Background: Chronic nonspecific low back pain is a multifaceted syndrome whose persistence directly correlates with psychomotor consequences such as fear of movement. This systematic review compared the effectiveness of active versus passive interventions on kinesiophobia and pain catastrophizing in patients with this condition.

Methods: The study followed PRISMA guidelines and was registered in PROSPERO (CRD420261483917). A systematic search of PubMed, Scopus, Web of Science, and Google Scholar was conducted up to August 2026. Methodological quality was assessed using RoB 2 and ROBINS-I tools, and data synthesis followed SWiM reporting guidelines.

Findings: From 1,667 initial results, 24 eligible clinical studies were included for data extraction. Evidence showed active exercises produced a deep and sustained reduction in kinesiophobia (p < 0.001, d = 0.86); reduced fear mediated 55% of the patients' physical improvement. Conversely, despite inducing neural desensitization and an expected immediate reduction in fear (p = 0.046), manual therapy showed no significant difference compared to the control group in sustainably changing avoidance behaviors over the long term (p = 0.140). Combining physical interventions with pain neuroscience education yielded the best and most lasting cognitive outcomes (p < 0.001).

Conclusion: Active exercises structurally correct avoidance beliefs through a gradual exposure mechanism, whereas isolated passive interventions lack cognitive durability. A phased clinical model is recommended, involving acute relief through passive interventions followed by an immediate transition to active interventions and cognitive education.