Exercise Self-efficacy Scale                                     Client ID#_________________

                                                                                   Date: ______/______/______

                                                                                   Assessment Point:  _____________

For numbers 1-18 you should rate how Confident you are that you could perform exercise routines regularly (three or more times a week) in each situation.

Please rate from 0 to 100 the number that best describes your feelings of confidence to perform exercise routines in each situation according to the following scale:

       0...............................................................50...................................................100

cannot do                                       moderately certain can do                  certain can do

            SITUATION                                                                                CONFIDENCE

_______________________________________________________________________

1) When I am feeling tired                                                                                 ______

2) When I am feeling under pressure from work                                                 ______

3) During bad weather                                                                                      ______

4) After recovering from an injury that caused me to stop exercising                   ______

5) During or after experiencing personal problems                                             ______

6) When I am feeling depressed                                                                        ______

7) When I am feeling anxious                                                                            ______

8) After recovering from an illness that caused me to stop exercising                  ______

9) When I feel physical discomfort when I exercise                                            ______

10) After a vacation                                                                                          ______

11) When I have too much work to do at home                                                 ______

12) When visitors are present                                                                            ______

13) When there are other interesting things to do                                                ______

14) If I don’t reach my exercise goals                                                                ______

15) Without support from my family or friends                                                   ______

16) During a vacation                                                                                        ______

17) When I have other time commitments                                                          ______

18) After experiencing family problems                                                              ______

______________________________________________________________________________

SCORING information unavailable at this time

3 FACTORS

Situational/interpersonal subfactor-factor 1(six items)

Questions: 11,12,13,16,17,18

Competing demands subfactor-factor 2(five items)

Questions: 4,8,10,14,15

Internal feelings sub-factor-factor 3(seven items)

Questions: 1,2,3,5,6,7,9

REFERENCE:

Shin, Y., Jang, H., & Pender, N. J. (2001). Psychometric evaluation of the exercise self-efficacy scale among Korean adults with chronic diseases. Research in Nursing & Health, 24, 68-76.