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This study explores additional factors that may be related to cardiac-focused kinesiophobia, including self-efficacy, PA engagement, and QoL. Sixty-three adolescents (mean age\u2009=\u200915.5 years; 49% female) with congenital or acquired HD completed the TSK-Heart-A, the Physical Activity Questionnaire for Adolescents (PAQ-A), the Pediatric Quality of Life Inventory (PedsQL\u2122) Generic Core and Cardiac Module, and the Domain-Specific Physical Activity Efficacy Questionnaire (DSPAEQ-A). Data were analyzed using Kendall\u2019s Tau correlations and bootstrapped partial correlations controlling for PA. Greater kinesiophobia correlated with lower PA across both PA measures (\u03c4 = \u2212\u20090.248), lower PA self-efficacy across household, leisure-time, and ambulatory domains (\u03c4 = \u2212\u20090.293 to \u2212\u20090.356), and poorer QoL for both generic and cardiac scales (\u03c4 = \u2212\u20090.403, \u2212\u20090.400). When controlling for PA, kinesiophobia remained significantly related to lower self-efficacy (\n                    <jats:italic>r<\/jats:italic>\n                    \u2009=\u2009\u2212\u20090.314 to \u2212\u20090.368) and poorer QoL (\n                    <jats:italic>r<\/jats:italic>\n                    \u2009=\u2009\u2212\u20090.558, \u2212\u20090.520). Cardiac-focused kinesiophobia is a salient psychological factor in pediatric HD and is tied to lower self-reported PA, poorer QoL and is independently associated with reduced PA self-efficacy\u2014a modifiable resilience construct. These findings support the development of interventions that target fear-avoidance mechanisms and build self-efficacy to improve everyday activity and psychosocial functioning in adolescent HD.\n                  <\/jats:p>","DOI":"10.1007\/s00246-026-04182-7","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T04:19:03Z","timestamp":1770869943000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Kinesiophobia, Physical Activity, and Physical-Activity Self-Efficacy in Adolescents with Congenital Heart Disease"],"prefix":"10.1007","author":[{"given":"William R.","family":"Black","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Cramer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsey","family":"Malloy-Walton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mollie","family":"Walton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Martis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandy","family":"Enneking","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelli M.","family":"Teson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica S.","family":"Watson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jami","family":"Gross-Toalson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"White","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"4182_CR1","first-page":"1","volume":"1","author":"DA White","year":"2020","unstructured":"White DA, Willis EA, Panchangam C, Teson KM, Watson JS, Birnbaum BF, Shirali G, Parthiban A (2020) Physical activity patterns in children and adolescents with heart disease. 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