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

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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

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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,

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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 &

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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.

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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

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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

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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

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(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

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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

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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

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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,

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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

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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 ~

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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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