the role of self-motivation in exercise adherence, part 4, pgs 103-138

36
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Master of Science Thesis, Western Washington University, Bellingham, Washington, May 1986.Physical fitness testing, exercise reports, and psychological measures were used to assess the role of self-motivation as measured by the Self-motivation Inventory (SMI) (Dishman, Morgan, & Ickes, 1980) in exercise adherence.

TRANSCRIPT

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3.

4.

Note: n=12. Probabi(.05. Final Be

STAI-STAIB = .4

113

Tabl-e 16

ple Regressj-onReported June

to Predict Weeks198s (EX2)

Varia le Entered

in STAI-T1984-June 1985

IB)

h Concern Cluster

Ileart Rate (lrRMAX)

n2

.46

.75

.86

x

.67

..87

.93

Sept(STA

llea1(cL1

.93 .96

ty of F-to-enter regression equationi'w"igtrt": lIR!4AX = - '67, SMI = '55 ', CLl = -.33.

Stepwise l'Iultof Exercis

Step No.

1.

2.

3.

Note: N=12. Probab(.05. Final BetSYS = .44,

4.

5.

6.

j

114

Table 17

ple Regressionfrom Composite

to Predict WeeksReport (EX3)

SMI

Force(FEV)

RestPres

Total

Weigh

Trunk

Expiratory

Systolice (SYS)

Varia le Entered

Chol-esterol

Volume

Blood

(TCHoL)

(wcr)

Extension (FLEX2)

lty of F-to-enter regression equationWeights: SMI = .63, FEV - .60,

= .28, WGT = .48, FLEXZ = 'L5'

n2

.40

.71

.86

.92

.99

r

.63

.84

.93

.96

.99

115

Appendix I

Questionnaire PacketSeptember 1984 Psychological Testing'

ARCO Petroleum Products ComPanY

Date:

Subiect:

From/Location:

To/Location:

lnternal CorresPondence tturr\\/

The attached survey quest'ions were preoared uy-3 glgduate student at l}lestern

washington univeriitv.- rr,.y have tio-bJars. -The-first goai is to help the

Western student'in his/her^ stud'i.s-ana"ine second is to help us better under-

stand the pluses una rinr'tei of our fitness program as it now exjsts' 51ith

this informatio. ilivu.'to,n.-.rr.n-o.i .unl*iir'be-made that will make it a b'it

more attractive to-itrose 'tho are not presently involved.

The information w'i'll be strictly confidential. Reports of the-findjngs willnot inc1ude names. The comp'leted-iorms shou'ld be returned to Emp'loyee

Rel ati ons .

A11 of the questionnajres ask you t9 provide information from your point of

view. p.lease be as frank u, poriiui., insr"r'ing them as you real]y feei or

describing what You rea11Y do'

There are d'irections with each questionnaire. Please read them carefuliy'Do not spend too much tire on..;-;;;-;uestion. iour first reponse is the

best.

Thank you for your part'it:ipation'

September 'l 9, .I984

Cherry Pojnt Excercise Program, '1984

F. FormwaY

A'lI Empl oYeers

?rro'+F. FormwaY

FF: mn

Attachments

APPC-7054(5-81 )ARCO Pct?olilm Produc6 Complny is '

oiYifion ot

F:rrrrs gg ourd Stu L

I

Timerlne I

June, '84 |

Qlys,?ilg'*J Ilesnr5 |

:::lISeprembe' I

I

0ctoberl

November I

I

December I

January, '85

|

February IMarch I

Apri I &Yaalogio\

,,av T'T I

L17

for Exerci se Adherence Study

Exerctbe-Re.forbs .

i-., J* 4ueshDilLlal/c,4 tt- I I utd e - 9Yuesn '" ' '*' "-

+ dd7ilru l-t?*)

anJ 3 o'

Forrns ffi and 7r'G

E,ms Lr9A) ctnd

5 o't' 6 a'".e7

118

Date

Read each of the following statements and circle the letter of

iiim nnich best deicribes how clraracteristic the statement 'is

Please be sure to answer every item and try to be as

honest and accurate as possibie in your resPonses' Your

.ns*.ts rtill be kept in the strictest confidence'

S. S. NumberFORI{ 1

iiel f-moti vation InventorY

1. I,m not very good at committing myself to do things.

2. lilhenever I get bored with p'rqjgcts I start, I drop

them and do something else.

3. I can Persevere at stressfttl tasks, even vhen they arephysically tiring or Painful.

4. If somethi ng gets to be too much of an effort to do'

I'm likely to just forget it.5. I'm real 1 y concerned about devel 0pi ng and mai ntai ni n9

sei f -di sc'iPi i ne.

6. I'm good at keeping prom'isrls' especially ones I make

to mysel f.

7. I don't work any harder thrn I have to'

8. I seldom work to my ful1 capacity'

9. I'm just not the goa1-setting type'

10. tJhen I take on a difficult job, I make a point of

sticking tlith it untii it's comp'leted'

t1.I'mwillingtoworkforthlngslwantaslongasit'snot a big hassle for me.

L?. I have a lot of self-motivation'

13.I'mgoodatmak.ingdec.is.ionsandstandingbythem.

14. I generally take the pattr of 'least resistance'

15. I get discouraged easilY.

16. If I tel 1 somebody I'l I rlo somethi n9, you can depend

on it being done.

Please be sure to comp'lete itrlms on other side'

uUE- r&r€6A_g oOUHG @rn6L EH6 4 NEUFt!= = E2E fr Eer < --o-u

adF>OJtr= = =-<-u*- U GG4- € x--

@ u

CDECDE

the alternawhen appl ied

UGU GrEBoE uFI@ qeUE Uo40d<<e-4o--O--JU<G-U-4U €*Eu@

ABAB

ti ve by eachto you.

AB

AB

AB

ABABABAB

ABABABABAB

DEDEDEDE

C

c

c

c

c

c

c

c

c

c

c

ctDEDEDEDE

r19

S. S. DATE:

Form #1 cont'd.

17. I don't I 'ike to overextend mysel f '

18. I'm basicallY 1azY.

19. I have a very hard-drivirrg, aggressive personality'

20. I vork harder than most of my friends'

21. I can persist in splte o{rpain or discomfort'

22. I like to set goais and ttork tovard them'

23. Sometimes I push myseif ltarder than I should'

24. I tend to be overlY aPatltetic'

25. I seldom if ever let mys'elf down'

26" I'm not verY ref iable'

27. I like to take on jobs that challenge me'

2g. I change my mind about th'ings quite easiiy'

29. I have a lot of n'i1'l Porer'

30. I'm not 1ike1y to put mlself out if I don't have to'

31. Things just don't mattet' much to me'

3?. I avoid stressful stiuat;ions'

33. I often nork to the poi rrt of exhausti on'

34. I don't 'impose much strrlcture on my activities'

35. I never force myseif to do things I don't feel fikedo'ing.

36. It takes a 1ot to get me going'

37. t'lhenever I reach a goai , I set a hi ther one'

38. I can pers'ist in spite of failure'

39. . I have a strong desi re to ach'ieve'

40. I don't have much self"discipiine'

G\4U ear5ro4:+o La=u4Aiu = =tr E G,- =

E

= 4 E= E EE*'88-aE==*

=

===

=

*ABCDEABCDEABCDEABCDEABCDEABCDEABCDEABCDEABCDEABCDEABCDEABCDEABCDEABCDEABCDEABCDEABCOEABCDEABCOE

ABABABABAB

DEDEDEDEDE

C

u

c

c

C

.-2-

t20

DateS. S. Number

DIRECTIoNS: A number of sbatements wh'ich people have

,i"o to describe themseives are given belon' Read

iain statement and then c'irc'le the appropriate number

io tn" right of the statement to indicate hov you

GENERALLY-fee]. There are no right or Yrong ansYers.

Oo'noi-ipend too much time on any one statement, butqive the'ansxer which seeils to describe hov you

drrueReuuv reet.

1. I feel Pleasant

2. I tire quicklY

3. I feel like crYing.

4. I nish I couid be as ltappy as others

5. I am losing out on things because I

F0Rt'1 2A

Sel f -Eval uat'ion Quest'ionna'ire

seem

can't

!rgg-'o!.=+)

2 E E 2-<. a E e

L 2 3

t23L?3123

4

4

4tobe.

make up mY mi nd

6.

7.

8.

9.

10.

11.

t2.

13.

t4.

15.

16.

t7.

18.

soon enough

I feel rested

I am "calm, cool, and col1ected"

I feel that difficulties are piling up so that Icannot overcome them

I worry too much over something that really doesn't matter

I am happy

I am i ncl i ned to take th'i ngs hard

I 'lack sel f -conf i dence .

I feel secure

I try to avo'id facing a crisis or difficulty

I feel bl ue

I am content

1234L234L?34

r234L?34

2323

r23123

234?34234234234234

Some unimportant thotrght runs through my mind

I take disappointmenl;s so keenly that I can'tof my mi nd

and

put

bothers me 1

them out

19. I am a steadY Person

20. I get in a state ofmY recent concerns

1;ensi on or turmoi I as I thi nk overirnd 'interests

FORM 2A

r2t

S. S. Number

Reasons for neSS-l-!-]

l dren, Parents )

---

DateF0Rt'l 3

Starti nq a Structured Exerci se Program

I evel .

I am.

Thisformshou.ldbecomP.letedbyindividualscurrentlyactiveinastructured exercise Program'

Please check the statements that best describe your reasons forstarti ng th.i s tierci se Progra11. ( Check al I that aPPl y' )

I Yant to Prevent heart attack'I Yant to get 'i n snaPe'ine comPanY i s Prov'idi ng i t'I want to lose weight'

- ,r"Fiiiiii

"n"ouragEO me. tJho encouraged you? (e.g. spouse'

chiI want to reduce tlY stressI want to find out hov fiti niu" never been able to exercise on my oun'i ' ;;-0."n ieel i ng out of shape 1 atel y 'Mv doctor encouragted me.

I'rant to stoP smc'|king.Mv friends are tak:ing Part'V6, .noufd take ctrre-of Yourself'I want to lower m)r blood Pressure'I 1i ke the way exilrc'i se makes me f eel 'i'ue neard th; pr0gram i s excel l ent'I want to do somel;ni ng f or mYsel f '0ther. (Please speci fY)

Hon confi dent areprogratn for eachalong the dottedYou are that You'inonths I i sted.01 = colllP'letelY certain that501 = a 50-50 chance that You1001= comPl etel Y certai n that

you bhat you can (ri 1l ) colt'i nue the exerc j se

of the fol I owi ng ti me sians? Pl ace an X anywhere

I i ne between 0i'and l00i to s i gni f y h9!-certa'i n

l'l sti 1l be .*!t.i ii.! af ter eicn number of

vou won't sti'l I be exerci si ng'wi t t sti I 1 be exerci si n9'

-

you wi i I sti l1 be exerc'i s'i ng'

(For example, if you think there is better than a 50-50 chance you

;iii;;iii b; exercisine in i months you could check it as

follows:3months l- -l l-X--l- -l)

01t-t-l-t-

257 501I

751" 1001t--lmonth

months

mo nths

months

t--ll--ll--ll--lr--tl--lL2

FORFl 3

r22

Nu mber DateFORM 4

Reasons For Not Starting A Structured Exercise Program

Thi s f orm shoul d be c,rnpl eted by i ncli vi dual s N0T currentl y actiin a structured exercise Program'

pjease check the statements that best describe your reasons fornot start'i ng a structured exerci se program noH'

VE

- I pl an to start I ater. ( hlhen?

- Exerci se takes too much ti me.

- Summer i s a bad t'i me f or me to

- Exercise is drudgerY.My doctor advi sed me not to exerci se.The classes are too far from my home.My fitness level is adequate.I'am not motivated enough to do it.I am 'afrai d I rro u I d i nJ ure mYsel f.I voul d f eel s'i 1 1y runni ng around 1 i ke a ki d'The c1 asses are at i nconveni ent ti mes.I exercise bY mYself.I don't I i ke the k'i nds of exerciI don't I i ke to exerci se.Hy f ri ends are not doi ng 'i t.I- don' t need to I ose vi eght.I nork so hard I can't exerci seI smoke and don't want to quit.

- My family doesn't want me to do

month. )

start thi ngs.

se of fered.

too.

i t. ldho? (e. g. sPouse'[-arents, chi 1 dren )

What do you feel Cherry Point should do for you to participate in a structuredexercise program (meaning to exerc'ise regulary)?

List suggestions in order of preference:

1)

2)

3)

tlhat type(s) of. exercise do

_ Joggi ng/runni ngAerobi c dance

- Swi mmi ng

- Cycl'i ng

_ lrJal ki ngRacquet s Ports

- ComPeti t'i ve games

- 0ther ( P I ease s Peci fY )

you prefer? (Check ail that aPPlY.)

Al one

- Informal grouPS

_ Cl asses_ Tournaments_ 0rgan'i zed games_ inf ormal games_ Non-comPeti ti ve games

L23

Bel ow i s a 1 i st of adject] Yes. Pl ease read them qui ck1 y and

put an uxu i n. ine' uoi" besi de each one you woul d cons'i der tobe self-descr,ptirti. Oo not uorry about.dupf ications'contrad.tctton.f'";;i'.o"lo;if

-woir quicklv and do lot spend

too much ti me l,n-i,ny-on" adiecti ve. 'Try to be f rank and

check those aoiecI ii.i *ni .[ -o".cri be y6u as you rea] I y are'

not as You Yould 1 ike to be'

S. S. Number

f;t affected

tf al ert

I a'l oof

Date

F0Rr-1 7Adjecti ve Checkl i st

fltltfElEEIEfltltltlflEE

arrogant

autocrat i c

boastful

concei ted

co ns i derate

cyni ca1

dissat'i sfied

effi ci ent

fai r-mi nded

fussy

heal thY

i ntol erant

1 ogi ca1

1oya1

tl moderate

il modest

tf moodY

fl organ'i zed

f] poi sed

E practi cal

il real i sti c

E sel f -denYi ng

il sPunkY

E stubborn

E thoughtful

t-l thri f tY

tf trusti ng

lf unaffected

f:l understandi ng

[f versati 1 e

tl tvar m

L-24

Appendix II

Questionnaire PacketFebruary 1985 Psychological Testing'

L25

DATES. S. Number

t. I feei Pleasant

FORM 28sr 1 f-Eval uati on Questi onnai re

DIRECTi0NS:AnumberofstatemerntswhichPeoPlehaveusedto descrio" tn.*u"iit' tt" g'ivetr below' Read each

statement and tnen circte tfie ayrprooriate number to the

riqht of the .t"t",nint-to inOiclle how you have felt IN

iiE"inii itiO rlotriis. There are no right or \{rong. ansHers'

Donotspendtoomuchtimeonallyonestatement,butgivethe ansyer 1,h1ch .1"*.-io-Oescri6e nor you have felt IN

THE LAST TI.IO MONTHS.

!rgE-,6

E E E Ee 35=t234

3

3

2

2

2

t

t

2. I tire quicklY

3. I feel like crYing'

4. I wish I could be as haPPY

5. I am losing out on thingssoon enough

as others seem

Iecause I can't

to be

make uP mY m'ind123123123

r234123{t234

4

4

232323

4

46.

7.

8.

I feel rested

I atn "calm, coo1, and colltrcted"

I feei that difficulties are piiing uP so that Icannot overcome them

I worry too much over someLhing that really doesn't matter

i am haPPY

I am inclined to take things hard

I lack seif-confidence

I feel secure

I try to avoi d faci ng a cris'is or difficultY

I feel bl ue

I am content

9"

10.

11.

12.

13.

14.

15.

16.

17.

18.

I

L

343434

L2L2t2t2

Some unimportant thought runs through

I take disappointments so keenly thatof my mi nd

my mi nd

I can't

bothers me

them out

and

Put 234234

19. I am a steadY Person

20. I get in a state ofmY recent concerns

tension or turmoil as Iand i nterests

FORM 28

thi nk over

r26

F0Rr'l 5l- Structured Exerci se Program

Thls form should be completed by indlvl,duals vho are

.iirr"niii partf ir piting' t n a stiuctured exerc'lse Program'

best descri be Your reasonsa structured exerci sePlease check the statements that

for iontl nul ng to Partl ci Pate i n

;;;s;;;. ( ch6ck ai t that aPPl Y' )

S. S. Number

Reasons For Cont'l nql!

Otn". (Please sPactfY)

Exercise can prevent heart attack';' iiri"-ir,e ti ine tq mysel f to thi nk'i t nis been hel Pi ng ire I ose xel ght'

. .., -.I have mole .n"F-cy'wtiin t exercise regYlarl y'

it"nii nii p.a me- ieouce my stress 'level '

The exercise .i'i,;;;-ni'e'heiped me keep exercising'i ;ti;t exercisirtg nlth frlends'E*;;:iii ng i s the-hi gh-poi nt of mv dav'iou inouit take (:are-of Yourself 'ii-nirps me contt'ol mI !lqod pressure'i'gIi'Ii.ottrorIalr'le 1-f I don't exercise'I f eel more t"ii,ito af ter an exerci se sessl on'

I vrant to see niii-rrin I gan irpror" my. frtness 'revet.

I yant t<, 9et ii'U.tIIr-rfrape f br compiti tl ve sports'It gl ves a good" tliion to 9;t out of the house'

ii is 1 t ke medi t rtl 9n. for tne'

How conf i dent are you that y9u 9an lY11'l I tontl nue to

exercl se for each bf the foi ioring it me^ipans? Pl ace an X

anyyhere along the dotted 1i;;-0"Ir""n 0f ind 10Ot to signifyhotl cerratn v.iu-.r"-th1! voul'i1-;iiii ue exercising after'diln-ii,iu.i i,r months 1l sted f rom noH'

01=completelycertalnyouwon.tbe.exerctsingthen.501 = 50-50 .[.i.,." ttrat vbr-riii itirt be exerc'l slns then'

100r= comp.letely cerl;aln tnai'vor-*rrl st'l 11 be exerclsingthen.

For examPl e,you will sti'lmark that as

3 months

lf you l;hink.1 be exrlrclslfo1 1 ows

there i s a better than 50-50 chance;;'r-tnontIs- ito* noY, You coul d

LoiX - - lui

- loo*

t----t----lt----l----l

month

months

months

mo nths

t____ltz ____l____l

Please note below whetheaverage of at least 3 tieach of the t'imes given

Date

November 1, 1984

November 15, 1984

December 1, 1984

December 15, 1984

January 1, 1985

JanuarY 15, 1985

February 1, 1985

FebruarY 15, 1985

oua

ow

L27

were Part'ici Pati ng

week and 15 minutesin vigorous exercise an

per session or not for

No

L28

S. S. Number DateF0Rr{ 6

Reasons for Di sconti nui ng a Structured Exerci se Program

Thi s form shoul d be co11Pl eted by i ndi vi dual s who recei ved a

pi,iiii;i;;i;;i aiseisment at t'tuJU-and started a structuredexerci se program and then deci ded not to conti nue 'i t.

P1 ease check the Statements that best descri be youl- reasonSfor di sconti nui ng your exerci se Program. ( check al I thataPPl y. )

Exercise took too much time.Exerci s i ng vas dr udgerY.

Tne cl asses riere too f ar f rom my home'

i[fuse, ch'i ldien, Par€r[tS) , , , , rr,: r ;r:;:--' -f,,li fitness didn,tr Seem I'd hoped.I vasn't moti vated enough to do i t'i ;;rton'i keep trP with-others in the class'

I-felt silly runlting around like a kid'I wasn't loiing rreight like I'd hoped'I did not l'ike-tlre Iypes of exerc'i se offered'

The cl aises vere at i nconveni ent ti mes '

Id.idnotenjoy(}xercisingw'iththeotherpeop.le.0ther (Please sPr:c'i fY)

tdhat type(s ) of exerc ise do you Pref er? (check al I thataPPl y. )

Al one

- I nformal grouPsCl asses

- Tournaments

- 0rgani zed games

_ Informal gamesNon-comPeti ti ve games

- Joggi ng/runni n9Aerobi c danceSwi mmi ng

_ Cycl i ng

_ l,lal ki ng_ Racquet sPorts_ Competi ti ve games

- 0ther ( P1 ease sPeci fY )

129

Appendix III

Que sti-onnaire PacketJune 1985 PsYchological Testing'

SS#

EXERCISE REPORT

Date in a structuredin a grouP' between

130

DAT E

aerobi c exerci se Program'September 1984 and MaY

al ready do'i ng, or

Di d you Part i ciby yourself or1 985?

YES NO

I f you

For each of the datres 'l

check mark i f You hrereat least 15 minutes; Per

September 1, 1984

September 15,1984

October 1, 1984

0ctober 15, 1984

November t, 1984

No vember I 5, 1 984

December 1, 1 984

December 1 5, 1984

January 1, 1985

January 15, 1985

February 1, 1985

February 15,1985

t'tarch 1, 1985

March 15,1985

dpril 1, 19&5i

April 15, 198:;

Hay 1, 198:i

May 15, i98l'

ansyered 'Y€rs" above, did tou:a. conti nure a, Program that you I'Jereb. start a'ne'w Program?

i sted bel ow, p'l ease 'l ndi cate wi th a

parti ci pati irg' i n aerobi c exerci se f or'

s es s i o n three t'i mes Per week .

131

DATES. S. Number

1. I feel Pleasant

F0Rf'1 28Siel f -Eval uati on Questi onnai re

DIRECTi0NS:Anumberofstatenpntswhich^peoplehaveused[i o..i.ioe themseiues .tu givtln belov' Read each

ii.iiiJi,t-incr then ciicte t6e approoriate number to the

riqht of the statemeni-to inOi,:ite l.row you have felt IN

iiE"inii iwo MOrurns. There arrt no riqht or Hrong answers.

Do not spend too much time on itny one-statement' but give

the answer rhich .i"iir-to-Oescr"i6e hon you have felt iN

THE LAST Tt.,O I'IONTHS.

aJ.,

urtnJ=r-iF

i/f .t- Z Ao irJ trJ O==F=-JOtLJ

1234

4

4

4

4

2. I tire quicklY

3. I fee'l f ike crYing'2

2

3

J

34. I wish I could be as haPPY

5. I am los'ing out on things

as others seem

because I can't

to be

make uP mY mi nd

6.

7.

8.

soon enough

I feel rested

I am "ca1m, cool, and coliected"

I feel that diffjcu'lties itre piling uP so that Icannot overcome them

I worry too much over somrlthi ng that reallY doesn't matter

I am hapPY

I am incllned to take things hard

I lack self-confidence

I feel secure

I try to avoid faci ng a <rrisis or difficultY

I feel bl ue

I am content

t23t?3t23

2323232

2

r2341234

9.

10.

11.

12.

13.

14.

15.

i6.

t7.

18.

1

1

1

1

t

4

4

3434

L?t2t2L?

343434

Some un'important thought runs through

I take disappointments sr> k€€n1y thatof my m'i nd

my mi nd

I can't

tension or turmoil as I think overand i nterests

and

put

bothers me

them out

19. I am a steadY Person

20. I get in a state ofmY recent concerns

FoRf"l 28

132

S. S. Number DateFORM 5

Reasons For Cont'i nui ng A Structured Exerci se Program

Thi s form shoul d be cclnpl eted by i ndi vi dual s who arecurrentl y parti ci pati ng j n a structured exerci se program.

Pl ease check the statements that best descri be your reasonsfor conti nui ng to parti ci pate i n a structured exerci seprogram. (Check al'l that aPPl Y. )

Exerc'l se can prevent heart attack.I f ike the time to mYself to think.It has been hel pi ng me I ose trei tht.I have more energy'when I exerci se regul arl y '

I it has helped me reduce my stress level.The exerciie classes have helped me keep exercising.

- Exerll ii ng i s the h'i th poi nt of ,my day.You shoul d take care of Yoursel f.

I ieel more rel axed after an exerci se sessi on'i *ant to see how much I can 'improve my f i tness I evel .

It is like fueditation for me.

Hoy confident are yoLt that you can (wil1) continue toexercise for each i,f the foitoning time spans? Place an X

inywnere along in. dc,tted l'l ne beIr+een 0t and 100r to signifyfrow certain y6u are t;hat you'1.l sti'l 1 be exercising aftereach number of monthsi listed from no!,.

0x = completely cer{;ain you won't be exerc'i sing then.50X = 50-50 chance ttrat y6u will st'i 1l be exercising then'1001= compl etel y cer'{;a'i n- that you vi i 1 st'i I I be exerci s'i ng

then.

For exampl e,you will stimark that as

3 months

month

months

months

mo nths

t-01

if you r;hink there is a

ll be ex(trcising 3 monthsf ol I ows

better than 50-50 chancefrom notl, you coul d

X. I

7I

10 01

I

I

I

I

I

2 51t-501 51

____l_-__l

____l_---tt2 ___-t

r33

S. S. Number

Reasons for Discon'sinui

P1 ease checkfor discontiapPl v. )

DateF0Rl,l 6

ng a Structured Exerci se Program

Th.is form should be crllllPleted by individuais who received a

pi,iviioiotiiar .ir.rs11rsnt at 6trtu and started a structuredexercise prog.i* and bhen decided not to continue it'

the statements that best descri be youl- reasonsnuing your exercise Program' (Check all that

Exercise took too much time'Exerci s i ng was drudgerY 'Mv doctor advised me to stoP'The cl asses \{ere too f ar f rom my home'

My f i tnesl li hn;i reeil-' fo-n; flni?vrnf t i t<e I'd hoped.

i","ini i-*oIi vateo enough to do - i t'.i ;;rior'I keep uP vith others in the class'I i nj ured mYsel f .

m, iri enOs were not parti c'ipati n9'i'r.rt-iiirv rurrning'around like a kid'i ,i.n'i t oii ng uei 9nt I i ke I'd hoPed'i ;ie"not iif. i;he Iypes of exercise offered.

The ttaises h,er(t at inconvenient times'prooram i"iOi"s ,,er"n'I irpporti ve and f.i endl y enough'' ' -Jr di d ,.r-;;i;t ii"ili s.i n9' ii th the other peopl e.

tlhat type(s) ofaPP'l v. )

- Joggi ng / runni ng

_ Aerobi c danceSwi mmi ngCycl i ngt^la1ki ngRacquet sportsCompeti ti ve gamesNo ne0ther (P1 ease sPeci fY )

exerci se do you prefer? (Check al I that

Alone

- Informal grouPs

- Cl asses

- Tournaments

- Orqan'i zed gamesInformal games

- Non-comPeti ti ve games

t34

F0Rl'l 7Artjecti ve Checkl i st

Below is a list of adjectiveri. Please read them quickly and put.an "x"

in the box beside.each one y()u nould consider to be self-descriptive' Do

not l,orry about Oriii.aiioni, contridictions, and so forth' l;ork quickly

;il i; n6t-iiinO lbo mucn tirne on gJrY one adjectivg.--Trv to be.frank and

in".f-tniie-lOieciives rihich describi you as you real'ly are, not as you

S.S. Number

would like to be.

t] affected

tr alert

E aloof

tl arrogant

tr autocratic

tf boastful

E conceited

tr considerate

tr cynical

tl dissatisfied

tr efficient

E f a'ir-mi nded

tr fussy

tr hea'lthY

tr intolerant

tr 'logi ca1

lf loyal

Date

tl moderate

trl modest

tl moodY

f} organized

Ll por seo

tf practical

trl real istic

tl sel f-denYi ng

El spunky

tr stubborn

tr thoughtful

tr thriftY

tl trusti ng

tr unaffected

tl understandi ng

tf versatile

tr l/arm

135

qalned weiqlrt during the past year?

h6w manY Pourrds?

(Y or N)

4.

5.

a.b.

a.

Have YouIf yes,

-T T T T T -6- -T -6- T 1T- -Tr 17 -13 -1T' Tr 1T

l ' Hiqh Blood Pressure 9' Disease of Kidney' Liver

2' Elivated B'lood iiigrycerides 10' Anemia

3' Elevated Blood' ittoi'iiitor 1l ' Arthritis4' 0venreight Problem l?' Hernia

3: fll:?i':: ""';:;;o"-Probrems

ii: i:H'":!:lll' tEmphvsema)

7. Gout (Elevated iliit"ntioi 15' Asthma

B. oii..i. or Thyroio l?: 3[:.i:]:rtili!"., (Bvpass

6.HaveyouhadaphysicalexaminationwithintheDasttwoyears?(Yor

To your knowledse,.d?-v:'1..?:-lu\t vou had anv

(Cfrlct the appropriate b'lx(es ) ' )

of the following?

--If so, please list the nanre and address of physician or place of

examining c'linic'

-Tr

Surgerv )

N)

Name

Address

of the followinq?7. 0o you have a fam'ily history of any

TTT'1. Diabetes2. Heart 0isease

8. Have you ever experjelced-any of

stairs, wortins bt exercising?

TTl. Chest Pain2. InaPProPri ate3. Fai ntness

1 Hioh Blood Pressure;. Muicul ar Probl erns

the followinq while walk'ing' c'limbing

-ra--4. Lisht-hea{e{nes.1 9I.?if iness

Breathlessness ;: ["t nlin -(claudicatron ';: iiirtoeat lrresularities

136

for heart Problems, highNi irottlycerin, Di gital is )?

bl ood Pressure(Y or N)

or9. a.

b.

a.

10. Have

Are you taking anY druQs

rel aied diseases ( i .e' 'I f yes , P1 dase s Pec'i fY '

b.

you recentlY exPerienced any of the following?

I " Local i zed Muscl e Soreness2. Painful Joints3. Joint Sti ffness4. Fl are-uP of old 'injrrries

11. a' Do You consider:/ourself :

(gniet the number of the

b. if You do exercil;e' whataporopriate activitY level ' )do you do?

your health and physical activity that you

aware of:

T -T_ T -'5_ T .T_8-

Loss of Local l'luscl e StrengthHoiiceaUte Loss of Muscle Sizenestricted Joint Hovemnt Ranqe

Pain in Lower Back

5.5.7.8.

'1.

2.

3.

4.

SEDENTARY ('little, if any' physical activitv)LIGHT ACTIVE ttpo"ioic e'licisL' iawn wort '

-other simi lar

;;i*^ll ffilllltilxercise r-2 days pgr yeek ror at reast

30 min/day: continuo" aerobi c acti vi t'v)

HIGH ACTIVE (exercii"-S-AtVs.Pef week or more at least

ii-*inia.Y: continuous activitY)

Conments concerningthink we should be

t?. Concerning your level of physical activity: (Enter Y or fl)

a. At your :ou uie'v9; #!;,::9:ltutv than active?

;: il ffi'gi-io" *aiks rer;uiarlv?c. Do you .*...i"-*tt than onte Per YeelS- -,d. Have you pu"iitipiito-in tihletics in the past?

c.b.

speci f.v:

a.

If yes to d, Pl ease

At what age? For hor 1 ong?

r31

Appendix IV

Backgtound Information Foru

Centei for Fitness Evaluation

r38

I,IESTERN t.lASHINGTOI\I UNIVERSITYCINTER FOR FITNESS EVALUATION

BACKGROUI{D INFORHATION FORH

Name Date

I ast

Age: Soc. Sec. #: Birthdate: Sex: (M=male' F-female)

-Fio. Day -Tr.

Height t'leightin inctres in ibs. 0ccuPation: Harital Status

:-5.s1ni,t=marD-di v

Street Address:

State: ZipCity:

l. a. Do you smoke cigaretttls now? (Enter Y or N)

b. If Yes, hor manY Per tlaY?

a. b.

?. a. Have you smoked in thrl past? (Y or N)

b. If Yes, how many Per tlaY?

Honre Phone:

a. b.

3. How long since You quit?

a. month/s

Business Phone:

b. - Year/s