Measuring Fear of Physical Activity in Patients with Heart Failure

  • Jeremia M. Hoffmann
  • Susan Hellwig
  • Vincent M. Brandenburg
  • Heike Spaderna



Fear of physical activity (FoPA) has been suggested as a psychological barrier to exercise-based cardiac rehabilitation and everyday physical activity (PA) in patients with heart failure (HF). We evaluated the recently developed Fear of Activity in Situations-Heart Failure (FActS-HF) questionnaire that assesses affective/cognitive fear reactions to situations of varying PA intensities.


The FActS-HF was given to 132 ambulatory patients with stable HF (67 ± 12 years, 80% men). In 121 participants with valid FActS-HF data, the questionnaire’s dimensionality was investigated. Psychometric properties were determined in terms of reliability and validity. We assessed convergent and discriminant correlations of FoPA with anxiety, kinesiophobia, and depression. External validation criteria encompassed clinical variables and objectively assessed accelerometer measures of everyday PA in a subsample of 61 participants.


The FActS-HF measures a unidimensional construct (i.e., FoPA) based on items presenting varying PA intensities (i.e., the more intense the PA, the stronger the fear response). The scale demonstrated good 2-week stability (r tt = 0.82) and excellent internal consistency reliability (α = 0.97). FoPA was moderately to strongly associated with anxiety and kinesiophobia, and weakly to moderately associated with state/trait depression, supporting convergent and discriminant validity, respectively. High FoPA was associated with feeling uninformed about HF, comorbidities, non participitation to cardio fitness groups, and less stair climbing, as measured by accelerometry.


The FActS-HF is a reliable and valid instrument to measure FoPA in patients with HF and provides a promising tool for further research and practice.


Heart failure Physical activity Kinesiophobia Psychometrics Accelerometry 



The authors thank PD Dr. Ralf Westenfeld (Medical Faculty, University of Düsseldorf), Dr. Armin Jansen (Cardiowell Wuppertal), Diane Hennig, Bianca Liebrand, Lisa Morck, Olena Shyshova, and Züleya Abanoz (all University of Wuppertal) for participant recruitment, and Dr. Stefan Hey and Panagiota Anastasopoulou (Karlsruhe Institute of Technology) for their assistance in analyzing the accelerometer data.

Compliance with Ethical Standards

Approval of the Institutional Review Board of the University of Wuppertal was obtained.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© International Society of Behavioral Medicine 2017

Authors and Affiliations

  • Jeremia M. Hoffmann
    • 1
  • Susan Hellwig
    • 2
  • Vincent M. Brandenburg
    • 3
  • Heike Spaderna
    • 1
  1. 1.Division of Health PsychologyTrier UniversityTrierGermany
  2. 2.Department of Individual DifferencesUniversity of Duisburg-EssenEssenGermany
  3. 3.Department of CardiologyUniversity Hospital of the RWTH AachenAachenGermany

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