graph, and flow network analysis was applied to examine the associations between symptoms and cardiac rehabilitation adherence. Results In the symptom network, “My body does not allow me to do certain activities even though I would like to,” “Being afraid of no longer being able to pursue hobbies,” and “Being afraid of relying on strangers for activities of daily living” were identified as central symptoms, while “Being afraid of pain” and “Having physical symptoms, e.g., rapid heartbeat, stomachache, nervousness” served as bridge symptoms. In the Bayesian network, “Being afraid of no longer being able to pursue hobbies” was located at the apex of the network. In the flow network, a total of 19 symptoms showed negative associations with cardiac rehabilitation adherence, among which “Being afraid of pain,” “I am afraid of any physical activity since I learned my heart problem,” and “My body does not allow me to do certain activities even though I would like to” exhibited strong negative correlations. The network comparison test revealed no statistically significant differences in global strength or network structure between the middle-aged and elderly groups. Conclusion Network analysis successfully identified the central and bridge symptoms in the kinesiophobia and fear of progression network among post-CABG patients, revealed the hypothesized directional relationships among symptoms, and identified the symptoms closely associated with cardiac rehabilitation adherence. These findings provide reference clues for postoperative symptom assessment and the subsequent development of personalized interventions.