Document Type : Original Article

Authors

1 1 Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Abstract

BACKGROUND: Exercise self‑efficacy has been identified as one of the primary determinants of 
physical activity in people with multiple sclerosis (MS). Therefore, assessment of exercise self‑efficacy 
is important to be measured with valid and reliable scale to provide tailored interventions.
MATERIALS AND METHODS: The English version of the exercise self‑efficacy scale was translated 
into Persian using a forward‑backward translation approach. Factorial validity was conducted using 
the expletory factor analysis (EFA) and the confirmatory factor analysis (CFA). In addition, construct 
validity was performed using convergent and known‑group validity. Reliability was evaluated by internal 
consistency and test‑retest reliability. Participants were recruited from two hospitals (MS clinics).
RESULTS: Expletory factor analysis identified a single factor structure which explained 64.7% variance 
in exercise self‑efficacy scale (EXSE). CFA supported a single factor structure with a good model fit. 
Average variance extracted = 0.60 and composite reliability = 0.93 values confirmed the convergent 
validity. The known‑group validity was verified with significant differences between subgroups. The 
Cronbach’s alpha coefficient = 0.93 and intraclass correlation coefficient = 0.85 supported reliability 
of EXSE scale.
CONCLUSIONS: Our findings provided sufficient evidence of validity and reliability for EXSE scale 
in people with MS. This measure can utilize by researchers and health‑care providers in studies and 
clinical practice as a robust measure to assess exercise self‑efficacy and to develop interventions 
in people with MS.

Keywords

1. Pearson M, Dieberg G, Smart N. Exercise as a therapy for 
improvement of walking ability in adults with multiple sclerosis: 
A meta‑analysis. Arch Phys Med Rehabil 2015;96:1339‑48.e7.
2. Criste G, Trapp B, Dutta R. Axonal loss in multiple sclerosis. 
Causes and mechanisms. In: Handbook of Clinical Neurology. 
New York: Elsevier; 2014. p. 101‑13.
3. Pilutti LA, Platta ME, Motl RW, Latimer‑Cheung AE. The safety 
of exercise training in multiple sclerosis: A systematic review. 
J Neurol Sci 2014;343:3‑7.
4. Frohman TC, Castro W, Shah A, Courtney A, Ortstadt J, Davis SL,
et al. Symptomatic therapy in multiple sclerosis. Ther Adv Neurol 
Disord 2011;4:83‑98.
5. Halabchi F, Alizadeh Z, Sahraian MA, Abolhasani M. Exercise 
prescription for patients with multiple sclerosis; potential benefits 
and practical recommendations. BMC Neurol 2017;17:1‑11.
6. Latimer‑Cheung AE, Pilutti LA, Hicks AL, Martin Ginis KA, 
Fenuta AM, MacKibbon KA, et al. Effects of exercise training on 
fitness, mobility, fatigue, and health‑related quality of life among 
adults with multiple sclerosis: A systematic review to inform 
guideline development. Arch Phys Med Rehabil 2013;94:1800‑28.
e3.
7. Suh Y, Joshi I, Olsen C, Motl RW. Social cognitive predictors of 
physical activity in relapsing‑remitting multiple sclerosis. Int J 
Behav Med 2014;21:891‑8.
8. Klaren RE, Sasaki JE, McAuley E, Motl RW. Patterns and 
predictors of change in moderate‑to‑vigorous physical activity 
over time in multiple sclerosis. Phys Act Heal 2017;14:183‑8.
9. Motl RW, Arnett PA, Smith MM, Barwick FH, Ahlstrom B, 
Stover EJ. Worsening of symptoms is associated with lower 
physical activity levels in individuals with multiple sclerosis. 
Mult Scler 2008;14:140‑2.
10. Motl RW, Sandroff BM. Benefits of exercise training in multiple 
sclerosis. Curr Neurol Neurosci Rep 2015;15:1‑9.
11. Motl RW, McAuley E, Sandroff BM, Hubbard EA. Descriptive 
epidemiology of physical activity rates in multiple sclerosis. Acta 
Neurol Scand 2015;131:422‑5.
12. Klaren RE, Motl RW, Dlugonski D, Sandroff BM, Pilutti LA. 
Objectively quantified physical activity in persons with multiple 
sclerosis. Arch Phys Med Rehabil 2013;94:2342‑8.
13. Streber R, Peters S, Pfeifer K. Systematic review of correlates 
and determinants of physical activity in persons with multiple 
sclerosis. Arch Phys Med Rehabil 2016;97:633‑45.e29.
14. Casey B, Coote S, Shirazipour C, Hannigan A, Motl R, 
Martin Ginis K, et al. Modifiable psychosocial constructs associated with physical activity participation in people with 
multiple sclerosis: A systematic review and meta‑analysis. Arch 
Phys Med Rehabil 2017;98:1453‑75.
15. Bandura A. Health promotion by social cognitive means. Heal 
Educ Behav 2004;31:143‑64.
16. Motl RW, Pekmezi D, Wingo BC. Promotion of physical activity 
and exercise in multiple sclerosis: Importance of behavioral 
science and theory. Mult Scler J Exp Transl Clin 2018; 4:1-8.
17. Sharma M, Romas J. Theoretical Foundations of Health Education 
and Health Promotion. 2nd ed. Sudbury: Jones & Bartlett Learning; 
2012.
18. Bandura A. Self‑Efficacy: The Exercise of Control. New York: NY: 
WH Freeman and Company; 1997.
19. McAuley E. The role of efficacy cognitions in the prediction 
of exercise behavior in middle‑aged adults. Behav Med 
1992;15:65‑88.
20. Motl RW, McAuley E, Snook EM. Physical activity and quality 
of life in multiple sclerosis: Possible roles of social support, 
self‑efficacy, and functional limitations. Rehabil Psychol 
2007;52:143‑51.
21. Resnick B, Jenkins LS. Testing the reliability and validity of the 
self‑efficacy for exercise scale. Nurs Res 2000;49:154‑9.
22. Resnick B, Luisi D, Vogel A, Junaleepa P. Reliability and validity 
of the self‑efficacy for exercise and outcome expectations 
for exercise scales with minority older adults. Nurs Meas 
2004;12:235‑47.
23. Dustin I, Resnick B, Galik E, Klinedinst NJ, Michael K, Wiggs E. 
Reliability and validity of the self‑efficacy for exercise in epilepsy 
and the outcome expectations for exercise in epilepsy scales. Nurs 
Meas 2017;25:22‑40.
24. Shaughnessy M, Resnick BM, Macko RF. Reliability and validity 
testing of the short self‑efficacy and outcome expectation for 
exercise scales in stroke survivors. J Stroke Cerebrovasc Dis 
2004;13:214‑9.
25. Everitt BS. Multivariate analysis: The need for data, and other 
problems. Br J Psychiatry 1975;126:237‑40.
26. Godin G. The Godin-Shephard Leisure-Time Physical Activity 
Questionnaire. Health and Fitness Journal of Canada 2011; 4:8-22.
27. Sikes EM, Richardson EV, Cederberg KJ, Sasaki JE, Sandroff BM, 
Motl RW. Use of the Godin leisure‑time exercise questionnaire in 
multiple sclerosis research: A comprehensive narrative review. 
Disabil Rehabil 2019;41:1243‑67.
28. Tabachnick BF. Using Multivariate Statistics. 6th ed. Boston: 
Pearson; 2013.
29. Weston R, Gore PA, Chan F, Catalano D. An Introduction to using 
structural equation models in rehabilitation psychology. Rehabil 
Psychol 2008;53:340‑56.
30. Fornell C, Larcker DF. Evaluating structural equation models with 
unobservable variables and measurement error. J Mark Res This 
2016;18:39‑50.
31. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 
2nd ed. New Jersey: Lawrence Erlbaum; 1988.
32. Nunnally J, Bernstein I. Psychometric Theory. 3rd ed. New York: 
McGraw‑Hill; 1994.