To Explore the Emotion of Fear as a Barrier to Physical Activity in Younger Adults Who Are Obese


Student thesis: Doctoral Thesis


Background: Physical activity helps weight maintenance and has health benefits, but adults with obesity report activity barriers. Although psychological concerns are important barriers, interventions underpinned by psychological theory have had limited success. This may be because of the limited focus on fear, particularly in younger adults.

Aim: To explore the emotion of fear as a barrier to physical activity in younger adults (aged 18-45 years) with obesity

Method: This PhD consisted of three phases: i) a scoping literature review on activity related fears; ii) a semi-structured interview study in 10 younger adults to explore activity-related fear experiences and iii) a cross-sectional survey to develop and validate a new tool on pain-related fear for younger adults and explore differences across body mass index groups.

Results: The scoping review identified 38 relevant papers. It confirmed fear as an important physical activity barrier but with limited information on younger adults with obesity. The semi-structured interviews suggested fear was an important activity related barrier in this group, particularly pain-related fear. These findings were used to develop a conceptual map of pain-related fear. Current measures of pain-related fear (PASS-20, PDI and NRS) only mapped onto the conceptual map when combined, but with considerable overlap. In total, 236 participants completed the three instruments. Factor analysis of their item scores resulted in a four-factor model with 12 items, with good construct and criterion validity. Participant scores on this new instrument confirmed those classified as obese had significantly higher pain-related fears compared to healthy weight adults (mean scores 29.8 vs 22.3; P= 0.000).

Conclusion: Fear, particularly pain-related fear, may be an important barrier to activity in younger adults with obesity. A conceptually underpinned new instrument, named the Pain-Related Fear Scale, will allow large-scale investigation of pain-related fear, and inform interventions to increase activity, within this under-researched group.
Date of Award20 Nov 2020
Original languageEnglish
Awarding Institution
  • Edge Hill University
SupervisorMARIA PAOLA DEY (Director of Studies), DEREK LARKIN (Director of Studies) & NICOLA RELPH (Director of Studies)


  • Obesity
  • Fear
  • Physical activity
  • Health behavior
  • Exercise
  • Behavior change

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