The purpose of this study was to determine whether distress, depression, anxiety or somatisation result in a diminished physical capacity in patients with heart conditions. Data on the Dutch version of the four dimensional symptom questionnaire (4DKL, with the components distress, depression, anxiety and somatisation) and physical capacity, expressed in peak oxygen uptake (VO2peak) and peak power output (POpeak) were collected on all patients who followed the rehabilitation program in the Rehabilitation Centre Amsterdam between January 2004 and August 2008. A total of 445 patients completed a symptom-limited bicycle exercise test and the 4DKL. Scores on the 4DKL were classified into low, medium or high for the four different dimensions. Differences in VO2peak and POpeak between these three groups were analysed. On the dimensions distress, depression and anxiety no differences were found in VO2peak or POpeak. Patients with a high somatisation score had a significantly lower POpeak (p=0.02) than patients with a low somatisation score while no difference was found in VO2peak. Except for somatisation, psychopathology has no diminishing effect on physical capacity in patients with heart conditions. The effect of somatisation on physical capacity might be explained by actual physical complaints apart from psychological well-being.