BACKGROUND: Physical activity (PA) offers advantages in the secondary prevention of coronary heart disease (CHD). However, in older adults, frailty and kinesiophobia may exert negative influences on PA engagement. OBJECTIVE: To investigate PA, frailty, and kinesiophobia among older adult patients with CHD in China. METHODS: This cross-sectional study enrolled older adult patients with CHD in the cardiac outpatient care unit of the *** University. The International Physical Activity Questionnaire, the Frailty Phenotype Scale, and the Tampa Scale of Kinesiophobia were used to evaluate PA, frailty, and kinesiophobia, respectively. RESULTS: A total of 239 participants (mean age: 72.0 ± 7.5 years, 148 males) were enrolled. The rates of frailty and pre-frailty were 20.5 % and 46.4 %, respectively. The mean kinesiophobia score was 43.13±5.48. The median metabolic equivalent of task of PA was 2784 MET-min/week, and 25.1 % of the patients did not reach the minimum recommended by AHA (150 mins/week). Spearman rank correlation analysis showed that PA was negatively correlated with frailty (r = -0.559, P <
0.001) and kinesiophobia (r = -0.463, P <
0.001). Multivariable logistic regression analysis showed that frailty [OR = 0.412, 95 % confidence interval (CI): 0.304-0.559, P <
0.001] and kinesiophobia (OR=0.936, 95 % CI: 0.879-0.997, P = 0.040) were independently associated with PA after adjustment for age, cardiovascular adverse events, comorbidities, Barthel index, and history of dizziness. CONCLUSIONS: Older adult patients with CHD had low levels of PA. Frailty and kinesiophobia were independently associated with PA in older adult patients with CHD. Reversing frailty and reducing kinesiophobia in older adult patients with CHD may increase PA levels.