USING EXERCISE TO INCREASE SELF-EFFICACY AND IMPROVE HEALTH BEHAVIORS
By
Jennifer Schaal Fletcher
A research manuscript submitted in partial fulfillment of the requirements for the degree of
MASTER OF NURSING
WASHINGTON STATE UNIVERSITY College ofNursing
April 1999
11
To the Faculty ofWashington State University:
The members of the Committee appointed to examine the clinical project ofJennifer Schaal Fletcher find it satisfactory and recommend that it be accepted.
Chair: Jacquelyn Banasik
Committee Members:
Lorna Schumann
Donna Tschida
III
USING EXERCISE TO INCREASE SELF-EFFICACY AND IMPROVE HEALTH BEHAVIORS
Abstract
By Jennifer Schaal Fletcher Washington State University
April 1999
Chair: Jacquelyn Banasik
Self-efficacy is the belief and conviction that one can perform a given activity (Caruso,
1992). Self-efficacy has long been considered to influence whether someone engages in, and
adheres to an exercise program. This review of literature looked at the effects of exercise on self-
efficacy and the relationship of self-efficacy to health behaviors. The literature review suggests
that exercise does increase an individual's self-efficacy and that those individuals with higher self-
efficacy are more likely to be successful at health behaviors such as weight control, stress
management, nutritional compliance, smoking cessation, and exercise adherence.
The goal ofprimary care providers is to help patients become healthier and to decrease
their morbidity and mortality, which is accomplished primarily through improved health behaviors.
Practitioners have the opportunity to promote optimal levels of self-efficacy for patients. By
helping an individual to increase their self-efficacy, practitioners may be more successful in
mediating positive health behavior changes.
In order to promote exercise and positive health behaviors practitioners need to provide
guidance to their patients based on their self-efficacy level. Once an accurate self-efficacy
assessment is made an appropriate exercise prescription can be given to
tv
specifically suit the patient. A self-efficacy scale and corresponding exercise prescription is
provided in this paper.
Further research is needed to compare the effect ofvarying exercise intensities and
durations on self-efficacy. Also more studies are necessary which examine the effects ofdifferent
types of exercises, i.e. aerobic exercise vs. weight training, on self-efficacy. Lastly, there is a need
to examine whether exercise programs which incorporate self-efficacy manipulation ~~ye
health behavior change.
v
Table of Contents
SIGNATURE PAGE ii
ABSTRACT iii
LIST OF TABLES vi
LIST OF FIGURES vii
INTRODUCTION 1
REVIEW OF LITERATURE 2
SELF-EFFICACY AND HEALTH BEHAVIORS 2
EXERCISE AND SELF-EFFICACy 4
IMPLICATIONS 7
CONCLUSIONS 11
REFERENCES 17
VI
List of Tables
1. Exercise and self-efficacy ... ... . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. 13
Vll
List ofFigures
1. Self-efficacy scale ... ... ... ... . .. .. . ... ... ... ... ... ... . .. ... . .. . .. .. . ... .. . . .. .. .. 14
2. Steps for practitioners . .. . .. .. . .. . ... ... ... . .. ... . .. . .. ... ... ... .. . ... ... . .. 15
3. Exercise effort scale ... . .. . .. ........ ... ... .. . ... .. . ... .. . .. . ... ... ... ... ... . .. . .. 16
1
INTRODUCTION
Can exercise be used to increase an individual's self-efficacy and therefore improve health
behaviors? Exercise and physical activity have demonstrated a wide range of effects on a host of
physical conditions including coronary artery disease, obesity, cancers, and overall mortality (Blair et
al., 1989; Bouchard, Shepard, Stephens, Sutton, & McPherson, 1990). Exercise may have benefits
beyond those due directly to improved physical fitness. This paper will review the literature regarding
the impact of exercise on an individual's self-efficacy. It will also examine the relationship between self
efficacy and health behaviors.
Self-efficacy is the belief and conviction that one can perform a given activity (Caruso & Gill,
1992). Bandura (1977), who is considered a leader in the notion of self-efficacy, believes that self
efficacy determines whether one attempts to perform a given task, how persistent one is when
difficulties are encountered, and ultimately how successful one is in performing the task. Someone with
a high self-efficacy is generally healthier because they can achieve what they set out to accomplish, they
are more effective, and generally more successful than those with a low self-efficacy (Bandura 1977,
1986). If a person's self-efficacy can be improved he or she may be more confident, competent, and
successful in today's society. A number of studies suggest that exercise is an effective means for
increasing self-efficacy.
Self-efficacy is an important mediator ofa broad array ofhealth behaviors (Bandura, 1986;
McAuley & Coumneye, 1992; O'Leary, 1985; Strecher, DeVellis, Becker, & Rosenstock, 1986).
Research findings that support the importance of individual behaviors in decreasing the risk ofmorbidity
and mortality, suggest that efforts to increase self-efficacy may improve health behaviors (Conn, 1998).
Practitioners may find more success with changing their patients habits by focusing on increasing a
patient's self-efficacy, which could result in significant health behavior changes, rather than elaborating
on the potential benefits or harms of specific health behaviors.
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REVIEW OF LITERATURE
SELF-EFFICACY AND HEALTH BEHAVIORS
Certain health behaviors are associated with a healthy lifestyle including a healthful eating
pattern, regular exercise program, and weight control. Upon reviewing the literature regarding self
efficacy and health behaviors the importance ofthis relationship was confirmed. Enhanced self-efficacy
has a positive influence on health behaviors.
Adherence To Exercise Behavior
In the typical supervised exercise setting, about 50% ofparticipants will drop out ofthe exercise
program within six months to a year (Dishman, 1988). Population estimates indicate that 41-51% of
adults between the ages of 18-65 remain sedentary (Stephens, Jacobs, & White 1985; Powel, Spain,
Christenson, & Mollencamp 1986). Only 20% ofAmericans exercise regularly and intensely enough to
meet current guidelines for fitness or reduced risk for several chronic diseases and premature death
(Stephens, 1985; Powell, 1986). Lifestyle-related diseases are most frequently related to an individual's
behavior and can be minimized by particular behavior changes (Berarducci & Lengacher, 1998).
Exercise has been shown to decrease morbidity and mortality. Sallis, et al (1986), Dishman
(1988), and Fontaine & Shaw (1995) found that adoption of and adherence to exercise was determined
by self-efficacy. They established that higher self-efficacy leads to greater adherence to exercise.
Garcia & King (1991) showed that the level of self-efficacy correlated with whether exercise was
maintained beyond program involvement. Therefore, measures to enhance self-efficacy are likely to
lead to greater exercise adherence, an essential health behavior.
Stress Management Behavior
Being able to control one's tension, anxiety, and stress are very important health behaviors
because chronic stress negatively affects physiological homeostasis. Stress has been associated with
ailments including stomach upsets or ulcers, decreased immune system function, headaches, arthritis,
3
colitis, diarrhea, asthma, cardiac dysrhythmias, sexual problems, muscle tension, and cancer (Clark,
1996). In several studies, enhanced self-efficacy was found to decrease anxiety, tension, negative affect,
and stress response while there was an increase in positive mood (Toshihiko, Don, Zaichkowsky, &
Delizonna, 1997; Stewart, Kelemen, & Ewart, 1994; Ewart, 1989; Rudolph & McAuley, 1995).
According to Tucker, Cole, & Friedman (1986), fitness acts as a buffer against stress. Unfit persons
generally have more distress in life than fit persons.
Weight-control Behavior
Obesity continues to plague our society. Obesity is a major health problem, with an estimated
34 million Americans aged 20-74 being 20% or more above their "ideal" weight (Crimmins Hintlian,
1995). Morbid obesity is a health hazard with 12-fold increase in mortality for persons aged 25-34
(Crimmins Hintlian, 1995). The most important medical complication of obesity is an increase in
mortality from coronary artery disease. In order to decrease morbidity and mortality related to obesity,
effective ways for persons to maintain their ideal body weight must be found.
Weinberg, Hughes, Critelli, England, & Jackson (1984) discovered that in their weight loss
program, persons with high pre-existing self-efficacy had increased weight loss. When self-efficacy was
enhanced by "having subjects attribute successful task performance to a previously unrecognized
capacity", they found that people lost more weight. Bernier & Avard (1986) came to the same
conclusion that higher self-efficacy was associated with increased weight loss; and in addition found that
those with higher self-efficacy had lower weight loss program dropout rates.
Nutrition Behavior
Healthy nutrition leads to a healthier, longer life span (Clark, 1996). The challenge to health
care providers is to find ways to encourage and maintain a healthy diet for patients. Self-efficacy may
be a useful tool for practitioners to use in order to improve the effectiveness of counseling. Several
studies have correlated higher self-efficacy scores with dietary changes to improve health (Smith &
4
Owen, 1992; Dewolfe & Shannon, 1993; McCann et aI, 1995; Vega et aI, 1988; and Sheeshka,
Wooleott, & MacKennon, 1993). Lower self-efficacy scores were associated with lower levels of
positive eating habit changes (Sanders-Phillips, 1994). The use ofmeasures to increase an individual's
self-efficacy may be effective means to help persons adopt healthy eating practices.
Smoking Cessation Behavior
Cigarette smoking is the major preventable cause ofdeath in the United States (Rigotti, 1995).
Approximately 27% of Americans continue to smoke despite intensive public health effort to discourage
smoking (Center for Disease Control, 1992). Seventy percent ofparticipants in formal smoking
cessation programs will relapse to smoking within a year (Shiffman, 1993).
Several studies, (Kowalski, 1997; DiClemente, 1981; Macnee & Talsma, 1995; and Strecher,
1986), have found that self-efficacy scores are higher for those persons who successfully progress
through the smoking cessation program. Maintainers of smoking cessation showed significantly higher
self-efficacy scores than those who failed. Kowalski (1997) found that pre-program self-efficacy
predicted 75% ofpatient's adherence or non-adherence to the smoking cessation program.
EXERCISE AND SELF-EFFICACY
Perceptions of personal efficacy have typically been identified as important predictors of exercise
behaviors (McAuley, Lox, & Duncan, 1993; O'Leary, 1985; Fontaine & Shaw 1995; Vidmar &
Rubinson, 1994). There has not been as much research, however, regarding the effects that exercise
may have on changing self-efficacy.
A review ofthe literature found a number of studies that suggest that exercise increases an
individual's self-efficacy (Table 1). Forms of exercise used in the research studies included weight
training, aerobic exercise, or both. The aerobic exercises used included cycling, running, and walking.
Weight training consisted ofeither circuit weight training or free weights. Most studies looked at only
one form ofexercise in their study.
5
Stewart, Mason, & Kelemen (1988) compared circuit weight training, which is weight training
and cardiovascular exercise combined, to cardiovascular only exercise. Those who participated in the
circuit weight training had more confidence and higher self-efficacy in their ability to penorm arm and
leg tasks compared to the cardiovascular only group. The cardiovascular only group actually declined
in their self-efficacy. Arm tasks included: lifting heavy objects and doing push-ups. Leg tasks included:
walking at a steady 3-mph pace, jogging at a steady 5-mph pace, and climbing stairs without stopping.
All the other studies that involved aerobic exercise, excluding Stewart (1988), found that self-efficacy
increased during and after exercise (Table 1).
Self-Efficacy Scales
Clearly there was no uniformity of self-efficacy scales in these studies. Some studies, such as the
one above, measured self-efficacy based on the subject's confidence that he or she could perform the
task in question. Caruso & Gill (1992) asked subjects to rate how confident (self report) they were in
performing a given number of repetitions for certain weight lifting exercises based on a scale of 0-1 00%
(see table 1 for results). Vidmar & Rubinson (1994) also used the selfreport of confidence subjects had
in performing activities involving: lifting, jogging, walking, climbing stairs, cycling, and engaging in
sexual intercourse.
Holloway, Beuter, & Duda (1988), Stidwell & Rimmer (1995), and Toshihiko, Don,
Zaichkowsky, & Delizonna (1997) used a self-efficacy scale developed by Ryckman, Robbins,
Thornton, & Cantrell in 1982. This selfreport scale measured subjects' general confidence. Some
examples ofthe items on the Ryckman (1982) self-efficacy scale include "sometimes I don't hold up
well under stress; I am not hesitant about disagreeing with people bigger than me; and I find that I am
not accident prone". Ryckman tested the physical self-efficacy scale in six different studies with yes/no
scale and found the test-retest and alpha reliabilities to be highly satisfactory with an alpha of .81.
Ryckman found that subjects with positive perceptions oftheir physical capabilities outperformed those
6
with lower perceptions. Subjects that perceived themselves as physically competent (increased self
efficacy) spent more time involved in sport activities and were more diverse in sport activities.
In studies conducted by McAuley et al (1991, 1992, 1993,1995) and Rudolph & McAuley
(1995), self-efficacy tools developed by Bandura were used (1977, 1986) in order to measure
individuals' confidence in tasks. Bandura's self-efficacy scales have internal consistencies in which all
alphas are >.85. Bandura's self-efficacy scale determined subjects' beliefs in their physical capabilities
to execute sit-ups, bicycling, and walking/jogging. These studies found an increase of self-efficacy with
exercise.
Schwarzer and Jerusalem (1993) developed a general self-efficacy scale that has a Cronbach
alpha ranging from .77 to .89 depending on the sample chosen. This scale has not been applied to
exercise (Figure 1).
Type OfExercise
Three research studies (Conn 1998; Rudolph & McAuley,1995; Vidmar & Rubinson 1994)
viewed past exercise practices of subjects and measured their self-efficacy and made comparisons.
These studies found that those subjects with a history of exercising had higher levels of self-efficacy.
The non-exercisers had lower self-efficacy measures.
In 1995, Tate, Petruzzello, & Lox examined cycling at 55% max V02 compared with 70% max
V02, and the increase in self-efficacy was virtually equal. Simply engaging in exercise increases self
efficacy, but the intensity ofthe exercise may not be an important factor.
Toshihiko (1997) found that weight training exercise increased self-efficacy with no significant
differences between 11igh and low intensity weight lifting. In order to maximize an individual's self
efficacy through exercise, the inten,sity of exercise must be regulated closely so that the exerciser
continues to be successful at the activity. Success leads to continued exercise, -and· exercise increases
the individual's self-efficacy regardless ofthe intensity ofthe exercise. Higher self-efficacy leads to
7
greater adherence to exercise (Sallis et al~ 1986, Dishman~ 1988, Fontaine & Shaw~ 1995, Garcia &
King, 1991). This leads to a positive feedback loop including success with activity, increased self
efficacy, and greater exercise adherence.
It is important that the exercise program include strength training (weight lifting) because
Stewart (1988) found that those who only did aerobic exercise decreased in their self-efficacy while
those who performed strength training and aerobic exercise increased their self-efficacy.
IMPLICATIONS
Self-efficacy is the mediator between knowledge and action, and it influences the selection of
behavior, the environment in which the behavior occurs, and the amount ofeffort and perseverance
expended on performing the behavior (Berarducci & Lengacher, 1998). Practitioners have the
opportunity to promote optimal levels of self-efficacy for patients. Bandura (1986, 1997) suggested
that persons who have greater self-efficacy are not only more successful but are also healthier. They are
healthier because they are more likely to adhere to exercise programs and they are more compelled to
cany out health behaviors such as weight control, stress management, and nutritional compliance.
The first step for practitioners is to identify persons who are engaging in, or at risk for engaging
in, unhealthy behaviors such as tobacco abuse, stressful lifestyle, and unhealthy diet. Next, an
assessment of self-efficacy may be done to tailor a program to target their specific self-efficacy needs.
Persons with low self-efficacy may benefit from activities aimed at increasing self-efficacy, prior to
focusing on health behavior issues.
There is no self-efficacy scale that is considered to be optimal. Therefore, practitioners can find
a scale which is specific to a certain health behavior they are interested in, such as smoking cessation or
weight control; they can use a general self-efficacy scale such as the ones developed by Ryckman
8
(1982), Schwarzer & Jerusalem (1993) or Sherer et al (1982); or they can develop their own self
efficacy scale and determine its reliability and effectiveness.
One way to increase an individual's self-efficacy is through exercise. By increasing self-efficacy
an individual would be more apt to engage in healthy behaviors such as effectively dealing with stress,
managing their weight, complying with a healthy diet, cessation of smoking, and adhering to exercise.
For many persons it is difficult to start a regular exercise program because ofnumerous factors
such as perceived barriers, lack of support, or low self-efficacy. How can people be persuaded to start
exercising so that they are less likely to succumb to unhealthy behaviors and adhere to those behaviors
that are healthful and promote a decrease in morbidity and mortality? Their self-efficacy may need to be
increased prior to attempting a change in behavior.
Beliefs in personal efficacy can be strengthened in four principal ways (Bandura, 1986). The
first is guided mastery of experiences, which involves learning and practicing appropriate behaviors and
concentrates on building coping capabilities. This is done by breaking the desired behavior into small,
graded tasks that are easily attainable in a relatively short time. Things such as social support, positive
incentives, and feedback are important self-efficacy builders. Once a component ofa task is
accomplished, another is added until the whole behavior is achieved. Arranging for "quick success" can
tum self-doubters into self-believers (Bandura, 1997). Easy, accomplishable tasks lead to quick
successes and increased self-efficacy. Practitioners can provide straightforward accomplishable exercise
prescriptions to move patients toward increasing their self-efficacy. Figure 2 provides steps for
practitioners to promote exercise and self-efficacy and it is described later in the paper.
Bandura's second approach to building self-efficacy centers on the power of social modeling to
build skills for a particular behavior and learn coping strategies. Social modeling involves learning the
skills ofa behavior by simply watching others. Models enhance self-efficacy because patients
9
successfully carry out tasks after the model has done so. Exercise trainers or leaders who can provide
social modeling may help to enhance a patient's self-efficacy.
Social persuasion, the third efficacy builder, instills comments that encourage patients to believe
that they have what it takes to succeed in changing their health habit. Activities and exercise are
explained and geared in a manner that brings success. For example, for someone who has never
previously exercised and wishes to start exercising, a goal ofdoing ten to twenty minutes ofvaried
aerobic exercise two times a week would provide small successes that lay the foundation for
accomplishing a large success of doing aerobic exercise for greater than thirty minutes three times a
week.
Social persuasion helps patients to accomplish small successes and will lead to increased self
efficacy, which will propel the patient towards meeting the big success such as improved health
behaviors. The steps provided for practitioners to promote exercise and self-efficacy is a clear example
of starting with small successes and gradually working towards larger successes (Figure 2).
The last method to increase one's self-efficacy is accomplished by reducing negative
physiological reaction or helping individuals to interpret them in less pessimistic ways. For example,
exercise may include muscle aches and shortness ofbreath, which avert some individuals from exercise.
By explaining to the person that these symptoms signify that the body is working to improve its strength
and capacity, this person may look at this bodily action in a different light.
STEPS FOR PRACTITIONERS TO PROMOTE EXERCISE AND SELF-EFFICACY
Figure 2 provides a guide for practitioners to create an exercise prescription that is based on
their patients' personal self-efficacy level. This model was created by Jennifer Schaal Fletcher and it has
not yet been tested in research.
Practitioners first assess their patient's self-efficacy using Schwarzer's general self-efficacy scale
(Figure I) and classify them into the following groups: low, moderate, or high self-efficacy level. Next
10
the patient is prescribed an exercise program based on their self-efficacy level. Regardless ofthe self-
efficacy level t]le exercise prescription includes both aerobic exercise and weight training. Low self
efficacy patients are encouraged to use a variety ofexercise equipment. For example, ride bicycle for
five minutes, walk on treadmill for five minutes, and climb stair-stepper for five minutes. Moderate and
high self-efficacy individuals can choose a variety of aerobic exercises or they can stick to one type of
aerobic exercise.
Patients base their intensity level on the exercise effort scale (BE) scale (Figure 3). The EE scale
asks the question "How much ofyour maximum effort do you feel like you are exercising?" The EE
scale provides patients with a tool that they can use to evaluate and adjust their intensity level. Patients
are advised to stay in the recommended exercise effort range for their self-efficacy level which are listed
in Figure 3.
Weight lifting involves completing a designated number of sets based on self-efficacy level. A set
is a group of repetitions of an exercise movement done consecutively until the designated number is
reached. For example, low self-efficacy individuals complete one set of6-8 repetitions. Weight lifting
should include the following muscle groups: biceps, triceps, deltoids, latissimus dorsi, trapezius, erector
spinii, hamstrings, quadriceps, gastrocnemius, soleus, and abdominal muscles. The higher the self
efficacy level the greater number of sets and repetitions are completed.
Throughout the exercise program the individual should complete a daily exercise log. The log
becomes an efficacy builder, mastery of experience, because it unveils successes and progress through
the exercise program. Efficacy builders, as discussed earlier in paper, should be instituted throughout
the exercise program.
In order to evaluate patients' success with their exercise program, self-efficacy level will be re
evaluated on an ongoing basis. The patients' exercise prescription will then be changed based on their
new self-efficacy level. The goal for patients is to increase their self-efficacy level. The increase in self
11
efficacy level is quite individualized, some people may increase gradually, while others may increase
quickly. Ifthere is a person who decreases in self-efficacy level, more efficacy builders need to be
initiated.
Exercise not only increases self-efficacy but it also improves mood, decreases stress, and
improves health behaviors. Practitioners should look for or ask about these changes with their patients.
As individuals get into the moderate and high self-efficacy levels they should notice improvement in
strength, better body composition (decrease in body fat, increase in muscle mass), and increased V02
max (the amount of oxygen utilized by the body at maximum effort).
CONCLUSIONS
The health benefits of exercise and physical activity have been documented to offset the relative
risk ofmorbidity and mortality from such disease conditions as coronary artery disease, obesity,
cancers, and overall mortality (Blair et al, 1989; and Bouchard, 1990). The literature suggests that
exercise also has psychological implications. Self-efficacy, the belief and conviction that one can
petfoffil a given activity (Caruso & Gill, 1992), is er.thanced with exercise. Research has also found that
those persons with increased self-efficacy are more likely to adhere to exercise programs (Dishman,
1988; Sallis et al, 1986). Persons with greater self-efficacy expectations also have more success with a
variety ofhealth behaviors, such as smoking cessation, weight control, stress reduction, nutritional
compliance, and exercise adherence (0' Leary, 1985; Bernier & Avard, 1986; Kowalski, 1997; Vega et
al, 1988). Therefore, measures to increase self-efficacy may not only lead to greater adherence to
exercise programs, but may also enhance other health behaviors.
One of the goals ofpractitioners is to help patients initiate and adhere to an exercise program.
Practitioners often give the basic exercise prescription ofthirty minutes ofcardiovascular exercise at
least 3 days a week. This exercise prescription does not take into account the patients' self-efficacy,
12
their confidence in their ability to carry out that exercise prescription. Exercise prescriptions need to be
individualized based on the individual's self-efficacy level. If persons are given an exercise prescription
that is specifically matched to their self-efficacy level, they may be more successful at adhering to the
exercise regimen and making positive health behavior changes. Enhancing their general self-efficacy
could make them more confident and successful in everyday tasks.
In order for practitioners to develop exercise prescriptions which maximize individuals' self
efficacy more research needs to be conducted. Further research needs to be conducted comparing
varying exercise intensity and duration and the effect it has on self-efficacy. Also more studies are
necessary which compare different exercises, i.e. aerobic exercise vs. weight training, and the effects on
self-efficacy. Lastly, there is a need to examine whether exercise programs which incorporate self
efficacy manipulation improve health behavior change. More information in this area would lead to
improved exercise prescriptions, greater exercise adherence, positive health behavior changes, and
possibly a decrease in morbidity and mortality.
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Table 1: Review ofExercise and Self-efficacy Studies
INVESTIGATOR YEAR SUBJECTS TYPE OF CONCLUSIONS EXERCISE
Caruso 1992 N=65, 18-30 years Weight training Weight training increased ofage weight training SE
Conn 1998 N=147, ~65 years Varied-lifelong Retrospect-lifelong leisure exercise exercise had significant
positive effects on SE Holloway 1988 N=59, adolescent Weight training Wt training increased SE
girls McAuley 1991 N=81, 45-65 years aerobic Exercise increased SE McAuley 1992 N=88, 45-64 years Graded exercise test Exercise bout increased SE McAuley 1993 N=44, 45-65 years Acute bout of Exercise bout increased SE
exerCIse McAuley 1995 N=32, 45-85 years 12 min bike Exercise bout increased SE
McAuley 1995 N=56, 45-64 years GXT&40min Extended exercise had aerobic exercise greater increase in SE than
acute bouts of exercise Rudolph 1995 N=60, aerobic Exercise increased SE. Also
undergraduate Retrospect-previously more students active persons have higher
SE Stewart 1988 N=25 males in 2 groups: Circuit CWT increased significant in
cardiac exercise weight training and ann and leg SE; aerobic only program,< 70 years aerobic & aerobic exercise decreased their SE
only Stewart 1994 N=51, 25-59 years Aerobic and strength Exercise training increased
Males with mild SE hypertension
Stidwell 1995 N=45, age 82.9± Strength, balance, Exercisers higher SE than 5.3 cardiovascular non-exercisers
Tate 1995 N=20, college age Cycling @ 55% Exercise increased SE in V02& @70% both groups, no difference V02 between intensities
Toshihiko 1997 N=42, 60-86 years Weight training High and low intensity wt training increased SE
Vidmar 1994 N=138, Phase II Aerobic Retrospect- exercisers had graduates of cardiac higher SE, non-exercises low rehab, 45-64 years SE
Table 1 key: SE = self-efficacy CWT = circuit weight training V02 = oxygen uptake during exercise GXT = graded exercise testing
14
Figure 1
The General Self-Efficacy Scale By Ralf Schwarzer & Mattias Jerusalem, 1993
Response Format:
1 = not at all true 2 = hardly true 3 = moderately true 4 = exactly true
1 I can always manage to solve difficult problems ifI try hard enough. 123 4
2 If someone opposes me, I can find means and ways to get what I want. 123 4
3 It is easy for me to stick to my aims and accomplish my goals. 123 4
4 I am confident that I could deal efficiently with unexpected events. 123 4
5 Thanks to my resourcefulness, I know how to handle unforeseen situations. 123 4
6 I can solve most problems if I invest the necessary effort. 123 4
7 I can remain calm when facing difficulties because I can rely on my coping abilities. 123 4
8 When I am confronted with a problem, I can usually find several solutions. 123 4
9 If I am in trouble, I can usually think of something to do. 123 4
10 No matter what comes my way, I am usually able to handle it. 123 4
Permission granted by Ralf Schwarzer to use, publish, alter, &/or replicate
Suggested scoring developed by Jennifer Schaal Fletcher:
Low self-efficacy ~ 13 Moderate self-efficacy 14-27 High self-efficacy >27
15
STEPS FOR PRACTITIONERS TO PROMOTE EXERCISE AND SELF-EFFICACY
Figure 2
• STEP ONE: Assess self-efficacy • Use self-efficacy scale by SChwarzer (1993) or other desired scale
• STEP TWO: Classify patient based on self-efficacy scale • SChwarzer's general self-efficacy scale
• Low self-efficacy: score .s...13 (May benefit SE enhancement before exercise program)
• Moderate self-efficacy: score 14-27 • High self-efficacy: score> 27
• STEP THREE: Exercise as a means to increase self-efficacy
• STEP FOUR: Evaluation
LOW ~
Aerobic 10-20 min Exercise varied
exercise effort ~3
Weight 1 set 6-8 repetions Training low weight
Goals Completing exercise time, 2-3 x/wk
Efficacy Daily Exercise Log Builders Social Persuasion
Social Modeling II. Support Ensuring success
Reducing Negative Reactions
Evaluation: self-efficacy
Practitioners Parameters For Success
Measure SE within 2 months of starting exercise, then every
6 months
Patient has: Increased self-Efficacy
Better mood Decreased stress
Positive health behavior Changes
Increased energy
SELF-EFFICACY LEVEL
MODERATE
20-30 min any equipment
exercise effort 4-6
2 sets 8-10 reps moderate weight
Frequency goal 3-5x/wk
same
MeasureSE every 6 months
HIGH
> 30 min any equipment
exercise effort 7-10
3 sets 10-12 reps moderate- heavy weight
Higher intensity
same
MeasureSE every 9-12 months
~ Those listed to left II. Increased strength and V02 max
Improved body composition ~
16
Figure 3 EXERCISE EFFORT SCALE
How much ofyour maximum effort do you feel like you are exercising?
Rate between 1-10
1 Exercising @ 10% ofMax
2
3
4
5 Exercising @ 50% ofMax
6
7
8
9
10 Exercising ~ 100% ofMax
Max = maximum effort that you can exercise
Exercise Effort Scale created by Jennifer Schaal Fletcher
Idea based on RPE scale (reference): Noble B., Borg GAV, Jacobs I., Ceci R., Kaiser P. Medical Science Sports Exercise15: 523-528.
17
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