A HANDBOOK TO EVALUATE PHYSICAL FITNESS PROGRAMS. i CENTERS FOR DISEASE CONTROL Center for Health Promotion and Education Atlanta, Georgia 30333 This handbook contains measures which have not yet been subjected to empirical verification. A subsequent project to validate the measures for use in health education programs is planned. Crv.2/ Ze¥ A HANDBOOK TO EVALUATE 2 BL PHYSICAL FITNESS PROGRAMS Prepared for THE CENTER FOR HEALTH PROMOTION AND EDUCATION CENTERS FOR DISEASE CONTROL in conjunction with THE OFFICE OF DISEASE PREVENTION AND HEALTH PROMOTION OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH DEPARTMENT OF HEALTH AND HUMAN SERVICES by I0OX ASSESSMENT ASSOCIATES Culver City, California 90230 Contract No. 200-81-0622 (Project Officers: Walter J. Gunn, Diane R. Orenstein, Donald C. Iverson, and Patricia D. Mullen) TABLE OF CONTENTS PREFACE A Capsule History of the Handbook's Creation The Handbook's Contents Acknowledgment of Contributors CHAPTER ONE: PROGRAM EVALUATION CONSIDERATIONS FOR HEALTH EDUCATORS Focusing the Evaluation Conducting Evaluation Studies Evaluation Design Options Selecting Appropriate Measures Sampling Considerations for Data Collection When to Administer Measures Data Analysis Reporting Results Linking Measurement and Program Design CHAPTER TWO: A DESCRIPTION OF THE HANDBOOK'S MEASURES Newly Developed Measures Other Indicators of Effects Existing Measures Test Specifications CHAPTER THREE: USING THE HANDBOOK'S MEASURES Selecting Evaluation Measures Administration Procedures Scoring Missing Data Interpreting Responses Enriching Evaluations Using Unproven Measures CHAPTER FOUR: PHYSICAL FITNESS PROGRAM OUTCOMES CHAPTER FIVE: NEWLY DEVELOPED MEASURES Behavioral Questionnaire Weekly Activities Index Knowledge Tests Facts About Exercise Exercise Facts Designing an Exercise Program Injury Prevention Avoiding Injury Page 11 20 25 27 30 33 34 38 43 45 46 47 47 48 49 50 53 55 56 59 65 67 70 74 77 81 85 Skill Tests Selecting an Exercise Program 89 Preventing and Caring for Injuries 99 Exercising Safely 106 Decision-Making 111 Systematic Decision-Making 122 Making Decisions 139 Make A Decision 146 Affective Inventories Effects of Exercise 153 Exercise and People 157 Exercising Regularly 161 Exercise Survey 165 Ideas About Systematic Decision-Making 168 Ideas About Decisions 172 Would You Use Systematic Decision-Making? 175 Would You Make Careful Decisions? 179 My Body : 182 CHAPTER SIX: EXISTING MEASURES 185 Behavioral Questionnaires Canada Fitness Survey - Physical Activities 186 Questionnaire on Exercise 191 University of Pennsylvania Alumni Health Questionnaire 193 Physical Activity Monitor 197 Seven Day Physical Activity Recall 199 Measuring the Body's Energy Needs 212 Knowledge Tests AAHPER Cooperative Physical Education Tests 213 Skill Test Standardized Test of Fitness (STF) 214 Affective Inventories Marten's Physical Education Attitude Scale 245 Exercise Questionnaire 251 Health Attitudes 253 CHAPTER SEVEN: TEST SPECIFICATIONS 259 Behavioral Measures 260 Knowledge Measures 264 Skill Measures 310 Affective Measures 352 ANNOTATED EVALUATION BIBLIOGRAPHY 375 INDEX OF HANDBOOK MEASURES 385 PREFACE In recent years health educators have increasingly recog- nized that systematic evaluation can help them appraise and improve their programs. For this potential to be realized, however, effective mechanisms for gathering relevant data are required. Until now, there have been instances where critical information about a program's effects has not been collected because of a lack of suitable measures for gauging program effects. The purpose of this handbook is to rectify, at least in part, this deficiency in the evaluation of physical fitness and exercise programs. This book is one of seven health education evaluation handbooks resulting from a project initiated by the United States Centers for Disease Control (CDC) in 1980.* The hand- book is not intended to be prescriptive or all-inclusive. Those who evaluate exercise programs should regard the hand- book only as a resource, that is, a collection of assessment tools which may be of use. The extent to which the handbook is actually useful depends, in large part, on the extent to which it contains materials that correspond to the evaluation needs of a particular health education program. A CAPSULE HISTORY OF THE HANDBOOK'S CREATION This handbook has been created by an external contract- ing agency, selected competitively on the basis of responses to a CDC-issued request for proposals. The contractor was to collect and develop evaluation measures for critical behav- ioral, knowledge, skill, and affective outcomes in the area of exercise and physical fitness. A panel of experts guided the contractor in determining which outcomes were important enough to exercise health education programs to require assessment devices. Three members of the panel were subject matter specialists who were selected on the basis of sugges- tions from prominent national associations with a primary mission in exercise. These nominations were screened to * The seven handbooks focus on the areas of alcohol and substance abuse, diabetes, exercise, immunization, nutrition, emoking, and stress management. Information regarding the handbooke is available from the Centers for Disease Control. ensure a panel with a balanced view of the field. So, for example, at least one of the subject matter experts repre- sented a national association and at least one possessed direct community level experience in administering local health education programs in exercise. In addition to these subject matter experts, a health education generalist selected from nominees suggested by national health education associations served on the panel. Two specialists in evaluation and testing, one of whom was a member of the contractor's staff, also served on the expert panel. Additional subject matter experts representing interested national associations were also invited to serve as panelists. The names and affiliations of the exercise panelists are provided at the end of the Preface. The expert panel met for two days at the beginning of the project in order to isolate the primary outcomes which exercise health education programs could be expected to promote. Preliminary statements reflecting these outcomes were suggested, then prioritized by the subject matter and health education panelists. The evaluation and testing specialists did not participate in this setting of priorities. The preliminary outcome statements selected by the panel were refined by the contractor's staff, then mailed to panelists and other interested individuals and organizations, all of whom rated the importance of each statement. The prioritized list of outcomes that resulted was used to guide the selection and development of the handbook's measures. All newly developed measures, along with the test speci- fications used to prepare them, were mailed to the panelists for review. In addition, many of the new measures were tried out with small groups of respondents. The new measures were revised based on the informal tryouts and the panelists’ review comments. All of the new measures were also reviewed by the contractor's staff in an effort to eliminate any potential sex, race, religious, or socioeconomic bias. While the new measures were being developed, a compre- hensive literature search was conducted to locate existing measures which might match the panel-identified outcomes. These measures were carefully screened for their correspon- dence with the panel-identified outcomes. All measures which matched one or more outcomes were then reviewed to ensure that they possessed no major technical flaws which would make them unsuitable for program evaluation. Whenever there was substantial duplication among existing measures, the measure with the strongest supporting psychometric data, or the measure that was clearest and easiest to use, was chosen. All existing measures which passed both the content screening and the subsequent reviews are included in this handbook. THE HANDBOOK'S CONTENTS The handbook's various sections are described below. CHAPTER ONE: PROGRAM EVALUATION CONSIDERATIONS FOR HEALTH EDUCATORS — a review of key fundamentals of systematic evaluation as applied to health education programs. CHAPTER TWO: A DESCRIPTION OF THE HANDBOOK'S MEASURES - explanations of the handbook's four categories of measures, the relationships among these measurement categories, the rationale behind the types of measures developed for the project, and the procedures used to select existing measures. CHAPTER THREE: USING THE HANDBOOK'S MEASURES - guidelines for using the handbook's measures in program evaluation, including practical suggestions for the selec- tion, administration, and scoring of measures and alterna- tive ways of employing the handbook's resources. CHAPTER FOUR: PHYSICAL FITNESS PROGRAM OUTCOMES - the behavior, knowledge, skill, and affective outcomes upon which the handbook is based. CHAPTER FIVE: NEWLY DEVELOPED MEASURES — a collection of measures developed specifically for this project. (It must be stressed that these new measures have not yet been subjected to empirical verification, hence should be regarded as assessment devices whose technical qualities have not yet been verified.) CHAPTER SIX: EXISTING MEASURES — extant measures selected for their correspondence with the handbook's outcomes. CHAPTER SEVEN: TEST SPECIFICATIONS —- the rules and content information used to create the measures specifically developed for this handbook. ANNOTATED EVALUATION BIBLIOGRAPHY - an annotated listing of follow-up readings for handbook users who wish to deal at greater length with the topics developed in Chapters One through Three. INDEX OF HANDBOOK MEASURES - a list, by title, of all the measures contained in the handbook. ACKNOWLEDGMENT OF CONTRIBUTORS The following individuals served as panelists for this handbook: Sharon Dorfman Ash Hayes Division of Health Education The President's Council on Johns Hopkins University Physical Fitness and Sports William L. Haskell Washington, D.C. School of Medicine Stanford University Wells Hively Central Midwestern Regional Steven Havas Educational Laboratory Bureau of Health Promotion St. Louis, Missouri and Disease Prevention Connecticut Department of Ralph Paffenbarger Health School of Medicine Stanford University The project which resulted in the creation of this handbook was funded by the Centers for Disease Control in Atlanta, Georgia. The project was initiated by the Research and Evaluation Staff, Health Education Division, of the Center for Health Promotion and Education. Dr. Walter J. Gunn, chief of that group, conceptualized the project, set forth its specifications, and supplied technical guidance throughout its existence. The project was originally con- ceived during conversations between Dr. Gunn and Dr. Carol D'Onofrio of the University of California, Berkeley School of Public Health. Throughout the project, Dr. Gunn and Dr. Diane Orenstein of the Centers for Disease Control and Dr. Donald Iverson and Dr. Patricia Mullen, both formerly of the Office of Health Information and Promotion, Office of the Assistant Secretary for Health, Department of Health and Human Services, served as project officers. As the handbook progressed, numerous health educators offered their insights. Without their expert assistance and without the continuing technical counsel of the project's officers, development of this volume would have been impos- sible. The members of the staff of IOX Assessment Associates who participated in the handbook's development are Eloise Appel, Carol Bloomquist, Phyllis Jacobson, Rebecca Jaramillo, Elaine Lindheim, W, James Popham, Celia Rodrigo, Laurie Salah, and Elanna Yalow. Robin Harte and Cecilia Marcelino prepared the handbook text. CHAPTER ONE PROGRAM EVALUATION CONSIDERATIONS FOR HEALTH EDUCATORS In recent years, a variety of program evaluation strategies have received substantial attention. Many of these recommended approaches to evaluation have been formally designated as evaluation "models," that is, systematic con- ceptualizations of the step-by-step manner in which evalua- tions should proceed. Some approaches emphasize the effects of a program. Others focus on the quality of a program's procedures. Still others attend primarily to the costs associated with a program. Today's health educators will find the evaluation terrain well charted, although its borderlines often reflect advocacy rather than agreement. The purpose of this chapter, however, is not to promote a particular evaluation model for health education programs. Rather, it will focus on considerations central in any evaluation effort.* Sometimes a program evaluation will be conducted by an individual not affiliated with the program itself--an individual formally designated as a program evaluator. Far more frequently, an evaluation will be carried out by the program personnel who are actually operating the program. These health educators will simply change roles for a while, exchanging their program implementation respon- sibilities for program evaluation responsibilities. Thus, whenever we use the term "evaluator" in these introductory *In thie introductory chapter an attempt will be made to present a seriae of salient considerations related to the evaluation of health education programs. Clearly, it is impossible in a single chapter to discuss all evaluation topics with adequate depth. Hence, a set of references for further reading has been provided. This evaluation bibliography, which has been annotated to provide a general description of each volume's contents, can be found on pages 373-381. Throughout the handbook's early chapters, readers will be directed to various of these references for further information about the topics being discussed. De chapters, we mean to refer both to the evaluator specialist and to the program staff member serving as evaluator. One major theme runs throughout the sections that follow, namely, that evaluation is a process that can markedly enhance the effectiveness of health education pro- grams. Evaluation should not be conducted merely for the sake of evaluation. Instead, we evaluate in order to find out if programs are working and how to make them work better. When evaluation is used in this way, it can make a signifi- cant contribution to the physical and psychological well- being of health education program participants and the community at large. FOCUSING THE EVALUATION Effective evaluations improve decisions about programs. Anyone setting out to evaluate a health education program, therefore, should focus the evaluation on the decisions that are likely to be at issue. In order to determine what these decisions are, an evaluator needs to have a clear idea about the purpose(s) of the evaluation as well as a clear identi- fication of the individual(s) or group(s) who may use the evaluation's results. The nature of the program being evaluated makes a sub- stantial difference in an evaluation's focus. Some health education programs are carried out chiefly to develop and refine the program itself. We can refer to these programs as experimental programs, in the sense that they are programs of yet unproven effectiveness. Evaluations of experimental programs attempt to isolate effective programs or effective program components. Other health education programs, referred to as demonstration programs, offer proven approaches in an effort to secure support or adoption from a larger clientele. Such programs have two audiences, the program's participants and the individuals or groups whom the demon- stration is supposed to convince. When evaluating demonstra- tion programs, we want to determine whether a program has been disseminated with fidelity to its original conception and, if not, why. Finally, there are service programs, which use proven approaches to improve the health and well-being of designated target groups. In such programs, evaluation often takes the form of monitoring.* *For an extended consideration of these three types of programs, see Gunn, W. J. Suggested guidelines for evaluation of health education programe. A paper presented at the Fifth International Conference on Health Education, London, September, 1979. “B= In these three types of programs, evaluation activities will differ depending on the purpose of the evaluation, the type of health education program being evaluated, and the nature of the decision-makers for whom the evaluation is being conducted. But program evaluation is needed in all three kinds of programs. Too often program personnel avoid evaluation on the grounds that theirs is only a demonstration program and, hence, needs no systematic appraizal. Or, again, those carrying out a service program might fail to evaluate their efforts because, "after all, we are merely disseminating a proven methodology." In all cases, however, the issue is not whether to evaluate, but how. OBJECTIVES AND EVALUATION. Health education programs are designed to bring about worthwhile effects. Most health education programs, therefore, are organized around some form of program objectives. The more explicitly these objec- tives can be stated, the more useful they are in carrying out evaluations. Indeed, one consideration in conducting an evaluation is the extent to which a program's objectives have been achieved. It is for this reason that evaluators often work with program personnel to create objectives which clearly describe the desired post-program behaviors (includ- ing performance on measuring devices) of program participants. Too often program designers describe their objectives in such lofty and loose language that it is impossible, even after the program is over, to tell whether those objectives have been attained. There is substantially more to program evaluation, how- ever, than merely discerning whether a program's goals have been achieved. For example, there may be program effects which, although profound, were not anticipated in the pro- gram's stated objectives. In addition, there is the quality of the objectives themselves. Perhaps the program's goals are truly trivial. A skillful evaluator can profitably work with program personnel to improve the nature of their aspira- tions. Clarified and more defensible objectives can be a boon to both program personnel and evaluators. Some evaluators believe that a program evaluation must be carried out exclusively in relation to a set of specific behavioral objectives, that is, objectives stated in terms of participants' post-program behaviors. This is a par- ticularly limited notion of educational evaluation. Although in the late sixties and early seventies there were many who urged educators to organize their instruction around litanies of hyper-detailed behavioral objectives, these objectives failed to prove particularly useful in program evaluations. Specificity did not automatically yield utility. Instead, too many targets turned out to be no targets at all. More recent thinking regarding behavioral objectives suggests that program objectives, while still measurable, should embrace larger domains of outcomes. Today's health education programs, rather than being organized around 50 miniscule objectives, might be organized around a half-dozen or so more global, but measurable, targets. SUMMATIVE AND FORMATIVE FUNCTIONS. Since the expressions "formative evaluation" and "summative evaluation" were intro- duced over a decade ago, considerable attention has been given to the virtues of each type of evaluation. In the late sixties and early seventies, a good many evaluators were persuaded of the virtues of summative studies to provide a final judgment of a program's overall effectiveness. To their distress, however, it often turned out that definitive judgments about program effectiveness were difficult to achieve. Rarely did a summative evaluation settle conclu- sively whether a given program was sufficiently meritorious to make a go/no-go decision on the basis of that evaluation alone. More often than not, a host of complicating elements influenced the final decision far more than the results of an evaluation study. As a consequence, it became increasingly clear that there were many instances when formative evaluation studies might prove more useful. Formative evaluation is not end-of- the-line evaluation. Rather, it is an ongoing endeavor con- ducted as the program is designed, installed, and maintained. Whereas summative evaluation's mission is to provide a final judgment of a program's overall merit, formative evaluation's mission is, on a continuing basis, to bolster a program's quality. The effective formative evaluator func- tions less as an external judge and more as a collaborator, a member of the team whose task it is to monitor the program in order to improve its quality and the decisions regarding it. These two evaluative roles are not mutually exclusive. An evaluator's main task is to collect information that can be used to improve the decisions made about programs. Evalua- tion should identify the areas in which a health education program is having an impact, as well as those in which it is not. Effective components can then be retained; ineffec- tive components can be strengthened or dropped. The system- atic collection of information regarding health education programs can provide a solid data-base for the continuing refinement of such programs and for improvement in the general level of services provided. CONDUCTING EVALUATION STUDIES How can evaluations be conducted so as to achieve their maximum benefits? It is sometimes thought that pro- gram evaluations must include complicated and elaborate data- gathering designs in order to yield decisive and compelling data. This is simply not the case. Program personnel and evaluators should strive to conduct their studies and gather data in such a way that the ambiguity of results can be kept to a minimum. That is, evaluations must attempt to deter- mine whether a program works, what makes a program work, or what prevents it from working. Evaluation data-gathering designs serve as the means to this end by setting forth the procedures to be used in exploring the nature and impact of a program, The design we choose for an evaluation will deter- mine the inferences we can make about a program's over- all impact on participants and the effectiveness of its various components. To select the best designs for their investigations, evaluators must have a broad knowledge of the available design alternatives and the strengths and weaknesses associated with each. Evaluators must also work closely with program staff to determine which decision options can actually be illuminated by evaluation studies. The most sensible evaluation study for a given context can then be planned. RIGHTS OF HUMAN SUBJECTS. Health education programs are designed to improve individuals' health and well-being. When we evaluate those programs, therefore, we typically focus on their impact on human beings. Some evaluators, however, become so caught up with the importance of apprais- ing a health education program that they overlook the rights of the individuals being evaluated. Above all, an evaluator should be guided by a respect for human dignity, hence should not engage in evaluative activ- ities which in any way demean an individual's rights. Promi- nent among the principles that should guide evaluators is informed consent. The principle of informed consent requires that an evaluator secure, in advance of the study, agreement of all participants in an investigation. This consent is obtained after the potential participants have learned about the nature of the investigation, at least insofar as their participation is involved. This principle properly reflects the evaluator's concern for human dignity, because it rules out the possibility of making individuals serve, unknowingly, as subjects in an evaluation. — A key tenet in most ethical codes regarding human subjects insists on the confidentiality of all information gathered about participants during an evaluation. Because the evaluator is not concerned with an appraisal of indi- vidual participants but, rather, with the worth of health education programs, the principle of participant confiden- tiality usually poses no problems. Evaluators must be care- ful, however, to devise protective safeguards, such as anonymous completion of forms and careful handling of data, that ensure the confidentiality of the data.* INTERNAL AND EXTERNAL VALIDITY. Characteristically, an evaluation seeks to determine whether individuals have changed as a result of their participation in a program. Can observed changes in the status of participants be attri- buted to the program? Could other factors such as partici- pant maturation, familiarity with the measures used in the evaluation (testing), or external influences such as a mass media campaign (history), account for the observed changes? Such questions revolve around the internal validity of the evaluation, that is, the validity with which we can infer that the program caused the effects we find. Ideally the data-gathering design should help to rule out explanations, other than the program, for measured effects. Threats to internal validity weaken the ability to attribute observed effects to the program and not to other factors. Another important issue involves the external validity of evaluation studies. Can the findings from a specific evaluation be generalized to the next group of participants or to variations of the program (for example, to a similar health education program held in a different place or during the following year)? Could we expect the program to have the same impact in other settings or at other times? What would be its effects with different participants, modes of presentation, or program personnel? External validity focuses on the need to demonstrate that the observed pro- gram effects can be expected to occur under conditions other than those associated with the specific program being evaluated. If evaluations possess external validity, they can serve as more than tributes to successful programs or postmortems for unsuccessful ones. Such evaluations can provide useful information as program personnel look to the future. *For additional information about the righte of human subjecte and the ethics of evaluation, see Amnotated References Nos. 1, 21, and 30. 10 = It is important to distinguish between internal and external validity, for different information may be required to establish each one. A procedure that increases internal validity may weaken external validity. Experimental control, which enhances internal validity, must be weighed against feasibility and generalizability. Evaluators must try to balance the problems associated with threats to internal and external validity by selecting a data-gathering design that best addresses the information needs of the program and allocating evaluation resources accordingly. These prior- ities must come from the context of the program itself, because there are instances in which an evaluator should stress one type of validity rather than the other. Emphases on internal or external validity will vary as a function of the program decisions to be made.* EVALUATION DESIGN OPTIONS The key to selecting an appropriate evaluation design is to pick the one that best deals with the needs of those involved with a program, such as the program's staff, partici- pants, or funding agency. In some instances, health edu- cators may be interested in the effects of the particular program that they are providing: "Will participants exercise regularly after attending this program?" In other instances, health educators may be trying to develop model programs that can be disseminated locally or even nationally: "Can we develop a program that will help individuals exercise regularly, whether they are teenagers in Duluth, working mothers in Tampa, or retired business executives in New Haven?" An evaluator would have to design very different studies in order to answer these fundamentally different questions. As indicated earlier, health educators must design each study so that it serves the specific purposes of that evaluation. There is no such thing as a general- purpose evaluation. By understanding a few basic principles, evaluators can select designs well suited to their needs and, perhaps more importantly, determine the limitations of whatever design they implement. No evaluation can be perfect. Every evaluation leaves some questions unanswered. Evaluators need to be clear regarding what they have learned about a program and the degree of certainty associated with their findings, then convey this information to other interested audiences. *For additional information about internal and external validity issues, see Annotated References Nos. 6, 9, and 10. = Low To illustrate some of the major considerations in selecting data-gathering designs, consider a six-month health education program aimed at modifying Behavior X. If partici- pants' status on Behavior X were measured at the close of the program, we could represent that situation schematically as follows: PROGRAM —P MEASUREMENT If this were the design employed, what could you tell about the program's impact on participants' behaviors? Using such a design, how confident would you be that the participants’ reported behavior changes were attributable to the program? It would be difficult, with confidence, to attribute any change in behaviors to the health education program. The program, indeed, may have been totally ineffectual, and participants' post-program behaviors might be identical to those they possessed before the program. The measurement process might be detecting behavioral patterns that partici- pants brought to the program, not those that were affected by the program. Because we have no measure of behaviors prior to the program, we can't distinguish between preexist- ing behaviors and program effects. Hence, with this data- gathering design, it may be impossible to determine whether the program had any impact on participants. But even with such a basic data-gathering design it may be possible to secure meaningful program evaluation data. Suppose, for example, that a health education program is promoting a knowledge outcome so advanced that most indi- viduals would not be familiar with its content. In such a setting one could assume that any post-program knowledge is attributable to the program's impact, because participants would probably not know the information without the program. It might not be worth the resources necessary to demonstrate conclusively that participants began the program unfamiliar with the outcome's content. ~12< This example illustrates the chief mission of data- gathering designs, namely, to rule out plausible rival hypotheses, other than the program's impact, that might account for the post-program status of participants. If there is reason to believe that participants' pre-program status may account for their post-program status, then a data-gathering design should be selected which permits the evaluator to rule out that rival hypothesis. Now suppose that, in order to avoid the major short- coming of the previous design, we measure participants’ behavior both before and after a health education program. We could represent that design as follows: MEASUREMENT —J» PROGRAM —JP> MEASUREMENT Let's assume that the result was a substantial shift toward more desirable behaviors between the initial and the final measurement. Could this change in behaviors be ascribed to the program? We cannot be sure. There are many other factors that may have led to the observed change in behaviors. For example, there may have been a significant event, an event totally unrelated to the program, which influenced participants' behaviors. If the program were designed for children, they may have matured during the time of the program. Thus it may have been increased maturity rather than the program which caused the altered behaviors. The program itself may have contributed nothing to the shift of behaviors. Such threats to the evaluation's internal validity decrease our ability to draw defensible conclusions about the program's impact. But, as was true with the earlier design, if there are no plausible rival hypotheses for explaining posttest results, the design is sufficient for the task at hand. In fact, many formative evaluations feature such simple yet service- able pretest-posttest designs involving only one group of participants.* ANote that thie design requires measurement before as well as after a program. This points to a commonly accepted but often overlooked principle of effective evaluation. Evaluation ie moet effective when it 18 initiated at the beginning of a program, often prior to the pro- gram's formal inception. If evaluators are not called in until the end of a program, they sometimes serve as little more than test proctors. “13 We can eliminate some of the more common rival explana- tory hypotheses by using data-gathering designs in which we employ comparison or control groups. The use of a control group (untreated individuals) or comparison group (individuals receiving a different program) requires two groups assumed to be equivalent before the program on all related variables. Only one of the groups is given the target program. This can be illustrated as follows: GROUP 1: MEASUREMENT —— PROGRAM —3p MEASUREMENT GROUP 2: MEASUREMENT —————————p MEASUREMENT In this design, as we see, a control group (Group 2) is assessed before and after the program, but never receives the program itself. Assuming that the groups were comparable before the program, if the program participants' pre-to-post behaviors change, and the control group's pre-to-post behaviors remain the same, we can be more confident that the program caused the change. There are, however, some disadvantages to this design. It may be that the initial measurement was reactive. A reactive measurement is one which by itself, or in combina- tion with the program, influences participants' behavior. Attitude inventories and self-report questionnaires about behavioral practices are often reactive. For example, a questionnaire administered before the program might alert participants to a desired behavior, hence influence their performance on the second measurement. Furthermore, measure- ment is expensive, and measuring control groups can waste valuable evaluation resources. Time and money can often be better spent in order to study the program being evaluated rather than to study a no-treatment control group of little interest. (The merits of comparative designs will be described later.) Health educators should not ritualistic- ally employ control groups in their designs if the questions at issue can be answered without their use. There are situations in which health educators may wish to appraise the effects of their programs on the basis of -14- periodic measurements, such as routinely administered ques- tionnaires or the kinds of archival data one often finds recorded in health agencies. For instance, suppose we were evaluating a "parent health awareness" program and were inter- ested in the number of checkups parents sought for their children. Assuming that such information were available from physicians in a county's health department, the eval- uator might use a time-series design. In a time-series design we measure at periodic intervals both before and after the program. By observing the pattern of measurements prior to and following the program we can discover if the program had any effect. To clarify, Figure 1.1 presents three illustrative time- series data patterns of six periodic measurements (M, through M.) taken every two months over a 10-month period. x six- week-long health education program is offered midway in the time series, that is, immediately following Measurement A A bn en rt 0 -0 Cc eo -@ @ My —s Mpg — M3 —up My —s M5 — Mg PROGRAM FIGURE 1.1 THREE DATA PATTERNS FROM A TIME-SERIES DESIGN -15- Sanjer Three (M,) and just before Measurement Number Four Note that the difference between My and M, (that is, HN gots before and after the program) 34s idefitical in Jon three data patterns. Yet in data patterns A and B we would be reluctant to attribute the M, to M growth to the program's effects. In pattern A therd are donsistent incre- ments over the entire 10-month period, not just the period associated with the program. In pattern B the increments and decrements fluctuate too much. Only in data pattern Cc could we make the attribution of program effects with some confidence. Although the data analysis procedures associated with time-series designs are fairly complicated, it is often possible to discern program effects merely from inspec- tions of patterns in plotted data such as those shown in Figure 1.1. In using time-series designs to evaluate programs, health educators must be particularly attentive to the possible impact of an event, external to the program, that may have influenced the observed data patterns. For in- stance, referring back to Figure 1.1, suppose that a widely publicized national outbreak of influenza had occurred at the same time as the "parent health awareness" program. Suppose also that parents were being urged by the media to seek checkups for their children. Then the growth pattern observed in pattern C might be more associated with that event's effects than with the health education program's effects. This is another illustration of a threat to a study's internal validity. A time-series design, though often used with archival data, can be employed with any sort of periodically gathered data such as routinely administered attitude inventories. A time-series design can be used to evaluate one program at a time or to evaluate several programs simultaneously. For example, suppose the three data patterns seen in Figure 1.1 were data associated with simultaneously offered programs. In this instance, the program yielding data pattern C would be the only one resulting in detectable effects. Evaluators using time-series designs should be certain to have a reasonable number of measurement opportunities over an extended time period. Such a design should not be employed unless there are enough data points so that clear data patterns are detectable. RANDOMIZATION. In the designs we have discussed thus far, the focus has been on evaluating one program with one group of participants. This may be the situation for many -16- health educators who are only interested in considering the specific program they are providing. But suppose, as we described earlier, you are interested in the general effec- tiveness of a program which will serve as a model to be implemented in a variety of settings, with different types of participants. How would you design such a study? One technique that can prove useful in such settings is randomization. We select or assign things randomly when we do so in a nonsystematic manner, such as by using a table of random numbers (found in most statistics texts). One application of randomization is randomized selection of subjects. This sort of randomization is particularly impor- tant when we wish to generalize from the results of a study to a larger population. When the participants taking part in the program to be evaluated have been selected at random from a larger population of potential participants, then we can be reasonably confident that those involved in the eval- uation will be representative of that larger population. There is less likelihood that the participants being studied in the evaluation are atypical, making it inappropriate to generalize the evaluation's results to the population at large. Randomized selection of subjects may also be useful when there are more applicants than vacancies for a program or when not all potential clients can be served. Another use of randomization arises when we determine which of several programs individuals are to receive. If we want to compare the effects of different programs, then we want participants in each program to be as equivalent as possible. To this end, we can employ a randomized assignment procedure whereby we randomly place individuals in the pro- grams to be compared. The two procedures of randomized selection and random- ized assignment are illustrated in Figure 1.2 on the next page. Note that we randomly select participants from the pool of potential participants, then randomly assign those individuals selected to either Program A or Program B. LT RANDOMIZED RANDOMIZED SELECTION ASSIGNMENT l }: ip an Ti « |PROGRAM ES =| Xx i X TT Hr" | x = Xx PROGRAM POTENTIAL PARTICIPANTS ACTUAL PARTICIPANTS PARTICIPANTS ASSIGNED TO PROGRAMS FIGURE 1.2 RANDOMIZED SELECTION OF PARTICIPANTS FROM POOL OF POTENTIAL PARTICIPANTS AND RANDOMIZED ASSIGNMENT OF PARTICIPANTS TO PROGRAMS Use of randomization techniques does not necessarily create equivalent groups. For example, if we were to ran- domly distribute 100 potential participants in a health edu- cation program into a treatment and a no-treatment group, it is still possible that one of the groups would end up with individuals who, when pretested, turn out to be signifi- cantly different in relation to characteristics of interest than those in the other group. In such instances evaluators must rely on statistical procedures in an effort to compen- sate for such disparities. In most instances, however, use of randomization will create groups of sufficient equivalence that such statistical adjustments are not needed. In practice, program personnel often may not have the luxury of constituting groups via randomized selection or assignment. There are, in fact, situations where program personnel would not want to use such procedures. When random- ization is not used, it is especially important to collect ~18= and examine descriptive data carefully, to determine where preexisting differences occur and to consider the ways in which they may influence outcome data. Even if randomization is impossible, attempts to constitute comparison groups with individuals as equivalent as possible can help minimize the influence of preexisting participant differences.* COMPARATIVE DESIGNS. Comparative designs offer another approach to collecting meaningful data. Comparative designs arise because of the basic function of evaluators, namely, to aid decision-makers. Decision-makers ordinarily make selections among alternative courses of action. Ideally, if a decision-maker is choosing between several optioans, the evaluator should supply evidence as to the merits of each one. For this reason, it is often less sensible to include an untreated control group in an evaluation than to include comparison groups representing the various options under consideration. For example, suppose that a program developer for a health education project were choosing between lectures and independent study as two ways of presenting program content. If possible, the evaluator would consult the research litera- ture regarding the probable virtues of each option. There- after, a study could be designed in which variations of both strategies were tried out for a reasonable period of time in order to compare the relative effectiveness of each one. In this situation there would be little reason to employ an untreated control group, because it is unlikely that a no- treatment option would be chosen by the program staff. In summary, the data-gathering designs treated in this chapter have been relatively simple. There are a number of far more complex designs than we have considered. Although program evaluators sometimes become so entranced with com- plicated data-gathering designs that they apply them when- ever carrying out an evaluation study, evaluations often do not need complex designs. In fact, such designs should be adopted only when needed to eradicate threats to internal or external validity. There are many instances in program evaluation when simple data-gathering designs are sufficient. The utility of simple designs is particularly apparent in formative studies when evaluators are looking for rapid-turnaround *For additional information about randomization, see Annotated References Nog. 6 and 19. -19- data to guide program personnel in making upcoming program decisions. In such settings the evaluator needs to assemble timely decision-relevant information. The use of complex data-gathering designs in such circumstances often repre- sents a squandering of evaluation resources and program time. Program evaluators also are often so concerned about detecting the effects of programs that they fail to consider the costs needed for the programs to produce those effects. Yet decision-makers need guidance regarding not only the results they can expect from a program, but also the finan- cial resources required to achieve those results. For this reason program evaluators should consider the relative costs of programs. To illustrate, how much does it cost Program A to produce a given result in relation to Program B's costs to produce comparable results? Judgments about a program's impact in the absence of considerations about its costs are potentially superficial.* SELECTING APPROPRIATE MEASURES Although there are various approaches to program evalua- tion, almost all share one common feature, namely, the acquisition of systematic evidence regarding a program's effects. To secure evidence of program effects, we usually employ measurement instruments. But some instruments are far more suitable for assessing a program's effects than others. CRITERION-REFERENCED MEASUREMENT. For more than a decade, educational measurement specialists have directed their attention toward an emerging form of assessment known as criterion-referenced measurement. In comparison to norm- referenced measurement, which attempts to ascertain exam- inees' status in relation to other examinees, criterion- referenced measurement attempts to ascertain examinees’ status in relation to a clearly defined set of behaviors. In fact, it is because the status of examinees can be inter- preted according to a clearly defined domain of criterion behaviors that we say a measure is "referenced" to those criterion behaviors, hence classified as a criterion-refer- enced measure. It is important to recognize that the word "criterion," as it is used in the phrase "criterion-referenced measurement," does not refer to a level of examinee perform- *Por additional information about various evaluation design options, gee Annotated References Nos. 6, 10, and 17. -20- ance. The level of performance we expect from examinees is a separate issue. The essence of a criterion-referenced instrument is the clarity with which its accompanying descriptive materials explain that which is being measured. Because norm-referenced instruments emphasize relative comparisons among examinees, they often do not need to provide a clear description of exactly what it is they are assessing. In contrast, criterion- referenced instruments are absolute measures, designed to determine exactly what it is that examinees can or cannot do without reference to the performance of other examinees. Thus, criterion-referenced tests must provide an unequivocal description of what they are measuring. It is this clarity regarding the attributes being assessed that renders criterion-referenced measures ideal for program evaluation. Consistent with the spirit of provid- ing useful information for decision-makers, criterion-refer- enced instruments describe the precise nature of what is being measured. Hence, when criterion-referenced measures are used in a program evaluation, decision-makers can readily interpret the evidence being supplied. The best way to determine what a particular criterion- referenced instrument measures is by reading the test speci- fications that are used to create the items on that measure. Test specifications identify the particular rules and content used in constructing a measure and in so doing operation- alize the attributes being assessed. As with any assessment strategy, there are varying degrees of quality in criterion-referenced measures. Not every instrument described as "criterion-referenced" truly deserves that label. Evaluators of health education programs, therefore, should become knowledgeable regarding the charac- teristics of high quality criterion-referenced measures. Several of those characteristics are described in the sections that follow. The single most important element of a properly con- structed criterion-referenced instrument is that it ade- quately describes the attributes it claims to measure. Such clarified descriptions, contained in the test specifications, may take a variety of forms. Irrespective of the particular form employed, in reading the descriptive information asso- ciated with a criterion-referenced instrument, it must be possible to discern unambiguously what is being measured. The test specifications contained in Chapter Seven provide an example of the level of descriptive rigor required by criterion-referenced tests. 3 Historically, many measures have attempted to cover vast arrays of content. The net effect of this broad coverage has often been that those attempting to use the results from such instruments become overwhelmed by the number of dif- ferent attributes being assessed. A properly constructed criterion-referenced instrument will focus on a manageable number of dimensions. As a consequence, program personnel can direct their efforts toward those dimensions. Evaluators can describe program effects along those dimensions. A criterion-referenced instrument that attempts to measure 10 or 20 different outcomes, for example, would likely prove less useful to program personnel and evaluators than an instrument that measures only one significant attribute. In some instances, particularly for diagnostic purposes, it may be helpful to design an instrument that assesses the major subdimensions of a more general attribute. Even in such cases, however, the guiding rule should be to employ only a manageable number of categories. In order for a measure to yield suitable information about examinees' status regarding a given attribute, it is often useful to provide multiple instances for examinees to display that attribute. Hence, criterion-referenced measures should provide a reasonable number of test items for each attribute measured. It is rarely sufficient to measure other than behavioral attributes with only one or two test items. In some cases, a handful of test items per measured attribute or its subdimensions can aid the evaluator in gaining rough estimates of certain program effects. But, generally speak- ing, at least five to ten items per attribute constitute a minimum for measuring most significant health outcomes.* RELIABILITY. All instruments used for evaluation must measure what they are measuring with consistency. The con- sistency with which an instrument measures is known as its reliability. To illustrate, suppose a 30-question know- ledge test is administered on a given day, then re-adminis- tered to the same examinees five days later with no interven- ing instruction. If the test is reliable, examinees should receive essentially the same scores on both testing occa- sions. If the test, when re-administered, yields substan- tially different examinee scores, we know that the test is not measuring with consistency, thus, is unreliable. There are several different indices which can be com- puted to reflect an instrument's reliability (for example, test-retest or equivalent-forms reliability coefficients). *Por additional information about the nature and development of eriterion-referenced measures, see Annovared References Nos. 4, 18, and 27. “DD The kind of reliability data needed to appraise a measure for possible use in an evaluation study should be consistent with the way the measure will be used in that study. If a measure is to be used on a test-retest basis, for example, then information about that type of reliability is germane. Reliability coefficients generally range from 0 to 1.0, with coefficients of .80 or higher indicating highly reliable measures. Although space limitations preclude a more com- plete discussion of reliability, evaluators should become conversant with this key attribute of properly constructed tests. At this point, it must suffice to alert program evaluators to the importance of securing evidence regarding the reliability of any measure used in an evaluation.* VALIDITY. A critical attribute of a properly constructed measure is that it be valid. An instrument is valid if it measures what it purports to measure. To illustrate, in the health field we often use self-report measures as a way of finding out about individuals' "real life" behaviors. If our self-report inventories are valid, then those measures will secure responses that are accurate indicators of the way respondents actually behave. To the extent that responses on the self-report measures do not coincide with respondents’ actual behaviors, then the measures are invalid. There are several varieties of validity studies, each yielding somewhat different but conceptually related evi- dence about a measure. For example, a need for one type of validity arises when we want to use self-report measures as proxies for physiologic measures. In order to establish this type of validity, we use self-report questionnaires to elicit an account of participants' health behaviors, then attempt to correlate the questionnaire responses with the results of physiologic tests that reveal something about people's actual behavior. If the questionnaire data do, in fact, correlate substantially with the physiologic measures, then the questionnaire is, at least to some extent, validated. Another type of validity must be demonstrated when we want to use measures as predictors of some subsequent cri- terion behavior, such as when we hope that responses to an affective inventory gauging individuals' intentions to engage in particular health behaviors will actually predict those later behaviors. If the affective measure does, in *For additional information about determining the reliability of measur ing instruments, see Annotated References Nos. 2, 15, and 27. 25 fact, correlate substantially with subsequent observations of the health behavior, then evidence of the measure's validity has been obtained.* ABSENCE OF BIAS. In the past decade we have become aware of the distressing truth that many educational assess- ment devices contain items which are biased against particular subgroups such as ethnic minorities or women. An example of a biased test item would be a knowledge question which, because of peculiarities in its content or wording, is harder for lower-income examinees to understand and answer cor- rectly. Test items that use content and terminology apt to be known only by the affluent would certainly.be biased against the less economically advantaged. Another type of bias that can adversely influence exam- inees' performances arises when test items are offensive to particular groups of individuals. For example, if test items include content that is seen to be derisive to women or to members of particular ethnic groups, then examinees from those groups are not apt to perform at their best on such items. Their agitation over the offensive content may interfere with their responses to the items. In a sense, of course, bias is present in measuring instruments whenever a particular group of individuals is disadvantaged or advantaged by the test. If, for example, poor Black Americans are disadvantaged by a particular test, then it is likely that affluent White Americans are advan- taged by that same test. Test developers must be sure that their instruments do not unfairly advantage any (or all) of the individuals to whom they are administered. A properly developed measure should include no biased items. There are now available both judgmental and empirical techniques for detecting the presence of such items. These approaches should be used to determine the degree of bias in a measure's items, ** In reviewing the various dimensions of properly con- structed measures, it is important to note that any given * For additional information about determining the validity of measuring instruments, see Annotated References Nos. 2, 15, and 27. *4Pop additional information about methods for avoiding test bias, see Annotated References Nos. 5 and 25. D4 instrument may not possess all these qualities. Often one must choose among measures that embody some but not all desired elements. The important point is that merely because a measure is labeled in a particular way, for example, as criterion-referenced or as non-biased, does not indicate that it is of sufficient quality to be used with satisfac- tion in evaluating a health education program. Further scrutiny of all aspects of the measure's quality is mandatory. SAMPLING CONSIDERATIONS FOR DATA COLLECTION If evaluators are not attentive, the data-gathering requirements of evaluation can become a burdensome intrusion into ongoing programs. Accordingly, evaluators should restrict their data-gathering forays to the least intrusive form possible. One way to minimize an evaluation's intrusive- ness is through sampling techniques. PERSON-SAMPLING. To estimate how a large group of people would respond on a particular measure, it is not necessary to administer that instrument to all the individuals in the group. Instead, we can sample individuals from the group by selecting either a simple random sample or a random sample stratified on the basis of program-relevant factors such as age, sex, and socioeconomic status. Assuming that the sample is correctly drawn, we can estimate the status of the total group based on the responses of this sample. In the type of sampling described above, we select representative samples of people to represent a larger population. Suppose, for example, that we want to use a measure to determine program effects. Assuming a reasonably large number of program participants, say 50 or so, we could randomly select half of the participants and administer the measure to this group only. In essence, this approach allows us to infer how the total group of participants would score on the measure although only half of the participants com- pleted it. We could thus estimate how the total group of participants would have responded, yet halve the amount of participant time required for data-gathering. In a similar sampling procedure, we could administer two or more measures at once. Suppose that two measures, Inventory X and Inventory Y, are to be given to program parti- cipants. We can randomly assign one half of the participants -25- to one measure and one half to the other. While each parti- cipant needs to respond to one measure only, we can still derive a defensible estimate of how all the participants would have responded to both instruments. ITEM SAMPLING. In addition to sampling persons, as in the previous examples, it is also possible to sample items so that different sets of items from a program evaluation measure are randomly selected to be administered to different persons.* In such an approach we give each participant only a sample of the items for which we want to obtain evaluation data. For example, suppose a program evaluator wishes to administer a 40-item test. Given, say, 60 participants in the program, the evaluator could divide the test into four sets of 10 items each and administer each set of 10 items to 15 participants. By having the four groups of 15 partici- pants each complete a different set of 10 items, the total group's performance can be estimated. This approach allows the data-gathering to be carried out in one-fourth the time that it would have taken to administer the total 40-item test to all participants. SAMPLE SIZE. Given the relatively small numbers of participants in some health education programs, is it really appropriate to sample either persons or items? How large must groups be before sampling procedures can be sensibly used? Although an unequivocal answer to this question would be desirable, such a definitive answer does not exist. Some texts on sampling do provide rules of thumb for estimating the size of samples needed for detecting group differences in relation to the magnitude of differences sought and the nature of the groups being sampled. At best though, these are rough estimates. It is important to recognize that the task of identifying a sufficiently large sample is more diffi- cult than usually thought. Intuitively, we may recognize that when we start with a very small group of program participants, the use of sam- pling is risky. For instance, if there were only 15 partici- pants in a program, few health educators would try to split *A measure, such as the measures found in thie handbook, generally con- sists of a group of items, such as questions on a test or statements om an attitude inventory. -26- these participants into three groups of five each for purposes of taking different tests. Even though each group represents one-third of the total population, there is too much likelihood that a sample of five individuals does not properly represent the total group. The variability of participants' anticipated perform- ance on the measures is the primary influence on the sample size necessary. The following example illustrates the effect of population variability on sample size. If a man's socks were all stored in a drawer, yet there were only black and brown pairs, he wouldn't need to draw out too many pairs until he had a reasonably good idea of the charac- teristics of the total population of socks in his drawer. But suppose he had socks in 10 different colors. Then he would most likely have to take out many more pairs until he could reach an accurate estimate of the colors of socks in the drawer. In much the same way, if it is expected that participants' scores on a test will be relatively homo- genous, a smaller number of respondents will be needed than if participants' scores are expected to vary widely. By employing any of these sampling procedures, an eval- uator is focusing on a group of participants in the aggre- gate. Because evaluations are typically concerned with the effects of programs on groups of participants, sampling pro- cedures are usually appropriate. If, however, program per- sonnel need individual data on all examinees on all measures, then sampling is not appropriate.* WHEN TO ADMINISTER MEASURES Decisions regarding when to administer measures depend on the data-gathering design selected. Conceivably, there are five temporal periods during which it may be useful to obtain information on participants, and there may also be reasons for repeated measurement during some of these periods. These periods are depicted in Figure 1.3 on the next page. *For additional information about sampling procedures, see Annotated References Nos. 7 and 8. -27- IMMEDIATE POSTTESTS PARTICIPANT SELECTION TESTS DELAYED POSTTESTS / / | ab oy al &- A PROGRAM FIGURE 1.3 POSSIBLE MEASUREMENT TIMES IN PROGRAM EVALUATION STUDIES PARTICIPANT SELECTION TESTS. The first time in a pro- gram that it might be useful to obtain information would be prior to the selection of participants. Some programs may have more applicants than program openings. Perhaps there are multiple variations of a program, and different participants are to be assigned to different variations. In such cases it may be useful to have information to help in participant selection. One may want to select those individuals most in need of the program, or those with the most (or least) perceived ability to attain the behavioral change sought in the program. In any event, information at this juncture may help the selection process become more effective than it might otherwise be. PRETESTS. Often it is useful to have information about participants immediately prior to their starting the pro- gram. Such information, often referred to as pretest data, may be used to identify participant weaknesses so that -28- instruction can be targeted directly to those areas rather than emphasizing things that participants already know. Such data may also be used as a baseline, in conjunction with data collected at the end of a program, to determine the impact of the program. If participant data have already been collected at the selection stage, it might be unneces- sary to re-administer measures unless it has been a long time since the initial administration, or unless there are reasons to expect a change in participants' performance. EN ROUTE TESTS. Measures can also be administered during a program to secure a current reading on the status of par- ticipants. Such en route data can then be used to redirect program resources during the program itself. One or more en route measurements can provide program personnel with ongoing status-checks on participants' progress. Such measurement may be even more useful than tests administered at the end of a program, for it provides information while there is still time to act on it. POSTTESTS. Measures can be administered directly follow- ing a program. The posttest data they yield may be compared to pretest data in order to provide an estimate of the changes in participants as a result of the program. Participants’ posttest performances can also be contrasted with scores from participants in other programs. Posttest data may also be used by themselves as a measure of the absolute status of participants. Data from delayed or follow-up posttests (for example, tests administered one year after a program's conclusion) are often equally if not more important than immediate post- test data in evaluating a program. Far too frequently, data collection efforts are limited to those times when measure- ment is most convenient. Ultimately, however, health edu- cators may be more interested in effecting long-term behav- ioral, affective, and cognitive changes. It is sometimes difficult to infer such long-term changes on the basis of information gathered solely at the end of a program. Hence, some follow-up measurement, perhaps repeated, is usually warranted. Clearly, it is not sensibles to administer all measures at all time periods. Evaluators, in collaboration with pro- gram personnel and other interested parties, need to select an evaluation design that focuses on the most appropriate times for gathering data. Just as it is desirable to avoid -29- administering an overwhelming number of different measures, it is also necessary to avoid an overwhelming number of admin- istrations. It may be useful to administer certain measures (for example, a behavioral measure) on a continuing basis, while others might be administered far less frequently. Decisions about when to administer measures should be guided by common sense, attentiveness to participants’ rights and feelings, the efficient use of resources, and any conven- tional expectations such as when a delayed posttest is ordinarily given. DATA ANALYSIS A frequent question asked of an evaluator is whether a study's results are statistically significant. Could a program's observed effects have occurred merely because of the particular sample used in the study? Are the differences so small that they might have occurred simply by chance? Statistical tests are used to answer these questions. In order to do so, these tests make certain assumptions about the data being analyzed. LEVELS OF MEASUREMENT, To illustrate the kinds of assump- tions that statisticians make about the data they analyze, we can consider levels of measurement scales. Statisticians draw distinctions among various levels of measurement, that is, nominal, ordinal, interval, and ratio scales. Nominal scales classify information into categories without any implied order. For instance, when we categorize individuals as males or females, we are using a nominal scale. An ordinal scale ranks information in a particular order, such as when we might rank a number of individuals according to their overall healthiness. An interval scale is one which assumes that there are equal intervals between points on a scale. To illustrate, the 10-point difference between scores of 43 and 53 on a 100-item test would be considered identical to the 10-point difference between scores of 67 and 77. A ratio scale is an interval scale for which a zero point exists, such as a weight or height scale, where there is a true zero. When we select statistical techniques, it is important to match those techniques to the type of data being analyzed. For example, in analyzing nominal data one must use statis- tical techniques specifically designed for such situations. Chi square, for instance, is one of several frequently «30 employed nonparametric techniques used for analyzing nominal data. Other nonparametric techniques are used to analyze ordinal data. A chi square test can be used to compare the actual frequencies in two or more nominal categories with the frequencies which might be expected by mere chance. Chi square, however, would not be a wise choice for analysis of ordinal or interval data because nonparametric tests often fail to use all of the available information, hence are frequently less powerful than more appropriate alternatives. Thus, one must be certain that the assumptions associated with particular statistical techniques have been satisfied. The statistical procedures to be discussed below are ones that are used primarily with interval and ratio data, that is, data from scales with equal intervals between points. Such procedures are known as parametric tests. Cognitive tests are almost always assumed to be interval scales. Affective scales, although not necessary interval scales, are also often analyzed using parametric procedures, under the dual assumptions that the points on the scale reflect equal increments of a characteristic and that data analyses are only slightly distorted if this first assump- tion is violated. Thus, knowledge, skill, and affective measures are frequently analyzed using the following proce- dures. BASIC STATISTICAL PROCEDURES, One of the most basic parametric procedures used is a t test. A t test assesses the significance of the difference between two independent means. (Recall that a mean is the arithmetic average of a group of scores, computed by summing all the scores in a group, then dividing this total by the number of scores in the group.) Suppose, for example, that an evaluation were conducted to compare the effectiveness of two health educa- tion programs, and that a knowledge measure were administered to a sample of participants at the conclusion of each program. A t test could be used to compare the mean posttest scores of those two programs to determine if observed differences were statistically significant. If three or more programs were compared in this way, an analysis of variance (ANOVA) would be used. Two other techniques, gain scores and analysis of covariance (ANCOVA), are frequently used (and, unfortunately, frequently misused) when both pre-program and posttest data are available for participants in one or more programs. Both techniques use pre-program information in an attempt to compensate for initial group differences between participants in different programs. So, for example, if an evaluator " were interested in determining the degree of attitudinal or cognitive change in participants as a result of a progran, the evaluator might compute a gain score (posttest score minus pretest score) as a measure of change. However, dangers associated with the use of gain scores are well documented, and such scores should not be used without considering the ways in which they may be misleading. ANCOVA is frequently used when an evaluator wishes to compare the mean differences between two or more programs on a posttest measure (as in ANOVA), but recognizes that there may have been preexisting differences among the groups, as identified by a difference in mean pretest scores or in demographics among groups. ANCOVA compares posttest means after adjusting the posttest scores for these preexist- ing differences. Unfortunately, however, if these differ- ences are systematic and not a function of random differences among groups, ANCOVA does not provide an adequate method for equating the groups. Hence, evaluators and program personnel need to use caution when conducting such an analysis or interpreting results from it.* As an evaluator becomes more conversant with the pur- poses sought by various statistical analysis procedures, it is possible to consider those purposes in relation to the levels of measurement (e.g., ordinal) required of each proce- dure. Many statistics texts have already done this and pro- vide easily used tables that indicate, for a given level of measurement, the statistical technique that should be used for a particular analytic purpose. To illustrate, if an evaluator wanted to analyze nominal data to see if there were differences between groups, then such a table would indicate that a chi square analysis was appropriate. Pro- gram evaluators who carry out frequent data analyses will find such purpose-by-measurement-level tables to be helpful guides. Another choice-point faced in the analysis of data concerns the appropriate unit of analysis, that is, the level at which data can defensibly be analyzed. Most people are familiar with analysis procedures in which the individual participant is the unit of analysis. Yet, there are instances *There are numerous computer packages and programmable calculators that conduct statistical procedures for users. Evaluators will make their data analysis efforts easier and more efficient if they anticipate the likely procedures and facilities to be used for analyzing their data, ‘then collect data in the manner most compatible with their analysis plan and the available computer software. -32- in which the unit of analysis should not be the individual participant but, rather, a group of participants. The guid- ing principle in selecting an appropriate unit of analysis is that one should choose the smallest independent unit to analyze. To illustrate, suppose a health education program involved the use of peer-support discussion groups of 10-12 people each in order to encourage adoption of a given health- related behavior. The individuals in each group would surely interact during discussions, hence not be independent. There- fore, it would not be appropriate to use the individual par- ticipant as the unit of analysis. Rather, each group's average score should be taken as the unit to be analyzed, because the group would be the smallest independent unit capable of being analyzed. In conclusion, statistical tests only help us detect statistical significance; they do not help us determine whether an observed difference has practical significance. A small difference between the average scores of two groups can be statistically significant, particularly when large numbers of participants are involved, yet be of no practical consequence whatever. Health educators will need to make sensible determinations regarding whether the magnitude of an observed difference, even though statistically signifi- cant, is sufficiently important to warrant action. In other words, although evaluators of health education programs should often carry out statistical significance tests, they should not be unduly swayed by the results of such analyses. Common sense must always be applied in interpreting the meaning of a statistically significant result.* REPORTING RESULTS Reporting the results of an evaluation study is a more difficult undertaking than is usually recognized. Evaluators must report their results to decision-makers in a timely fashion. It does no good to receive an evaluation report three weeks after key program decisions had to be made. Evaluators must also be careful to disseminate their studies to all appropriate audiences. If possible, an evaluator should circulate the preliminary draft of a program evalua- tion report to program personnel so that they can react to its accuracy and objectivity. Aor additional information about data analysis, see Annotated References Nos. 13, 19, 28, 33, and 35. -33- The decision-makers whom evaluators are assisting may have little experience with quantitative data. As a con- sequence, complicated statistical presentations may be of little value to them. Evaluators should select data-presenta- tion procedures that will match the technical sophistication of the decision-makers involved. In any evaluation report, there is nothing wrong with simple graphs or "percentage correct" tables. If Program 2 participants outperformed Program Q participants by 15 per- cent, then a bar graph representing that difference is a readily understood technique for communicating Program 2 participants' advantage. (In the creation of such graphic presentations, be certain that the form of the graph accu- rately represents the data being depicted.) The more intui- tively comprehensible the data presentation techniques, the better. Program evaluators should provide straightforward presentations of data, without fearing that such approaches will be regarded as too elementary. Adequate technical back- up can be appended elsewhere. Evaluators should not be reluctant to make speculations based upon their hunches about a program, so long as these conjectures are identified as such. Similarly, if any of the evaluation's findings are equivocal, then the evaluator should advise concerned audiences of this. Honesty and objectivity are the hallmarks of effective evaluation report- ing. In addition, because decision-makers are typically busy, evaluators should strive for reasonable brevity in their reports, The preparation of executive summaries to accompany lengthy reports is a useful practice. The whole thrust of the evaluation enterprise is to sharpen the decisions that are made. Decision-making will not be illuminated by incomprehensible presentations. The quality of decision-making can be enhanced only if an evalua- tion's results are reported in a way that can be clearly understood. * LINKING MEASUREMENT AND PROGRAM DESIGN As was explained earlier, criterion-referenced measures can be particularly useful in health education evaluations #Por additional information about reporting the resulte of an evaluation, see Annotated References Nos. 21 and 26. -34-~ because their test specifications provide clear descriptions of what is being assessed. Those descriptions can also be particularly useful to program designers and program eval- uators who attempt to create programs that focus on promot- ing certain attributes. To illustrate, one powerful instruc- tional principle for promoting skills involves providing learners with adequate "time-on-task." By giving individuals sufficient time-on-task, that is, sufficient opportunity to practice the skills sought, as those skills are described . in the test's specifications, learners can more readily attain those skills. The more clearly the skills being measured are explicated, the easier it is for program designers to organize instruction that is congruent with those skills and, thus, the greater the likelihood that program participants will acquire those skills. A health education program's designers should become intimately familiar with an intended measure's test specifications before they com- plete the design of their program. Clearly described measures can become powerful catalysts to effective program design. Ideally, the measures used to evaluate a program will have been deliberately constructed so that they not only assess important outcomes, but also so that they assess them in such a way that those outcomes can be promoted more effectively. Part of the challenge in evaluating health education programs is to select criterion-referenced measures which are not merely end-of-program gauges of effects. Instead, measures should be selected which function pro- actively to guide program designers and program evaluators as they attempt to improve the program's quality. -35- “30~ CHAPTER TWO A DESCRIPTION OF THE HANDBOOK'S MEASURES This handbook contains a number of program evaluation measures. These are measuring instruments which may be employed in the evaluation of physical fitness and exercise programs. Many of these measures have been specifically developed for this project, while others have been selected from existing measures because of their correspondence with the handbook's outcomes. For the newly developed measuring instruments, one form of a measure is typically provided for use with adults and older adolescents. Where appropriate, a simplified version of that measure designed for elementary grade children is also provided. The reader is once more reminded that the technical adequacy, that is, the reli- ability and validity, of the newly developed measures has not yet been established. In this chapter the nature of the handbook's measures is briefly described. Several types of measurement strategies not included in the handbook are also discussed. There are numerous ways of classifying measuring devices. Sometimes, for example, tests are distinguished according to the way in which an examinee's responses are scored. To illustrate, we often refer to multiple-choice or true-false tests as objectively scored measures. We refer to essay examinations as subjectively scored tests. Measuring devices, however, can also be categorized according to the type of examinee behavior that they are designed to elicit. One of the most commonly employed schemes for classifying measures is the three-category divi- sion of cognitive, affective, and psychomotor behaviors. A cognitive measure focuses on an examinee's intellectual behaviors. An affective measure deals with attitudes, interests, and predispositions. A psychomotor measure gauges proficiency in performing small or large muscle skills, =37 = NEWLY DEVELOPED MEASURES The classification system used to develop and cate- gorize the measures contained in this handbook is based upon four categories of outcomes considered of interest to health educators. These four categories are (1) behaviors, (2) knowledge, (3) skills, and (4) affect. It is generally held that individuals' behaviors are influenced by their knowledge, skills, and affective dispositions. Consonant with that view, when the expert panelists suggested outcomes for which measures were to be included in the handbook, they first identified potential behavioral outcomes, then attempted to isolate the knowledge, skill, and affective outcomes that would contribute to each one. Let's look more closely now at each of the four types of measures included in this handbook. BEHAVIORAL MEASURES. Measures for behavioral outcomes attempt to assess the typical behavior of individuals under normal circumstances, such as whether or not individuals exercise regularly. Most health education programs strive to bring about lasting behavior changes in program parti- cipants, hence are ultimately focused on the promotion of behavioral outcomes. For example, a program designed to encourage individuals to exercise regularly is less con- cerned with participants' end-of-program scores on a test about the effects of exercise than with participants' actual exercise patterns well after the program has ended. There are several commonly employed data-gathering pro- cedures used to secure information about individuals' behav- iors. We can observe peoples’ actual behavior (observation), physically monitor that behavior (physiologic indicators), or ask them to tell us about that behavior (self-report). Evaluators are sometimes intuitively drawn to the virtues of observational approaches because, after all, "if we observe a behavior of interest, then we can be certain that the behavior actually took place." But, intuition aside, there are substantial difficulties with the use of observational techniques in assessing the impact of health education programs. For one thing, it is difficult and often costly to train observers so that they observe the behavior of interest with accuracy and consistency. More importantly, however, in most health settings we are inter- ested in human behaviors that occur at various and unpredict- «38 able times over an extended period. Often these behaviors occur in private. Not only would the cost of paying for continuous observations be staggering, but it is clearly impractical (and, possibly, unethical) to observe individuals on an around-the-clock basis. It is possible to employ physiologic measurements in order to make inferences about the nature of some health- related behaviors. A laboratory analysis of a person's blood composition can, for instance, reveal whether that individual has been consuming alcohol. Similarly, other physiologic tests can be used to detect traces of nicotine in the body, allowing reasonable conclusions to be made about an individual's smoking behavior. In many instances the cost of using such physiologic measures may make their use prohibitive for the conduct of routine program evaluations. However, when conducting "high stakes" evaluations of major impact programs, or when it is relatively easy to administer physiologic measures, evaluators will certainly wish to con- sider using such measures in lieu of, or in addition to, self-report or observational techniques. As with observational techniques and physiologic measures, there are definite problems associated with the use of self-report measures to identify individuals’ behaviors. Not the least of these problems is the possi- bility that individuals will distort their responses so that these responses do not reflect actual behavior. Yet, on balance, the use of self-report measures often offers eval- uators the best practical method of securing meaningful evidence about the actual behaviors of participants. In light of these practical considerations, therefore, the handbook's newly developed behavioral measures are all of the self-report variety. A number of recent studies suggest that self-report assessment devices can be effectively employed as supplements to physiologic measures.* KNOWLEDGE MEASURES. Most health education programs have a great deal of factual information to transmit to partici- pants. The evaluator's task is to employ measurement devices which can effectively assess participants' recall of this information. Most such tests consist of objectively scored paper-and-pencil measures of one sort or another. 4See, for example, Petitti, D.B., Priedman, G.D., & Kahn, W. Accuracy of information on smoking habits provided on self-adminigtered research questionnaires. American Journal of Public Health, 1981, 711, 308-311. «30 Knowledge tests typically pose questions related to a body of factual information. There is often substantial ambiguity, however, regarding the information that will be tested. Suppose, for example, that an instructor in a physical fitness program knows only that there will be a post- test dealing with injury prevention. There is no way for this instructor to anticipate the enormous variety of test items which could be written regarding injuries. To the extent that the program's quality is being judged, at least in part, by participants' performances on the posttest, the program's evaluation is at the mercy of the test writer. No one except the test writer knows for sure what is to be tested. To counteract the difficulties arising from an unspeci- fied body of eligible test content, all of the knowledge measures specially developed for this handbook are based directly on a series of statements that present the important factual information related to the outcome being tested. All of these statements are listed in content supplements that accompany the test specifications used to develop the test items. These content supplements, which may be of par- ticular interest to program personnel, appear in Chapter Seven, as a part of each knowledge measure's test specifica- tions. The test specifications also explain how these state- ments can be used to create test items. As a result of this careful explication of content, a program's instructional staff and its evaluator can be certain of the universe of content upon which each knowledge test is based. All of the handbook's newly developed measures consist of binary-choice True/False items. One advantage of using this type of test item is that, as explained above, a com- plete list of all the content eligible for testing can be compiled. An additional advantage of this approach to the assessment of knowledge is that, if a program includes indi- viduals with limited reading skills, the items can be read aloud to participants with little increase in the necessary testing time. Reading aloud a series of multiple-choice or matching items would be far more cumbersome. It is sometimes feared that the results of a binary- choice test may reflect mere chance rather than what examinees actually know, simply because examinees can correctly guess answers at a 50 percent rate. Although guessing can play a major role with one or two True/False items, with longer tests the odds of guessing one's way toward success are slight indeed. For example, there is one chance in four that an examinee could correctly guess answers on two binary- choice items. To guess ten out of ten such items correctly, =H Om however, the odds shrink to less than one in 1,000. By using binary-choice tests that contain a sufficient number of items, for instance tests with 20 or more items, we substan- tially reduce the likelihood that guessing will so influence an examinee's test score that we will not secure a reasonable estimate of that examinee's knowledge. Because examinees will always be able to guess some items correctly on a binary-choice test, program personnel should not become too jubilant over scores that are slightly above the 50 percent correct expected by chance alone. With reasonably long binary-choice tests, however, there usually will be more than enough variability in examinee performance to detect differences in the effectiveness of programs. SKILL MEASURES. Program outcomes dealing with skills call for participants to apply knowledge, not merely recall it. The attributes assessed in the handbook's newly developed skill measures are all higher order cognitive skills. An individual's ability to select an appropriate exercise pro- gram is an example of the type of skill for which the hand- book provides measures. These skill measures emphasize the use of higher order cognitive processes to make choices in a variety of simulated real-life settings. All of the choices focus on health- related courses of action that an individual might pursue. Application, not recollection, has been sought in the hand- book's skill measures, requiring examinees to demonstrate skills in settings approximating those they would encounter in real life. In many instances the skill measures build directly on the knowledge measure(s) associated with related outcomes, It should be noted that observational techniques can often be used to assess participants' mastery of cognitive or performance skills, particularly if the observations are made while the program is in progress or immediately at its conclusion when participants are still readily accessible. Observation-based skill measures, however, are not provided in the handbook. AFFECTIVE MEASURES. Affective outcomes refer to the variety of noncognitive variables, such as attitudes, interests, and values, which are thought to predispose indi- viduals to act in a particular manner. For example, an individual's positive attitude toward the effectiveness of regular exercise is though to incline that individual to exercise regularly. f° Ty Although it is possible to infer the nature of an indi- vidual's affective status from observations of that person's behavior, the most common technique for assessing affect uses self-report inventories. A self-report affective inventory can be constructed to require either (1) modest inferences to interpret the scores or (2) substantial infer- ences to interpret the meaning of the scores. We refer to the former as low-inference self-report measures, and to the latter as high-inference self-report measures. Low-inference self-report measures typically present respondents with a series of straightforward questions or statements, such as those asking for the degree of agreement with positive and negative statements about regular exercise. Responses to such measures can be readily interpreted if respondents are telling the truth. To heighten the likeli- hood of securing truthful responses, those completing affec- tive measures are often directed to return them anonymously. High-inference self-report measures are typically designed to be less apparent in what they are attempting to measure. To illustrate, if a relationship had been found between individuals' outlook on life and their exercise patterns, we might ask people about their outlook on life in order to get at their attitudes regarding exercise. The virtue of high-inference measures is that, because their purpose is masked, it is difficult for respondents to pro- vide dishonest responses or to respond in the direction deemed desirable. On the other hand, in order to interpret the results from high-inference measures, we often must make quite tenuous inferential leaps. The less obvious the purpose of the items, the less likely that individuals will respond untruthfully, but the greater the required inference. Because of the interpretation risks associated with high-inference assessment schemes, all newly-developed measures of affect in the handbook employ low-inference strategies. These self-report affective inventories some- times rely on Likert-type scales wherein respondents register varying degrees of agreement with statements about exercise. In other instances, respondents are asked to esti- mate whether or not they would behave in a certain way (such as exercise regularly), then are asked to indicate the degree of confidence which they have in each estimate. GENERIC MEASURES. This handbook contains not only measures designed to match outcomes specifically identified by the exercise expert panel, but also several measures - 2 deemed appropriate for a variety of health education pro- grams. These generic measures assess skill and affective outcomes of potential relevance to the specific behaviors being sought in exercise. The handbook's generic measures correspond to the outcomes of Decision-Making and Respect for One's Body. RELATIONSHIPS AMONG OUTCOME MEASURES. In general, it is assumed that a person's knowledge, affect, and skills contribute directly to that individual's behavior. And because most health education programs are ultimately inter- ested in modifying participants' behaviors, the acquisition of appropriate knowledge, affect, and skills can be seen as precursive to the attainment of desired behavior. This notion of outcomes that precede desired behaviors can be used in evaluating health education programs that have not succeeded in achieving desired behavioral changes. In such programs it is often possible to detect shortcomings in the promotion of en route outcomes dealing with knowledge, skills, or affect. The experts who determined the outcomes for this hand- book were asked to suggest physical fitness outcomes deal- ing with behaviors, knowledge, skills, and affect. The panelists were sometimes able to rely on empirical studies relating, for example, behavior to skills. In many instances, however, the links among the four categories of outcomes were posited chiefly on the basis of experience-based judg- ments. Thus, a causal or highly associational network among the four categories of measures should not be assumed to have been demonstrated. Rather, the relationships among the various types of outcomes should be regarded as reflecting the informed judgments of experts. OTHER INDICATORS OF EFFECTS As indicated earlier, this handbook does not contain observational assessment techniques although it does contain a physiologic measure of fitness, in the existing measures section. The previously described behavioral, knowledge, skill and affective categories of measures certainly do not exhaust the range of possible assessment tools that evaluators should consider when they undertake an evaluation. There are other sorts of extant data and more complex assessment strategies which can be helpful. As an example of the kind of existing data that eval- uators often find useful, we can think of the numerous -43- archival records of relevance to health behavior, for example, records of doctor's visits or the incidence of heart disease. Such archival data can often prove illuminating in making decisions about health education programs. Evaluators must attempt to locate existing records of phenomena that pertain to the decisions under consideration. To illustrate the kinds of more elaborate assessment strategies which might be used, we will briefly describe one technique designed to secure responses to sensitive ques- tions. The randomized response technique (RRT) is an effec- tive technique for obtaining accurate information from respondents on a small number of highly sensitive issues such as the use of illegal drugs or alcohol. By presenting respondents with both a sensitive and a nonsensitive ques- tion, and by having respondents themselves use a random procedure (such as a coin flip) to select the "to be answered" question, respondents are expected to answer the sensitive question honestly because the interviewer cannot know which question is actually being answered. An example of the non- sensitive question might be, "Have you attended a PTA meeting at school during the past 12 months?" The sensitive question might ask, "Have you used heroin during the past 12 months?" An accurate estimate of the number of people responding "yes" to the sensitive question (for example, the number of people reporting heroin use) can then be computed by subtracting the likely proportion of "yes" responses to the nonsensitive question. * Another strategy for gaining information about sensi- tive topics involves the use of respondents as "informants" who report information about relatives, friends, etc. Often these reports can be made so that the individual about whom the report is made remains anonymous. This procedure, described as the multiplicity technique by some and the nominative technique by others, is described in more detailed elsewhere. ** * For additional information about the randomized response technique, see Annotated Reference No. 39. *4pighborne, P. Survey techniques for studying threatening topics: A case study in the use of heroin. Unpublished doctoral dissertation, New York University, 1980. EXISTING MEASURES In addition to the development of new measures to coincide with high priority outcomes, an extensive effort was made to identify existing high quality measures which corresponded to these outcomes. This effort included a comprehensive computer search of seven data bases and reviews of measures, books, and articles recommended by panelists and panel-identified experts. The computer search was conducted at the UCLA Bio- medical Library using the following data bases: the Medline, ERIC (Educational Resources Information Center), Psychologi- cal Abstracts, Excerpta Medica, NIMH (National Institute of Mental Health), NCMH (National Clearinghouse for Mental Health), and SSIE (Smithsonian Science Information Exchange). In addition to input from the project panelists, area-specific experts and agencies identified during the project were sent summaries of the panel meeting accompanied by a letter request- ing assistance in the effort to locate existing measures and relevant publications. Once collected, all measures were subjected to an initial content screening by an experienced reviewer. The purpose of this screening was to determine whether a measure corresponded to the panel-identified outcomes. Measures which satisfied the outcome-congruence screening were then subjected to a further psychometric review. Prior to initiat- ing the review of a measure's psychometric quality, however, the authors or agencies who developed the measure were contacted and asked for any available supporting documenta- tion about the instrument. In addition to being given an overview of the purpose of the project, authors were informed of the criteria to be used in the psychometric review so that they might supply relevant data. The primary criterion for a measure's inclusion in this handbook was its degree of congruence with panel-identified outcomes. Several measures of high quality had to be excluded because they did not possess sufficient correspondence with the outcomes to be of use to evaluators interested in assessing those outcomes. There are, in fact, several hand- book outcomes for which no previously developed measures have been included, primarily because existing measures targeted to those outcomes could not be found. When multiple measures with adequate correspondence to given outcomes were found, the measures included in the handbook were selected on the basis of their item quality and the extent to which the set of measures selected for an outcome represented a range of approaches to the measurement of that outcome. -45- TEST SPECIFICATIONS A set of test specifications was created to guide in the construction of each measure developed for the handbook. As indicated in the first chapter, this set of specifications operationalizes the outcome statement for which the measure serves as an indicator. The test specifications for all newly developed measures are presented in Chapter Seven. Evaluators and program personnel should find the test specifications quite useful, as the specifications present, in unequivocal terms, the attributes being measured. This clarification of what is assessed should permit program personnel and evaluators to target their efforts to the pro- gram outcome as operationalized by the set of specifications. While the measures can be employed without referring to the specifications, handbook users will be markedly benefited by studying the set of specifications for each measure selected. Program personnel, in particular, may want to consult the content supplements and the descriptions asso- ciated with many of the measures when planning their programs. The test specifications also permit program personnel to generate additional test items, if they desire, by follow- ing the rules for item construction which have been set forth. Additional test items for knowledge and skill out- comes may be particularly useful during the course of a pro- gram as instructional tools and to monitor participant progress. Evaluators should realize, however, that any new measures created from the test specifications will not necessarily be equivalent forms, that is, forms equal in difficulty and other psychometric aspects to the form of the measure presented in the handbook. Performance information on both the original form and any alternate forms would have to be gathered before the equivalence of such measures could be demonstrated. Therefore, evaluators should be reluctant to use alternate forms as though they are equivalent, for example, in a pretest-posttest design. To reiterate, then, Chapters Five, Six, and Seven, respectively, contain the newly developed measures, the existing measures, and the specifications for the newly developed measures. All of the outcomes upon which these measures are based are presented in Chapter Four. Each chapter is introduced with a brief description of its con- tents. Chapter Three offers suggestions for using the hand- book's measures in program evaluation. i CHAPTER THREE USING THE HANDBOOK'S MEASURES SELECTING EVALUATION MEASURES The measures selected for a program evaluation should correspond, as closely as possible, to outcomes of interest and importance to program personnel or other decision-makers associated with the program (for example, the program's sponsoring agency). In some cases the measures may corres- pond directly to program goals. Other measures may be selected because they correspond to outcomes of ancillary interest. For example, if a program were focused on modify- ing participants' health behaviors, it might be of interest to see if attitudinal changes also resulted. The desire to have a broad understanding of the impact of the program, potentially across all four areas for which this handbook presents measures, must be balanced with the need to avoid unnecessary use of program or evaluation resources. There are likely to be many interesting questions to ask about a program. But answering those questions requires the time and money of the program and the time of program participants. Because personnel and financial resources are limited, and also because participants may come to resent what they consider to be unnecessary intru- sions, measures should be selected carefully. An emphasis should be placed on using those measures that are likely to have implications for improving the program in the future. One way to use the handbook and its measures is to deter- mine the extent to which the outcome statements in Chapter Four coincide with a program's stated objectives. Measures for those outcomes can then be considered as possible assess- ment devices for gauging the attainment of program objec- tives. . Another way to use the handbook is to consider its measures as reflecting possible outcomes that might be promoted by programs. As indicated earlier, program designers can create more effective programs if they comprehend clearly the nature of the targets at which the program is aimed. Although the measures included in this handbook are far from exhaustive, and certainly not prescriptive in any sense, they do represent a range of possible program aspirations. Furthermore, the measures are based on outcomes deemed important by a panel of experts well acquainted with programs in exercise and physical fitness. By reviewing all of the measures in the handbook, at least by reading each measure's accompanying description, program designers and program evaluators can increase the range of options they may wish to consider as potential pro- gram outcomes. All of the handbook's measures have been prepared for copying and reproduction by health educators. Handbook users may use all the measures without further permission from any authors or agencies. ADMINISTRATION PROCEDURES Evaluators need not develop special directions in order to administer the measures presented in this handbook. Directions are provided with each measure, informing respon- dents how to supply the requested information. Test adminis- trators should be sure to familiarize themselves with the directions and the measure itself before administering it. They can thus provide clear and accurate information to any requests for clarification by respondents. Test administrators, whether or not they are program personnel, should be sensitive to the potential difficulty some respondents may have in reading either the directions or the test items themselves, hence be available to assist respondents as needed. It may be useful, if there is concern about the reading ability of the respondents, to read the directions aloud and check that all respondents understand what they are to do. If there is doubt about respondents’ ability to read the measure itself, the items can generally be administered orally, either to groups of participants or to individuals. Respondents should bes encouraged to ask questions if they do not understand their task or any items on a measure. Bi As a related issue, the measures do not require respon- dents to supply their names. This helps ensure the confi- dentiality of responses to potentially sensitive issues. If program evaluators believe that the integrity of the data would not be compromised by asking respondents to provide their names or other personal or demographic information, such information may be requested. Alternatively, if eval- uators wish to link performance on one measure to perform- ance on another, every individual can be assigned a code number to use whenever providing data. Respondents may select their own identification code (for example, their mother's maiden name) if this would help alleviate fears about preserving confidentiality. When using codes, it is important that the same one be used on all measures. The use of anonymously completed measures illustrates a general concern associated with the administration of measures in a program evaluation context. Test administrators should strive to create conditions in which respondents are as comfortable as possible about supplying truthful answers. Too often program personnel may administer evaluation devices under conditions which create subtle pressures for partici- pants to respond in a manner satisfying to program staff. An effective evaluation, however, is based on honest responses, not socially desirable ones. Thus, all aspects of measure administration should be conducted with careful attention to the possible impact on participants' responses. For example, an external person rather than a member of the project staff could administer measures. Responses could be collected anonymously, then placed in sealed envelopes in plain view of all participants. Other such techniques might be devised in order to elicit honest responses. Additional considerations related to possible response bias will be discussed later in this chapter.* SCORING Scoring keys are provided for all newly developed knowledge, skill, and affective measures, as well as for all existing measures which had such information available. A more complete justification of the proposed scoring scheme associated with each newly developed affective measure is also presented in its corresponding test specifications. %Por additional information about administration procedures, see Annotated References Nos. 15 and 27. -49-~ As a general rule, knowledge and skill measures are scored by computing the total number of correct responses. Affective measures are scored by computing the average response for a given measure. This procedure for affective measures simplifies interpretation of the obtained score. For example, a respondent would obtain a score of 4.2 on a 5-point scale, rather than obtaining a score of, for example, 46 out of 55 points. The procedure also reduces confusion in dealing with omitted responses. On the newly developed measures, higher scores are better. That is, higher scores on the knowledge and skill measures indicate that the respondents answered more items correctly. Higher scores on the affective and behavioral measures indicate desirable affect or behavior. Items on some of the newly developed affective measures are categorized so that the different dimensions in the measure can be considered. Part scores as well as total scores can be computed to provide a more in-depth analysis of participants’ responses. Similarly, an analysis of incor- rect responses is provided for selected skill measures to assist program personnel in determining the kinds of incor- rect answers that were selected by examinees. The test speci- fications for these measures provide a complete explanation of the correct and incorrect answer categories. By consider- ing not only whether items were answered correctly, but also by looking for patterns in the incorrect responses and try- ing to infer why specific incorrect options were selected, health educators can often target their programs towards reducing common misconceptions. MISSING DATA One of the most frequent sources of confusion in scor- ing measures stems from the treatment of missing data. For purposes of this discussion we shall consider two types of missing data. The first type arises when a respondent does not answer certain items on a measure. The second type occurs when a respondent does not return a measure at all. OMITTED RESPONSES. Suppose a respondent omits one or more items on a measure. Should the evaluator infer that the respondent didn't read the item, didn't know the answer, or didn't understand the question? The way these concerns are treated depends on the type of measure (cognitive, -50- affective, or behavioral), the scoring procedures being used, and the judgment of the person responsible for data analysis. As a general guideline, one should try to treat omitted responses in a manner consonant with the most plausible assumptions about why they were omitted. A few examples may illustrate. Blanks or omitted responses are often treated as incorrect responses for cognitive measures (that is, those assessing knowledge and skill). Respondents' scores are then the sum of the correct responses, under the assumption that respon- dents would have marked an answer if they felt they knew it. If there are other more plausible assumptions about why a response was omitted, such as confusion about what the ques- tion was asking, evaluators might consider missing and incor- rect responses separately, thus creating a slight increase in the complexity of the analysis procedure. The best procedure for dealing with missing affective and behavioral responses should, again, be consistent with the general guideline of selecting the procedure that requires the fewest unsubstantiated assumptions about the missing responses. Consider the case in which respondents are asked to indicate the extent of their agreement with a series of statements on, for example, a 5-point Likert scale. Because a score on this measure is obtained by averaging the numerical values of the responses, omitted responses can usually be ignored, and a score computed based on the items for which there are responses. This assumes that the responses to the unanswered questions would be the same as the responses to the questions that were answered. A different approach may be used if this assumption seems unwarranted. For example, if all the items of a particular type are omitted, it may be unwise to assume that the answers to those items would be the same as the answers to all the other items. In this case, the entire measure may have to be excluded from the analysis. In affective measures which require respondents to esti- mate their confidence regarding a series of statements, pro- cedures similar to those just discussed for treating missing responses can be used. Hence, on affective measures respon- dents are typically not penalized as they are on cognitive measures for omitting responses. UNRETURNED MEASURES. The problem of how to deal with missing data when there are no responses for some partici- pants on selected measures is a more difficult one than the problem just addressed. That is, what can be done if, because the respondent either refused or was unavailable to -5]1- complete the measure, we have no data at all regarding a given participant's status on a given outcome? The answer to this question depends on the data-gathering design that is being used and on the most likely reasons that the measure was not obtained. One of the more frequent contexts in which this problem arises is when a pretest-posttest design is used. In this design, measures are administered to program participants prior to beginning the program and, again, at the conclusion of the program. Observed changes between pretest and posttest scores are attributed to the impact of the program. But suppose that some participants do not complete the program and, therefore, are unavailable to complete the posttest questionnaires. Differences between the participants' aver- age pretest scores and their average posttest scores may come from systematic differences between the individuals who took the pretest and the individuals who completed the pro- gram, hence took the posttest. For example, suppose that, even before a program began, some participants had strong intentions to behave in a healthful way. Others did not. Now, suppose that a large number of those respondents who did not intend to behave in a healthful way dropped out of the program. If we considered the posttest responses of those participants who remained in the program for its dura- tion, while also considering the pretest responses of all the original participants, we would find that the posttest scores indicated stronger intentions to behave in a healthful way. But such a shift in scores might not reflect the pro- gram's effect on participants' intentions. The shift might arise because a disproportionate number of respondents who did not intend to change their behavior had left the program. Thus, observed changes might be due to differences in respon- dent characteristics rather than program impact. To safeguard against this possibility, evaluators must be attentive to the characteristics of respondents, particu- larly when data from different points in time are compared. In the preceding example, it might be advisable to exclude the pretest data of those participants who did not provide posttest data, and to compute pretest and posttest means on the basis of those individuals for whom complete data exist. To do this would require using some unique and consistent identification code on all measures completed by each par- ticipant, so that one could know whose pretest responses should be excluded. If it is necessary to eliminate a par- ticular category of respondents from the analysis, evaluators should be aware of the limitations this imposes on the ability to generalize the findings from the remaining respon- dents to the broader group of eligible participants. This -52- means that in the example where a large number of partici- pants left the program, we should only describe the effects of the program on participants who already intend to make the desired behavioral change, not on any person who might consider enrolling in this particular health education program, The key issue in deciding what to do when individuals or groups of individuals fail to return some measures is to determine the extent to which the non-respondents differ in any systematic way from the respondents. Are non-respondents less motivated initially? Do they vary on any major demo- graphic variables, such as sex, ethnicity, or previous edu- cation? Are they more knowledgeable about the given health area than those who completed all the measures? If the answer to any of these questions is yes, then it is important not to compare all pretest responses with all posttest responses. If, however, there appear to be no systematic differences between those respondents for whom complete data are available and those who did not return all measures, then it may be acceptable to consider all available data. This might be the case if, for example, several partici- pants were sick on the day posttest measures were adminis- tered, but the absent respondents did not differ systematic- ally from the other participants. Thus, the degree of atten- tion to this type of missing data depends on the extent to which there is reason to suspect a systematic bias in the findings as a result of the missing information. At the very least, an evaluator should describe the characteristics of the participants who completed the measures at each administration period, so that those using the evaluation report can consider for themselves whether the assumptions guiding the treatment of missing data appear to be justified. INTERPRETING RESPONSES It would be comforting to assume that the data, once collected and analyzed, provide accurate accounts of the respondents' cognitive, affective, and behavioral status. Unfortunately, however, there are many instances in which one cannot be certain that the inferences made from the data are fully justified. For example, in the cognitive areas we assume that the more items correctly answered by an indi- vidual, the more that individual knows about the outcome being tested. But it is also possible that some respondents who are highly knowledgeable about the information being tested did not get high scores because they couldn't under- -53— stand some of the items or had a hard time reading the test. It is the test developer's responsibility to try to reduce such confusion by ensuring that the items are written as simply as possible and that there are no extraneous sources of difficulty. It is the test user's responsibility to remember that there will inevitably be the potential for some confusion, and to interpret the measures in light of this likelihood. The problem of interpreting responses is more apparent with affective and behavioral measures. It has been well documented that there are "response sets" or systematic sources of bias in responses to such measures. To illus- trate, one of the best known response sets involves social desirability, or the tendency of individuals to provide responses which are consistent with what they believe to be expected of them. So, for example, individuals might indi- cate that they intend to exercise regularly because they believe that it is "appropriate" for them to do so, rather than because they actually have that intention. There is little that one can do to preclude completely the possibility of such response sets. To reduce, at least somewhat, the likelihood of response sets, evaluators can (1) avoid language that clearly indicates the desired response, (2) preserve the anonymity of respondents, and (3) ensure respondents that the evaluation is more concerned with understanding the program than with describing individual participants. An atmosphere which promotes honesty rather than "proper behavior" is definitely more conducive to obtaining accurate responses in sensitive areas. Although the handbook's measures have been developed to encourage accurate responses, it is the responsibility of program personnel and evaluators to do all that they can to promote such responses and to minimize the threat of repercussions should individuals behave in undesirable ways. Guaranteeing anonymity is one common procedure, but estab- lishing credibility with respondents is also critical. In addition, observation, physiologic measurement, and proce- dures such as the randomized response technique may be used to verify the accuracy of behavioral self-reports. The problem is not as overwhelming as it may sound. Clearly, whenever one must rely on self-report data, the possibility of inaccurate responses exists. But careful measure development can reduce the degree of perceived threat in the measures and this can promote honesty. Furthermore, program personnel can help allay the anxiety of respondents and in so doing increase the honesty of responses. In addi- tion, the threat of corroboration by an external source can «5h often reduce the likelihood that respondents will bias their responses. Many data-gathering designs compare responses at one point in time to responses at another, or compare different groups of respondents to each other. In these comparative designs, whatever systematic bias there is may be found at all measurement times and, hence, may not influence indices of change. By being aware that such prob- lems may exist, those who use evaluation measures can encour- age caution in interpreting evaluation findings and urge verification of data where it is warranted. ENRICHING EVALUATIONS This handbook provides measures that may be useful in assessing a program's outcomes. Typically, a health edu- cator might select not merely one but several measures to use in a program evaluation. Multiple outcome measures can markedly enhance the quality of an evaluation. Although the outcomes measured in the handbook have been deemed important, they may not coincide directly with the outcomes of interest to any given program. And they certainly do not exhaust the issues that may be of interest to those individuals involved in a program. Program evaluators and personnel should not limit their data-gathering efforts to the measures provided in this handbook. Rather, they should supplement these measures with other strategies that address the particulars of the evaluation settings in which they find themselves. The emphases of any supplementary evaluation activities should coincide with the information needs and interests of those concerned with the program. Probably the most useful information elicits ways to enhance the effectiveness of the program, either as it has already been implemented or as it will be carried out in similar programs planned for the future. For example, questionnaires may be administered to program participants asking them to identify any follow-up support or information they might need. Participants might also be able to provide specific suggestions for improvement of the program should it be offered to others. It is impossible to isolate all the information that might be useful to gather for an evaluation. But the follow- ing point cannot be overstated: Evaluations should focus on the systematic collection of data that can be used to improve the quality of health education programs and, in -55= turn, the well-being of participants. Evaluation must increase the effectiveness of health education programs. It can only fulfill this promise if those guiding the evalua- tive efforts use their resources wisely. The measures that comprise the majority of this handbook should provide a solid foundation for effective evaluation efforts. But program personnel and evaluators in the field must structure evalua- tions to serve the needs of all those with a stake in the findings, and their professional insights are likely to be the best guide possible. USING UNPROVEN MEASURES In the remainder of this handbook there are numerous measures available for use by evaluators of health education programs. The measures developed specifically for this pro- ject, as well as some of the already existing measures included here, share one substantial shortcoming. They have not been subjected to rigorous empirical investigations to ascertain their psychometric qualities, especially their reliability and validity. When using such measures, how should program evaluators proceed? The answer is all too clear--with great caution. Although all of the measures included in the handbook were developed under close scrutiny, until there have been reliability and validity studies carried out which verify those measures' technical adequacy, they should be employed with substantial care. To illustrate, in the absence of reliability and validity data, one should be most reluctant to draw inferences about the meaningfulness of an individual's score on particular measures. In using measures for purposes of program evaluation, we often aggregate results for a group of participants rather than working with individual participant's responses. By using the pooled responses of many individuals, we can have more confidence in our results because anomalous scores will tend either to cancel each other out or be outweighed by the total set of responses. Even with such aggregated scores, however, care is warranted when using measures whose reliability and validity have not been empirically confirmed. -56- The general caveat regarding the use of measures which have not yet been subjected to empirical analysis is to pro- ceed very carefully in employing such assessment instru- ments. The new measures that are included in Chapter Five of the handbook have been developed employing a variety of internal and external review procedures to assure that their content and form are appropriate. Although one can have confidence that their development was systematic and thought- ful, there has been no opportunity to subject those measures to empirical verification. Such an appraisal of the new measures' technical adequacy is planned for the future. It is likely that the handbook's measures may be superior to the hastily created measures often seen in the evaluation of health education programs. Nonetheless, evaluators of health education programs should regard the handbook's measures as a resource to be used--but to be used with prudence. -57- -58- CHAPTER FOUR PHYSICAL FITNESS PROGRAM OUTCOMES The outcomes presented in this chapter are program evaluation goals identified by a panel of subject matter and health education experts selected as advisors for this project. The panelists identified one major behavioral out- come, maintenance of an acceptable activity level. Know- ledge, skill, and affective outcomes considered likely to predispose individuals to adopt this target behavior were also selected. The process by which these outcomes were isolated and prioritized is explained more completely in the handbook's Preface. This chapter's program outcome statements have guided the development of the rest of the handbook. Chapter Five presents newly developed measures designed to assess each outcome. Chapter Six contains existing measures selected for their congruence with the outcome statements. Chapter Seven consists of test specifications for all the newly developed measures. These specifications, in essence, operationalize the outcomes. The outcome statements that follow are relatively brief definitions of a particular behavior, knowledge, skill, or attitude considered important for physical fitness programs. The title of each outcome statement is used throughout the handbook to reference the measures corresponding to it. As a further aid to handbook users, the outcome statements presented in this chapter are accompanied by the titles of the measures that correspond to each. The target population for each measure is also noted. Handbook users can locate each measure for an outcome by turning to the page specified. -59- BEHAVIORAL OUTCOME MAINTENANCE OF AN ACCEPTABLE ACTIVITY LEVEL Individuals maintain a planned exercise program of continuous rhythmical motion using large muscle groups. Although the specific program may vary, it must require at least 60 per- cent of maximal cardiovascular capacity, for at least 20 minutes, three times a week. The program should also enhance muscular strength, muscular endurance and flexibility. Veeakly Activities Index « + us so os 50 5s » ss.» sv o'page Target population: Adults or Adolescents Canada Fitness Survey - Physical Activities . . . . page Target population: Adults or Adolescents Questionnaire on Exercise « « + « » ¢ o« » o « ¢ o + page Target population: Adults or Adolescents University of Pennsylvania Alumni Health Questionnaire ° . * ° ° . . . . ° . ° . ° ° . * ° ° page Target population: Adults or Adolescents Physical Activity MONLLOY oo sis site sin iniseiin siwspage Target population: Adults or Adolescents Seven Day Physical Activity Recall . . . . . « « « page Target population: Adults or Adolescents Measuring the Body's Energy Needs . » « « « « « « « page Target population: Adults or Adolescents KNOWLEDGE OUTCOMES EFFECTS OF EXERCISE Individuals can accurately recall information about the physiological, psychological, and sociological effects of exercise. ~B80- 67 186 191 193 197 199 212 Facts About EXercise . « o o o ¢ o so ¢ ¢ o o o Target population: Adults or Adolescents Exercise FACLE © o ov... iv .s wo aicn wu wu ‘ele ve» vile. w Dage 74 Target population: Elementary school children AAHPER Cooperative Physical Education Tests . . . . page 213 Target population: Elementary school children or Adolescents EXERCISE PROGRAM DESIGN Individuals can accurately recall information about the com- ponents of an exercise program and the factors relating to exercise activity selection and implementation. Designing an Exercise Program . « o « o « « « « o o page 77 Target population: Adults or Adolescents INJURY PREVENTION Individuals can accurately recall information about the nature of exercise-related health risks and the types of injury prevention strategies associated with cardiovascular, muscular/skeletal, and environmental problems. Injury Drevention + vie eis. aw wim winile sie. s ww + page 81 Target population: Adults or Adolescents Avoiding INJUry + sis’ s sw os sin es als. aie .v «is page 85 Target population: Elementary school children SKILL OUTCOMES FITNESS SELF-ASSESSMENT Individuals can conduct those activities associated with a fitness self-assessment. Such activities include selecting appropriate assessment procedures, using those procedures accurately, scoring and interpreting assessment results —Bl~ correctly, and determining the level at which to initiate an activity program based upon the results of the assessment. The areas to be measured in a self-assessment include pulse rate, height, weight, muscular strength, muscular endurance, and flexibility. Standardized Test of Fitness (STF) «+ +» + +s +s + » » Dage 214 Target population: Adults or Adolescents PROGRAM DESIGN Individuals can use fitness assessment data to select exer- cise programs consisting of activities appropriate in type, frequency, intensity, and duration to achieve personal physical fitness goals. Selecting an Exercise Program . «+ « s«» os +» s so +s » page 89 Target population: Adults or Adolescents AVOIDANCE AND CARE OF INJURIES Individuals can prevent exercise-related injuries insofar as possible amd can safely attend to those injuries which do occur. This skill includes the ability to select appro- priate equipment and clothing for an exercise activity, pace oneself, perform warm-up amd cool-down exercises, avoid fluid loss, recognize warning signs, modify activities as needed in relation to self-monitoring, use simple self-care tech- niques, and know whem to seek medical advice. Preventing and Caring for Injuries . . +» «+ » s « » page 90 Target population: Adults or Adolescents Exercising Safely + « + ¢ sv 0 0 die sd st dT] $DATE 106 Target population: Elementary school children USING SYSTEMATIC DECISION-MAKING SKILLS Individuals can use systematic decision-making skills in health-related contexts. Decision-Making . . ° ° * . ° ° * ° e . . ° ° ° ° eo page 111 Target population: Adults or Adolescents ~52~ ° . . . . ° . LJ ° . ° page 122 Systematic Decision-Making . Target population: Adults or Adolescents Making Decisions + « « « « « Target population: Elementary school children . . . ° . . . ° . ° page 139 Malte A DECISLON + ¢ + » « & 2 + 5 + 3 ole a os » is « page 146 Target population: Elementary school children AFFECTIVE OUTCOMES BELIEF IN POSITIVE EFFECTS OF EXERCISE Individuals believe that there are positive consequences associated with regular exercise. . page 153 Effects of Exercise . Target population: Adults or Adolescents page 157 . ° ° . ° . . ° . ° ° . . ° Exercise and People . . Target population: Elementary school children Marten's Physical Education Attitude Scale . . . . page 245 Target population: Elementary school children PERCEIVED ABILITY TO EXERCISE REGULARLY Individuals believe that they possess the ability to exer- cise regularly, even if faced with situations that might present barriers to the maintenance of a regular exercise program. page 161 Exercising Regularly . Target population: Adults or Adolescents INTENTION TO EXERCISE REGULARLY Individuals believe that they intend to exercise regularly. BG BXorciSe Survey “« vie + ss % ws eiin-wie 0 we se se Page. 165 Target population: Adults or Adolescents Exercise Questionnaire , vis. + sisi eww ies wmiie eo. page 251 Target population: Adults or Adolescents BELIEF IN THE UTILITY OF SYSTEMATIC DECISION-MAKING Individuals believe that a systematic decision-making process is an effective way of making decisions. Ideas About Systematic Decision-Making . . . . . . page 168 Target population: Adults or Adolescents Jdeas About DeciSiOnsS «+ + « +s + oo 4 5s 3s so +s ss so s « page 172 Target population: Elementary school children INTENTION TO USE SYSTEMATIC DECISION-MAKING Individuals believe that they will use systematic decision- making in a variety of situations. Would You Use Systematic Decision-Making? . . . . . page 175 Target population: Adults or Adolescents Would You Make Careful Decisions? « . « « « « « « « page 179 Target population: Elementary school children RESPECT FOR ONE’S BODY Individuals are willing to engage in those activities that are indicative of a respect for their body and the need to take care of it. My Bod y ° ° * ° ° ° ° e ° ° ® . ° ° ° ° ° ° ° ° ° ° page 182 Target population: Elementary school children Health Attitudes » ° . ° ° ° . . ° . . . ° . . . ° page 253 Target population: Adults or Adolescents —Gd CHAPTER FIVE NEWLY DEVELOPED MEASURES This chapter contains all of the measures that have been newly developed to correspond to the program outcome statements listed in Chapter Four. The measures are nresented in the same order as the outcome statements, that is, behavior followed by knowledge, skill, and affect. MEASURE TITLE PAGE A title page precedes each measure. This page indicates the type of measure (behavioral, knowledge, skill, or affective), the title of the outcome assessed, and the target population for the instrument. A general descrip- tion is presented, providing an overview of the assessment strategy employed in the measure. Finally, in the section labeled additional information, the pages in the handbook where the test specifications for the measure can be found are cited. USING THE MEASURES All of the measures in this chapter have been readied for photocopying, with directions to respondents printed at the top of the first page of each instrument. Scoring instructions follow all measures. These instructions have been placed on separate pages to facilitate reproduction of the measures for administration. All of the measures in this chapter are in the public domain, hence handbook users have permission to employ them for health education uses. mB USING THE TEST SPECIFICATIONS The test specifications for the newly developed measures are found in Chapter Seven. Handbook users may wish to review these specifications when considering the measures themselves. Each measure's set of specifications describes in detail the attribute measured by the instrument and the manner in which the measurement is accomplished. In addition to describing how a measure has been constructed, test specifications present other program- relevant information, according to the type of measure being considered, as explained below. ~ TEST SPECIFICATIONS FOR BEHAVIORAL MEASURES. These specifications include guidelines for scoring and interpret- ing the data collected by a measure. TEST SPECIFICATIONS FOR KNOWLEDGE MEASURES. These specifications contain an all-inclusive listing of the con- tent eligible for testing. In all instances, this content extends beyond the information tested in the form of the measure appearing in the handbook. TEST SPECIFICATIONS FOR SKILL MEASURES. These specifi- cations include a definition of the types of information contained in test questions and the criteria used to deter- mine correct and incorrect answer choice options. For example, the decision-making skill measures presented in the handbook are based upon a systematic decision-making model. The test specifications for these measures present this model in complete detail, indicating the relationship between the model and the test items based upon it. TEST SPECIFICATIONS FOR AFFECTIVE MEASURES. These specifications include an explanation of the rationale under- lying the scoring and interpretation of a measure. As can be seen, only by reviewing a measure's test specifications can a potential user of the measure gain a thorough understanding of the measure's intellectual under- pinnings. Handbook users are strongly urged to review a measure and its specifications as a totality. -66- WEEKLY ACTIVITIES INDEX TYPE OF MEASURE: Behavioral OUTCOME ASSESSED: Maintenance of an ‘Acceptable Activity Level TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: Individuals are asked about the frequency, dura- tion, and intensity of their participation in planned exercise activities during the preceding week. Responses to this survey can be used to measure the extent to which individuals maintain an activity level sufficient to promote cardio- respiratory fitness, muscular strength, muscular endurance and flexibility. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 260-263. -67- WEEKLY ACTIVITIES INDEX Various activities are listed on the next page. For each activity in which you participated during the past week please record the following: In the FREQUENCY column: Indicate the number of different times you participated in this activity during the past WEEK. In the AVERAGE DURATION column: Indicate the average amount of time (in minutes) that you spent per session. In the INTENSITY column: Indicate how strenuous, on average, the activity was for you, that is, how much effort it required. Record your answer in the INTENSITY column using one of the follow- ing letters: L = Light activity (Small increase in heart and breathing rate) M = Medium activity (Some increase in heart and breathing rate) H = Heavy activity (Large increase in heart and breathing rate) If you participated in other exercise activ- ities that are not included on this list, Please write them in the spaces labeled "Other." Fill out the FREQUENCY, AVERAGE DURATION, and INTENSITY columns for each activity you add. 38 Weekly Activities Index Page 2 AVERAGE ACTIVITY FREQUENCY DURATION INTENSITY (number/ week) (minutes) (L, M, H) Badminton Baseball /softball Basketball Bicycling Bowling Calisthenics (general exercises) Dancing (Type: ) Football Golf (with a cart? ) Handball /racquetball/squash Hiking | Jogging /running Judo/karate Rope skipping Rowing Skating Skiing (Type: ) Soccer Stretching Swimming Tennis Volleyball Walking (for exercise) Weight training Wrestling Yoga Other: Other: -69~- FACTS ABOUT EXERCISE TYPE OF MEASURE: Knowledge OUTCOME ASSESSED: Effects of Exercise TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: Individuals are presented with statements about physiological, psychological, and sociological effects of exercise. Individuals indicate whether each statement is true or false, ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 264-273. TO TRUE FACTS ABOUT EXERCISE This test consists of 20 statements about the effects of exercise. Some of the statements are true and some are false. If you think a statement is true, put a check in the column labeled TRUE. If you think a statement is false, put a check in the column labeled FALSE. FALSE 1. People who are muscularly fit are auto- matically also cardiovascularly fit. 2% Regular exercise increases the heart rate at rest. 3. All the cardiovascular benefits that result from regular exercise are gradually lost if exercise is not continued. 4, A single exercise session can have a lasting effect on the cardiovascular system, 5. Muscles that are not exercised turn into fat. 8. Regular exercise usually increases a person's resting blood pressure. / Regular exercise can strengthen the bones. 8. Regular exercise may help prevent lower back muscle pain. 9. Regular exercise has no effect on the body's ability to use fat. 10. Regular exercise combined with dieting is a more effective way to reduce fat than just dieting. am Facts About Exercise Page 2 TRUE FALSE 11. The number of calories burned during exercise depends only on the type of exercise. 12, A heavier person uses more calories than a lighter person during comparable exer- cise periods. 13. An individual's body composition can be determined by skinfold measurements. 14. Regular exercise decreases the maximum amount of oxygen the body can process while exercising. 15. A person's physical fitness refers to how that person's body looks. 16. Physically active individuals are less likely than inactive individuals to have a heart attack. 17. Regular exercise can slow down the natural decline in lung capacity. 18. Experts believe that there is no relation- ship between physical fitness and work performance. 19. Exercise can provide an opportunity to make new friends. 20. Participation in a regular exercise program can improve one's ability to fall asleep quickly. -72- SCORING KEY FACTS ABOUT EXERCISE Answer F — ct © 0 NN 5.9 A Oke 1D = bt CD HE Ee Ee © 0 NN OO UO bd WN _ = = = = = "9 [1 3 =9 3 = 3 = =™9 =5 = 3 nN o -73 EXERCISE FACTS TYPE OF MEASURE: Knowledge OUTCOME ASSESSED: Effects of Exercise TARGET POPULATION: Elementary school children GENERAL DESCRIPTION: Children are presented with statements about physical, psychological, and social effects of exercise. Children indicate whether each statement is true or false. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 274-282. Tl TRUE EXERCISE FACTS This test has 15 statements about exer- If the sentence is true, put a check under the word TRUE. If the sen- tence is false, put a check under the word FALSE. cise. FALSE 10. 11. 12, 13. 14. 15. Fitness means how a person's body looks, not how well the heart and other parts of the body work. Experts agree that exercise can help keep a person from getting sick. Regular exercise helps the heart beat more quickly at rest. Regular exercise helps a person lose fat. Exercising even once will help the heart. Regular exercise can help a person feel less muscular pain. Regular exercise can help make bones stronger. Good posture as a child can help a person avoid back pains as an adult. Muscles that are not exercised turn into fat. Exercise makes the body use up fewer calories. With regular exercise, a person becomes able to get the same amount of air with fewer breaths. Regular exercise lets the body use more oxygen while exercising. Regular exercise can help keep the lungs healthy as a person gets older. People with breathing problems should never exercise. Regular exercise can help people feel better about themselves. -75- SCORING KEY EXERCISE FACTS Item Answer 1 F 2 T 3 F 4 T 5 F 6 T 7 T 8 T 9 F 10 F 11 T 12 7 13 T 14 F 15 7 wf 6= DESIGNING AN EXERCISE PROGRAM TYPE OF MEASURE: Knowledge OUTCOME ASSESSED: Exercise Program Design TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: Individuals are presented with statements about exercise program components and the factors relating to activity selection and implementation. Indi- viduals indicate whether each statement is true or false. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 283-291. -T - TRUE DESIGNING AN EXERCISE PROGRAM This test consists of 20 statements about exercise program design. Some of the statements are true and some are false. If you think a statement is true, put a check in the column labeled TRUE. If you think a statement is false, put a check in the column labeled FALSE. FALSE exercise session. building muscular strength. 4, Flexibility is the ability to move a particular joint in the body through its full range of motion. that a person exercises. 15 minutes. 7. All individuals should see a doctor before starting an exercise program. cool-down period. exercise program. 78 i. Participating in an activity program where everyone exercises at the same level of intensity can be dangerous. 2. An individual's exercise program does not need to specify the length of each 3. A conditioning program is used only for 5. The benefits gained from exercise depend, in part, on the number of days per week 6. The warm-up and stretching period of an exercise session should last from 5 to 8. An exercise program should include a 9. Warm-up and stretching exercises will have little effect on the muscle soreness often felt when first starting an Designing an Exercise Program Page 2 TRUE FALSE 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Cool-down activities help prevent soreness. The target level for a healthy person building cardiorespiratory endurance is 90 to 100% of one's maximum heart rate. Cardiorespiratory endurance refers to the ability of the body to perform rhythmical exercise for very short periods of time. Cardiorespiratory endurance activities must be repeated at least three times per week in order to get the most benefit. Swimming has little effect on one's cardiorespiratory endurance capacity. Muscular strength is the ability to move a heavy weight many times. All sports provide the same benefits. Playing volleyball regularly improves one's cardiorespiratory endurance capacity. A regular exercise program does not need to take a great deal of time. Individuals exercising below their target heart rates show little improve- ment in cardiorespiratory fitness. Bicycling can improve one's cardiores- piratory endurance capacity. Pe SCORING KEY DESIGNING AN EXERCISE PROGRAM of ot ® B Answer © 0 NO Oh WN = —- Oo =O ee © 0 NN O&O Ob» WN = orl = ME ot rg ke eM Me] Ed Ted Md M3 Ym nN o -80- INJURY PREVENTION TYPE OF MEASURE: Knowledge OUTCOME ASSESSED: Injury Prevention TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: Individuals are presented with statements about exercise-related health risks and injury prevention strategies associated with cardiovascular, muscular/ skeletal, and environmental problems. Individuals indicate whether each statement is true or false. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 292-300. -81- TRUE INJURY PREVENTION This test consists of 20 statements about exercise and injury prevention. Some of the statements are true and some are If you think a statement is true, false. put a check in the column labeled TRUE. If you think a statement is false, put a check in the column labeled FALSE. FALSE Sweat evaporates quickly during exer- cise in humid weather. The intensity of exercise is a factor which can influence the development of heat stress. Most of the heat produced by the body during exercise is lost through the evaporation of sweat. The chances of developing heat disorders decrease if a person wears a sweat shirt and sweat pants while exercising in hot weather. Individuals should start an exercise program with very vigorous activities. The loss of body fluids is the major cause of heat disorders. A person should not drink large quantities of liquids before exercising in the heat. Body fluids lost during exercise can only be replaced with special electrolyte solutions. Cool-down exercises reduce the risk of muscle cramps. -82- Injury Prevention Page 2 TRUE FALSE 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Cold stress occurs when the body produces heat faster than it is lost. Exercising in cold weather is generally a greater health risk than exercising in hot weather. Exercising in low temperatures can lead to hypothermia. Individuals who exercise on cold days should not wear a hat. Until the individual adapts to the alti- tude, exercise at high altitudes reduces performance capabilities. Muscular injuries often occur when improper equipment is used. Learning the rules of a game can help prevent muscular injuries. Warm-up and stretching exercises are a frequent cause of muscle strain. Individuals should call a doctor imme- diately if they have pain in the midchest area during or just after exercising. Being in the proper physical condition to handle the physical stress of a particular exercise program can help prevent the onset of cardiovascular problems. During an exercise session individuals should cool down quickly to prevent the possible onset of cardiovascular problems. -83- SCORING KEY INJURY PREVENTION Item Answer 1 F 2 7 3 T 4 F 5 F 6 T 7 F 8 F 9 7 10 F 11 F 12 T 13 F 14 7 15 7 16 T 17 F 18 T 19 T 20 F -84- AVOIDING INJURY TYPE OF MEASURE: Knowledge OUTCOME ASSESSED: Injury Prevention TARGET POPULATION: Elementary school children GENERAL DESCRIPTION: Children are presented with statements about the nature of exercise-related health risks and injury prevention strategies associated with cardio- vascular, muscular/skeletal, and environmental problems. Children indicate whether each statement is true or false. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 301-309. -85-~ TRUE AVOIDING INJURY This test has 15 sentences. Read each one. If the sentence is true, put a check under the word TRUE. If the sen- tence is false, put a check under the word FALSE. FALSE Much of the heat built up by the body during exercise escapes as sweat. A person who exercises or plays in very cold weather should wear a hat. Heat exhaustion happens when the body sweats more than it needs to. Hot, dry skin is a sign of heat stroke. At first, exercise at a high altitude is easier than exercise at a low altitude. Heat stroke can lead to death. When a person is exercising, pounding in the head can be an early warning sign of heat problems. A person should drink very little liquid before exercising in the heat. When the body begins to lose heat faster than it can be built up, cold stress can happen. -S6~ Avoiding Injury Page 2 TRUE FALSE 10. A fast heart rate is one sign of altitude sickness. 11. People with big muscles have little chance of having problems while exer- cising in the heat. 12, Following the rules of a game can help a person avoid injuries. 13. Warm-up and stretching exercises slow down the flow of blood to the heart. 14. Cool-down exercises cause the blood to stop flowing to the muscles. 15. During exercise, people should start at their highest level of activity to avoid heart problems. -87~ SCORING KEY AVOIDING INJURY Item Answer 1 T 2 T 3 F 4 T 5 F 6 T 7 T 8 F 9 T 10 T 11 F 12 T 13 F 14 F 15 F -88- SELECTING AN EXERCISE PROGRAM TYPE OF MEASURE: Skill OUTCOME ASSESSED: Program Design TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: Individuals are presented with personal physical fitness goals for fictitious persons. Individuals are asked to select from among four possible plans the exercise program most appropriate to each described person's physical fitness goal. The correct choice will be an exercise program that consists of activities that are appropriate in type, duration, frequency, and intensity to attain the personal physical fitness goal for the person described. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 310-314. -89- SELECTING AN EXERCISE PROGRAM This test presents descriptions of indi- viduals who want to select an exercise" program that will meet their personal physical fitness goals. All individuals have their doctor's approval to start such a program. Read each description. Then put a check ( y) in the box under the plan that is most appropriate to achieve the fitness goal given. le. Name: Rose Wheaton Age: 37 Fitness goal: cardiorespiratory endurance Put a check in the box under the plan that is most appropriate for Rose: PLAN A PLAN B PLAN C PLAN D Cardiorespiratory Tennis Calis- Bicycling Badminton activity: thenics Number of sessions per week: 2 4 3 3 Length of each session: 60 min. 30 min. 15 min. 30 min. Target heartrate (for 10 seconds): 18-21 14-17 14-17 22-25 Other activities: - - - - (Check answer here) -90- Selecting an Exercise Program Page 2 2. Name: Ray Grand Age: 29 Fitness goal: cardiorespiratory endurance and muscular strength Put a check in the box under the plan that is most appropriate for Ray: PLAN A PLAN B PLAN C PLAN D Cardiorespiratory Volley- Rowing Jogging Swimming activity: ball Number of sessions per week: 3 3 2 4 Length of each session: 30 min. 20 min. 20 min. 30 min. Target heartrate (for 10 seconds): 21-25 19-21 29-32 30-34 Other activities: Stretching — Weight - training (Check answer here) bi Name: Age: Fitness Put a check in the box under the plan that is most appropriate for Donna: Donna White 58 goal: and flexibility cardiorespiratory endurance PLAN A PLAN B PLAN C PLAN D Cardiorespiratory activity: Bicycling Tennis Jogging Swimming Number of sessions per week: 4 3 3 4 Length of each session: 20 min. 30 min. 20 min, 25 min. Target heartrate (for 10 seconds): 26-30 21-23 18-20 17-22 Other activities: Yoga - Golf (Check answer here) "ym Selecting an Exercise Program Page 3 4. Name: E Fitness goal: Anne Lawry 22 cardiorespiratory endurance Put a check in the box under the plan that is most appropriate for Anne: PLAN A PLAN B PLAN C PLAN D Cardiorespiratory Jogging Skating Rope skip-| Weight activity: ping training Number of sessions per week: 3 2 3 3 Length of each session: : 20 min. 20 min. 25 min. 25 min, Target heartrate (for 10 seconds): 20-24 25-27 30-34 16-18 Other activities: - n - - (Check answer here) 5 Name: age 41 Age: Fitness goal: Charles Jager cardiorespiratory endurance and muscular endurance Put a check in the box under the plan that is most appropriate for Charles: PLAN A PLAN B PLAN C PLAN D Cardiorespiratory Weight Racquet- Running Badminton activity: training ball Number of sessions per week: 4 3 3 2 Length of each session: 20 min. 30 min. 25 min, 20 min. Target heartrate (for 10 seconds): 15-17 20-23 27-30 19-24 Other activities: - - Karate Judo (Check answer here) -92- Selecting an Exercise Program Page 4 6. Name: Luis Carlos Age: 17 Fitness goal: cardiorespiratory endurance Put a check in the box under the plan that is most appropriate for Luis: PLAN A PLAN B PLAN C PLAN D Cardiorespiratory activity: Badminton | Calisthenics | Handball Rowing Number of sessions per week: 1 3 4 3 Length of each session: 40 min. 20 min, 20 min, 20 min. Target heartrate (for 10 seconds): 23-26 14-17 22-27 31-33 Other activities: - - - - (Check answer here) 7. Name: ge: A Fitness goal: Put a check in the box under the plan that is most appropriate Gwen Harrington 20 cardiorespiratory endurance for Gwen: PLAN A PLAN B PLAN C PLAN D Cardiorespiratory Yoga Walking Rope skip- Running activity: ping Number of sessions per week: 3 4 5 6 Length of each session: 30 min. 20 min. 10 min. 15 min. Target heartrate (for 10 seconds): 14-17 23-25 27-29 31-33 Other activities: - = — (Check answer here) “O53 Selecting an Exercise Program Page 5 8. Name: David Johnson Age: 30 Fitness goal: cardiorespiratory endurance Put a check in the box under the plan that is most appropriate for David: PLAN A "PLAN B PLAN C PLAN D Cardiorespiratory activity: Baseball Swimming Tennis Squash Number of sessions per week: 2 3 1 4 Length of each session: 60 min. 30 min. 60 min. 25 min. Target heartrate (for 10 seconds): 13-16 29-32 23-25 24-27 Other activities: - Volleyball - - (Check answer here) 9. Name: Gloria Mays Age: 49 Fitness goal: cardiorespiratory endurance Put a check in the box under the plan that is most appropriate for Gloria: PLAN A PLAN B PLAN C PLAN D Cardiorespiratory Jogging Rope skip- Swim— Walking activity: ping ming Number of sessions per week: 3 3 3 2 Length of each session: 20 min. 10 min. 20 min. 20 min. Target heartrate (for 10 seconds): 27-29 21-24 20-22 23-25 Other activities: - - - - (Check answer here) -94 ~ Selecting an Exercise Program Page 6 10. Name: Henry Monroe Age: 61 Fitness goal: cardiorespiratory endurance and flexibility Put a check in the box under the plan that is most appropriate for Henry: PLAN A PLAN B PLAN C PLAN D Cardiorespiratory activity: Bowling Bicycling Swimming Walking Number of sessions per week: 3 2 4 4 Length of each session: 30 min. 20 min, 25 min. 25 min. Target heartrate (for 10 seconds): 12-14 18-20 25-27 16-18 Other activities: Calis- - - Stretching thenics (Check answer here) 11, Name: Joe Leonard Age: 56 Fitness goal: cardiorespiratory endurance Put a check in the box under the plan that is most appropriate for Joe: PLAN A PLAN B PLAN C PLAN D Cardiorespiratory activity: Swimming Bicycling Rowing Soccer Number of sessions per week: 3 3 2 3 Length of each session: 20 min. 15 min. 15 min. 20 min. Target heartrate (for 10 seconds): 16-18 17-19 21-23 25-28 Other activities: - - - - (Check answer here) -95- Selecting an Exercise Program Page 7 12, Name: Sylvia Rapp Age: 48 Fitness goal: cardiorespiratory endurance and muscular endurance Put a check in the box under the plan that is most appropriate for Sylvia: PLAN A PLAN B PLAN C PLAN D Cardiorespiratory activity: Walking Jogging |Calisthenics | Swimming Number of sessions per week: 2 3 4 3 Length of each session: 20 min, 20 min. 15 min. 25 min. Target heartrate (for 10 seconds): 13-15 20-23 13-15 12-15 Other activities: —- - Golf Weight training (Check answer here) Name: Age: 13. 51 Fitness goal: Denise Strom cardiorespiratory endurance Put a check in the box under the plan that is most appropriate for Denise: PLAN A PLAN B PLAN C PLAN D Cardiorespiratory activity: Bicycling Bowling Calisthenics| Skating Number of sessions per week: 3 3 3 3 Length of each session: 20 min. 40 min. 10 min. 25 min. Target heartrate (for 10 seconds): 19-21 13-15 14-16 26-28 Other activities: - —- - - (Check answer here) -96- Selecting an Exercise Program Page 8 14. Name: Arthur Wingerski Age: 33 Fitness goal: Put a check in the box under the plan that is most appropriate and flexibility cardiorespiratory endurance for Arthur: PLAN A PLAN B PLAN C PLAN D Cardiorespiratory activity: Jogging Walking Rowing Basketball Number of sessions per week: 2 2 3 3 Length of each session: 20 min. 20 min. 20 min. 25 min. Target heartrate (for 10 seconds): 20-24 15-17 20-24 20-22 Other activities: Wrestling Karate Yoga Weight training (Check answer here) 15. Name: i; ® Fitness goal: Put a check in the box under the plan that is most appropriate for Victor: 59 Victor Lindquist cardiorespiratory endurance PLAN A PLAN B PLAN C PLAN D Cardiorespiratory Hiking Handball Rope skip- Weight activity: ping training Number of sessions per week: 3 2 3 3 Length of each session: 60 min. 20 min. 15 min. 20 min. Target heartrate (for 10 seconds): 16-20 19-21 16-18 12-14 Other activities: - — — - (Check answer here) -97- SCORING KEY SELECTING AN EXERCISE PROGRAM Item CEN WN += Answer PQPrPrmPUOQUWQI>POWUO INCORRECT ANSWER CHOICE ANALYSES Insufficient Inappropriate Activity for Exces- Cardio- sive respiratory Muscular Inten- | Inten- | Fre- Dura-| Endur- Muscular | Endur- Flexi- Item |sity sity quency | tion rance Strength ance bility 1 B, C A Cc B 2 Cc, D C A A, D 3 A B,C 4 C D B D 5 Cc A D A 6 D B A B 7 D A GC, D A 8 B A A, C A 9 A D B 10 C A B A B 11 D C B,C 12 A, C, Di A C C C 13 D B, C C B,.C 14 B A, B D A, D 15 D B C D OB PREVENTING AND CARING FOR INJURIES TYPE OF MEASURE: Skill OUTCOME ASSESSED: Avoidance and Care of Injuries TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: Individuals are presented with brief descriptions of situations in which a person wants to act to prevent or care for an exercise-related injury. Individuals select from among three possible options an appropriate course of action or indicate that none of the suggested options is appropriate. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 315-323. -99- PREVENTING AND CARING FOR INJURIES This test presents descriptions of indi- viduals who want to prevent or care for exercise-related injuries. Read each description. Circle the letter of the appropriate action for the individual to take. If there is no choice presented that is appropriate, circle Choice D, "None of the above." Jane had no difficulty sleeping before she started an exercise program, However, now she is troubled with insomnia. She would like to treat her sleep problem. An appropriate action for Jane to take would be to: A. Increase the intensity and duration of her exercise program. B. Reduce the intensity and duration of her exercise program, C. Avoid eating for at least two hours before exer- cising. D. None of the above. Brian has begun a running exercise program and wants to prevent tendinitis in his ankles. An appropriate action for Brian to take would be to: A. Perform warm-up exercises before running. B. Perform cool-down exercises after running. C. Run in an area that is free of obstacles and traffic. D. None of the above. Suzanne began a bicyling exercise program two weeks ago. Recently she has felt nauseous after exercising. She wants to act safely. An appropriate action for Suzanne to take would be to: A. Perform warm-up exercises for a longer time before bicycling. B. Increase the intensity but reduce the duration of the bicycling, -100- Preventing and Caring for Injuries Page 2 C. Reduce the intensity of the bicycling and prolong the cool-down period. D. None of the above. Art is going cross-country skiing for the afternoon. He wants to prevent hypothermia. An appropriate action for Art to take would be to: A. Wear a thick layer of loosely-woven clothing, protective goggles, and knitted gloves. B. Wear several thin layers of tightly-woven clothing, a hat, and mittens. Cc. Perform warm-up and cool-down exercises. D, None of the above. Hilda has been jogging regularly for several months. She has just noticed bursts of rapid heartbeats while jogging. She wants to act safely. An appropriate action for Hilda to take would be to: A. Stop jogging for several days, then resume jogging at a slower pace. B. Reduce the intensity of the jogging and prolong the cool-down period. C. Reduce the intensity and the duration of the jogging. D. None of the above. Corrine is beginning a rowing exercise program. She wants to prevent heat disorders. An appropriate action for Corrine to take would be to: A. Wear light, loose clothing and drink water freely. B. Take salt tablets and perform cool-down exercises after rowing. Cis Wear waterproof clothing and perform sufficient warm-up exercises before rowing. D. None of the above. -101- Preventing and Caring for Injuries Page 3 Jim is suffering from tendinitis in his elbow due to playing tennis. He wants to treat the condition. An appropriate action for Jim to take would be to: A. B. C. D. Apply heat to his elbow. Massage his elbow. Apply ice to his elbow. None of the above. Tina's toes became frostbitten while she was hiking. She wants to treat the frostbite. An appropriate action for Tina to take would be to: A. Apply ointment and bandages to her toes. Put her feet in cold water. Put her feet in lukewarm water. None of the above. Frank wants to prevent dislocating his shoulder while playing football. An appropriate action for Frank to take would be to: A. B. Perform warm-up exercises for 15 to 20 minutes before the game starts. Use appropriate protective clothing and equipment and proper playing techniques. Perform cool-down exercises for 15 to 20 minutes after the game is over. None of the above. -102- Preventing and Caring for Injuries Page 4 10. 11, 12. Carlos becomes extremely breathless while playing handball. His breathlessness continues for 15 to 20 minutes after he stops playing. He wants to act safely. An appropriate action for Carlos to take would be to: A. Continue to play vigorously but shorten his playing time. B. Prolong his warm-up period. C, Prolong his cool-down period. D. None of the above. Sandra plays racquetball regularly. She just contracted viral influenza and wants to prevent a viral infection of the heart muscle. An appropriate action for Sandra to take would be to: A. Stop exercising until several days after she has fully recovered from the influenza. B. Play racquetball for only half the usual length of time while she is recovering. C. Play racquetball at a lower than usual level of intensity while she is recovering. D. None of the above. Jose is bicycling in the afternoon with his friends. He begins to feel dizzy, weak, and breathless, and his pulse is very rapid. An appropriate action for Jose to take would be to: A, Rest until his pulse is normal and then ride home. . Drink plenty of liquids before riding home. B Ce. Ride more slowly the rest of the way. D . None of the above. ww l03=~ Preventing and Caring for Injuries Page 5 13. 14. 15. Rose sprained her ankle while exercising in a gymnastics program. She wants to act safely. An appropriate action for Rose to take would be to: A, Massage her ankle gently. B. Sit with her ankle raised and apply hot towels to it, Co Sit with her ankle raised and apply ice to it. D. None of the above. Michael wants to avoid cardiovascular problems as he begins a swimming exercise program. An appropriate action for Michael to take would be to: A. Swim only in a heated pool. B. Build up slowly to his target fitness level. C. Take swimming lessons to improve his form. De None of the above. Peter feels bursitis in his shoulder each time he pitches for his baseball team. He wants to act safely. An appropriate action for Peter to take would be to: A. Rest his shoulder and apply ice to it. Be Alternate hot and cold compresses until the pain stops. Cc. Apply pressure to his shoulder and then tape it. De. None of the above. -104- SCORING KEY PREVENTING AND CARING FOR INJURIES Item CON UbhWN HH Answer > PEQOPOXTQOQ>0WTAO INCORRECT ANSWER CHOICE ANALYSES The incorrect answer choice for each item are listed below using the following method of annotation. Direct violation - Ineffective — Incorrect - Item Caco UmbwWN HH Direct Violation A od Lo Ww Q Tew Wer w Q ow a response that is a direct violation of an appropriate action. a response that is ineffective in avoiding or caring for the injury described. the response "None of the above" when a correct response is provided as one of the other response options. Ineffective Incorrect Cc D B, C D A D A, 0 D B D B D A D A, C D B,C D A D AC D C D -105- EXERCISING SAFELY TYPE OF MEASURE: Skill OUTCOME ASSESSED: Avoidance and Care of Injuries TARGET POPULATION: Elementary school children GENERAL DESCRIPTION: Children are presented with brief descriptions of situations in which a person should act to prevent or care for an exercise-related injury. Children select from among three possible options the best action for the person to take. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 324-331. -106- EXERCISING SAFELY This test tells about people who want to prevent or care for an exercise injury. Read each question. Then circle the letter of the best action for the person to take. Tony rides a skateboard. He wants to prevent scrapes. The best action for Tony to take is to: A. Wear protective clothing. B. Do warm-up and cool-down exercises. Ce Use his skateboard on the sidewalk only. Donna has begun ice skating. She notices that she is out of breath for about fifteen minutes after skating. She wants to act safely. The best action for Donna to take is to: A, Make sure not to eat anything right before skating. B. Stop doing cool-down exercises after skating. Cc. Skate less hard so that she can talk while skating. Leon's toes became frostbitten while he was cross-country skiing. He wants to take care of his frostbite. The best action for Leon to take is to: A. Rub his toes with ice or snow. B. Warm his toes by holding them in his hands. C. Put his toes in the hottest water that he can stand. -107- Exercising Safely Page 2 Anita is going hiking on a very warm day. She wants to prevent heat exposure. The best action for Anita to take is to: A. Walk very quickly so that she will feel the breeze. B. Wear loose, light clothing and drink plenty of water. Ce Do cool-down exercises as soon as the hike is over. Jeff pitches for his baseball team. He wants to prevent swelling of his wrist. The best action for Jeff to take is to; A. Do warm-up exercises before playing. B. Put ice on his wrist before playing. C. Rub his wrist during the game. Karen plays soccer. She wants to keep from spraining her ankles. The best action for Karen to take is to: A. Play in a clear area and wear correctly fitted shoes. B. Perform cool-down exercises at the end of the game. C. Drink plenty of water before playing. Angela is sunburned from playing volleyball in the sun all afternoon. She wants to treat her sunburn. The best action for Angela to take is to: A. Put cool water on her sunburn. B, Rub her skin with cloths dipped in hot water. C. Wash her skin with soap and water. -108- Exercising Safely Page 3 10. Gary has a blister on his heel from running. He wants to treat the blister. The best action for Gary to take is to: A. Put ice on the blister. B. Put a bandage on the blister. C. Keep the blister uncovered. Juan swims regularly. He has started feeling very tired after swimming. He wants to act safely. The best action for Juan to take is to: A, Swim harder to wake himself up. B. Swim in colder water. C. Swim for a shorter period of time. Ray scraped his knees while roller skating. He wants to care for his knees. The best action for Ray to take is to: A, Wash and bandage his knees. Ba. Leave his knees uncovered. Ca. Put heat on his knees. -109- SCORING KEY EXERCISING SAFELY Item Answer 1 A 2 C 3 B 4 B 5 A 6 A 7 A 8 B 9 C 10 A INCORRECT ANSWER CHOICE ANALYSES The incorrect answer choices for each item are listed below using the following method of annotation: Direction violation = an action that is a direct violation of an appropriate action. Ineffective = an action that is ineffective in prevent- ing or caring for the injury described. Item Direction Violation Ineffective 1 B, C 2 B A 3 A, C 4 A C 5 B, C 6 B, C 7 B Cc 8 Cc A 9 A B 10 B C -110- DECISION-MAKING TYPE OF MEASURE: Skill OUTCOME ASSESSED: Using Systematic Decision-Making Skills TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: Individuals are presented with fictional descrip- tions of people who are attempting to make decisions in a health-related context. Individuals are asked to select from among four options the next step to be followed using a systematic approach to decision- making. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 332-336. -111- DECISION-MAKING This test presents descriptions of people who are trying to make decisions that may affect their health or the health of others. Read each item. Circle the letter of the next step that the person should take in order to be making decisions using a systematic approach. Katherine is slightly overweight and wants to go on a diet. Although she has tried to diet before, she has never had much success with the diets she has chosen. Now Katherine realizes she must choose a diet that isn't too difficult so that she will stick with it. She discusses her desire to find a suitable diet with one of her close friends. Together they identify several different diet plans that may be useful for Katherine. Katherine thinks about how she feels about going on a diet. She then discusses the different diets with her family doctor who points out the positive and negative features of each. They also discuss what Katherine will have to do in order to stick to each diet plan. What is the best thing for Katherine to do next in order to use the systematic decision-making approach? A. Discuss the different diets with another friend. Bs Select one of the diets. Co Have her doctor select one of the diets for her. De. Realize that she must choose a suitable diet. -112- Decision-Making Page 2 William started smoking many years ago, before the dangers of cigarette smoking were known. Now he recog- nizes that his cigarette smoking is bad for his health. Although William knows that it might be difficult, he wants to quit smoking. Some of his friends who used to smoke have already quit. William is sure that there are many different ways to stop smoking. He wants to choose the way that is right for him. What is the best thing for William to do next in order to use the systematic decision-making approach? A. Call a smoking clinic to find out about its program, Be. Decide how he will quit smoking. Ce. Make a list of all the possible ways he can stop smoking. D, Think of one way he can stop smoking. Cindy has been invited to a party where other people will probably be smoking marijuana. Although Cindy has never smoked marijuana, she is curious about it. She realizes that she must decide what she will do if some- one at the party offers her marijuana. Cindy thinks about what she might do. After Cindy goes to the library and reads some books on marijuana, she decides not to smoke at the party. While at the party, Cindy is offered marijuana several times but turns down the offers. What is the best thing for Cindy to do next in order to use the systematic decision-making approach? A. Talk to her friends about smoking marijuana. B. Read more books about marijuana. Ce Avoid the people who offered her marijuana at the party. De. Consider whether she's happy about her decision. -113- Decision-Making Page 3 4. Martin enjoys being active and tries to exercise on the weekends. He would like to exercise every day after work. Some of his co-workers go to a gym near his office. His wife jogs every evening at the local park. What is the best thing for Martin to do next in order to use the systematic decision-making approach? A. Think of one type of exercise he enjoys. B. Start to jog after work. Cc, Realize he must choose a regular exercise program. Da. Talk to his co-workers about the gym. Phil works in a very busy office. He has a great deal of work to do and sometimes he is unable to complete it on time. Phil knows that he is under stress at work and he wants to find a good way to reduce it. He discusses his problem with some of his friends. He then makes a list of all the ways that he knows of to reduce stress at work. What is the best thing for Phil to do next in order to use the systematic decision-making approach? A, Get information about his ideas from the company doctor. Be Select one of the ideas on his list. Cc. Ask his doctor to choose a good way for him to reduce the stress at work, D. Realize that he must find an appropriate way to reduce the stress at work. -114- Decision-Making Page 4 8. Mary wants to take her son to be immunized at a local clinic. The clinic is very busy. Her child can have an appointment only on a day when Mary has an important business meeting. Mary already has made a doctor's appointment in two months for her child's routine checkup. She realizes that she must decide whether to take her child to the clinic or wait and have her child immunized at the doctor's office. Mary thinks about her possibilities. She calls the doctor and the clinic to find out if it is safe to wait. What is the best thing for Mary to do next in order to use the systematic decision-making approach? A. Think about the possible choices that are avail- able to her. B. Decide what to do about immunizing her son. C. Be aware that she must make a decision about her son's immunization. De Complain to the clinic's staff that they aren't flexible enough. Phyllis works for the Westinger Company. For the last few months Phyllis has been swimming during lunch hour. She enjoys the swim and is pleased with the improvement in her health and appearance. Her boss now wants Phyllis to attend board meetings that are held every Monday, Wednesday, and Friday at lunch time. She tells Phyllis that attending the meetings will be important for her growth in the com- pany. What is the best thing for Phyllis to do next in order to use the systematic decision-making approach? A. Choose between swimming and attending the board meetings. B. Try to convince her boss that she doesn't need to attend board meetings. Cc. Talk to her boss about the decision she must make. D. Realize that she must decide between swimming and attending the meetings. -115- Decision-Making Page 5 8. Debbie has diabetes. She keeps her diabetes under control by eating a special diet. Debbie's new boss is having a dessert party in a few days and Debbie is invited. All of the guests are sup- posed to bring their favorite dessert. Debbie shouldn't eat sweets and desserts, but she doesn't want to offend her boss by turning down the invitation. Debbie realizes that she must decide whether or not to go to the party. She thinks about the options that she has and discusses them with a friend who also has diabetes. She calls her doctor to ask his advice about eating sweets just one time. She also thinks about whether she would be able to resist eating anything at the party if she went. What is the best thing for Debbie to do next in order to use the systematic decision-making approach? A. Decide whether to go to the party. B. Have her doctor decide whether she should go to the party. C. Sign up for a special baking class for people with diabetes. D. Make a list of her possible choices. Se Gary visits the doctor once a year for a checkup. At one checkup the doctor discovers that Gary's blood pressure is slightly higher than it should be. He wants Gary to use deep relaxation because that may lower Gary's blood pressure. If it doesn't, Gary may have to take a special medicine. Gary recognizes that he must decide whether or not to use deep relaxation. He wants to follow his doctor's advice, but Gary understands that using relaxation may not lower his blood pressure. Gary makes a list of possible choices and the consequences. What is the best thing for Gary to do next in order to use the systematic decision-making approach? A. Decide whether or not he will follow his doctor's advice. B. Talk with a friend who has high blood pressure about the effects of relaxation. C. Realize that he has a decision to make about using relaxation. Da. Discuss the possibilities with his doctor. -116- Decision-Making Page 6 10. 11. Diane is going to make some big changes in her life soon. She will be moving to a new city to start school and she is nervous about it. Diane has heard that changes can cause stress, but that there are ways to reduce it. She wants to choose a way to reduce some of the stress she's feeling. What is the best thing for Diane to do next in order to use the systematic decision-making approach? A. Start a regular exercise program. B. Discuss with her family the possible ways she can reduce her stress. C. Decide on a way to relieve the stress she feels. D. Have the family doctor choose a way for her to reduce the stress. Bob is quite heavy. He wants to lose weight and realizes that he must decide how he's going to do it. He dis- cusses the situation with his wife. Together they realize that Bob will either have to go on a diet, start exercising regularly, or do both. Bob calls his doctor to get his advice. The doctor says that regular exer- cise may reduce Bob's appetite so that it will be easier to stay on a diet. The doctor suggests that Bob try to diet and exercise. Bob, however, doesn't enjoy exer- cising so he decides to go on a diet only. Bob tries to diet for three weeks. He's unhappy because he's not losing much weight and is often hungry. What is the best thing for Bob to do next in order to use the systematic decision-making approach? A. Think about whether he is satisfied with his deci- sion to lose weight by dieting. B. Read books about weight loss. © Stay with his diet for at least another week. D. Start a running program in order to follow his doctor's advice about exercising. -117- Decision-Making Page 7 12. 13. Joe drinks a great deal of alcohol. He always has many drinks after work. Lately he has been drinking when he gets up in the morning. He knows that he has a drink- ing problem. What is the best thing for Joe to do next in order to use the systematic decision-making approach? A, Enroll in an alcoholism treatment program. B. Watch other people to see if they drink as much as he does. C. Recognize that he must decide what to do about his drinking. D. Realize that he will have to decide what changes to make in his life. Margaret wants to stop smoking. She knows that there are many ways to quit and that she should choose the best way for her. She discusses the matter with a friend. They come up with several plans: (a) Margaret could stop smoking completely on a certain day, or (b) Margaret could slowly reduce the number of cigarettes she smokes each day until she gives them up completely. Margaret calls her doctor to ask her doctor's opinion. She also talks to other people who have already quit smoking. Margaret decides to stop smoking gradually. At the start of every week she reduces the number of daily cigarettes she smokes by one. Unfortunately, Margaret isn't too happy with her program and she has trouble keeping track of the number of cigarettes she smokes. What is the best thing for Margaret to do next in order to use the systematic decision-making approach? A. Have her doctor choose a way for Margaret to stop smoking. B. Think again about her decision to stop smoking gradually. C. Stick with her decision regardless of how she feels about it. D. Read some books about how to stop smoking. -118- Decision-Making Page 8 14. 15. Stan wants to get into good physical condition, even though he smokes and has not exercised in years. He is aware that there are many ways to exercise and that some ways are better than others. He wants to find an exer- cise program that will be comfortable and effective for him. Stan talks to some friends to find out what they do to get and stay in shape. What is the best thing for Stan to do next in order to use the systematic decision-making approach? A, Decide on an exercise program. Be Quit smoking before he starts an exercise program. C. Read some books about the different exercises he has heard about. D. Jog regularly because he enjoys being outside. Tom has been on a low-salt, low-fat diet for several months. He is pleased with the diet, even though following it can be difficult. He does have to prepare most of his meals himself from fresh foods. Tom has been asked to go on vacation with some friends. He wants to go but he knows that he won't be able to prepare his own meals. If he goes, he may not be able to stay on his diet very well. Tom realizes that he has a decision to make about going with his friends. What is the best thing for Tom to do next in order to use the systematic decision-making approach? A. Decide not to go on vacation. Bs Have his doctor decide if Tom should go with his friends. Ss Think about whether his friends would mind if he didn't go. D. Consider the options that are available to him. -119- SCORING KEY DECISION-MAKING Item Answer l B 2 C 3 D 4 C 5 A 6 B 7 D 8 A 9 D 10 B 11 A 12 C 13 B 14 C 15 D INCORRECT ANSWER CHOICE ANALYSES Although there may be some overlap, it may be useful to con- sider the incorrect answer choices for each item using the following method of annotation. Skipped step = a response that describes one of the decision- making steps that occurs after the correct step. Repeated step = a response that describes one of the decision- making steps that has already occurred. Ineffective implementation of correct step = a response that describes the correct decision-making step, but violates one or more of the step's effec- tiveness criteria. Ineffective implementation of incorrect step = a response that describes an incorrect decision-making step and violates one or more of the step's effectiveness criteria. Deflective action = a response that is unrelated to effective decision-making and may deflect the decision- maker from taking necessary action. -120- INCORRECT ANSWER CHOICE ANALYSES (Cont.) DECISION-MAKING Ineffective Ineffective Implementa- Implementa- tion of Skipped Repeated tion of Cor- Incorrect Deflective Item Step Step rect Step Step Action 1 A,D C 2 B D A 3 A,B C 4 B,D A 5 B D 0 6 A,C D 7 A,C B 8 D B C 9 A GC B 10 A,C D 11 B c,D 12 A D B 13 D Cc A 14 A,D B 15 A,C B -121- SYSTEMATIC DECISION-MAKING TYPE OF MEASURE: Skill OUTCOME ASSESSED: Using Systematic Decision-Making Skills TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: Individuals are presented with fictional descriptions of people who are making decisions in a health-related context. Individuals are asked to indicate whether the decision-makers correctly use the systematic decision- making process. If individuals indicate that the decision-making process is carried out incorrectly, they are then asked to describe the nature of the error. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 337-342. -122- SYSTEMATIC DECISION-MAKING This test presents descriptions of people who are making decisions that may affect their health or the health of others. Each person has either completed the entire decision-making process correctly or has made one mistake in this process. Read each item. Circle Yes or No to indi- cate whether the person correctly completed each step in the decision-making process. If you circle No, briefly describe what the person did wrong. William started smoking many years ago, before the dangers of cigarette smoking were known. Now he recog- nizes that his cigarette smoking is bad for his health, and he wants to quit. William knows that there are many ways to stop smoking. He realizes that he must choose the way that is right for him. He thinks of some different ways to stop smoking. He then discusses his ideas with a friend who has already quit smoking. He also talks to his doctor to get his opinion on the matter. William chooses one of the approaches and begins to try stop smoking. After a few weeks William's friend tells William how proud he is that William is trying to stop smoking. A. Did William correctly complete each of the steps in the decision-making process? Circle One: Yes No B. If No, what did William do wrong? -123- to Systematic Decision-Making Page 2 Katherine is slightly overweight and wants to go on a diet. Although she has tried many diets before, she has never had much success with them. Now Katherine realizes she must choose a diet that isn't too diffi- cult so that she will stick with it. She discusses her desire to find a suitable diet with one of her close friends. Together they identify several different diet plans that may be useful for Katherine. Katherine thinks about how she feels about dieting. She then discusses the different diets with her family doctor who points out the positive and nega- tive features of each. They also discuss what Katherine will have to do in order to stick with each diet plan. Katherine knows that the decision is difficult, so she has the doctor pick one of the diets for her. She starts the diet the next week, but has a hard time staying on it. Katherine realizes that she's not happy with the diet and should stop it and find a better one. A. Did Katherine correctly complete each of the steps in the decision-making process? Circle One: Yes No B. If No, what did Katherine do wrong? -124- Systematic Decision-Making Page 3 3. Cindy has been invited to a party where other people will probably be smoking marijuana. Although Cindy has never smoked marijuana, she is curious about it. Cindy realizes that she must decide whether she will smoke any marijuana if she is offered some at the party. She makes a list of her available options. Cindy decides not to smoke at the party. While at the party, she is offered marijuana several times but turns down the offers. Later, Cindy thinks about how she felt at the party and realizes that she's happy with her decision not to smoke. A. Did Cindy correctly complete each of the steps in the decision-making process? Circle One: Yes No Be If No, what did Cindy do wrong? -125- Systematic Decision-Making Page 4 4. Martin would like to start exercising regularly. He realizes that he must decide on an exercise program that is best for him, Some of Martin's co-workers jog together every day after work. Martin thinks that jogging with them is the only way that he will exercise regularly. He talks to his co-workers about it. He then makes an appoint- ment with his doctor to get his opinion about jogging. Martin decides to jog after work with his co-workers. He starts jogging the next day. After several weeks, Martin thinks about his decision to jog. He's pleased because he is feeling good and looking fit. A. Did Martin correctly complete each of the steps in the decision-making process? Circle One: Yes No B. If No, what did Martin do wrong? -126- Systematic Decision-Making Page 5 5. Phil works in a very busy office. He has a great deal of work to do and sometimes he is unable to complete it on time. Phil realizes that he is under stress at work and that he should decide on a way to reduce that stress. He discusses the situation with his boss. He then makes a list of all the ways he knows that would reduce stress at work. He gets information about the ideas on his list from the company doctor. After thinking about his decision, Phil picks one of the choices. He decides to sit quietly for a short time each day. He does this and finds that he is more relaxed and productive at work. He thinks about his decision and realizes that he has made the right choice. A. Did Phil correctly complete each of the steps in the decision-making process? Circle One: Yes No B. If No, what did Phil do wrong? -127- Systematic Decision-Making Page 6 6. Mary wants to take her son to be immunized at a local clinic. The clinic is very busy. Her child can have an appointment only on a day when Mary has other plans. She is part of a sales team at the Bishop Company and should attend a sales meeting that day. Mary already has made a doctor's appointment in two months for her child's routine checkup. She realizes that she must decide whether to take her child to the clinic or wait and have her child immunized at the doctor's office. Mary thinks about the possibilities that are available to her. She gets some information from a co-worker on the importance of the meeting and the risk involved in delaying her son's immunization. Mary takes her son to the clinic. Later, she considers her decision and realizes that she's happy with the way everything worked out. A. Did Mary correctly complete each of the steps in the decision-making process? Circle One: Yes No B. If No, what did Mary do wrong? -128- Systematic Decision-Making Page 7 7. Phyllis swims during her lunch hour at work. She enjoys the swim and is pleased with the improvement in her health and appearance. Her boss now wants Phyllis to attend board meetings that are held every Monday, Wednesday, and Friday at lunch time. She tells Phyllis that attending the meet- ings will be important for her growth in the company. Phyllis realizes that she must decide between swimming at lunch time and attending the meetings. She lists her possible choices. She could either: (1) go to the meetings, (2) continue to swim at lunch, or (3) go to the meetings and swim at a different time. Phyllis talks to her boss about the meetings. She also calls several pools in the area to see when they're open. After thinking about her feelings on the subject, Phyllis decides to attend the meetings and swim before work. She begins this new program the following week. After several weeks, Phyllis thinks about her program. She realizes that she's unhappy with her choice because she doesn't like getting up so early in the moruing. She understands that she needs to think again about her decision. A, Did Phyllis correctly complete each of the steps in the decision-making process? Circle One: Yes No B. If No, what did Phyllis do wrong? -129- Systematic Decision-Making Page 8 8. Debbie has diabetes. She keeps her diabetes under con- trol by eating a special diet. Debbie's new boss is having a dessert party in a few days and Debbie is invited. Debbie shouldn't eat sweets and desserts, but she doesn't want to offend her boss by turning down the invitation. Debbie realizes that she must decide what to do about the party. She makes a list of the options that are available to her. Debbie decides that she will go to the party and only eat a small amount of sweets. She doesn't think it will hurt her. After the party, Debbie thinks about her decision to eat some of the desserts. She thinks that she might have made a mistake because her sugar levels were irregular for several days afterwards. Au Did Debbie correctly complete each of the steps in the decision-making process? Circle One: Yes No B. If No, what did Debbie do wrong? -130- Systematic Decision-Making Page 9 9. Gary visits the doctor once a year for a checkup. At one checkup the doctor discovers that Gary's blood pressure is slightly higher than it should be. He wants Gary to use deep relaxation because that may lower Gary's blood pressure. If it doesn't, Gary may have to take a special medicine. Gary recognizes that he must decide whether or not to use deep relaxation. He wants to follow his doctor's advice, but Gary understands that using relaxation may not lower his blood pressure. Gary thinks about his possible choices and the consequences. He discusses the matter with the doctor. He also talks to his family about his decision. Gary decides that he will follow his doctor's advice and use deep relaxation. He starts learning relaxation the following week. Gary's doctor calls him six weeks later to see how Gary is doing. A. Did Gary correctly complete each of the steps in the decision-making process? Circle Ome: Yes No B. If No, what did Gary do wrong? -131- Systematic Decision-Making Page 10 10. Diane is going to. make some big changes in her life soon. She will be moving to a new city to start school and she is nervous about it. Diane has heard that changes can cause stress, but that there are ways to reduce it. She realizes that she must decide on a way to reduce some of the stress she's feeling. Diane talks to her friend Mitch to find out what he does to feel better when he's under stress. She finds out that Mitch runs every day. Diane thinks that regular running is probably the only way to reduce stress so she talks to her doctor about it. The doctor gives Diane some information about running and its benefits. Diane decides to start running. She begins the program the next day. Several weeks later, Diane considers her decision. She realizes that she's feeling less nervous and is happy with her decision to run daily. A. Did Diane correctly complete each of the steps in the decision-making process? Circle One: Yes No B. If No, what did Diane do wrong? -132- Systematic Decision-Making Page 11 11. Bob is quite heavy. He wants to lose weight and realizes that ne must decide how he's going to do it. He discusses the situation with his wife. Together they identify several plans. Bob will either have to go on a diet, start exercising regularly, or do both. Bob then calls his doctor who points out that regular exercise can reduce a person's appetite. He says that it may be easier for Bob to stay on a diet if he exercises regularly. Bob asks his wife to decide which plan he should use. She tells Bob that he should diet, but not exercise. Bob tries to diet for three weeks. He's unhappy because he's not losing much weight and is often hungry. He thinks about whether he's satisfied with the decision to lose weight by dieting. A. Did Bob correctly complete each of the steps in the decision-making process? Circle One: Yes No B. If No, what did Bob do wrong? -133- Systematic Decision-Making Page 12 12. Joe drinks a great deal of alcohol. He always has quite a few drinks when he gets home from work. Joe knows that he has a drinking problem. He recognizes that he must decide what to do about it. Joe discusses the situation with a close friend. They make a list of the different things Joe could do to deal with the problem. Joe could: (1) get professional help, (2) try on his own to reduce the amount he drinks, or (3) do nothing about the problem. Joe decides to try on his own to limit the amount he drinks. He will have no more than two drinks when he gets home from work. Joe begins this new program, but he finds it more diffi- cult than he expected. He thinks that he may not have made the right choice and reconsiders his decision. A. Did Joe correctly complete each of the steps in the decision-making process? Circle One: Yes No Be If No, what did Joe do wrong? -134- Systematic Decision-Making Page 13 13. Margaret wants to stop smoking. She knows that there are many ways to quit and that she should choose the best way for her. She discusses the matter with a friend. They come up with two plans: (1) Margaret could stop smoking completely on a certain day, or (2) Margaret could slowly reduce the number of cigar- ettes she smokes each day until she gives them up com- pletely. Margaret calls her doctor to ask her doctor's opinion. She also talks to other people who have already quit smoking. Margaret decides to stop smoking gradually. At the start of every week she reduces the number of daily cigarettes she smokes by one. Unfortunately, Margaret isn't too happy with her program and she has trouble keeping track of the number of cigarettes she smokes. She thinks again about her decision to stop smoking gradually. A. Did Margaret correctly complete each of the steps in the decision-making process? Circle One: Yes No B. If No, what did Margaret do wrong? -135- Systematic Decision-Making Page 14 14. Stan wants to get into good physical condition, even though he has not exercised in years. He wants to decide on an exercise program that will be comfortable and effective for him. Stan talks to his co-workers to find out what they do to get and stay in shape. He finds out that most of them either swim, jog or play tennis regularly. Stan thinks about what he might enjoy doing. He then talks to a good friend who tells Stan about the health effects of exercise. Stan starts swimming several times a week. He thinks he's made the right decision because he's getting stronger and more energetic. A, Did Stan correctly complete each of the steps in the decision-making process? Circle One: Yes No Bs If No, what did Stan do wrong? -136- Systematic Decision-Making Page 15 15. Tom has been on a low-salt, low-fat diet for several months. He is pleased with the diet, even though following it can be difficult. He does have to prepare most of his meals himself from fresh foods. Tom has been asked to go on vacation with some friends. He wants to go but he knows that he won't be able to prepare his own meals. If he goes, he may not be able to stay on his diet very well. Tom realizes that he has a decision to make about vacationing with his friends. He considers the options that are available to him. Tom then talks to his doctor to get his advice on the matter. He also calls the hotel where his friends plan to stay, to see if special meal arrangements are pos- sible. After thinking about whether his friends would mind if he didn't go, Tom decides to go on the vacation. Several weeks later, some of Tom's friends invite him to their house to look at pictures from the trip. A. Did Tom correctly complete each of the steps in the decision-making process? Circle One: Yes No B. If No, what did Tom do wrong? -137- SCORING KEY SYSTEMATIC DECISION-MAKING Point values are assigned to responses as follows: 1 point 0 points: A Yes response in part A, if each of the steps in the systematic decision-making process has been completed correctly. If one of the steps in the systematic decision-making process has been omitted or completed incorrectly, one point should be awarded if this is indi- cated by a No response in part A and a con- structed response that accurately identifies the nature of the error. This constructed response must indicate either what was done incorrectly or what should have been done. Steps can be identified by using the title or label of the step, or by providing a spe- cific exemplar of the step. Any response that is not acceptable accord- ing to the above criteria. Guidelines for correct responses by item are indicated below: Item Response A 10 11 12 13 14 15 No No No No Yes No Yes No No No No No Yes No No Response B Skip: Evaluates the decision. Incorrect Implementation: Makes/imple- ments the decision. Skip: Gathers/processes information. Incorrect Implementation: Identifies possible decision options. Incorrect Implementation: Gathers/ processes information. Skip: Gathers/processes information. Skip: Evaluates the decision. Incorrect Implementation: Identifies possible decision options. Incorrect Implementation: Makes/imple- ments the decision. Skip: Gathers/processes information. Incorrect Implementation: Gathers/ processes information. Skip: Evaluates the decision. -138- MAKING DECISIONS TYPE OF MEASURE: Skill OUTCOME ASSESSED: Using Systematic Decision-Making Skills TARGET POPULATION: Elementary school children GENERAL DESCRIPTION: Children are presented with fictional descriptions of young people who are attempting to make deci- sions in a health-related context. Children are asked to select from among three options the next step to be followed using a systematic approach to decision-making. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 343-346. -139- MAKING DECISIONS This test is about young people who are trying to make decisions. Read each story. Circle the letter of the next thing that the person should do in order to be making a decision in the best way. Ken is unhappy because he is heavy. He needs to lose weight and understands that there are many different ways to do it. Ken knows that he must decide on a way to lose weight that is best for him. What should Ken do next in order to be making a deci- sion in the best way? A, Make a list of ways to lose weight. B. Decide how he will lose weight. C. Start a diet. Katie has been going swimming with her best friend every day after school. Katie enjoys it very much. Now Katie's music teacher wants Katie to be in the school band. Band practice is held after school every day from 3:30 - 5:00 o'clock. The pool where Katie swims is only open from 3:00 - 5:00 o'clock. What should Katie do next in order to be making a deci- sion in the best way? A, Keep swimming because she likes it so much. Be Know that she must decide whether to join the band or continue to swim at the pool. Ce. Have her best friend decide whether she should continue to swim or join the band. -140- Making Decisions Page 2 Karen has diabetes and should not eat sweet foods. She is invited to her friend Anne's birthday party. There will be cake and ice cream at the party. Karen wants to go but she thinks that it might be hard not to eat any of the sweets. Karen knows that she must decide what she should do about the party. She talks to her mother about the problem. Together they make a list of things that Karen could do: (1) Karen could go to the party after the other children finish eating, (2) Karen could eat some sweets at the party, or (3) Karen could eat something besides cake and ice cream at the party. What should Karen do next in order to be making a decision in the best way? A. Decide what to do about the party. B. Call Anne and a nurse at her doctor's office to get information. C. Have Anne decide what Karen should do about going to the party. Joe and his family have just moved to a new city. Joe will be starting at a new school soon. Joe is feel- ing nervous because of all the changes, and wants to find a way to feel better. He talks to his older brother about his problem. They think of several different things Joe could do to feel less nervous. Joe could swim at the neighborhood pool after school or spend a little time each day sitting quietly. Joe calls to find out what time the pool is open. He talks to his family about whether he could have a room to himself for quiet time. Joe also thinks about what might make him feel best. What should Joe do next in order to be making a decision in the best way? A. Make a list of all the possible ways to feel less nervous. Be. Try not to think about how nervous he feels. Cc. Decide whether he wants to swim or have quiet time after school. -141- Making Decisions Page 3 S. Margaret has been invited to a party. She thinks that some of the children might have marijuana at the party. Margaret has never smoked marijuana, but she thinks that she might be asked to try some. Margaret knows that she must decide what she will do if someone at the party offers her marijuana. She thinks about whether or not she will smoke it at the party. She goes to the school library to get some infor- mation about marijuana. Margaret also thinks about what her friends would think if she smokes marijuana. What should Margaret do next in order to be making a decision in the best way? A, Understand that she will have to decide whether to smoke marijuana at the party. B. Ask her friends if they have gone to any parties lately. Cc. Decide whether she wants to smoke marijuana at the party. Harold wants to start some kind of team sport. He knows that there are many different sports to choose from. He wants to decide on a sport that he can be good at and will enjoy. Harold talks to his father about his idea. Together they make a list of all the different team sports that Harold might like to play. Then Harold talks to his physical education teacher to see which sports on the list he thinks Harold might be good at. Harold also thinks about which sport he should pick. Harold decides that he would like to play basketball. He signs up for the team and starts practicing every day after school. What should Harold do next in order to be making a decision in the best way? A. Know that he must choose a sport. B. Think about whether he's happy with his decision to play basketball. C. Have a party for the basketball team. -142- Making Decisions Page 4 Mike has been asked to spend the night with his friend Phil next Friday. Phil told Mike that his parents will be out that evening and that he has some cigarettes they can smoke. Although some of Mike's friends have started smoking, Mike has never smoked a cigarette before. What should Mike do next in order to be making a decision in the best way? A. Know that he must decide whether he will smoke cigarettes. B. Talk to his parents about smoking. C. Plan on smoking just one cigarette with Phil. Tom goes to the park almost every afternoon to play. Some of his friends have started drinking beer at the park. One of them told Tom that he could try a little beer the next time they have some. Tom has never had any beer, but he has wondered what it's like. Tom knows that he must decide whether or not he wants to drink any beer. He thinks about the different things he might do. He asks some questions in his health class about drinking. He also thinks about how his parents would feel if they found out. He decides to try some beer because he doesn't want his friends to think he's scared. The next time Tom is in the park he drinks beer with his friends. What should Tom do next in order to be making a decision in the best way? A. Avoid going to the park. Be Understand that his friends were wrong to ask him to drink with them. Ce. Think about how he feels about his decision to drink beer. * -143~ Making Decisions Page 5 10. Carol just went to her doctor. The doctor told Carol and her mother that Carol is too heavy and needs to go on a diet. Carol thinks that a diet will be good for her. Carol understands that there are many diets she might choose. She knows that she needs to pick the diet that is best for her. Carol and her mother talk about different diets and make a list of them. What should Carol do next in order to be making a decision in the best way? A. Talk about the diets on her list with her doctor. B. Decide on one of the diets. C. Ask her mother to pick one of the diets for her. Donna is upset about a big test she must take next week. Although she has been studying, she still feels nervous about the test. Donna's teacher has told her that there are many things a person can do to feel less nervous. Donna wants to find something that she can do to feel better about the test. What should Donna do next in order to be making a decision in the best way? A, Ask her parents to help her study for the test. Be. Talk to her teacher about all the things she can do to feel less nervous. Cs. Decide to sit quietly right before the test. -144- SCORING KEY MAKING DECISIONS Item Answer © 0 NN O&O Ob Ww NH ww > QPF Ww OQ ww oe [= oO INCORRECT ANSWER CHOICE ANALYSES Although there may be some overlap, it may be useful to consider the incorrect answer choices for each item using the following method of annotation. Skipped step = a response that describes one of the decision- making steps that occurs after the correct step. Repeated step = a response that describes one of the decision- making step that has already occurred. Ineffective implementation of a step = a response that describes a decision-making step but is clearly inconsistent with one or more of the step's described characteristics. Deflective action = a response that is unrelated to effec- tive decision-making and may deflect the decision-maker from taking necessary action. Skipped Repeated Ineffective Imple- Deflective Step Step mentation of a Step Action 1 B,C 2 A C 3 A C 4 B 5 A B 6 A Cc 7 B,C 8 A,B 9 58,0 10 A c -145- MAKE A DECISION TYPE OF MEASURE: Skill OUTCOME ASSESSED: Using Systematic Decision-Making Skills TARGET POPULATION: Elementary school children GENERAL DESCRIPTION: Children are presented with fictional descriptions of young people who are attempting to make decisions in a health-related context. Children are then asked to write a description of the next step to be followed using a systematic approach to decision- making. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 347-351. -146- MAKE A DECISION This test is about young people who are trying to make decisions. Read each story. Then write what the person should do next in order to be making a decision in the best way. Ken is unhappy because he is heavy. He needs to lose weight and understands that there are many different ways to do it. Ken knows that he must decide on a way to lose weight that is best for him. What should Ken do next in order to be making a deci- sion in the best way? Katie has been going swimming with her best friend every day after school. Katie enjoys it very much. Now Katie's music teacher wants Katie to be in the school band. Band practice is held after school every day from 3:30 - 5:00 o'clock. The pool where Katie swims is only open from 3:00 to 5:00 o'clock. What should Katie do next in order to be making a deci- sion in the best way? : -147- Make A Decision Page 2 Karen has diabetes and should not eat sweet foods. She is invited to her friend Anne's birthday party. There will be cake and ice cream at the party. Karen wants to go but she thinks that it might be hard not to eat any of the sweets. Karen knows that she must decide what she should do about the party. She talks to her mother about the problem. Together they make a list of things that Karen could do: (1) Karen could go to the party after the other chil- dren finish eating, (2) Karen could eat some sweets at the party, or (3) Karen could eat something besides cake and ice cream at the party. What should Karen do next in order to be making a decision in the best way? Joe and his family have just moved to a new city. Joe will be starting at a new school soon. Joe is feeling nervous because of all the changes, and wants to find a way to feel better. He talks to his older brother about his problem. They think of several different things Joe could do to feel less nervous. Joe could swim at the neighborhood pool after school or spend a little time each day sitting quietly. Joe calls to find out what time the pool is open. He talks to his family about whether he could have a room to himself for quiet time. Joe also thinks about what might make him feel best. What should Joe do next in order to be making a decision in the best way? -148- Make A Decision Page 3 a ° Margaret has been invited to a party. She thinks that some of the children might have marijuana at the party. Margaret has never smoked marijuana, but she thinks that she might be asked to try some. Margaret knows that she must decide what she will do if someone at the party offers her marijuana. She thinks about whether or not she will smoke it at the party. She goes to the school library to get some information about marijuana. Margaret also thinks about what her friends would think if she smokes marijuana. What should Margaret do next in order to be making a decision in the best way? Harold wants to start some kind of team sport. He knows that there are many different sports to choose from. He wants to decide on a sport that he can be good at and will enjoy. Harold talks to his father about his idea. Together they make a list of all the different team sports that Harold might like to play. Then Harold talks to his physical education teacher to see which sports on the list he thinks Harold might be good at. Harold also thinks about which sport he should pick. Harold decides that he would like to play basketball. He signs up for the team and starts practicing every day after school. What should Harold do next in order to be making a deci- sion in the best way? -149- Make A Decision Page 4 Mike has been asked to spend the night with his friend Phil next Friday. Phil told Mike that his parents will he out that evening and that he has some cigarettes they can smoke. Although some of Mike's friends have started smoking, Mike has never smoked a cigarette before. What should Mike do next in order to be making a deci- sion in the best way? Tom goes to the park almost every afternoon to play. Some of his friends have started drinking beer at the park. One of them told Tom that he could try a little beer the next time they have some. Tom has never had any beer, but he has wondered what it's like. Tom knows that he must decide whether or not he wants to drink any beer. He thinks about the different things he might do. He asks some questions in his health class about drinking. He also thinks about how his parents would feel if they found out. He decides to try some beer because he doesn't want his friends to think he's scared. The next time Tom is in the park he drinks beer with his friends. What should Tom do next in order to be making a decision in the best way? -150- Make A Decision Page 5 10. Carol just went to her doctor. The doctor told Carol and her mother that Carol is too heavy and needs to go on a diet. Carol thinks that a diet will be good for her. Carol understands that there are many diets she might choose. She knows that she needs to pick the diet that is best for her. Carol and her mother talk about different diets and make a list of them. What should Carol do next in order to be making a deci- sion in the best way? Donna is upset about a big test she must take next week, Although she has been studying, she still feels .nervous about the test. Donna's teacher has told her that there are many things a person can do to feel less nervous. Donna wants to find something that she can do to feel better about the test. What should Donna do next in order to be making a deci- sion in the best way? -151- SCORING KEY MAKE A DECISION Point values are assigned to responses as follows: 1 point: 0 points: A response that correctly identifies the next step of the decision-making process. If the last step described in the stimulus is either "identifies possible decision options" or "gathers/thinks about information", one point can also be awarded for continuation of that step. One point should be awarded for repetition of early steps only if a rationale is provided that would justify returning to an earlier step. Steps can be identified by the title or label of the step, or by providing a specific exemplar of the step. Any response that is not acceptable according to the above guidelines. Appropriate next steps by item are indicated below: Item Nd © 0 I OO Un bh Ww 10 Appropriate Next Step Identifies possible decision options. Identifies the decision to be made. Gathers/ thinks about information. Makes/carries out the decision. Makes/carries out the decision. Evaluates the decision. Identifies the decision to be made. Evaluates the decision. Gathers/thinks about information. Identifies possible decision options. -152- EFFECTS OF EXERCISE TYPE OF MEASURE: Affective OUTCOME ASSESSED: Belief in Positive Effects of Exercise TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: This inventory is a Likert scale in which respon- dents are asked to register their degree of agree- ment with a series of statements about the possible effects of exercise on a person's body image, sexu- ality, coordination, strength, social acceptability, personal adjustment, self-concept, ability to manage stress, and health. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 352-354. -153- EFFECTS OF EXERCISE This survey describes some possible effects of regular exercise. Please respond to all the state- ments in the survey. Read each statement. Decide the extent to which you agree with it. Circle the appropriate letter to the left of the statement. Use the following scale: SA = Strongly Agree A m= Agree U = Uncertain D = Disagree SD = Strongly Disagree SA A UD SD 1. Exercise is helpful in reducing anxiety. Sa: A UD 8D De Exercise increases a person's ability to have more satisfying sexual relationships. S& A-U DD SD 3. Exercise does nothing to improve a person's coordination. SA AU ‘D':SD 4, People who exercise are healthier than people who don't exercise. SA A U D 8D 5. Exercise does not increase a person's ) physical strength. SAAD D=S8D 6. Exercise does not make a person more socially accepted. SA A= 1D SD 7. People who exercise are more likely to feel good about themselves than people who don't exercise. SAA" U:'D “SD 8. Exercise decreases a person's sexual satisfaction. -154- Effects of Exercise Page 2 SA A U D SD 9. People who exercise are stronger than people who don't. SA A U D SD 10. People who exercise like the way their bodies look. SA A U D SD 11. Exercise makes it easier for a person to adjust to life. SA A OU DD 8D 12. People who exercise are well accepted in social situations. SA A U D SD 13. Exercise does nothing to reduce stress. SA A U D SD 14. People who exercise are no happier with the way their bodies look than people who don't exercise. SA A U D SD 15. People who exercise have better physical coordination than people who don't exercise. SA A U D SD 16. Exercise does nothing to help people like themselves. SA A U D SD 17. People who exercise get sick just as often as people who don't exercise. SA A U D SD 18. Exercising does not help a person to be better adjusted. -155- INSTRUCTIONS FOR SCORING EFFECTS OF EXERCISE Point values are assigned to responses according to the following scoring key. SCORING KEY sa A u D SD 1, 5 4 3 2 T 2. 5 4 3 2 1 3. i 2 3 4 5 4, 5 4 3 2 1 5. 1 2 3 4 5 8. 1 2 3 4 5 7» 5 4 3 2 1 8S. 1 2 3 4 5 9. 5 4 3 2 1 10. 5 4 3 2 1 11. 5 4 3 2 1 12. 5 4 3 2 1 13. 1 2 3 4 5 14. 1 2 3 4 5 15. 5 4 3 2 1 16. 1 2 3 4 5 17. 1 2 3 4 5 18. 1 2 3 4 5 This inventory can be scored by adding the point value of every response and dividing this sum by the number of responses. The maximum score attainable of 5 points indicates a strong belief in the positive effects of exercise on body image, sexuality, coordination, strength, social accepta- bility, personal adjustment, self-concept, ability to manage stress, and health. In addition to an overall score for this outcome, responses can be considered separately as follows: Area Items Body image 10, 14 Sexuality 2, 8 Coordination 3, 15 Strength 5, 9 Social acceptability 6, 12 Personal adjustment 11, 18 Self-concept 7, 186 Stress management 1, 13 Health 4, 17 -156- EXERCISE AND PEOPLE TYPE OF MEASURE: Affective OUTCOME ASSESSED: Belief in Positive Effects of Exercise TARGET POPULATION: Elementary school children GENERAL DESCRIPTION: This inventory is a Likert scale in which children are asked to register their degree of agreement with a series of statements about the possible effects of exercise on a person's body image, coor- dination, strength, social acceptability, self- concept, ability to manage stress, and health. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 355-357. -157- YES YES YES YES YES YES YES YES YES EXERCISE AND PEOPLE The statements below are about what exer- cise might do. shows if you agree with each statement. Circle the word that YES = 1 agree MAYBE = I am not sure if I agree NO = I do not agree MAYBE NO 1. Exercise helps people feel less anxious. MAYBE NO 2. Exercise doesn't help people be less clumsy. MAYBE NO 3. People who exercise usually get sick less often than people who don't exercise. MAYBE NO 4, People can be just as strong, whether or not they exercise. MAYBE NO 5. Exercise does not help people make friends. MAYBE NO 8. People who exercise are more likely to feel good about themselves than people who don't exercise. MAYBE NO 7. People who exercise are usually : stronger than people who don't. MAYBE NO 8. People who exercise usually like the way their bodies look. MAYBE NO 9, People who exercise have more friends than those who don't. -158- Exercise and People Page 2 YES MAYBE NO 10. People who exercise are just as likely to be nervous as those who don't. YES MAYBE NO 11. Exercise does not help people like the way their bodies look. YES MAYBE NO 12. People who exercise are usually less awkward than people who don't exercise. YES MAYBE NO 13. Exercise doesn't help a person stay healthy. YES MAYBE NO 14. Exercise does not affect how people feel about themselves. -159- INSTRUCTIONS FOR SCORING EXERCISE AND PEOPLE Point values are assigned to responses according to the following scoring key. SCORING KEY =< = wn MAYBE 1. 2. 3. 4. 5. 6. Te 8. 9. 10. ii. 12. 13. 14. CO NO OVNCNIN NSO NN OC | =o EE Ee NN 'NMIO RB NO CLO OM NN OO ND |Z This inventory can be scored by adding the point value of every response and dividing this sum by the number of responses. The maximum score attainable of 2 points indi- cates a strong belief in the positive effects of exercise on body image, coordination, strength, social acceptability, self-concept, ability to manage stress, and health. In addition to an overall score for this outcome, responses can be considered separately as follows: Area Items Body image 3, 11 Coordination 2, 12 Strength 4, 7 Social acceptability 5, 9 Self-concept 6, 14 Stress management 1, 10 Health 3, 13 -160- EXERCISING REGULARLY TYPE OF MEASURE: Affective OUTCOME ASSESSED: Perceived Ability to Exercise Regularly TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: This measure is designed to assess individuals’ perceived self-efficacy in being able to exercise regularly. Individuals are presented with a series of situations which might promote or serve as barriers to regular exercise and asked to indicate if they can exercise regularly in each situation. If they indicate that they can exercise regularly, then they are asked to estimate, on a 10 to 100 numerical scale, how confident they are of their ability to exercise regularly in that situation. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 358-360. -161- EXERCISING REGULARLY This survey is about exercising regularly im various situations. Regular exercise requires 20 minutes or more of strenuous activity at least three times per week. Read each statement. Circle YES or NO to show if you could exercise regularly in that situation. If you circle YES, then use the Confidence Scale to show how certain you are of your answer. The following examples show how the Confidence Scale is used. IF YES, CAN YOU HOW CERTAIN Physical Strength Examples DO THIS? ARE YOU? You can lift a 50 pound weight. NO 70 You can lift a 200 pound weight. YES{NO) Confidence Scale 10 20 30 40 50 60 70 80 90 100 Very Somewhat Very Uncertain Certain Certain IF YES, CAN YOU HOW EXERCISE CERTAIN REGULARLY? ARE YOU? You are on a vacation. YES/NO There are no convenient places to exercise. YES/NO You notice you are putting on a few extra pounds. YES/NO You are unusually busy. YES/NO You would like to try a new sport. YES/NO You find yourself with extra time on your hands. YES/NO -162- Exercising Regularly Page 2 7. You have just moved to a new neighbor- hood. 8. You feel as though you'll never be good at sports. 9. You are trying to save money. 10. Friends or relatives from out of town are visiting for several weeks. 11. You can't find others who want to exercise with you. 12. - You've taken on some major addi- tional responsibilities and don't have much free time. 13. You don't have the necessary equipment for a sport you'd like to try. 14. A few of your friends are starting a regular exercise program and want you to participate with them. 15. You are facing major financial diffi- culties. 16. You are tired and low on energy. 17. The weather has been bad and is expected to stay that way for a while. 18. You feel overworked. 19. You have just recovered from an injury you got while exercising. 20. You have been feeling depressed for quite awhile. -163- IF YES, CAN YOU HOW EXERCISE CERTAIN REGULARLY? ARE YOU? YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO INSTRUCTIONS FOR SCORING EXERCISING REGULARLY This inventory can be scored in several ways, two of which are described below. The first procedure relies on the YES/NO responses only, providing an easily obtained gross index of perceived ability to exercise regularly. The second procedure combines the YES/NO responses and the confi- dence ratings in a single score, providing an index that reflects perceived ability to exercise regularly across a variety of settings, coupled with the level of confidence manifested in that ability. ANALYSIS OF YES/NO RESPONSES ONLY Count the number of YES responses, disregarding the confi- dence ratings. The maximum score attainable of 20 YES responses represents a strong perceived ability to exercise regularly in a wide variety of settings. ANALYSIS COMBINING YES/NO RESPONSES AND CONFIDENCE RATINGS Total all of the confidence ratings made in conjunction with a "YES" response and divide this sum by 20 (the total number of items in the inventory.) Confidence ratings made in conjunction with a "NO" response should be omitted from the analysis. The maximum score attainable of 100 represents a strong perceived ability to exercise regularly across a wide variety of settings, along with a high level of confi- dence in that ability. It should be noted that this scor- ing procedure assumes a confidence rating of zero for those items to which respondents indicated "NO," meaning that they do not think they are able to exercise regularly in the situation described. -164- EXERCISE SURVEY TYPE OF MEASURE: Affective OUTCOME ASSESSED: Intention to Exercise Regularly TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: This measure is designed to assess the extent to which individuals intend to exercise regularly. Individuals are asked whether they intend to exer- cise regularly for the next 12 months. If indi- viduals indicate that they intend to exercise regularly for the next 12 months, then they are asked to estimate, on a 10 to 100 numerical scale, the strength of their intention. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 361-362. -165- EXERCISE SURVEY This survey asks about your intention to exercise regularly. Regular exercise requires 20 minutes or more of strenuous activity at least three times per week. Please answer Question 1. If your answer to Question 1 is "YES," please answer Question 2. il. Do you intend to exercise regularly for the next 12 months? (Circle One) YES NO 2 If yes, how strong is your intention to exercise regularly? (Circle One) 10 20 30 40 50 60 70 80 20 100 Very Very Weak Strong -166- INSTRUCTIONS FOR SCORING EXERCISE SURVEY Point values are assigned to Question 1 as follows: YES NO 1 0 | For Question 2, the point value is the numerical value circled. Because Questions 1 and 2 call for different types of responses, those responses should not be combined when aggregating the data for a group of respondents. -167- IDEAS ABOUT SYSTEMATIC DECISION-MAKING TYPE OF MEASURE: Affective OUTCOME ASSESSED: Belief in the Utility of Systematic Decision-Making TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: This inventory is a Likert scale in which respondents are asked to register their degree of agreement with a series of statements about making decisions system- atically. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 363-365. : -168- SA SA SA SA SA SA SA SA SA IDEAS ABOUT SYSTEMATIC DECISION-MAKING This survey is about making decisions systematically. Please respond to all the statements in the survey. Read each statement. Decide the extent to which you agree with it. Circle the appropriate letter to the left of the statement. Use the following scale: SA = Strongly Agree A = Agree U = Uncertain D = Disagree SD = Strongly Disagree D SD i People who make decisions systematically reach better decisions than people who don't. D SD 2. Systematic decision-making takes too much time. D SD 3. People who use systematic decision- making have greater control over the events in their lives. D SD 4. People makes equally good decisions no matter how they arrive at them. D SD 5. Systematic decision-making is too complicated. D «8D 6. It is worth the time to make decisions systematically. D SD 7. A systematic decision-making process doesn't consider how people feel. D 8D 8. People who use systematic decision- making won't make hasty decisions that they will regret later. D SD O. Systematic decision-making is too intellectual. -169- Ideas About Systematic Decision-Making Page 2 SA A 1 D 8D 10. Systematic decision-making helps people make the best choice when deciding about important things in their lives. SA A ‘UD 8D 11, Systematic decision-making only works when making decisions with a group of people. SA ‘A UD 8D 12, Systematic decision-making is the best way to make decisions. SA AU -D 8D 13. Systematic decision-making is easy when people learn how to use it. 8A A U DD: SD 14. Only logical people have the skills needed for systematic decision- making. SA AU D-8SD 15. Systematic decision-making is not flexible enough. SA 54 1 D+8D 16. The effort involved in making decisions systematically is well worth it. SA: A 1. D 8D 17. It is too hard to get the information needed to make decisions systematically. SA: A-1 "D SD 18. Systematic decision-making helps people think about their values when they make decisions. SA A UD 8D 19. People follow through with decisions they have made systematically. SA A UD SD 20. People make their best decisions when they follow their first impulses. -170- INSTRUCTIONS FOR SCORING IDEAS ABOUT SYSTEMATIC DECISION-MAKING Point values are assigned to responses according to the following scoring key. SCORING KEY U I> Io 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. HOUR RRQUIROHEOROIE =O =O 2 NBR PN PNR RNARNERERNDPNDN DNS GO LO CO LO CO LO CLO LI LO LO LOL CLO LLL WWW BONEN RENNER NERD NDB DNDN UHHH OURROROROROO ROR |2 This inventory can be scored by adding the point value of every response and dividing this sum by the number of responses. The maximum score attainable of 5 points indi- cates a strong belief in the utility of making decisions systematically. -171- IDEAS ABOUT DECISIONS TYPE OF MEASURE: Affective OUTCOME ASSESSED: Belief in the Utility of Systematic Decision-Making TARGET POPULATION: Elementary school children GENERAL DESCRIPTION: This inventory is a Likert scale in which children are asked to register their degree of agreement with a series of statements about systematic decision-making. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 366-367. -172-~ YES YES YES YES YES YES YES YES YES IDEAS ABOUT DECISIONS The statements below are about making decisions. Circle the word that shows how much you agree with each statement. YES = I agree MAYBE = I am not sure if I agree NO = 1 do not agree MAYBE NO Ne It is worth the time it takes to make decisions carefully. MAYBE NO 2. People should go with their first ideas when making decisions. MAYBE NO 3 People are happier with their decisions when they take the time to make them carefully. MAYBE NO 4, Making careful decisions is too difficult, MAYBE NO 5. Making careful decisions takes too much time. MAYBE NO 6. When making decisions people should do what they feel, not what they think. MAYBE NO 7» It is easy to make decisions care- fully. MAYBE NO 8. People make equally good decisions no matter how they arrive at them. MAYBE NO 0. People who make quick decisions are usually disappointed with them later. MAYBE NO 10. Smart people take time to make decisions carefully. -173- INSTRUCTIONS FOR SCORING IDEAS ABOUT DECISIONS Point values are assigned to responses according to the following scoring key. SCORING KEY YES MAYBE NO 1. 2 3 0 2, 0 1 2 3, 2 1 0 4. 0 t 2 Be 0 1 2 6. 0 1 2 Ze 2 1 0 8. 0 1 2 9. 2 3 0 10. 2 1 0 This inventory can be scored by adding the point value of every response and dividing this sum by the number of responses. The maximum score attainable of 2 points indi- cates a strong belief in the utility of making decisions systematically. -174- WOULD YOU USE SYSTEMATIC DECISION-MAKING? TYPE OF MEASURE: Affective OUTCOME ASSESSED: Intention to Use Systematic Decision- Making TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: This measure is designed to assess the extent to which individuals intend to use systematic decision- making. Individuals are asked whether they would use systematic decision-making in a variety of situations. If individuals indicate that they would use systematic decision-making, they are asked to estimate, on a 10 to 100 numerical scale, how con- fident they are of their intention. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 368-370. -175- WOULD YOU USE SYSTEMATIC DECISION-MAKING? This survey describes situations in which people might use systematic decision-making. Read each statement. Circle Yes or No to indicate whether you would use systematic decision-making in the situation described in the item. If you circle Yes, then use the Confidence Scale to show how certain you are that you would use systematic decision-making in that situation. The following examples show how the Confidence Scale is used. WOULD YOU USE IF YES, SYSTEMATIC HOW DECISION- CERTAIN MAKING? ARE YOU? 1. You are deciding om a career. NO qo 2. You are choosing where to eat lunch. @EsyNo 10 3. You are swerving to avoid a car accident. YES (NO) Confidence Scale 10 20 30 40 S50 60 70 80 20 100 Very Somewhat Very Uncertain Certain Certain WOULD YOU USE IF YES, SYSTEMATIC HOW CERTAIN SITUATION DECISION-MAKING? ARE YOU? You are deciding whether to start an exercise program. YES/NO You are choosing a diet. YES/NO You are being rushed by others to make a quick decision. YES/NO You are choosing an exercise program. YES/NO -176- Would You Use Systematic Decision-Making? Page 2 SITUATION 5. You are being urged by 10. 11. 12. 13. 14. 15. others to make a decision in their favor. You are selecting a way to reduce your stress. You are deciding whether to see a doctor. You are making a decision and have many other things to do. You are deciding whether to take vitamins. You are deciding what to eat for dinner. You are deciding whether to use a non-prescription drug. You are deciding whether to start a diet. You are deciding what to do for a cold. You are making a decision while you have many things on your mind. You are deciding what to do to relax. -177- WOULD YOU USE IF YES, SYSTEMATIC HOW CERTAIN DECISION-MAKING? ARE YOU? YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO INSTRUCTIONS FOR SCORING WOULD YOU USE SYSTEMATIC DECISION-MAKING? This inventory can be scored in several ways, two of which are described below. The first procedure relies on the YES/NO responses only, providing an easily obtained gross index of intention to use systematic decision-making. The second procedure combines the YES/NO responses and the confidence ratings in a single score, providing an index that reflects intention to use systematic decision-making in a variety of situations, coupled with the level of confidence manifested in that intention. ANALYSIS OF YES/NO RESPONSES ONLY Count the number of YES responses, disregarding the confi- dence ratings. The maximum score attainable of 15 YES responses represents a strong intention to use systematic decision-making in a variety of situations. ANALYSIS COMBINING YES/NO RESPONSES AND CONFIDENCE RATINGS Total all of the confidence ratings made in conjunction with a "YES" response and divide this sum by 15 (the total number of items in the inventory). Confidence ratings made in coan- junction with a "NO" response should be omitted from the analysis. The maximum score attainable of 100 represents a strong intention to use systematic decision-making in a variety of situations, along with a high level of confidence in that ability. It should be noted that this scoring procedure assumes a confidence rating of zero for those items to which respondents indicated "NO," meaning that they do not intend to use systematic decision-making in the specified situation. -178- WOULD YOU MAKE CAREFUL DECISIONS? TYPE OF MEASURE: Affective OUTCOME ASSESSED: Intention to Use Systematic Decision- Making TARGET POPULATION: Elementary school children GENERAL DESCRIPTION: Children are asked whether they would make a careful decision in a variety of situations. They are then asked to select the response that best describes their intentions. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 371-372. -179- WOULD YOU MAKE CAREFUL DECISIONS? Read each question. ( Vv) under the answer that best tells if you would make a careful decision. Then put a check Would you make a careful deci- sion when... 1. «ss YOU are deciding whether to stay up late at night? 2. ees you are choos- ing a way to lose weight? decid- you any 3 sss YOU are ing whether want to try drugs? 4, «ss yOu are decid- ing whether to do what your friends want you to do? 5, «ses yOu are being rushed to decide quickly? 6. ess you are decid- ing whether or not to drink alcohol? 7 ® 0 0 ing for choos- eat you are what to lunch? 8. «es yOu are decid- ing whether cigarettes? 9. ees you are decid- ing how to relax? 10. you are choos- ing a way to exer- cise? CERTAINLY PROBABLY YES YES to smoke -180- MAYBE PROBABLY CERTAINLY NOT NOT INSTRUCTIONS FOR SCORING WOULD YOU MAKE CAREFUL DECISIONS? Point values are assigned to responses as follows: CERTAINLY YES = 5 PROBABLY YES = 4 MAYBE = 3 PROBABLY NOT = 2 CERTAINLY NOT = 1 This inventory can be scored by adding the point value of every response and dividing this sum by the number of responses. The maximum score attainable of 5 points indicates a strong intention to use systematic decision- making in a variety of situations. -181- MY BODY TYPE OF MEASURE: Affective OUTCOME ASSESSED: Respect for One's Body TARGET POPULATION: Elementary school children GENERAL DESCRIPTION: This measure is designed to assess children's respect for their bodies. Children are asked to indicate whether they would engage in activities that are healthful and avoid activ- ities that are harmful to the body. ADDITIONAL INFORMATION: Test specifications for this measure can be found on pages 373-374. -182- MY BODY Read each question. ( Vv) under the answer that best tells what you are willing to do to take care of your body. Then put a check In order to take care of your body, are you willing £0 ous CERTAINLY PROBABLY YES YES MAYBE PROBABLY CERTAINLY NOT NOT 1. 10. ess €Xercise several times each week? «ss never drink large amounts of alcohol? ees do what your doctor tells you to do? «oo never smoke any cigarettes? ees get immuni- zations against diseases? «oo get at least 8 hours of sleep every night? «ss See your doctor regularly? ... keep yourself from getting too anxious? ees be careful about what you eat? .»s never take unnecessary drugs? -183- INSTRUCTIONS FOR SCORING MY BODY Point values are assigned to responses according to the following scoring key: SCORING KEY CERTAINLY YES PROBABLY YES MAYBE PROBABLY NOT CERTAINLY NOT nw unnan HNDWk Oo This inventory can be scored by adding the point value of every response and dividing this sum by the number of responses. The maximum score attainable of 5 points indi- cates a strong respect for one's body, as evidenced by a willingness to engage in activities that are good for it and to avoid those that are not. -184- CHAPTER SIX EXISTING MEASURES This chapter contains the existing measures that were located as a result of a comprehensive literature search, then identified as corresponding to the outcome statements listed in Chapter Four. The process by which existing measures were screened and selected is explained more com- pletely in Chapter Two. MEASURE TITLE PAGE A title page precedes each measure. This page indicates the type of measure (behavioral, knowledge, skill, or affec- tive), the title of the outcome assessed, and the target population for the instrument. A general description is presented, providing an overview of the assessment strategy employed in the measure. The general description also pro- vides information about the manner in which the instrument has previously been used. A technical information section summarizes any psychometric information that has been col- lected for the instrument. Authorship information for each measure is also supplied. If .there is any additional information available for a measure, reference citations are also given. USING THE MEASURES All of the measures in this chapter have been readied for photocopying. Directions to respondents and scoring instructions have been provided whenever they were available. The scoring instructions have been placed on separate pages to facilitate reproduction of the measures for administra- tion. Handbook users have permission to use all of the measures in this chapter without seeking further permission from the measures' authors. -185- CANADA FITNESS SURVEY - PHYSICAL ACTIVITIES TYPE OF MEASURE: Behavioral OUTCOME ASSESSED: Maintenance of an Acceptable Activity Level TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: Canada Fitness Survey - Physical Activities is a self-administered questionnaire designed to elicit information about individuals' physical activities. Respondents are asked to describe the frequency and intensity of their current daily and weekly activities, then to recall additional activities in which they participated during the last month and year. Physical Activities is one of the measures used in the Canada Fitness Survey, a program designed to collect fitness and physical activity statistics. Other measures include questions about leisure time as well as health and lifestyle (not included here). The Standardized Test of Fitness (STF) is also administered as part of this battery. (See Standardized Test of Fitness, page 214). AUTHORS: Canada Fitness Survey Ottawa, Canada ADDITIONAL INFORMATION: The entire Canada Fitness Survey, as well as a detailed report describing how to calculate total energy expendi- ture in kcal/kg/day, based on the questionnaire, is available from: Canada Fitness Survey 506-294 Albert Street Ottawa, Canada K1P ©6EG6 -186- CANADA FITNESS SURVEY - PHYSICAL ACTIVITIES rail N. 2. WEEKLY ACTIVITIES 1) PHYSICAL ACTIVITIES WHAT YOU DO AT WORK OR AT SCHOOL OR IN THE HOME, PLUS YOUR ACTIVITY IN YOUR LEISURE TIME ALL CONTRIBUTE TO YOUR CURRENT LEVEL OF FITNESS. THE FOLLOWING QUESTIONS WILL PROVIDE A COMPLETE PICTURE OF ALL YOUR ACTIVITIES. TO HELP YOU DESCRIBE YOUR ACTIVITIES, WE HAVE DESIGNED FOUR QUESTIONS — ONE FOR THOSE YOU DO DAILY, ONE FOR THOSE YOU DO EACH WEEK, ONE FOR THOSE YOU HAVE DONE IN THE LAST MONTH, AND THE FOURTH FOR THOSE ACTIVITIES YOU HAVE DONE IN THE LAST YEAR. DAILY ACTIVITIES For those activities which you do most days of the week (such as work, school and housework), how much time do you spend. . . Almost ail About 3/4 About 1/2 About 1/4 Almost none of the time of the time of the time of the time of the time Sitting wld Gl Gl Gl Gl Standing ol Gl Gl J Gl Walking wld Gl GJ GJ GJ Walking up stairs o nl ] Gl [J Gl Lifting or carrying heavy objects » J Gl Gl nl Gl Please refer to the reference card for a list of activities. Answer the following for the physical activities you do each week. Light housework and handywork: washing dishes, ironing, making beds, mowing lawn, etc Intensity Light m Heavy Average Somepers- Heavy } time Slight ~~ pirstion pers- Number of occasions actually change Above piration each month spent on from normal Heavy each occasion normal breathing breathing J FM AM J J A S O N D Hs Mins WERE EME ae EE Lo LO 08 07 08 9 10 1" Heavy housework and handywork: washing and waxing floors, painting, etc Intensity Light Medium Heavy Average Somepers- Heavy ) time Slight piration pers- Number of occasions actually change Above piration each month spent on from narmal Heavy J FM A M J J A 8S O N D “in Mi ddl tt entre oo 13 i) 13 18 7’. 19 Name of activity l ka | 2 2 Organized Number of occasions Average: tntensity inlevels or each. month time Light Medium Heavy in a league Competitive J F A ¥ J J A S O N D Hrs Mins Yes No Yes No Ld LL od hte Lad et Ld 0 & LO OU 2 u = ss z 2 2 2 Name of activity | | , | ed, id 3 r Number of occasions Average intensity oh To time Light Medium Heavy Organized Competitive J FM A M ° N Hrs Mins Yes No Yes No et IL Jul Od &@ OE OG 1 u © a Name of activity [ | | kal | 2 a Number of occasions Average Intensity each month time Light Medium Heavy Organized Competitive J FM AM J J Hrs Mins Yes No Yes No J Jul Edd UG Oa 4% 48 51 2 Name of activity | | I) | 3 54 Number of occasions Average Intensity each month time Light Medium Heavy ganze Serpaiive JF M AM J J A Ss O N D Hrs Mins CO] Lola ll (Il @ 3 06 0a) 56 % EF) 9 60 -187- Canada Fitness Survey - Physical Activities Page 2 £ 3. ACTIVITIES IN THE LAST MONTH Please refer to the reference card for a list of activities. Answer the following for the physical activities you have done at least once in the last month. (Do not include activities already listed in Weekly Activities.) Gardening and cultivating such as spading, digging, weeding Intensity Medium Light Some Heavy Slight perspir- Heavy Change ation perspir- Qccasions Average time from Above ation in the last actually spent normal normal Heavy month on each occasion state breathing breathing Lr Al pm ol @ a 04 Shovelling snow Intensity Medium Light Some Heavy Slight Perspir- Heavy Change ation perspir- Occasions Average time from Above ation in the last actually spent normal normal Heavy month on each occasion state breathing breathing Lo i mem 05 08 0 8 Mowing the lawn (pushing a power mower) Intensity 2) + BB pea dad -188- Medium Light Some Heavy Slight perspir- Heavy Change ation perspir- Occasions Average time from Above ation in the last actually spent normal normal Heavy month on each occasion state breathing breathing od re Bm § 4) 10 1" 12 Name of activity L y| eked 1 Occasions Organized in the last Intensity in lavels or month Average time Light Medium Heavy in a league Competitive ieee oon B28 08 3 15 16 17 18 19 2 Name of activity | | Lata 21 2 Occasions in the last Intensity month Average time Light Medium Heavy Organized Competitive Jp lan 2 2 x 2 z 2 Name of activity | | dedi | 2 0 Occasions : in the last Intensity month Average time Lignt Medium Heavy Organized Competitive E Hrs Mins Yes No Yes No An » n 4 3» » Name of activity | dy | 7 8 Occasions in the last Intensity month Average time Light Medium Heavy Organized Competitive Hrs Mins Yes No Yes No td Lot fot BBG Ooh » 40 4 Q Qa “ Name of activity l | tad 4% % Occasions 3 in the last Intensity month Average time Light Medium Heavy Organized Competitive Hrs Mins Yes No Yes No lL. i HBS E dl a7 48 49 30 51 82 Name of activity | + do | 3 Occasions in the last Intensity month Average time Light Medium Heavy Organized Competitive Hrs Mins Yes No Yes No Canada Fitness Survey - Physical Activities Page 3 ‘© Lot ag 3) 4. ACTIVITIES IN THE LAST YEAR Please refer to the reference card for a list of activities. Answer the following for the physical activities you have done in the last 12 months. Average number of (Do not include activities you have already lisiad. ) gs : Ex en : Walking for exercise aoadanodonasd Luooo Jogging (using short strides) GOGO Oo0 DOL ID O00 Running (using long strides) ROCoOnOOO0Co0Ll 00 oan Bicycling 000000000000 Ld - 0 - ol amass srws LOOOAAAAAAAE DODD Exercise classes 000000000000 LI 000oa0 Weight training 000000000000 LJ Oa4aaad Yoga poooooooooao wl gd 0 0 snwmmmeamimens. IOASSAAABN CI TOT D Racquetball 00000000000... 004ao Squash CACC OoooOL Ba O00 Tennis Oo0000000aono wd J Cl C] [] Basebel Aaaooaooaoad Cuoomd Softball CoooopoooooDLLI oon c Ice hockey o0000Oooado ww oaaga Curling LananonononaiL.l go CJ C] Simian aogaoaooaood Laooad Cross country skiing Qaoooodocadag uw gaaa Alpine/Downhil skiing CooL ong — 000000000000 LI ggo0 Names of activities: J FMA MUJUJ AS OND as B® 0 more 1aaaadaoaaonod Coooao ul SOOO 00000 o 00 LL. gn uy A 0000000000001. O00 ng wl - Oooo 0000LI 00 O00 | 000000000000 WLW ggog ir J aoaooaotobat Coooroo wud | I I 0 wit | I RP A al | 00Q0O000ococd L111 ooao nL | 0000000000caOo LJ ooadg) -189- Canada Fitness Survey - Physical Activities Page 4 2 2 PHYSICAL ACTIVITY IN YOUR LEISURE TIME B. Here is a list of reasons why some people do physical activities during their leisure time. How important is each of these to you? Very Of some Of litte Of no important importance importance importance To feel better mentally and physicaily od A Gl J To be with other people 8 For pleasure, fun or excitement To control weight or to look better ® To move better or to improve flexibility 2 As a challenge to my abilities 8 To relax or reduce stress To learn new things Bhabha hhah Because of fitness specialist's advice for improving health in general Because of doctor's orders for therapy or rehabilitation FRB EaEERE El El FIFE) EY EYE) EE) FEOF e El Other With whom do you usually do your physical activities in your leisure time? O O Immediate family 2 No one 13 Friends 14 or relatives 0 Classmates O 5 Co-workers 16 at school 7 Others 7. When do you usually do your physical activities? (Indicate one only.) WJ Weekdays Gl Weekends GJ Both 8. At what time do you usually do your physical activities? (Indicate more than one if you usually do activities more than once a day.) = In the morning 2 a At lunchtime 2 O In the afternoon we in the evening 15 At no special time © Where do you usually do your physical activities? (Indicate one or more.) School, college or % O Home zn a Work EY) university facility il Park = OJ Recreational facility a OJ Other Commercial facility Outside using no % or private club 2 special facility 10. How long have you been doing some physical activity in your leisure time at least once a week? O | don’tdo an For less than From 3 months to From 6 months to n activity each week xn 3months x just under 6 months % just under 1 year 0 From 1 year to just From 3 years to Five or more » under 3 years 7 just under 5 years » years 1. Comparing yourself to others of your own age and sex, would you say you are. . . . SL More fit Gl Less fit As fit i -190- QUESTIONNAIRE ON EXERCISE TYPE OF MEASURE: Behavioral OUTCOME ASSESSED: Maintenance of an Acceptable Activity Level TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: The Questionnaire on Exercise is designed to elicit information about individuals' planned physical activities. Respondents are presented with a variety of physical activities, e.g., archery, football, isometrics, then asked for the quantity, duration, and frequency of each activity. Respondents are also asked if they enjoy participating in each activity. The inventory concludes with six general health and well-being questions. AUTHORS: Richard Carter, M.D. Private Practice, Seattle, Washington ADDITIONAL INFORMATION: Carter, R. Exercise and happiness. Journal of Sports Medicine, 1977, 17, 307-313. -191- QUESTIONNAIRE ON EXERCISE QUESTIONNAIRE ON EXERCISE (slightly modified) All information will be kept confidential. Age... Sex... Height... Weight Marital status... Sis or EE) Activity 554s 32E{ Er > =z Activity £54, 3 Zc 2233 SBER 15025 £% ARs 533% gd ZR (8333 Archery k : 1 Ping-pong Badminton Rope skipping Basketball “| Rowing Billards/Pool Running in place Bowling Running-jogging Boxing Shuffleboard "Calisthenics Skating Cycling-bike Skiing : Daseing specity “Soccer/ILacrosse eT step: Fencing Seam : Stair climbing Footbal) Swimming rT a + RE TT lin ; inl Gi Vollyball rer =r ling | Isometrics Yrolght Bitving Isotonics Wrestling — Yoko, Kingla, Other, specify karate About how many total hours do you spend, in an average week, exercising? How would you describe your health? poor... fair. good........ . excellent... Do you consider yourself: underweight... ... about right ......... overweight. ..... ... Taken all together, how would you say you are these days? very happy. . pretty happy not too happy . . Please mark the line which best describes the wav you feel right now. Happy Unhappy 6 5 4 3 2 1 Reprinted with permission of the American Orthopedic Society, Journal of Sports Medicine, 1977. -192- UNIVERSITY OF PENNSYLVANIA ALUMNI HEALTH QUESTIONNAIRE TYPE OF MEASURE: Behavioral OUTCOME ASSESSED: Maintenance of an Acceptable Activity Level TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: The Alumni Health Questionnaire is designed to elicit information about individuals' physical activities. Respondents are asked to list the kinds of sports, recreation, or other physical activities they have participated in and how long they remained physically active with each. Together with data on walking and stair climbing, sports participation is converted into a physical activity index generally expressed in kilocalories of energy expended per week. The questionnaire also elicits information about social and dietary habits as well as general health status of the subject and his/her parents. The questionnaire has been used in an ongoing study with the University of Pennsylvania alumni to determine how life styles influence health. AUTHORS: Dr. Ralph Paffenbarger Mr. Robert Hyde Stanford University, Palo Alto, California Mr. Alvin Wing Harvard University, Boston, Massachusetts -193- UNIVERSITY OF PENNSYLVANIA ALUMNI HEALTH QUESTIONNAIRE College & Year Date of Birth Degree Height Weight PHYSICAL ACTIVITIES . How many flights of stairs do you climb up each day? lights per day (let one flight = 10 steps) 2. How many city blocks or their equivalent do you walk each day? blocks per day (Let 12 blocks = | nule) 3. List any sports or recrcation you have participated in during the past week. Please include only the time you were physically active (i.e.. actual playing time, jogging time, bicycling time, swimming time, brisk walking, gardening, carpentry, calisthenics, etc.) Number of Average Time per Episode Number of Sport, Recreation, or Other Times per Weeks per Physical Activity Week Hours Minutes Year 4. List any sports or recreation you have actively participated in during the past year. Please remember seasonal sports or events. Number of Sport, Recreation, or Other Weeks per Physical Activity Year Time Hours 5. On a usual weekday and a weekend day during the past week how much time did you spend on the following activities? Total for each day should add to about 24 hours. Week when Active Minutes Years of Participation Weekday Hours per Day Weekend Day Hours per Day A. heavy carpentry, bicycling on hills, etc.) Vigorous activity (digging in the garden. strenuous sports, jogging, chopping wood. ing, repairing. light carpentry, bicycling on level ground, etc.) Moderate activity (housework, light sports. walking, yard work, lawn mow ing. paint- Light activity (sitting, office work. driving a car. eating, personal care, etc.) D. Sleeping -194- Total = 24 hr University of Pennsylvania Alumni Health Questionnaire Page 2 6. Would you say that during the past week you were less active than usual, more active, or about as active as usual? O less active than usual 0 more active than usual 0 about as active as usual 71. Atleast once a week, do you engage in any regular activity akin to brisk walking, jogging. bicycling, etc. long enough to work up a sweat? 0 No Q Yes How many times per week? ________ Activity 8. How much time do you spend in an automobile? —— Hours per weex How much time do you spend watching TV? —— Hours per week Are there any other physical activities that you engage in? On most Saturdays or Sundays the average person in your age group spends one hour at each of the following activities: walking, gardening, extra household chores, and *‘do-it-yourself’* projects. Compared with such a person how physically active do you consider yourself? Very active iit Fairly active a , Average] Fairly inactive a Very inactive a (Check one category only, please.) SOCIAL AND DIETARY HABITS . Do you smoke CIGARETTES now? (OO No 0 Yes How many CIGARETTES per day? Do you drink COFFEE now? ONo (0 Yes How many CUPS per day? Do you drink TEA now? ONo 0O Yes How many CUPS per day? eS — Do you drink MILK now? ONo 0O Yes How many GLASSES per day? ————(l glass=80:.) Do you drink alcohoiic beverages? a No 0 Yes Number Per Week a. Wine, sherry, port —— Glasses per week (/ glass = 4 oz.) b. Spirits or hard liquor _________ Drinks per week (/ drink = 1% 02.) c. Beer, ale, etc. ——— Bottles per week (I bottle = 12 o=.) . How many times a week do you eat each of the following foods? Fish ems Meat + POUITY ces EER comms Chest . Butter or margarine ——; Breads & cereals — Potatoes : Rice ——; Vegetables —; Green salads; Fruits and fruit juices . Sweet d ts . Candy . When eating meat, do you avoid eating the fat? Yes 0 No O . Do you often add salt to your food? Yes OO No J; Pepper? Yes OO No OJ; Catsup, mustard, or spices? Yes OJ No (I: Mayonnaise or salad oil? Yes O No O . How often do you use the following types of medicine? Aspirin, Bufferin......... Never 0 Occasionally 0 Frequently O Vitamin pills ............ Never O Occasionally 0 Frequently O Sleeping pills ............ Never O Occasionally O Frequently O Tranquilizers ............ Never O Occasionally O Frequently O Laxatives... cocvinunssv Never 0 Occasionally O Frequently O Anti-acid medicine ....... Never OO Occasionally 0 Frequently O . Do you have a medical check-up regularly every year? Yes 0 No O . How often do you experience: Never Occasionally Frequently Sensation of heart beating (except after exercise) ..... a Oo a ISOMER Gimli 0 0 anminiasmspraisin slot taesISIoIAIS Bone Rabe a a Sense of exhaustion (except after exercise) Weve psi a a 0 : Periods of alternating gloom and cheerfulness........ Q a Oo Periods of being particularly self-conscious .......... a a Oo -195- University of Pennsylvania Alumni Health Questionnaire Page 3 HEALTH STATUS 17. Has a doctor ever told you that you had any of the following? No Yes Year of Onset No Yes Year of Onset Coronary Heart Discase: Arthritis: Angina Pectoris ........... ao Rheumatoid..........o0ne Q:0 Myocardial Infarction ...... a Degenerative .............. a a Coronary Surgery.......... a COME, ovo rstinesrnenensnnes QO OD eis Chronic Bronchitis ........... a Other , eves eressnnavnnsss 0 OO Emphysema ....ccocvenenaenn a Unspecified ............... 0 0 a—— Bronchiectasis .....coccvvennnn a CIhoSiS «cress esnreesnsss OD is High Blood Pressure .... a Prostate Disease .. ld c—— SORE, .o0vvee tersreresusuns a Multiple Sclerosis... J 0 cee Thrombophlebitis.....occee.. a 0 Parkinson's Disease .......... 0 OQ c— Peptic Ulcer: CRUCOMB +1vvvererovononses 00 — Le a o CAA ous aivesersnenevons 0 BO ee Duodenum......ccoeeenaes Q:'0 Nervous Breakdown: Gall Bladder Disease . ........ QQ PeyChOSIS +c esvseoesrnnes 0 0 Appendicitis ...c.ceivnennnn. QQ NeUrosis. ..convcevunvsness 0: 0 ce Ulcerative Colitis .....ocue... aq Depression......veeevecen. 0 0 —— Diverticulitis . . cov eeveneeanse 0 'Q AONOISMY «oovvnerenvssnnse OB 0 oes Diabetes v.c.ocsviscesnvsanis QQ 0 Cancer 00 cm—— Chronic Back Pain........... a a site or organ 18. Family History Coronary High Blood Age Age Heart Disease Pressure Stroke PARENT if at (Check) (Check) (Check) If dead, specify cause: Living Death No Yes No Yes No Yes Father Mother 19. What is your pulse rate now? beats per minute. 20. May we contact your doctor regarding your health status? Doctor's Name and Address Name Date -196- PHYSICAL ACTIVITY MONITOR TYPE OF MEASURE: Behavioral OUTCOME ASSESSED: Maintenance of an Acceptable Activity Level TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: The Physical Activity Monitor is designed to assess physical activity levels. Respondents are asked to keep track of daily physical activity for one week. All activities should be included, but activities to specifically improve physical fitness are underlined. The date, activity, time of day, duration in minutes, intensity, and rating regarding how the activity felt are recorded on the chart. This measure is part of a fitness education program entitled Fitness for EveryBody. AUTHOR: Sharon Dorfman, Sc.M. formerly of: University of Massachusetts Health Services/Valley Health Plan Health Education Division Amherst, Massachusetts currently: Division of Health Education The Johns Hopkins University School of Hygiene and Public Health Baltimore, Maryland -197- -86T- PUYSICAL ACTIVITY MONITOR Fitness For EveryBody Physical Activity Monitor Please keep track of your daily physical activity for one week. Include all activity, but underline any activity you are consciously doing to improve your fitness level. Exercise counts, of course, but so does bicycling to work, an afternoon in the garden, walking the dog, etc., Record: 1. The date 2. The activity: swimming, frisbee, housework, dancing, etc. 3. Time of day 4. Duration: how many minutes? 5. Intensity: rate 1, 2 or 3 (3 = very strenuous; 2 = moderately strenuous: 1 = not very strenuous) 6. Rating: how did it feel? (5 = terrific; 4 = good; 3 = okay; 2 = not very good; 1 = dreadful) DATE ACTIVITY TIME OF DAY DURATION INTENSITY RATING . # of min. 1.203 3, 2. 3, 4 or 5 SEVEN DAY PHYSICAL ACTIVITY RECALL TYPE OF MEASURE: Behavioral OUTCOME ASSESSED: Maintenance of an Acceptable Activity Level TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: The Seven Day Physical Activity Recall (PAR) is designed to measure habitual physical activities. The items are interviewer-administered. Respondents are asked to recall their sleep habits as well as the physical activities they participated in during the previous seven days. Respondents are asked to think of their activities as moderate, hard, or very hard with the aid of a reference table, then tell the interviewer how many hours they spent doing each category of activities. Interview techniques and complete scoring procedures are provided, including a worksheet for calculating daily energy expenditures as well as average kilocalories per day expenditures for individuals of different ages. TECHNICAL INFORMATION: In an effort to supply data regarding the validity of the PAR, the instrument was administered to 81 initially sedentary middle-aged men, 48 of whom had been assigned to an experimental walking/jogging program. The control subjects were asked to maintain their current physical activity habits. The experimental group (exercisers) made significant changes on a series of physiological dimensions. Differences between the experimental and control groups on the PAR were statistically significant at six months and 12 months. The PAR was also administered to 1,206 women and 1,077 men aged 16-74 as part of a community health survey. The resulting PAR energy expenditure estimates were consistent with predictions for men and women (men reporting higher values) and for different aged groups (older subjects reporting lower values). AUTHOR: Steven N. Blair, P.E.D. University of South Carolina, Columbia -199- ADDITIONAL INFORMATION: Blair, S.N. How to assess exercise habits and physical fitness. In Matarazzo, Miller, Weiss, Herd & Weiss (Eds.), Behavioral health: a handbook of health enhancement and disease prevention. New York: John Wiley and Sons, in press. Blair, S.N., Haskell, W.L., Ho, P., Paffenbarger, R.S., Williams, P., Farquhar, J.W., & Wood, P.D. Assessment of habitual physical activity by a seven day recall interview. Unpublished report, Stanford University School of Medicine. (Reprint requests should be directed to Dr. Steven N. Blair, Department of Health Education, School of Public Health, University of South Carolina, Columbia, South Carolina 29208.) -200- SEVEN DAY PHYSICAL ACTIVITY RECALL Now we would like to know about your physical activity during the past 7 days. But first, let me ask you about your sleep habits. 1. On the average, how many hours did you sleep each night during the last five week day nights (Sunday-Thursday)? Hours 2. On the average, hou many hours did you sleep each night last Friday and Saturday nights? " Hours Now I am going to ask you about your physical activity during the past 7 days; that is, the last 5 week days : » and last weekend, Saturday and Sunday. We are not going to talk about Tight activities such as slow walking, light housework, or unstrenuous sports such as bowling, archery or softball. Please look at this list whicH shous some examples of what we consider moderate, hard and very hard activities. (Interviewer: Hand subject card #9 and allow time for the subject to read it over.) People engage in many other types of activities, and if you are not sure where one of your activities fits, please ask me about it. 3. First, let's consider moderate activities. What activities did you do and how many total hours did you spend during the last 5 week days doing these moderate activities or others like them? Please tell me to the nearest half hour. . [] Hours 4. Last Saturday and Sunday, how many hours did you spend on moderate activities and what did you do? (Probe: Can you think of any other sports, job or household activities that would fit into this category?) 1] Hours 5. Now, let's look at hard activities. What activities did you do and hou many total hours did you spend during the last 5 week days doing these hard activities or others like them? Please tell me to the nearest half hour. 1] Hours 6. Last Saturday and Sunday, how many hours did you spend on hard activities and what did you do? (Probe: Can you think of any other sports, job or household activities that would fit into this category?) . [] Hours 7. Nou, let's look at very hard activities. What activities did you do and how many total hours did you spend during the last § week days doing these very hard activities or others like them? Please tell me to the nearest half hour. 4 Hours 8. Last Saturday and Sunday, how many hours did you spend on very hard activities and what did you do? (Probe: Can you think of any other sports, job or household activities that would fit into this category?) 1] Hours -201- INSTRUCTIONS FOR ADMINISTERING AND SCORING SEVEN DAY PHYSICAL ACTIVITY RECALL Interviewing Technique. Your technique should limit bias and prevent the interview from becoming tedious. It may be difficult for participants to remember their past week's activity. Some may not try very hard and others may get bogged down in details. You should strive to achieve a happy medium. You should control the pace of the interview, extraneous talk should be avoided. If a participant is going into excessive detail, you should remind him or her that they need not account for every minute, but that an average or estimate is expected. You might ask, "How much time in general?" (Instructions adaptated from Taylor et al, 1978). It is important to remember that most of the participants you see will spend the vast majority of their waking hours in light activity. Many tiring and unpleasant household and/or occupation tasks do not have a very high energy cost. A clerk in a store, for example, may be on his feet all day and may feel fatigued, but the energy cost is in the light category. An exception to this example would be time spent in stocking shelves, which would probably be moderate activity. Also, for most occupational tasks that require at least moderate energy expenditure, it is important to accurately determine the time spent in the activity. In the stock clerking example, even though a person might do that activity for an entire shift, it probably would not equal eight hours. You should try to subtract time spent on lunch, breaks, etc. Interviewing suggestions. You will be handing people lists of moderate, hard, and very hard activities (Table 1). We have found it to be easier to give them all three lists at once to look at before we ask them any questions about their activity level in the past seven days. Explain the following things before you hand them the list of activities. Otherwise they may not attend to what you are saying because they'll be too busy looking at the list: 1. Think of the past seven days, stress that this is a recall of actual activities for the past week and not a history of what they usually do. 2. Weekdays and weekends will be treated separately. You may even help them figure out which days to include, e.g., Monday--Thursday this week and Friday last week would comprise the past five weekdays. -202- Seven Day Physical Activity Recall Page 2 3. Weekdays include evenings as well. 4. We are not considering light activities such as deskwork, standing, slow walking, light housework, softball, archery, bowling, etc. 5. Also consider types of activities not included on the lists, but that are similar in strenuousness. Mention the following things before you ask them questions about their activity level: x. You will ask them questions about each category of activities separately (because people tend to give stream of consciousness reports of their week). 2. You may ask them if the amount of activity they report is more, less, or about the same as usual (because people tend to be defensive, exaggerate the numbers, or offer rationales for low activity levels). This may enable the participant to give a more accurate estimate of his/her activity level. While they are reporting the frequency with which they engage in various activities, be aware of the following: Ta 2. Don't let them sidetrack you. You may wish to ask them about their weekends first. This enables them to practice giving you the information you need in a smaller block of time. Check if the amount of time that they are reporting is per weekend, per week, or per day. For example, someone may say, "I did one hour of digging this past weekend," when they really mean, "I did one hour of digging each of the two days this past weekend. Some people have trouble recalling or pinpointing what moderate to very hard activities they have done in the past seven days. In this case, try to cue them, e.g., how about any housework that made you work up a sweat; do you take stairs at work; do you walk briskly to work; did you participate in any sports, any vigorous family activities; did you do any vigorous home repair or gardening? Some people have trouble quantifying the amount of time they spent doing moderate, hard, or very hard activities. In this case, break down all of their activities into specific events and ask them how long they did each activity. Then sum up the amount of time relevant to each category. Finally for good measure, ask them if they agree with your calculations. -203- Seven Day Physical Activity Recall Page 3 10. If you are unclear as to the strenuousness of an activity that they may have participated in, ask them to describe the physical effort involved, e.g., what does the activity entail, what other activity is it comparable to, do they work up a sweat? We have found that walking and running provide good frames of reference for classifying other activities. Everyone should be familiar with the relative intensity of brisk walking which is at about the midpoint of the moderate activity category. Therefore, if some other activity seems subjectively to be about as strenuous to the individual as if they were walking briskly, then the activity should be coded as moderate. Running at any speed falls into the very hard category. If some activity seems about as strenuous to the individual as running, classify the activity as very hard. If the activity in question seems harder than walking, but not as strenuous as running, place it in the hard category. A point of caution is to be certain that the activity in question is performed continuously for at least five minutes. Some activities may be quite strenuous, but if they are performed intermittently the overall energy cost may place them in the moderate category. A good example of this is weight lifting. If the last week was totally atypical, e.g., in the hospital, or in bed, family crisis, work crisis, or travel, it is permissible to go to the previous week for the survey. Do not take this action lightly, only in unusual circumstances. If a person has weekdays instead of weekends off from work (for example, Tuesday and Wednesday instead of Saturday and Sunday), count the days off as weekend for the survey. Be sure that the time reported for an activity was actually spent doing the activity. For example, being at the pool for two hours, but only swimming for 15 minutes, should be recorded as 15 minutes, not two hours. Working in the garden all day Saturday (eight hours) should mean actually "working" for eight hours. Do not count the time on breaks, rest periods, meals, etc. For most activities the rate at which they are performed can make a huge difference in the energy cost. It is possible to play tennis singles in such a way as to not move around very much and not spend much energy. The rate of digging, for example, could make the MET cost range from 3-12. Try to get some indications of how hard they are working at a particular task. 2.4-2. Recall questions. The actual questions asked during the interview are presented above. We have trained several interviewers in four community health survey centers to use the seven-day recall procedure. A few hours of training, some role -204- Seven Day Physical Activity Recall Page 4 playing and guided interviews, and follow-up support and supervision have made the method relatively easy to implement. The most common problems or questions arise over how to classify some unfamiliar activity. Use of energy cost tables in standard physiology textbooks (e.g., Katch & McArdle, 1977) can usually help determine to which category an activity should be assigned. 2.4-3. Application and Calculations. Raw data from the questionnaire (hours in the various categories) is used to calculate energy expenditure. The basis of these calculations is that resting metabolism (one MET or RMR) requires 3.5 ml of O09 per kg of body weight per minute. This is equal to approxi- mately one kilocalorie (kcal) per kg per hour (kcal-kg™"-hour™t). Therefore, activities_requiring three METS (WMR/RMR = 3) would expend three kcal: kg=1-hour~1. The activity categories and associated MET values for the seven-day recall are: Sleep = 1 MET Light activity = 1.1 - 2.9 METS Moderate activity = 3.0 - 4.9 METS Hard Activity = 5.0 - 6.9 METS Very hard activity = 7.0 METS In making the energy cost calculations, consider light activities averaging 1.5 METS, moderate activities averaging four METS, hard activities averaging six METS, and very hard activities averaging 10 METS. To calculate energy cost in kcal kg 1+ day! simply multiply the hours spent in an activity category by the average MET value for that category and sum over all categories. Table 2 gives examples for these calculations from the raw data for both an active and an inactive person. Note that the hours in each activity category are on a per day basis, this requires calculating an average value from the response to the recall questions. It is easier to do the recall if participants recall week-end and week-day activities separately and if you obtain total time for each category for the week-days and week-end days, but calculations are done on an average day. Early on, we asked participants if the last week's activity was more, less, or about the same compared to their usual activity. Adjustments based on their responses did not prove to be useful, and we now recommend no adjustment. As noted in the instructions, if the last week was highly atypical, the previous week can be used for the recall. The calculations demonstrated in Table 2 can easily be done by computer. It may also be useful to sum energy output for hard and very hard activities as an index of vigorous activity. The recall procedure can also be used in clinical work as a daily record. Participants can record this activity each day in an activity log and make their own calculations with a -205- Seven Day Physical Activity Recall Page 5 calculator. The worksheet presented in Table 3 gives a step-by-step approach to the calculations. The average values presented in Table 3 are based on random samples of more than 2,000 men and women from four California towns (data courtesy of the Stanford Heart Disease Prevention Program, Dr. J. Farquhar, Director). We find that individuals who have relatively active lifestyles have energy expenditures of 40 kcal-kg-~—1. day™~ or greater, persons with values in the mid to high 30's are inactive and those with scores in the low 30's are very inactive. These standards are relatively constant for men and women across the age range. Although fitness levels and ability to do high intensity work is less in women and declines with age, the total amount of exercise needed for good health is relatively constant (ACSM, 1978). -206- Seven Day Physical Activity Recall Page 6 Table 1. List of activities shown to participants during seven-day physical recall interview. Occupational tasks: 1. Household activities: 3. 4. Moderate Activities delivering mail or patrolling on foot house painting truck driving (making deliveries -- lifting and carrying light objects) raking the lawn sweeping and mopping mowing the lawn with a power mower cleaning windows Sports activitiies (actual playing time): i. 2. volleyball ping pong brisk walking for pleasure or to work (3 mph or 20 min/mile) golf =- walking and pulling or carrying clubs calisthenic exercises -207- Seven Day Physical Activity Recall Page 7 Table 1 (continued) Occupational tasks: 1. 2. Household tasks: 1. Hard Activity heavy carpentry construction work--doing physical labor scrubbing floors Sports activities (actual playing time): 1. 2. Occupational tasks: 1. tennis doubles disco, square, or folk dancing Very Hard Activity very hard physical labor - digging or chopping with heavy tools carrying heavy loads such as bricks or lumber Sports activities (actual playing time): 1. Sw nN jogging or swimming singles tennis racquetball soccer -208- Table 2. Activity Sleep Light activity** Moderate activity Hard activity Very hard activity Sleep Light activity** Moderate activity Hard activity Ver hard activity Seven Day Physical Activity Recall Page 8 Calculation examples for seven-day recall data Active Person Raw Met Value data (hours)* for activity 8.0 1.0 12.5 1.5 2.0 4.0 0.5 6.0 1.0 10.0 24 + Inactive Person 9.0 1.0 14.0 1.5 1.0 4.0 0 6.0 0 10.0 24 Total (keal-kg) day”) 8.0 18.75 8.0 3.0 10.0 47.75 9.0 21.0 4.0 0 0 34.0% * Data from seven-day physical activity recall interview ** (Obtained by subtraction (24 hours - moderate, hard, and very hard activity) t+ Total energy output per day -209- Seven Day Physical Activity Recall Page 9 10. Table 3. Worksheet for calculating daily energy expenditure. ENERGY EXPENDITURE CALCULATIONS Add up all of the hours of sleep and naps you had. Multiply the total number hours of sleep and naps (line 1) by 1. ¥1= Add up the total number of hours spent in moderate activity. Multiply the hours spent in moderate activity (line 3) by 4. x 4= Add up the total number of hours spent in hard activity. Multiply the hours spent in hard activity (1ine 5) by 6. x 6= Add up the total number of hours spent in very hard activity. Multiply the hours spent in very hard activity (line 7) by 10. x 10= Add up the figures in lines 1,3,5 and 7 (1+3+5+7) = Hours spent in light activity is equal to 24 hours minus the hours in lines 1+3+5+7. 24 - (1434547) = -210- Seven Day Physical Activity Recall Page 10 Table 3 (continued) 11. Multiply the figure in line 10 by 1.5. 12. Add up the figures in lines 2, 4, 6, 8 and 11 - (2+4+6+8+11) = 13. The figure you arrived at in line 12 is the total kilocalories per kilogram of body weight expended per day (kcal-kg™'.day™) = 14. In order to calculate the total number of calories you expended in one day, multiply your total body weight in kilograms (weight in pounds = 2.2046 = kilograms) by the figure in line 13. -1 -1 kg -day = Below are some average kcal-kg~ of different ages: 17-19 years male = 44 female = 35 40-49 years male = 37 female = 31 Body weight (kg) x kcal: = total calories expended. 1 20=29 years male = 40 female = 35 50-59 years 36 30 male female -211- for individu 30-39 years male = 38 female = 33 60-69 years male = 34 female = 29 X15 em cm ese. als MEASURING THE BODY'S ENERGY NEEDS TYPE OF MEASURE: Behavioral OUTCOME ASSESSED: Maintenance of an Acceptable Activity Level TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: This measure is designed to provide a detailed method for determining daily energy needs. Respondents are asked to recall their physical activities for a 24-hour period, then note how many minutes were spent at each of eight energy levels. The energy cost in kilocalories for each activity is calculated and totalled to obtain the daily energy expenditure. Charts and graphs are provided to aid in the step- by-step calculations. The physical activities logs are used to classify the respondents' lifestyles based on activity levels. Classifications range from sedentary to vigorous. AUTHORS: Eva May Hamilton and Eleanor Whitney Florida State University ADDITIONAL INFORMATION: This measure is copyrighted. The measure and directions for use can be found in: Hamilton, E. M. & Whitney, E. Nutrition: Concepts and Controversies. St. Paul, Minnesota: West Pub. Co., 1970, 181-171. -212- AAHPER COOPERATIVE PHYSICAL EDUCATION TESTS TYPE OF MEASURE: Knowledge OUTCOME ASSESSED: Effects of Exercise TARGET POPULATION: Elementary school children or adolescents GENERAL DESCRIPTION: The AAPHER Cooperative Physical Education Tests are designed to measure knowledge of the effects of physical activity. The tests are comprised of multiple-choice items relevant to the physical and psycho-social effects of activity or knowledge of basic body mechanics. Other items concern the protective requirements for minimizing exercise-related health risks and the factors modifying participation in activities, e.g., nutrition, stress, substance abuse, etc. The tests are available in six forms. Forms 4A and 4B are appropriate for grades 4, 5, and 6. Forms 3A and 3B are appropriate for grades 7, 8, and 9. Forms 2A and 2B are appropriate for grades 10, 11, and 12. A handbook for scoring and interpreting test performances is also provided. TECHNICAL INFORMATION: The internal consistency (KR20) of the six forms of the test was calculated on the basis of tests administered to the norming sample at grades 4-12. The number of subjects involved in the analyses for a given form at a particular grade level ranged from 410 to 1,0005 students. The KR20 coefficients ranged from .72 to .82. Alternate forms' reliability coefficients (Form A vs. Form B) were calculated for grades 4-12 with well over one thousand students per grade. These coefficients ranged from .69 to .76. In addition to content validation procedures based on the use of authority-recognized materials for test content, the test developers also computed correlations between test scores and end-of-course grades for samples of 54 to 191 students in grades 4-12, These coefficients ranged from -.02 to .65. Of the 36 correlation coefficients computed, 16 were statistically significant beyond the .01 level. AUTHORS: American Association for Health, Physical Education, and Recreation Educational Testing Service Princeton, New Jersey ADDITIONAL INFORMATION These tests are copyrighted. The test forms and handbook are available from Educational Testing Service, Princeton, New Jersey. -213- STANDARDIZED TEST OF FITNESS TYPE OF MEASURE: Skill OUTCOME ASSESSED: Fitness Self-Assessment TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: The Standardized Test of Fitness (STF) is designed to establish a field test of fitness and to standardize cardiovascular and other performance tests as a motiva- tion for individuals to pursue physical fitness train- ing. The test is comprised of a battery of tests and measurements of anthropometry, muscular strength, muscular endurance, flexibility, and cardiorespiratory endurance. Assessment evaluations, norms, and percentile scores are provided. The developers recommend that the Physical Activity Readiness Questionnaire (PAR-Q) be administered prior to the actual fitness assessment and that physical activity counseling follow the fit- ness test. The Lifestyle Assessment (pages 147-149) is optional and could be replaced by any questionnaire which stimulates discussion of lifestyle issues with the test subject. The booklets, Assessment Report and Aerobic Calculator, are available to provide individuals with immediate knowledge of their test results, basic information on fitness, and instructions on how to use these test results to initiate a walk/ jog exercise prescription. The STF is one of the measures used in the Canada Fitness Survey, a program designed to collect fitness and physical activity statistics. (See also Canada Fitness Survey - Physical Activities, page 186.) AUTHOR: Fitness and Amateur Sport Government of Canada ADDITIONAL INFORMATION: Copies of Assessment Report may be obtained in packages of 25 at $7.50 (Canadian) per package from: Canadian Government Publishing Centre Supply and Services Canada Hull, Quebec KIA 089 Prepayment is required. Check or money orders should be made payable to the Receiver General of Canada. -214- STANDARDIZED TEST OF FITNESS Preliminary Considerations Qualifications of the Examiners It is recommended that the examiners of the Standardized Test of Fitness be familiar with laboratory fitness testing procedures and have a working know- ledge of exercise physiology, fitness and exercise prescription. Instruction and certification in cardio-pulmonary resuscitation (CPR) from a recognized authority prior to commencing testing is strongly advised. Testing Locale A room measuring at least 12’ x 20°, removed from noise and excessive heat (>22° C), and in which the temperature can be controlled, is required for the testing locale. The locale should be arranged to permit the subjects to change into their testing attire or it should be located close to changing quarters. Some equipment may be purchased from local distributors or medical supply dealers. Additional information may be obtained from Departments of Physical Education at various colleges and universities, or by writing to Fitness Canada. The flexometer and ergometer steps may be constructed by following the plans enclosed within the Appendices. Calibration of Equipment Calibration of equipment before and during the test period is essential to assure valid results. Whether you are employing the tape or record version of the Canadian Home Fitness Test, it is imperative that the cadence recorded be verified using a timer. For correct stepping cadences refer to the following table: Stepping cadence (per min.) Equipment Kit and Supplies Stage Males Females ’ 1 66 66 The equipment kit required to implement > 84 84 the test and measurements is as follows: 3 102 102 ~ 4 114 114 Description Cost’ 5 132 120 Harpenden fat caliper $ 115.00 6 144 132 K & E anthropometric tape 20.00 7 156 Wall tape 5.00 Seca spring-scale 65.00 The Seca spring-scale should be Stoelting hand dynanometer 140.00 calibrated with the use of known Modified Wells and Dillon weights. To calibrate the Stoelting hand flexometer 50.00 dynamometer contact your local Ergometer steps 50.00 university equipped with a research lab Propper stethoscope 25.00 for assistance. Propper sphygmomanometer 75.00 Emergency Procedures Timer 25.00 Recorder-cassette or record player 50.00 If the tests are properly administered Set of C.H.F.T. tapes or record 5.00 the chances of an untoward event Room thermometer 500 during the testing is unlikely. Notwith- Aerobic Calculator — ‘Prices as of January 1979. standing, the examiner should develop an emergency protocol which should be posted in a suitable location. -215- Instructions for the Subjects In order to achieve standardization, the following information should be given to the subject in writing at least 48 hours prior to the testing session. Dress It is recommended that subjects be attired in the following dress: males - loose fitting shorts - shirt or T-shirt females - loose fitting shorts - preferably the top part of a two-piece swim suit or a loose blouse Pre-test information (related to step-test) The subject should not exercise prior to the testing session. The subject should not consume alcohol for six hours prior to the test, nor eat, smoke or drink tea or coffee for at least two hours. Preferably, the test should be taken in the morning with the subject having eaten a light breakfast at least two hours before the test. Standardized Test of Fitness Consent for the Standardized Test of Fitness I, . authorize the said Examiner of ' to administer and conduct an exercise fitness test designed to determine my physical work capacity. | understand that | will perform tests of grip strength, push-ups, trunk flexion and sit-ups. | understand that | will step on double 20.3 cm steps at speeds identified for my age group. During the performance of the test my heart rate will be monitored and my blood pressure will be measured prior to and at the completion of the test. | will first be given a three minute warm- up exercise at a rate equivalent to 65 to 70% of the average aerobic power anticipated in a person ina 10 year older age group than mine. If a pre- determined heart rate is not exceeded, I will then exercise for a further three minutes at 65 to 70% of the average aerobic power for a sedentary person of my own age. If again my predeter- mined heart rate is not exceeded | will Date Subject (Signature) Witness -216- exercise for a further three minutes at 65 to 70% of the average aerobic power for an individual ten years younger than | am. The test will be discontinued when i reach a predetermined heart rate or if | become distressed in any way or develop any abnormal response which- ever of the above occurs first. Every effort will be made to conduct the test in such a way as to minimize discomfort and risk. However, | understand that just as with other types of fitness tests there are potential risks. These include episodes of transient lightheadedness, fainting, chest discomfort, leg cramps and nausea. In agreeing to such an examination, | waive any legal recourse against the examiner or the Department of Labour, from any and all claims resulting from personal injuries sustained or death resulting from these tests. This waiver shall be binding upon my heirs and my personal representatives. Standardized Test of Fitness Page 3 Testing Procedures Tests and Measurements The tests and measurements of the Standardized Test of Fitness consist of the following: ® Pre-Test Forms and Questionnaires Consent Form Lifestyle Information (optional) Physical Activity Readiness Questionnaire Anthropometric & Performance Data Record ® Anthropometry Standing height Weight Girths (optional): chest abdomen gluteal thigh Skinfolds: triceps biceps subscapular supra-iliac ® Strength and muscular endurance Grip strength: right and left hand 60 second sit-ups (optional) Push-ups (optional) @® Trunk forward flexion @ Cardo-respiratory fitness Canadian Home Fitness Test (advanced version) Each section has been designed to measure a specific component of fitness. The amount of space used to describe each test component is not an indication of the importance of that component within the protocol. -217- Sequence of Testing Questionnaires and tests must be administered in the following sequence and strictly adhered to: Completion of the testing consent form; Completion of the Lifestyle Information (optional) and Physical Activity Readi- ness Questionnaire (PAR-Q); Recording of the anthropometric measurements in the order in which they are listed on the recording form; Administration of grip strength; Administration of the Canadian Home Fitness Test; and Administration of the remaining tests in the following order: push-ups, trunk flexion, sit-ups. The above sequence has been chosen to minimize any error with the skin-fold measurements which might be caused by body perspiration. Standardized Test of Fitness Page 4 Completing Forms and Questionnaires All subjects are strongly advised to read, understand and must sign a consent form (See page 22) and PAR-Q (See page 23). PAR-Q has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them. A sub- ject should not perform any of the tests if he/she refuses to sign these forms. To aid the examiner in post-test counselling on lifestyle and fitness, a lifestyle information questionnaire should be administered. Inform the subject that the data requested will be kept confidential. See page 24-26 for a sample questionnaire. In addition to recording the anthropometric and performance data in the subject's Assessment Report booklet, the examiner may wish to record each subject's test results on a separate recording sheet and store this data for future post-test counselling or for research purposes. See page 27 for a sample recording sheet for the Standardized Test of Fitness. Procedures for Recording the Anthropometric Measurements Standing Height Equipment: Metric wall tape, set square Procedure Position the tape against a wall. Ensure that the wall tape is perfectly straight and even with the floor. Measure to the nearest “0.2 cm” from the highest point on the top of the head. The subject must be without foot-wear, the back square against the wall tape, heels together, with the body stretched upward to the fullest extent, the shoulders relaxed and the arms stretched downward Record the heightin “cm” in the space provided. eg. [1,84 5| Note: To determine the measurement employ a set square resting on the top of the head and against the tape. Weight Equipment: Seca scale Procedure Ensure the scale is on a flat surface. If laid on a rug, use a half-inch board under the scale. Measure to the nearest 0.5 kg. The subject must be without footwear and in light clothing (shorts and socks for men; shorts and upper part of a two- piece swimsuit or a blouse for women). Record the weight in “kg” in the space provided. e.g. 0,68 : 5 -218- Standardized Test of Fitness Page 5 Girth Measurements (Optional) Equipment: K & E anthropometric tape or equivalent. Procedure Ensure that the tape is properly located in accordance with the instructions and illustrations. Measure to the nearest 0.1 cm. All measurements should be taken on the right side of the subject. Girth measurements are most useful in a test/re-test situation, for comparison. Chest girth With the subject standing, measure from the side of the subject to the nearest 0.1cm. Ensure that the tape is perfectly horizontal. Measure on the chest at the level of the mesosternale . This is approximately on the midline of the sternum. The measure- ment is taken at the end of normal expiration. Record in “cm” in the space provided. eg. [0,99 ; of Abdomen Girth From a side view, with the subject standing. measure to the nearest 0.1 cm on the unclothed abdomen at the level of minimum girth. Record in “cm” in the space provided. eg. 0,88; 5] -219- Standardized Test of Fitness Page 6 Gluteal girth With the subject standing, from a side view, measure to the nearest 0.1 cm posteriorly at the maximal protrusion of the gluteals, and anteriorly at the level of the symphysis pubis. Record in “cm” in the space provided. eg. [0,72 5] Thigh girth With the subject standing, from a side view, measure to the nearest 0.1 cm on the unclothed right side just below the gluteal furrow (see arrow — ) at the maximal girth. Record in “cm” in the space provided. eg. [0,38 ; 2] -220- Note: To standardize the tape tension for all girth measurements, apply only a light tension to the tape so that indentation of the skin surface does not occur. Standardized Test of Fitness Page 7 Skinfold Measurements Equipment: Harpenden caliper Procedure Select the prescribed site. Grasp the skinfold between the thumb and index finger 1 cm above the site and apply pressure. The skinfold is raised and maintained with the thumb and forefinger with the crest of the fold following the specified alignment. Apply the caliper jaws at right angles to the prescribed site. Release the spring handles fully. Read the measurements after the full pressure of the caliper jaws has been applied. and the drift of the needle has ceased. Record to the nearest “0.2 mm”. Repeat measurements twice. If the difference is greater than 1 mm, take a third measure and record the mean of the closest pair in the space provided. eg. [16 . 4 Triceps skinfold Measured on the back of the unclothed pendant right arm at a level midway between the tip of the acromion (see arrow—) and the tip of the elbow. With the forearm flexed at an angle of 90°, establish the midpoint. This can be approximated with the thumbs by placing the fifth finger of the left hand on the subject's right shoulder and the fifth finger of the right hand on the tip of the subject's elbow. Lift the skinfold parallel tothe long axis of the arm. Ask the subject to lower the forearm and then apply the caliper jaws to the site. -221- Standardized Test of Fitness Page 8 Biceps skinfold Measured on the front of the right pendant upper arm over the biceps ata level midway between the acromion and the tip of the elbow as described for the triceps. The skinfold is lifted parallel to the long axis of the upper arm. Note: Remember that the accuracy of your measurement depends on: — precise identification of the site of the skinfold; — forming the skinfold prior to the application of the caliper jaws; — the standardization of the alignment of the skinfold crest; and — complete release of the spring handles of the caliper. Subscapular skinfold With the subject standing, measured about 1 cm below the lower angle of the right scapula. The crease of the skinfold that is lifted should run at an angle of aL about 45° downwards from the spine. N° Supra-iliac skinfold Measured 3 cm above the iliac crest, with the fold running parallel to the crest. The fold should be taken at the midline of the body. -222- Standardized Test of Fitness Page 9 Muscular Strength Test of Cardio-Respiratory Fitness Hand grip strength General Equipment: The Canadian Home Fitness Test, a Stoelting hand grip dynamometer Procedure Adjust the grip of the dynamometer to the most comfortable setting for the hand size of the subject. Lock in place. The second joint of the fingers should fit snugly under the handle and take the weight of the instrument. Have the subject take the dynamometer in the appropriate hand, holding it in line with the forearm and letting it down by the thigh. The grip is taken between the fingers and the palm at the base of the thumb. When firmly gripped, the instru- ment is held away from the body and squeezed vigorously, exerting maximum force. During the test neither the hand nor the dynamometer should be allowed to touch the body or any other object. Measure both hands alternatively giving two trials per hand. Add the best score for each hand and record as a single score to the nearest “kg” in the highlighted area as follows: lo,9,0] -223- double step test, was selected as the field test to measure the cardio-respiratory fitness of the subject. In order to appre- ciate the dimensions of this test you should be familiar with the following literature: Bailey, D.A. et al. Validation of a self- administered home test of cardio- respiratory fitness. Can. J. Appl. Sports Sci., 1,67, 1976. Shephard, R.J. et al. Development of the Canadian Home Fitness Test. Can. Med. Assoc. J., 114,675, 1976. Jetté, M. et al. The Canadian Home Fitness Test as a predictor of aerobic capacity. Can. Med. Assoc. J., 114, 680. 1976. Jetté, M. An exercise prescription program for use in conjunction with the Canadian Home Fitness Test. Can. J. Public Health. 66, 461, 1975. Equipment: Stethoscope, sphygmomanometer, tape recorder and CHFT tapes (or record player and CHFT record), timer, steps. Procedure Preliminaries: Have the subject remove his/her shoes, sit and rest for five minutes. Use a comfortable chair with arm rests. During this time, question the subject to ensure that all pre-testing instructions have been followed and briefly explain how the test is to be conducted and for what purposes. Blood Pressure (Optional) Some test administrators may find it difficult or are unable to measure blood pressure accurately. Unless administra- tors are capable and are familiar with the influence of exercise upon blood pressures, they would be advised to omit the measurement of blood pressure. Standardized Test of Fitness Page 10 Sphygmomanometer application: Apply the blood pressure cuff to the subject's left arm. The cuff should be wrapped firmly and smoothly around the arm with the lower margin 2 -3 cm above the antecubital space. The arm should be comfortable, supported with the lower edge of the cuff at heart level and at an angle of 0° - 45° from the trunk. The subject will wear the cuff throughout the step test. If it tends to slip, tape it to the shoulder. { # WY YX oh ~g . “ae: wy oF Measurement of the resting heart rate and blood pressure: Determine the resting heart rate with the stethoscope using a 15 second count five minutes after the subject has been seated and record in beats/min. in the space provided as follows: 10,8,8| Then measure the blood pressure as follows: Position the stethoscope in your ears with the ear piece pointing forward. Locate and note the brachial artery at the antecubital space by palpation. Rapidly inflate the cuff to a level above the radial palpatory pressure. Quickly position the diaphragm of the stethoscope over the brachial artery. Apply minimum amount of pressure so as not to distort the artery. The dia- phragm should be in complete contact with the skin. The stethoscope should not touch the cuff or its tubing. Release the cuff pressure at a rate of approximately 2 mm per second. The systolic pressure level is determined by the first perception of sound (first Korotkoff sound). The diastolic fourth-phase level (D,) is determined when the sounds cease to be tapping in quality and are fully muffled. ™ Deflate the cuff to zero pressure. Record visually the resting systolic and diastolic fourth phase (Dy) to the nearest 2 mmHg in the appropriate space as follows: Systolic [1,20] Diastolic (Dy) |o,8,0] In the event the resting heart rate of a subject is above 100 b/min., and/or the resting systolic blood pressure is over 150 mmHg, and/or the fourth phase diastolic is over 100 mmHg, wait an additional five minutes and take the readings again. The subject should be excluded from the cardio-respiratory fitness test if the values are still above the criteria. Explain briefly that the heart rate and/or blood pressure readings are i _ slightly out of the range for which the -224- test was designed. Advise the subject to consult with his/her physician before attempting the test. Blood pressures may be taken after the final stage of the step test. This is per- formed to monitor the subject's return to pre-test blood pressure values. No additional tests should be administered if values greatly exceed pre-test results. Standardized Test of Fitness Page 11 Step testing sequence and cadence: 1. STEP: 2. STEP: Demonstrate and have the subject practice the stepping sequence de- Place your right foot up on the Bring your left foot up to the scribed below. first step. second step. START: Stand in front of the first step, feet together. 3. UP. 4. STEP: 5. STEP: Bring your right foot up on the Start down with your left foot to Bring your right foot down to second step, feet together. the first step. the ground level. 6. DOWN: STEP -STEP- UP! STEP - STEP - DOWN! Bring your left foot to the ground level, feet together. UP-2-3'!DOWN-2-3! UP-2-3!DOWN-2-3! -225- Standardized Test of Page 12 Have the subject practice the starting sequence, first without the music and then with the music, but no more than twice each time. Ensure that the subject places both feet completely on the second step and that the legs are completely extended and back upright during this phase of the movement. During the test ensure that the subject maintains the proper cadence. Count and/or step a few steps with subjects who are experiencing difficulty. Starting exercise. Determine the starting stepping exercise of the subject, based on age, using the following table: Age Starting Exercise Males ~~ Females g0andover 1(66)° 1(66) 50-89 .. - 2(8%) - 1(66) 0-9 3(102) 2084) 30-39 TTI a(4) 3(102) 20-29 © 5(132) 3(102) 1519 50132) . 4(118) * (Stepping Tempo in steps per minute.) The subject should then be informed that the first stepping exercise is three minutes in duration. The subject will cease to step when the music stops and remain motionless. Indicate that upon completion of this first stage you will inform the subject if he/she is to stop or continue for a second stage. Post-exercise heart rate - first stage only. Start the tape recorder (or record player) and have the subject perform the first stage of the test. Observe the subject for signs of intolerance.” When the music stops have the subject remain motion- less. Determine the post-exercise heart rate with the stethoscope. Start count- ing on the command word COUNT and continue counting until the command word STOP. (A 10-second timing sequence). ‘dizziness, unusual fatigue, angina, staggering, distressful breathing, nausea, and facial expressions that indicate difficulty in maintaing the cadence. Fitness DO NOT stop the tape (or record player) during the test. Pulse counting pauses have been recorded on the tape. It is imperative that the tape (or record player) continue operating for the dura- tion of the test. Pulse counting and determination of the subject's ability to complete the next stage must be accomplished during the timed interval between the musical stepping tempos. The determination of an accurate post- exercise heart rate is the critical measurement for deciding if the subject should continue to another stage and to predict maximum oxygen consumption (VO, max.). Quickly determine if the subject is to continue or stop the test. The subject is not to continue if the heart rate is equal to or exceeds these Ceiling Post-Exercise Heart Rates (10 seconds count): Ceiling Post-Exercise Heart Rates (10 sec.) after after Age 1st stage 2nd stage 60 and over : : 24 o E : ; 23 50-59 Be 40-49 s 26 24 an lE Be isin er sR i 2B 15-19 30 27 Completing a second or third stage. If there are no contraindications, have the subject complete a second stage. Repeat the measurements as for the first stage. Determine if the subject is to continue for a third and final stage. Final post-exercise heart rates. After the subject has completed a third and final stage of stepping, or when the test has been terminated on the basis of post- exercise heart rate measurement (while standing), have the subject sit down. -226- Blood pressure measurements (Optional). Record the systolic and diastolic (D,) pressure readings between the thirty-second (0:30) and first minute (1:00) post-exercise period. Record the final blood pressure readings between the two-minute thirty-second (2:30) and the three-minute (3:00) post-exercice period. Record a final post-exercise heart rate between three-minutes (3:00) and three-minute thirty-seconds (3:30) post-exercise, using the stethoscope. Discontinuation of the test. The examiner will discontinue the step test if the subject begins to stagger, complains of dizziness, extreme leg pain, nausea, chest pain, or shows facial pallor. Have the subject lie down, check his heart rate and blood pressure. Request assist- ance from a nurse or physician if the subject does not seem to recuperate after a few minutes. If necessary, have someone call an ambulance. If it becomes obvious that the subject is unable to maintain the proper cadence after the first minute of stepping, step with the subject. If the difficulty in stepping appears to be related to some physiological disfunction discontinue the test. Suggest that the C.H.F.T. could be retaken later at a mutually convenient time. Note: An overall summary of the C.H.F.T. procedure may be found in the Appendix: Physical Fitness Evaluation Chart. Standardized Test of Fitness Page 13 Push-Ups (Optional) If the subject does not want to perform Procedure this test, is over the age of 50, or in poor physical condition as assessed in the Males previous tests and measurements, omit. this test and leave the recording space The subject lies on his stomach, legs blank. together. Hands pointing forward, are positioned under the shoulders. The Equipment: subject pushes up from the mat by straightening the elbows and using the Mat (optional) toes as the pivotal point. The upper body must be kept in a straight — line. The subject returns to the starting position, chin to the mat. Females The subject lies on her stomach, legs together. Hands pointing forward, are positioned under the shoulders. The subject pushes up from the mat straightening the elbows and using the knees as the pivotal point. The upper body must be kept in a straight line. The subject returns to the starting position, chin to the mat, allowing the feet to swing upwards simultaneously. Note: The push-ups are to be performed consecutively and without a time limit. The test will be discontinued as soon as the subject is seen to strain forcibly to complete a push-up. If the subject's feet slip, assist by placing your feet behind and perpendicular to the subject's feet. Count the initial movement and each repetition successfully completed. Record in the highlighted area as follows: [01,5] -227- Standardized Test of Fitness Page 14 Trunk Forward Flexion 60-Second Sit-Ups (Optional) Completing the Testing (Sitting) Session Equipment: If the subject does not want to perform Inform the subject that the testing Modified Wells and Dillon sit and reach apparatus Procedure Have the subject warm-up for this test by performing slow stretching movements before taking actual measurements. The subject, barefoot, sits with the legs fully extended with the soles of the feet placed flat against the horizontal crossboard of the apparatus, with the inner edge of the sole placec 2 cm from the scale. Keeping the knees fully extended, arms evenly stretched, palms down, the subject bends and reaches forward (without jerking) pushing the sliding marker along the scale with the fingertips as far for- ward as possible. The position of maximum flexion must be held for approximately two seconds. The test is repeated twice. Do not allow jerking movements. If the knees flex, the trial is not counted. DO NOT ATTEMPT TO HOLD THE KNEES DOWN. Record the maximum distance reached to the near- est 0.5 cm in the highlighted area as follows: Note: The subject should not attempt this test if bothered by low back pain or other ailments. Advise the subject that lowering the head will maximize the distance reached. this test, is over the age of 50, or in poor physical condition as assessed in the previous tests and measurements, omit this test and leave the recording space blank. Equipment: Mat (optional), timer session is over. Complete and provide the subject with the Assessment Report booklet. If this is not feasible, arrange an appointment for this purpose. Procedure The subject lies in a supine position, knees bent at aright angle, and feet about 30 cm apart. The hands with fingers interlocked are placed behind the head and must be maintained in this position for the whole duration of the test. Hold the ankles of the subject and ensure that the heels are in constant contact with the mat. When ready, give the command “Begin”. The subject is required to sit up and touch the knees with the elbows and return to the starting position. The subject will perform as many repetitions as possible within one minute. The subject may pause when- ever necessary. Note: Ensure that the subject's back returns to its initial position, that the interlocked fingers make contact with the mat or floor and that the subject exhales when sitting up. Record the number of sit-ups completed in 60 seconds in the high- lighted area as follows: 13,0) -228- Standardized Test of Fitness Page 15 Physical Activity Readiness PARTICIPANT IDENTIFICATION Questionnaire (PAR-Q)"* PAR-Q is designed to help you help yourself. Many health benefits are associated with regular exercise, and the completion of PAR-Q is a sensible first step to take if you are planning to increase the amount of physical activity in your life. For most people physical activity should not pose any problem or hazard. PAR-Q has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them. Common sense is your best guide in answering these few questions. Please read them carefully and check (v/) the O YES or O NO opposite the question if it applies to you. YES NO Oo 0 4 Has your doctor ever said you have heart trouble? 2. Do you frequently have pains in your heart and chest? 3. Do you often feel faint or have spells of severe dizziness? 4. Has a doctor ever said your blood pressure was too high? O0O0Oa0o 0000 5. Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise, or might be made worse with exercise? a 0 oo . Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to? . Are you over age 65 and not accustomed to vigorous exercise? YES to one or more questions NO to all questions If you answered PAR-Q accurately, you have reasonable assurance of your present suitability for: © A GRADUATED EXERCISE PROGRAM - A gradual increase in proper exercise pro- motes good fitness development while minimizing or eliminating discomfort. ® AN EXERCISE TEST - Simple tests of fitness (such as the Canadian Home Fitness Test) programs or more complex types may be undertaken if you so desire. postpone Answered If you have not recently done so, consult with your personal physician by telephone or irl person BEFORE increasing your physical activity and/or taking a fitness test. Tell him what questions you answered YES on PAR-Q, or show him your copy. After medical evaluation, seek advice from your physician as to your suitability for: ® unrestricted physical activity, probably on a gradually increasing basis. ® restricted or supervised activity to meet your specific needs, at least on an initial basis. Check in your community for special programs or services. If you have a temporary minor iliness, such as a common cold. * Developed by the British Columbia Ministry of Health Conceptualized and critiqued by the Multidisciplinary Advisory Board on Exercise (MABE) Translation, reproduction and use in its entirety 1s encouraged. Modifications, by written permission only. Not to be used for commercial advertising in order to solicit business from the public. Reference: PAR-Q Validation Report, British Columbia Ministry of Health, 1978. * Produced by the British Columbia Ministry of Health and the Department of National Heaith & Welfare -229~ Standardized Test of Fitness Page 16 Lifestyle information Questionnaire Confidential 1 A Name 2 10 Social Insurance Number ~~ Pp» clase 1. Heres a hist that describes some of the ways people feel at different times. During the past few weeks, how often have you felt... A. On top of the world? Often 11 0 Sometimes 11 200 v Nm IW > Mowing the grass Shoveling snow Cleaning floors Raking leaves Gardening 12 12 12 B Very lonely or remote from other people? 1 1 2 Bo 30] 13 13 13 C. Particularly excited or interested in something? 1 0 2 Od a[J 14 14 14 D Depressed or very unhappy? 1 O 2 3 sd 15 15 15 E. Pleasea about having accomplished something? 1 [3 2 0 a0 Your Feelings > 16 16 16 F. Bored? Od 2 0 3 O 17 17 17 G. Proud because someone complimented you on something you had done?, Et Od 2 O 3 0 18 18 18 H So restiess you couldn't sit long in a chair? 0 2 0 sd 19 19 19 I That thungs were going your way? 1 O 2 0 sd 20 20 22 J Upset because someone criticized you? 1 [3 2 O 3 O 2. Taking things all together, how would you say things VERY HAPPY PRETTY HAPPY NOT TOO HAPPY are these days — would you say you're 21 21 21 > 10 [J 3] 1. Which of the loliowing best describes how you spent your leisure time during tne last two weeks? (Please check (y’) one box only) 22 22 1 0 Almost all of it by myself «0 Alot of it with others 22 22 2 0 A lot of it by myself s[J Almost all of it with others Your 2 Activities The following 3 O About half of it by myself and half of it with others questions are » Bo 2. During the last two weeks, Times in 2. a. About how much time did you spend on each occasion? and leisure how many times did you do the last two actwities following tasks around your home? weeks Minutes usually spent 1-15 16-30 25 25 0 20 28 28 Odd 200 31 31 0 0 34 3 0 20 37 37 WO J 31-60 25 sO 28 30 31 0 37 «0 28 «0 31 «0 «0 37 0 -230- Standardized Test of Fitness Page 17 Confidential 1 [Al 2 10 Social Insurance Number ~~ P» 11 11 11 2. Cont'd Times in 2. a. Cont'd last two weeks wv 1-15 16-30 31-60 >60 Making beds im 200 sO 4 14 16 16 16 16 Carpentry CC] > OJ 2] 3 «0 17 19 19 19 19 Handyman work, painting C1] > 1 Od 20 3 ad 4 a 20 22 22 22 22 Ironing J > Od 2. sO «0 37 39 39 39 39 Other (Please specify) CC] > 1 0 2 Oa 3 a 4 Od 23 | 0 tr11r 40 or [J 1did nothing like this in the last two weeks 3. During the last two weeks, how Times in 3. a. About how much time did you spend on each occasion? many times did you do any of last two the following exercises. sports weeks or recreational activities? Minutes usually spent — v 1-15 16-30 31-60 >60 Walking (including to and from “ 43 43 43 43 work or school) > Od 0 sd «dd Jogging or running 10 2 sO «OJ 47 49 49 49 49 Your Activities P| caiisthenics [1] > 0 2] sO « Bicycling (including to and from 50 52 52 52 52 work or school) > Od 0 a 0 53 55 55 55 55 Bowling CC] > Od 2 a «OJ 56 58 58 58 58 Vigorous dancing C1] > 1 0 2 O dd 4 a 59 61 61 61 61 Sirs CI» 8 fA A 0 62 64 64 64 64 Skiing (downhill, crosscountry) J > 1 a 2 0 3 ad 4 0 65 67 67 67 67 ‘ Curling ] > 1 3 2 Od 3 a 4 Racquet sports (tennis, badminton, 8 70. no 70 70 squash, racquetball) > Odd 20 0 a) mn 73 73 73 73 Baseball/Softball CL] > 0 2] 3 a 74 76 76 76 76 Other team sports (hockey, basketball, Fo football, soccer, volleyball) > 1 a 2 a 3 Od 4 O 7 79 79 79 79 aon CI» B LB 8 0 80 82 82 82 82 Swimming 1] > 1 0 200 sO «Od 97 99 99 9 9 Other (Please specify) - > 1 0 2 a 3d 4 O 83 | Ll it tt ft i 1 1 1 1 1.1 100 Or Od I did nothing like this in tre {ast two weeks -231- Standardized Test of Fitness Page 18 Confidential 1 Al Name 2 10 Social Insurance Number Pp celeb 4. Which of the following choices best describes the work or other activity which you usually do? (Please check (\/) one box only) 101 | am usually sitting during 0 the day and do not walk about very much. 10% 2 0 | stand or walk about quite a lot during my day, but | do not have to carry or lift things very often. 101 | usually lift or carry 3 a light loads, or | have to climb stairs or hills often. 101 a 0 I do heavy work or carry very heavy loads. 1. Check any of the following which you now smoke daily 2. What experience with cigarettes have you had? (Please check (1/) one box only) ¥ 1 O Pipes 16] Never smoked 2 200 Cigars 16 i Now smoke occasionally 3 1» Cigarillos 16 0 Used to smoke occasionally Tobacco These questions 4 are about your experience with 1“ 0 Cigarettes (Go to Question 3) 16 O Used to smoke daily tobacco and smoking 15 0 None of these 3. About how many cigarettes do you now smoke a) if daily b) if occasionally About A Day Or About | A Week 17 18 19 1. About how often do you usually drink aicohol? 1 6 20d Two or more times a day 21 C) 2 or 3times a month 2 7 21 | Once a day 21 0 About once a month 3 8 21 0) 4 to 6 times a week 21 O Less often than once a month 4 9 2[] 2or 3times a week 21 O Not at all in the last 12 months 5 10 21 3 About once a week 20 Not at all Alcohol The following questions are 2. About how many drinks do you have at a time? about your I experience with alcohol 1 4 200 One 22 0 Six or Seven 2 5 22 O Two or three 22 0 More than that 3 6 22[] Four or five 22] Do not drink The following table might help you in answering some of the above questions. One drink equals... — One pint bottle of beer (12 ounces) ~- — One small glass of wine (4-5 punces) — — One shot of hquor or spirits (1-1'z ounces) with or without mix — A shot with a beer chaser or a double should be counted as two drinks -232- Standardized Test of Fitness Page 19 Confidential 13] Anthropometric and Performance Data Record Name Social Insurance Number Sex Age Date of Test Time of Test Room (24 Hour Clock) Temperature 2 10 2 13 D M Y Lada lag 1 rk wd i—1 | 11 Anthropometric Data 14 17 18 21 Weight (kg) Pp» Height Standing (cm) Pp» : . Ji | | Girths (cm) (Optional) Pp | Chest » Abdomen Pp : Gluteal Pb Thigh Is . | | 11 11 id 1 2 3 | Mean 1 2 3 | Mean rt a eee lr bt Ln Li kinfold: Skistonis trim) > 1 2 3 | Mean 1 2 3 | Mean ; Ss ii Biceps » : . uprailiac Pp a 7 . : ot 1 1 JE I 1 Lf jt 1-1 22 24 25 28 Pi Fat Ideal Body ercent Body Fa » . Worm ey) >» ” 1 I Strength — Muscular Endurance — Flexibility 1 2 | Max 1 2 | Max 29 31 Grip Strength p> RightHand Bp LeftHand p> ist Yah IS 11 $d 11 1 1 11 J..} PR I 1 2 |34 Max. 36) 37 38 39 4 i Positi Sit-Ups Push-Ups (Optional) » Trunk Flexion | “ 4 Bi Orriobe | 2 ] bd Li fad ] Canada Home Fitness Test 40 42 43 45 46 48 Resting Heart Rate (b/m) » | Resting Blood Pressure ~~ P» | Systolic » | Diastolic | 3 11 I 3 Heart Rate Response i 49 51 Maximum Oxygen 4 « Stage 1 5-15sec. PB Stage | 2 | 5-15sec. | 4 Stage | 3 | 5-15sec. » Consumption » v 11 Jd Lot.) (oikgirin | Post-Exercise 52 54 55 57 58 60 BOLT: ; 5 ; i Post-Ex. Heart Rate (0:30-1:00 Min.) Systolic > Diastolic » (b/m) (5-15 sec) > Blood Pressure, 11 1 | | (Optional) 61 63 64 66 67 69 " ; ; i ; Post-Ex. Heart Rate (2:30-3:00 Min.) Systolic » Diastolic > (b/m) (3-00 Min.) » 11 1 1 1 Comments Name of examiner (Please print) Signature of examiner -233-~ Standardized Test of Fitness Page 20 Construction Plan for Ergometer Steps It is advised that steps be constructed in 1.2 meter (4 foot) lengths in order to store and transport easier. In mass testing situations, the smaller stepping benches may be joined to form larger testing benches. Details 1. Double 20 cm steps, cut to desired length. 2. Use 1.88 cm plywood. 3. Supporting panels (F) every .9-1.2m. 4. Width Dimensions: A 18.13cm B 25cm C 20cm D 45cm byi.2m E 38.13cm A F 70cm 20 em pe— 45cm ——in 5. Handrail Dimensions: “38.13 cm—> G Approx. 100 cm 4 25cm —» H Approx. 137.5cm © 6. Support Panel Dimensions. 2y 70cm ————b Flexometer Design A modified Wells and Dillon flexometer may be constructed according to directions herein. It should be noted that the “ruler” arm should be attached at the 25 cm mark (arm extended toward the subject, with the “0” mark closest to the subject). 50550 # J mm AL ANGLE BRACKET 6 mm DRILLED HOLE CENTRED 19 mm FROM T -234- SCORING CRITERIA STANDARDIZED TEST OF FITNESS Body Fat and Skinfolds* Skinfolds Males (age in years) Females (age in years) {mm) 17-29 30-39 40-49 50+ 16-29 30-39 40-49 50+ 15 48 - - - 10.5 - - - 20 81 122 122 128 14.1 17.0 19.8 214 25 105 142 150 156 16.8 18.4 222 240 30 129 16.2 17.7 186 19.5 218 245 26.6 Ss 35 147 17.7 196 20.8 215 237 264 285 40 164 192 214 229 234 255 282 30.3 45 17.7 204 230 247 250 269 296 31.9 50 19.0 215 246 265 265 282 31.0 334 55 201 225 259 27.9 27.8 204 321 346 aN 60 21.2 235 271 292 29) O06 33% O57 65 222 243 282 304 302 31.6 34.1 36.7 70 231 251 203 316 #2 305 m0 m7 75 740 P59 DOS O27 322 334 359 387 80 248 266 312 - 338 331 343 - 367 396 85 255 27.2 321 34.8 34.0 351 375 40.4 9 262 27.8 330 358 348 358 383 412 Sit 9 269 284 337 366 356 365 390 419 100 276 200 344 374 364 37.2 397 426 ®) 105 282 206 351 382 37.1 37.9 404 433 110 288 301 358 39.0 378 386 410 439 a 115 29.4 306 364 39.7 384 39.1 415 445 X. - 120 300 311 37.0 404 30.0 396 420 45.1 welll 125 305 315 376 411 396 401 425 457 130 310 319 382 41.8 402 _ 40.6 430 462 135 315 323 387 424 408 411 435 467 ( 140 320 327 392 430 413 416 440 472 145 325 331 39.7 436 41.8 421 445 41.7 150 329 335 40.2 44.1 423 426 450 482 aD 155 33.3 339 40.7 446 428 43.1 454 48.7 160 387 o% 413 451 433 436 458 49.2 165 341 346 416 456 437 440 46.2 496 170 345 348 420 46.1 441 444 466 50.0 175 34.9 - —- - - 448 470 504 180 33 — - = 452 474 508 Som 185 35.6 - — - — 456 478 51.2 190 35.9 ao hy =] Tem 4509 ABZ B18 195 - - - le 46.2 486 B20 ad 200 — = —- = 468 488 624 _ 205 — - — ve — —- 491 527 210 - - — —- — 44 530 In two-thirds of the instances the error was within £3.5% of the body-weight as fat for the women and £5% for the men. **NOTE: These norms are pre- liminary only, based on a non-representative sample. Canada Fitness Survey will publish new norms in late spring 1984, based on a representative household- based sample of 15,000 persons age 7-69 years. The equivalent fat content, as a * percentage of bodyweight, for a range of values for the sum of four skinfolds (biceps, triceps, subscapular and supra- iliac) of males and females of different ages. % By J.V.G.A. Durnin and J. Womersley. “Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years.” British Journal of Nutrition, 32, 77-97, 1974. -235- Scoring Criteria Standardized Test of Fitness Page 2 Norms and Percentile Scores by Age Groups for Estimated Percentage of Body Fat | Males! Females? Age (Yr) 17-19 20-29 30-39 40-49 50+ Obese >23 > 2 >2 > 29 >21 > > 3 > 3 > > 33 $iDove 18-22 24-28 20-24 24-28 23-26 25-29 27-31 26-30 20-34 27-32 average 3 : Average 12-17 19-23 15-19 19-23 { 1922 20-24 20.26 21-25 23-28 22-26 Ideal 7-11 14-18 9-14 14-18 { 1518 14-10 16-21 15-20 17-22 16-21 Slim £6 <3 <8 < 13 LH. <1 £15 WM <16 < 15 Age (Yr.) Percentile 17-19 20-29 30-39 40-49 50+ 100 76 98 ]s9 100 105 9.2 11.0 10.2 137 11.6 95 88 151 {111 153 152 15.0 16.9 16.1 19.2 17.2 90 103 16.2 12.6 16.3 16.1 16.1 18.1 17.2 203 18.4 85 12 17.5 135 17.6 17.3 176 19.5 18.7 217 19.9 80 120 18.3 l142 183 18.0 18.4 201 19.5 225 20.8 75 127 18.9 149 19.0 186 19.1 212 20.3 232 21.6 70 133 19.5 15.4 195 19.2 19.8 218 20.9 238 22.3 65 139 20.0 161 200 19.6 20.4 24 215 243 228 60 145 20.6 16.6 20.6 201 210 280 221 - 249 235 55 151 21.1 17.2 21.0 205 215 235 226 25.4 24.0 50 15.7 216 17.7 215 21.0 220 241 232 259 246 45 162 22.1 183 22.0 215 226 247 237 26.4 25.2 40 169 225 189 225 219 23.1 252 243 26.9 258 35 175 23.1 195 23.0 24 237 258 24.9 27.5 26.4 30 182 236 201 235 228 24.3 263 254 28.0 27.0 25 18.9 24.2 209 241 234 249 27.0 26.1 28.7 27.7 20 19.8 24.9 218 24.7 240 256 278 26.8 203 28.4 15 214 256 233 255 247 265 286 27.7 30.2 29.3 10 226 27.0 244 268 259 27.9 30.1 29.1 ‘316 30.9 5 |232 280 259 27.8 26.8 29.1 31.2 30.3 326 32.1 0 27.1 333 329 329 342 349 37.2 36.2 i382 38.2 11977 Canadian Public Health Association project (5,833 sub, 1an Public Hea ssociation project (3,470 su -236- Scoring Criteria Standardized Test of Fitness Page 3 Norms and Percentile Scores by Age Groups for Combined Right and Left Hand Grip Strength (kg) ales! Females? Age (Yr.) 17-19 20-29 30-39 40-49 50 - 59 60 - 65 Excellent §> 119 > 78 > 128 > 7 > 125 > 72 >122 >713 [>13 >67 }> 107 > 60 Good 101-118 61-77 105-122 59-70 ~~ §06-124 60-71 pos-121 59-72 96-112 55-66 90-106 50-59 Minimum | 82-100 45-60 87-104 57-58 88-105 48-59 | 85-102 45-58 [78-95 44-54 "73-89 39-49 Bow 63-81 28-44 | 68-86 3546 69-87 36-47 66-84 32-44 61-77 32-43 ‘57-72 28-38 minimum f F 3 : Poor < 62 < 27 < 67 < 34 b< 68 < 35 < 65 < 31 < 60 < 31 <5 < 27 Age (Yr.) Percentile 17-19 20-29 30-39 40-49 50 - 59 60-65 100 138 94 142 83 143 84 140 86 I 78 71 95 17 75 121 70 122 70 19 71 $111 65 59 20 13 72 17 67 118 68 115 68 1107 63 56 85 107 67 112 63 113 64 110 64 102 59 53 80 104 64 109 61 110 62 107 62 99 58 52 75 102 62 106 60 107 61 104 60 97 56 50 70 99 60 1104 58 105 59 102 58 95 54 49 65 97 58 102 57 103 58 100 57 93 53 47 60 95 56 100 55 101 56 55 91 52 46 55 . 93 55 i 98 54 99 55 54 89 51 45 50 91 53 . 96 53 97 54 52 [ 87 50 44 45 89 51 52 .95 53 51 L 85 48 43 40 | 87 50 50 93 51 49 47 42 35 85 48 49 91 50 48 46 4 30 83 46 48 89 49 46 45 40 25 . 81 44 46 87 47 45 44 38 20 E78 a 44 84 45 43 41 37 15 75 30 42 . 81 43 40 40 35 10 69 34 39 76 40 36 36 32 5 “65 31 36 C72 97 33 34 30 0 44 12 22 (51 24 18 21 18 CR LT rd TA -237- Scoring Criteria Standardized Test of Fitness Page 4 Norms and Percentile Scores by Age Groups for Maximal Oxygen Consumption (ml/kg/min.) Females? Age (Yr.) 17-19 3 20-29 40-49 50-59 60-65 Excellent f > 62 > 43 > 57 > 4 >4 >38 F>am >3 Ew > R>% > Good 55-61 40-42 51-56 38-40 © 45-48 35-37 [| 40-42 31-34 + 36-39 27-31 32-35 25-27 Minimum 49-54 37-39 45-50 34-37 [40-44 31-34 , 36-30 28-30 [32-35 23-26 28-31 21-24 Below 1.4348 54.38 30-44 31-33 35-30 28-30 3235 24-27 F 28-31 1822 fF 2427 17-20 minimum 4 ir ! ot i Poor t < 42 < 33 .< 38 < 30 mod € 27 iE 31 <. 23 ne 2] <7 23 < 16 Age (Yr.) Percentile 17-19 20-29 30-39 40-49 50 - 59 60 - 65 100 67.9 46.2 feo 44.5 £540 41.6 Joe 38.7 43.8 36.3 40.1 32.1 95 160.8 42.7 56.2 40.5 148.7 37.7 42.9 345 139.2 31.2 356 27.8 90 "59.4 42.0 foes 39.7 “47.6 37.0 f420 337 '38.3 30.2 34.7 27.0 85 57.7 41.1 je 38.7 46.3 36.0 £40.9 3256 372 28.9 33.6 25.9 80 } 56.6 40.6 52.2 38.1 45.5 35.5 £403 32.0 '36.5 28.2 329 253 75 .55.7 40.2 {514 37.7 '44.8 35.0 ¥39.7 315 1359 27.6 £323 24.8 70 54.9 39.8 {506 37.2 443 345 joo 31.0 354 27.0 31.8 24.3 65 : 54.3 39.4 50.0 36.8 437 34.2 £388 30.6 $35.0 26.5 31.4 23.9 60 {53.5 39.0 £49.3 36.4 432 338 ¥38.3 30.2 (34.5 26.0 30.9 23.4 55 52.9 38.8 F48.7 36.1 42.7 33.4 £37.90 29.8 341 255 30.5 23.1 50 .52.2 38.3 148.0 35.7 42.2 33.1 Fars 29.4 336 25.0 30.1 22.6 45 51.5 38.1 $47.4 35.3 417 327 37.0 29.0 332 246 120.6 22.2 40 ‘50.9 37.7 46.8 35.0 41.2 32.4 bon 28.7 328 24.1 [29.2 21.9 35 50.2 37.4 46.1 34.6 £40.7 32.0 {36.2 28.2 323 236 [28.7 21.4 30 49.5 37.0 45.4 34.2 140.2 31.6 Foss 27.8 31.9 23.1 28.3 21.0 25 48.7 36.6 447 338 [39.6 31.2 135.3 27.4 31.4 22.5 ¥27.8 20.5 20 ; 47.8 36.2 438 33.3 38.9 30.7 {34.7 26.8 30.8 21.9 27.2 20.0 15 46.7 35.7 428 327 38.1 30.1 fas. 26.2 30.1 21.1 26.6 19.4 10 "450 34.8 F411 31.7 36.8 29.1 1329 25.2 200 19.9 1254 18.3 5 436 34.1 39.8 30.9 £358 28.4 320 24.4 28.1 18.9 245 17.5 0 [36.5 30.6 33.0 27.0 30.4 24.5 j27.5 20.2 [23.5 13.8 20.0 13.2 P1977 Canadian Public Health Association project {5,578 subjects, 21977 Canadian Public Health Association project (3,381 subjects) -238- Scoring Criteria Standardized Test of Fitness Page 5 Norms and Percentile Scores by Age Groups for Push-Ups ‘Males! Females? Age (Yr.) 17-19 20-29 30-39 40 -49 50-59 60 - 65 Excellent > 5 > 32 >43 >3 B>3 >3 f>8 > f=>28 >28 f>2 >2 Good 35-50 21-31 § 30-42 23-32 25-36 22-33 18-27 18-27 15-22 ¥ 17-26 13-20 Minimum 19-34 11-20 17-29 12-22 . 13-24 10-21 8-17 9-17 7-14 : 816 512 Below, i 4-18 0-10 . 416 1-1 s 2-12 0-9 0-7 0-8 0-6 © 0-5 04 Poor ig * <3 0 <1 . ‘ ‘, . 2G Age (Yr.) Percentile 17-19 20-29 30-39 40-49 50 - 59 60 - 65 100 65 45 56 44 | 48 46 38 37 32 :37 29 95 49 32 41 32 35 32 37 22 25 20 90 45 3 39 30 33 29 24 24 20 23 18 85 41 28 35 26 29 26 22 22 18 20 16 80 38 26 |] 33 25 27 24 20 20 17 19 14 75 36 25 { 31 23 26 22 19 {19 15 7 8 70 34 23 29 22 24 21 17 17 14 16 12 65 52 22 28 21 23 20 16 16 13 15 1 60 8? 26 19 22 18 15 g 15 12 14 MN 55 20 20 25 18 21 17 14 14 12 13 10 50 21 19 23 19 16 13 13 11 ‘129 45 26 17 22 16 18 14 12 12 10 b10. 8 40 24 16 21 5 17 13 1 i 119 ~9 7 35 S22 15 19 14 16 12 10 E10 8 ’8 6 30 = 21 14 18 12 14 10 9 9.7 7. 5 25 19 13 16 11 C139 7 8.6 6 4 20 C16 1 SEVER no7 6 gis 4 3 15 i 149 { 2 = 9 5 4 5 3 3 2 10 9 6 8 5 6 2 2 2. 1 FY. 3 5 E 6 4 6 2 J 1 t-.0 i 0 © 0 0 0 | 0 0 0 0 0 0 0 0 #1877 CanadianPublic Health Association project (5,353 sublects) 21977 Canadian Public Health Association project (2,641 subjects) -239- Scoring Criteria Standardized Test of Fitness Page 6 Norms and Percentile Scores by Age Groups for Trunk Flexion (cm) | Males! Females? Age (Yr.) 17-19 20-29 30-39 40-49 50-59 60-65 Excellent >4 >a | 34 >a 24 >a 24 34 [F342 > >a >u Good 37-47 37-46 | 38-44 37-48 34-44 38-48 32-42 36-45 | 31-41 35-44 | 29-40 34-43 Minimum 26-36 28-38 235 27-3 § 2x 2638 22-31 25-35 19-0 25-34 18-28 24-33 Seiow 15-25 19-27 15-24 17-28 | 13-23 18-28 1-21 14-24 § 818 1524 [ 617 1423 minimum 4 A 3 Poor &M €£W YT £€u €1 < 12 < 15 «Ww. en te? mu ras an Age (Yr) Percentile 17-19 20-29 30-39 40- 49 50 - 59 60 - 65 100 sso ses | 56.0 56.5 1585 57.0 [540 57.0 1530 55.5 20 540 95 E465 455 445 45.0 1435 455 1420 45.0 1405 44.0 Q 425 % Tass as £420 430 410 430 39.5 425 (38.0 42.0 {365 40.0 85 Las a0 [39.0 405 f380 40.0 365 39.5 i350 39.0 335 ars 80 130.5 295 a7.0 385 ‘385 385 {345 375 ,330 375 is 25s 75 380 38.0 } 36.0 37.0 bso 37.0 §330 38.0 $315 38.0 130.0 34.5 70 365 370 1350 36.0 1335 360 1315 350 130.0 345 i285 33.0 65 1355 360 £340 35.0 i325 350 fas 33s 128.5 33.8 i270 320 60 {340 350 [325 34.0 1310 335 120.0 325 (71.5 325 260 310 55 $33.0 340 31.5 33.0 joo 325 128.0 31s i260 315 (24.5 30.0 50 1320 330 Yas 320 £290 315 27.0 300 250 300 23s 285 45 {205 320 $205 310 £280 30.0 260 29.0 240 29.0 20 715 40 295 31.0 285 30.0 [210 200 250 28.0 {25 28.0 2 26.5 as [28.0 30.0 fare 28.5 255 28.0 fas 26.5 2's 27.0 jas 25.5 30 [on 29.0 260 27.5 1245 27.0 1225 25.5 §200 26.0 {18.5 245 25 255 27.5 25.0 26.0 jz 26.0 21.0 245 i185 245 317.0 23.0 20 {240 280 235 25.0 ;215 240 19.5 225 {170 230 {155 21s 15 1225 245 215 23.0 {200 225 17.5 210 (15.0 215 1135 200 10 i190 220 19.0 205 417.0 200 j145 180 12.0 18.5 {10.5 17.0 s j17.0 20 185 18.0 145 175 {125 155 {9s 16.5 180 150 0 f 50 95 £50 7.0 bP 25 6.0 £00 35 {00 50 foo 3s [1977 Canadian Public Health Association project (5.757 subjects) 21977 Canadian Public Health Association project (3,445 subjects) -240- CB TA oT See © Em vr Wl Wr Cn ale See. aT Len 4 end ree tv a i p——_— 3 J FT $= For recon RS We LP Scoring Criteria Standardized Test of Fitness Page 7 Norms and Percentile Scores by Age Groups for Sit-Ups (No. in 60 seconds) Males! Females? Age (Yr.) 17-19 20-29 30-39 40-49 50 - 59 60-65 Excellent >84 > 48 >85 > 4 >4 > >38 > 30 32 [> >» Good EL 44-53 35-45 40-50 31-40 34-43 24-32 20% 207 | 2532 12 23-32 15-2 Minimum | 34-43 24-34 0-39 21-30 =n 1523 } 22028 1219 16-24 613 132 7-14 Below | es rz 2029 11-20 1524 614 1 M9 31 715 08 “12 08 minimum : L Poor . £23 € 13 <19 < 10 <4 <5 €10 <2 <6 . < 3 + Age (Yr.) Percentile 17-19 20-29 30-39 40-49 50-59 60 - 65 100 63 56 61 51 53 42 a 37 Je 2 a Nn 95 52 44 49 4 a 22 a7 28 Ja = 3 22 % 0 42 a 37 © as 26 Hao 21 29 20 8s a “4 35 8 27 dae 23 i128 19 27 18 80 4% 37 42 3 ® 2 | 3 22 26 18 25 17 75 las 38 1a 2 » 25 0 21 Js 7 24 16 70 43 34 0 30 Mu 428 20 2¢ 18 22 15 65 2 Bn 8 2 3 23 27 19 123 15 21 14 a 2 7 28 n 2 26 18 12 1a 20 13 55 0 Nn 138 2 0 20 12s 17 ar 13 19 12 39 3 as 26 2 20 Js 18 da 12 1B n 45 as 29 u 25 2 19 Jae 15 19 n 17 10 40 7 2 13 2 zn 18 83 14 1B Nn ) 16 9 35 8 26 32 23 2 17 122 13 17 10 5 8 30 ‘las 25 3 2 2 16 { 21 12 ‘118 9 147 25 U4 24 2 20 2% 18 19 1 Js 8 13 6 20 32 22 28 19 23 13 118 10 14 7 "nn s 15 31 20 17 21 12 17 8 12 8 ‘10 4 10 28 17 23 14 18 9 14 6 0 3 x7 2 5 28 15 21 12 w 7 12 4 8 2 5 1 0 15 3 9 1 5 0 2. .0 0 0 0 0 : » Canadian Public Health Association project (3,194 subjects) : ij - -241- Scoring Criteria Standardized Test of Fitness Page 8 Taping the Stepping Sequences for the Canadian Home Fitness Test The most efficient system to use in selecting the proper testing tempos for the step test is the taping of the appro- priate tempos on audio-cassettes. The table below identifies the seven sequen- ces which are necessary to test all subjects who qualify for the test. The sequences described allow the test administrator to use a three-stage test if required. Note: Taping the sequences below should be done continuously from the instructions on the tape or record, “This is stepping exercise number...” of the starting tempo until the instruction, “Check your score on the chart to see whether you go on,” of the third and final tempo of the stepping sequence. It is mandatory that no interruption occurs in the taping or in the actual administration of the test — except when the test is being terminated according to directions within the test methodology. Tape Subjects Being Tempos STF Tested (by age) | (beats/min.) Tape (Side)* #1 Males: 60s 66,84;102 AorB Females: 60s, 50s #2 Males: 50s 84;102;114 AorB Females: 40s #3 Males: 40s 102;114;132 A #4 Males: 30s 114;132;144 A #5 Males: 20s; 15-19 132;144;156 A LH Females: 30s; 20s 102;114;120 B #7 Females: 15-19 114;120;132 B . "Each STF Package contains a cassette with the testing tempos. The appropriate side(s) for taping is/are identified within the above table. -242- Scoring Criteria Standardized Test of Fitness This chart summarizes the administration and interpretation of the step test. Ina mass testing situation, test administrators may find it easier to use a two-stage rather than a three-stage test. The three- stage test however is mandatory if predictions of maximal oxygen con- sumption are computed rather than the categorical fitness categories — undesirable, minimum or recommended. Page 9 Physical Fitness Evaluation Chart: CHFT Age group Sano soong Your pulse rate after first exercise STOP if 24 or more i 24 or more You have an undesirable Personal fit- ness level. STOP if 25 or more i 25 or more You have an undesirable Personal fit- ness level. Ni if 26 or more STO P You have an : undesirable if 26 or more | | Personal fit- ness level. N | if 28 or more STOP | | foumes undesirable if 28 or more Personal fit- ness level. WN if 29 or more STOP You have an me er! . if 29 or more | | Personal Nee 'sdais (wd £02) youj Iybia 10) pazipiepuels uaaq aney $a109s jes asind HV :810N STOP it 30 or more - N\ if 30 or more You have an ungesiradle Persona fit- ness level. -243- GO iy GO ola or less STOP if 23 or more if 25 or more 5%) STOP Scoring Criteria Standardized Test of Fitness Page 10 Test administrators should use their discretion when testing subjects 70 years of age and older. Enquiries should be made about their daily activity habits in addition to the use of PAR-Q. Unless hand-rails are available on the testing steps, the test administrator should step with older subjects as a precaution against falls. Your pulse rate after second exercise Your pulse rate after third exercise # 23 or more ¥ 22 or less © Caution: The advanced version of You have the You have the the Canadian Home Fitness Test minimum Per- recommended Advanced ONLY is intended for use only by those sonal fitness Personal fitness individuals who have attained the ol. - level Recommended Fitness Level. pm) if 23 or more "21-22 [| if 20 or less ¥ 23 or more You h You have the You have the You have the G 0 Everybody ae recommended recommend minimum Per- only if 22 Personal fitness Personal fitness Personal fitness sonal fitness I STOP |e level. level. level. 0 le9s GOOD VERY GOOD | |EXCELLENT H2¢ormore [~|N22-23 it 21 or less # 24 or more You have the You have the You have the You have ne if Everybody recommended | | recommended recommended minimum Per- i ersonal fitness ersonal fitness ersonal fitness sonai fitness au! 3 STOP ||ieve. level. level. avy Xi GOOD | |VERYGOOD | | EXCELLENT H250ormore | | it 23-24 if 22 or less ¥ 25 or more Everybody You have the You have the You have the You have the recommended recommend recommended minimum Per- only if 24 Personal fitness Personal fitness Personal fitness sonal fitness STO P level. level. level. level. Of less GOOD VERY GOOD | [EXCELLENT 28 it 26 or more 24-25 | 1 23 or less or Mare Everybody | | You have the You have the You have the You have the 1 recommended recommended recommended minimum Pey- only if 25 Personal fitness | | Personal fitness | | Personal fitness onc fitness or less STOP level. level. level. evel. GOOD |_| VERY GOOD wm EXCELLENT i" ¥27ormore | | If 25-28 [| If 24 or less 27 or more G 0 You have the You have the You have the You have the ! Everybody recommended recommenced recommended minimum Per- i only if 26 Personal fitness | | Personal fitness Personal fitness sonal fitness \ STO Pp level. level level. eve Of less GOOD VERY GOOD EXCELLENT ee] a -244- MARTENS' PHYSICAL EDUCATION ATTITUDE SCALE TYPE OF MEASURE: Affective OUTCOME ASSESSED: Belief in the Positive Effects of Exercise TARGET POPULATION: Elementary school children GENERAL DESCRIPTION: Martens' Physical Education Attitude Scale is designed to assess children's attitudes about physical education and its benefits. Respondents are presented with 29 statements specifically about physical education, then asked to agree or disagree with each statement. Each item has been given an assigned score value. Mean scores are calculated for the items marked 'agree." Those mean scores are then used as the students’ attitude ratings. TECHNICAL INFORMATION: The scale was administered on a test-retest basis (duration of temporal interval upspecified) to 669 subjects in grades four to seven. The resulting stability coefficient was .68. To supply evidence of the scale's validity, the author correlated scores with students' self- ratings of their attitudes toward physical education (by placing an x on a line representing a 0-5 continuum). The resulting validity coefficient (n = 547) was .44. AUTHORS : Dr. Fred L. Martens University of Victoria, Victoria, British Columbia ADDITIONAL INFORMATION Martens, F. L. A scale for measuring attitude toward physical education in the elementary school. Journal of Experimental Education, 1978, 47, 239-247. -245- MARTENS®' PHYSICAL EDUCATION ATTITUDE SCALE by Fred L. Martens University of Victoria NAME DATE SCHOOL GRADE AGE Instructions to the teacher: Distribute the scale and read the instructions carefully with the children. Do the practice statements together. Best results are obtained with grade 4's and some grade 5's if the teacher reads the statements to the children. "Below you will find some statements about physical education. We would like to know how you feel about each statement. Think of physical education as the school course taught in regular periods and not as the games played out of school time and on Saturdays." (a) Read the statement carefully. (b) If you agree with the statement, place an "X" in the "agree" column; if you disagree, place an "X" in the "disagree" column. There are no right or wrong answers. THIS IS NOT A TEST. Therefore answer the statement exactly as you feel about it. PRACTICE ON THESE STATEMENTS: Agree Disagree i. Riding a bicycle is more fun than walking. 2. The study of science is interesting. 3. Children should not be allowed to watch television after eight o'clock at night. -246-~ Martens' Physical Education Attitude Scale Page 2 ANSWER THESE STATEMENTS EXACTLY AS YOU FEEL ABOUT THEM Agree Disagree agree lisagree 1. I can hardly wait for my next physical education period. 2. If I had my choice I would not take physical education. 3. I like practicing skills to become better at doing them. 4, The only reason I like physical education is to get away from other school work. 5. In physical education you learn to dislike others who are poorer players than you are. 6. Playing together in physical edu- cation helps you get to like other children better. 7 I am glad physical education periods are short. 8. No real good comes out of physical education. 9. Physical education is needed for learning how to become fit and healthy. 10. Taking part in most physical edu- cation things makes life more fun. (Like games, dance, gymnastics) 11. Physical education games give you too many chances to get upset and angry at other players. 12. Learning new stunts and skills is one of the things I like best about physical education. 13. My body has all the strength it needs without taking part in physical education. -247- Martens' Physical Education Attitude Scale Page 3 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24, 25. 26. It does not matter to me if I take exercise or not. I do not like any part of physical education. If for any reason a few subjects have to be dropped from the school programme, physical education should be one of the subjects dropped. Belonging to a team in physical education games makes me feel good. I enjoy playing and running hard in physical education. Physical education gives you about the poorest chance of any subject to make friends. Taking part in the things we do in physical education is helpful in learning how to make friends. I get a lot of fun out of being able to do the tricks and skills in physical education. I do not learn anything in physical education that helps me in playing with my friends at home or in playgrounds. Playing games in physical education just gets you dirty. Most ways of getting exercise are boring. Physical education is the only subject I wish we did not have. Many kinds of exercise (running, playing games hard, doing push- ups, and sit-ups) make me feel better. -248- Agree Disagree Martens' Physical Education Attitude Scale Page 4 27. You learn to like exercise in physical education. 28. Playing games is a waste of time. 29. Most children look forward to physical education classes. -249- Agree Disagree MARTENS PHYSICAL EDUCATION ATTITUDE SCALE FOR THE INTERMEDIATE LEVEL SOORING INSTRUCTIONS Scale Values for Items 1. 8.13 16. 2.34 2. 1.88 17. 7.80 3. 7.75 18. 6.76 4. 3.04 19. 1.36 5. 1.99 20. 7.59 6. 6.41 21. 7.40 7. 2.87 22. 1.90 8. 2.05 23. 2.38 9. 7.97 24. 2.11 10. 7.81 25. 2.05 11. 2.93 26. 6.90 32. 7.02 27. 0 13. 2.84 28. 1.95 14. 4.83 29. 17.56 15, 1.41 Procedure: Score only the items checked in the “agree” column. The mean of all the scale values of the items agreed with by the student is his/her attitude rating. No norms have been developed but results using 669 children in six different schools yielded an overall mean of 6.70 (S.D. = .65) and the '"re-test" yielded a mean of 6.79 (S.D. = .70). -250- EXERCISE QUESTIONNAIRE TYPE OF MEASURE: Affective OUTCOME ASSESSED: Intention to Exercise Regularly TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: The Exercise Questionnaire is designed to assess how often existing barriers prevent individuals from exercising regularly. Individuals are presented with fourteen reasons people often cite for not exercising, e.g., lack of energy, lack of time, etc., then asked how often each barrier prevents them from getting exercise. Responses are marked on a continuous line between always and never. The intensity of responses is reflected by where they are placed on the line. Use of a continuous measurement scale (marking anywhere on the line, then quantifying the response using a ruler or other continuous scale), rather than a semantic differential scale (e.g., checking one of five boxes: always/often/sometimes/rarely/never), allows for analysis using nonparametric rank order correlations. This enables the user to assess the degree of associa- tion between variables. AUTHOR: Fern Goodhart New Jersey Department of Health, Trenton -251- io. 11. 12. 13. 14. 15. EXERCISE QUESTIONNAIRE II. These are some reasons people cite for not exercising. Please place a check anywhere on the line which best indicates how often these factors prevent you from getting exercise. The intensity of your response is reflected by where it is placed on the line. For example, if you almost always do not exercise because of a "lack of time," your response would be: X Always Often Sometimes Rarely Never Lack of time ~~=—=—=———ecm————— Lack of self-discipline. --- Lack of energy ——-——-—————e—-- Lack of company =-==—==——————— Lack of motivation —-=—=——==--= Lack of enjoyment from exercise ———————————- Discouragement ——=—————=m————- Lack of equipment OF MONEY =m mm mm mem mm ow rm wm wm wm Lack of good weather —--=——=-- Lack of facitilities Or Space ==—==————————————— Lack of knowledge about how to exercise ———————=——= Lack of good health --—————- Fear of injury —-—————=—mm——- Lack of ability to access own level of fitness --—-- Other: Always Often Sometimes Rarely Never -252- HEALTH ATTITUDES TYPE OF MEASURE: Affective OUTCOME ASSESSED: Respect for One's Body TARGET POPULATION: Adults or Adolescents GENERAL DESCRIPTION: Health attitudes consists of sub-scales designed to measure the salience of heart disease risk factors, perceived susceptibility to heart disease, perceived costs and benefits of risk reduction activities, self- efficacy for behavior change, and behavioral intentions related to heart health. The measure is designed to look at the process of attitude change as it relates to behavior change. Individuals are presented with 62 statements about exercise, nutrition, and stress, then asked whether they strongly agree, somewhat agree, slightly agree, slightly disagree, somewhat disagree, or strongly disagree with each statement. The inventory is comprised of statements such as, "It's hard for me to stick to a regular schedule of physical activity," or "The foods I eat are not as healthy as they could be." This measure is one in a series of health inven- tories used in the Stanford University Five-City Project, a community-based education project. AUTHOR: Dr. William Haskell, Ph.D., Doug Solomon, Ph.D. et al Stanford University Medical Center -253- 10. 13. 14. 15. 16. 17. 18. 19. HEALTH ATTITUDES The foods that I eat are not as healthy as they could be. It's impossible for me to shut off my thoughts after a hectic day. The amount of physical activity I now get is enough to keep me healthy. I am more aware of my health now than I was a year ago. People who weigh less have louer blood pressure. I just can't keep myself from eating snacks betueen mozls. I would feel much better if I got more exercise. I feel I already exercise a sufficient amount. Even though I try, I can't seem to stay calm when annoying things happen. .Once you have high blood pressure, you're in for serious health problems unless you control it. It's impossible for me to leave food on my plate. If [ decided to use a special relaxation method my family and friends would encourage me to do it. Feeling good is not really related to how much you ueigh. I need to learn to feel more comfortable in tense situations. It's hard for me to stick to a regular schedule of physical activity. Most of the people around me are very careful to eat healthy foods. I'm the kind of person who will never get enough exercise. Foods low in salt are bland and uninteresting. / It is perfectly OK to gain weight as you get older. I seem to worry about my health more than other people worry about theirs. -254- ies git Ahi (AR) (0) Rorss’™" Bislares Gizactes (A) (d (00) (1) (2) (&) (4) (S) (6) AR A a d 0 00 AA A a d 0 boo AA A a d 0 00 AA A a d 0 00 AA A n d 0 00 AR A a d 0 08 AA A a d 0 00 AA A a d 0 00 AA A a d 0 00 AA A a d 0 00 AA A a d 0 i] AA A a d 0 00 AA A a d 0 0D AA A a d 0 00D AA A a d 0 00 AA A a d b 00 AA A a d 0 00 RA A a d D 5 AA A a d 0 00 Health Attitudes Page 2 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 3S. 36. 37. 38. People who don't know how to relax are candidates for a heart attack or stroke. I just cannot resist eating sueet desserts. People who don't get regular . phys] sai activity are risking serious ealth problems. If I only ate things that were good for me, food would be boring. From now on I plan to relax more. I feel I already relax a sufficient amount. It is impossible for me to resist eating when I am around others who are eating. People who weigh less have a lower risk of heart disease. When I promise myself to change some- thing about me that I don't like, I always do it. Eating healthy foods is very expensive. I would get along better with people if I didn't get so tense. I just can't do much about what I weigh. If I became a more relaxed person, my general health would probably not change. I worry more about my health now than 1 did a year ago. People who get easily frustrated have a greater risk of heart disease. If I decided to eat healthier foods, my family and friends would encourage me to do it. Finding enough time to relax is practically impossible for me. Even.if I wanted to eat more nutritious foods, changing what I eat would cause my household too much trouble. I just can't get myself to walk short distances instead of driving. During the past year, I have been ill more often than usual. -255- Strongly Slightly Somewhat Agree Agree Disagree (AA) (D Somewhat Slightly Strongly Agree Bigagree Disagree (A) (d (0D) {Nn (2) 3) (4) (5) (6) AA A a d D DD AA A a d D DD AA A a d D DD AA A a D 0D AA a D 0D AA A a d D 0D AA A a d D 0D AA A a d D DD AA a D DD AA a d D DD AA A a d D DD AA A a d D 0D AA A a d D DD AA A a d D DD AA A a d D 0D AA A a d D 00 AA A a d D 0D AA A a d 0 DD AA A a d D DD Health Attitudes Page 3 Strongly Slightly Somewhat Agree Agree Disagree (AA) (a) (D) Somewhat Slightly Strongly Agree D1gSgnee Disagree (A) (d (06D) (1 (2) (3) (4) (5) (6) 39. 1'd exercise more if I had someone to exercise with. AA A a d D DD I feel 1 already exercise a sufficient amount. 40. I ought to eat less red meat and eat more fish, poultry and vegetables. AA A a d D DD [] I eat no red meat. 41. Not getting enough exercise is a serious problem for me. AA A a d D 0D 42. I have trouble keeping myself from eating a lot when I go out to eat. AA A a. d D DD 43. It seems as though almost everything I really enjoy eating is bad for me. AA A a d D DD 44. 1 plan to find new ways to get more exercise soon. AA A a d D 0D I feel I already exercise a sufficient amount. 45. A balanced diet which leads to weight-loss is bland and uninteresting. AA A a d D 0D 46. My weight is a real problem for me. AA A a d D DD 47. There is not much I can do to keep from getting sick. AA A a d 0 0D 48. If I decided to get more physical activ- ity I know I'd be able to stick to it. AA A a d D 0D 49. I plan to eat healthier food soon. AA A a d 0 DD I feel 1 already eat sufficiently healthy food. 50. The way I handle stress is a serious problem for me. AA A a d D DD 51. I intend to begin a serious weight control program for myself soon. AA A a d D DD I am satisfied with my present weight. $2. It's hard to find the time in a day to get some exercise. AA A a d 0 Do 53. If I decided to eat healthier foods, I would probably be very successful in doing it. AA A a d D 0D 54. It takes a great deal of physical activity to make any difference in your weight. AA A a d D DD 55. When I'm exercising or playing sports, I feel self-conscious about the way I look to others. AA A a d D DD -256- Health Attitudes Page 4 56. I really need to lose some weight. §7. I'm the kind of person who doesn't get enough exercise. 58. I feel powerless to prevent myself from eating when I am anxious or unhappy. 59. g3ing to have a regular schedule of Ln gin activity soon. I already have a regular schedule of physical activity. 60. It would be very difficult for me to change the kinds of foods I eat. 61. If I lost some weight I would feel much better. I am satisfied with my present weight. 62. Soon I'm going to start eating less beef. [] I do not eat beef. -257- Strongly Slightly Somewhat Agree Agree Bigagree (AA) (a) D Somewhat Slightly Strongly Agree Disagree Disagree (A) d (DD) (1) (2) (3) (4) (S) (6) AA A a d b DD AA A a d 0 0D AA A a d D DD AA A a d D DD AA A a d U DD AA A a d D DD AA A a d D DD Nd «= EA AN pi CHAPTER SEVEN TEST SPECIFICATIONS This chapter contains the test specifications for all the newly developed measures presented in Chapter Five. The specifications are arranged in the same order as that chapter's measures, that is, behavior first, followed by knowledge, skill, and affect. - COMPONENTS OF TEST SPECIFICATIONS Test specifications describe in detail both what an instrument measures and the manner in which the assessment is accomplished. Each set of test specifications begins with a General Description that presents a brief overview of the scope and nature of the measure to be specified. A Sample Item follows, showing a typical item contained in the measure and the directions to respondents that accompany the instrument. The Stimulus Attributes section lists the rules that explain how the items for the measure are to be constructed. The Response Attributes section lists the rules that explain how the response options for the measure are to be constructed. Many of the sets of specifications have one or more addi- tional sections. A Technical Terms Supplement lists content- specific words that exceed the normal readability restric- tions of a measure but are used because of their importance. A Specifications Supplement, contained in all knowledge test specifications, presents an exhaustive listing of the con- tent eligible for testing. Knowledge test specifications also contain a Bibliography which cites the references consulted in developing the content listing. Behavioral and affective test specifications include a Scoring and Inter- pretation section which explains the rationale and procedures to be employed when using the measure's data. Some test specifications also include a section entitled Measure Format that presents an item-by-item overview of the measure itself, highlighting the different variables represented by each item. -259- TEST SPECIFICATIONS WEEKLY ACTIVITIES INDEX GENERAL DESCRIPTION Individuals are asked about the frequency, duration, and intensity of their participation in planned exercise activities during the preceding week. Responses to this survey can be used to measure the extent to which indi- viduals maintain an activity level sufficient to promote cardiorespiratory fitness, muscular strength, muscular endurance and flexibility. SAMPLE ITEM Various activities are listed on the next page. For each activity in which you participated during the past week please record the following: In the FREQUENCY column: Indicate the number of different times you participated in this activity during the past WEEK. In the AVERAGE DURATION column: Indicate the average amount of time (in minutes) that you spent per session. In the INTENSITY column: Indicate how strenuous, on average, the activity was for you, that is, how much effort it required. Record your answer in the INTENSITY column using one of the follow- ing letters: L = Light activity (Small increase in heart and breathing rate) M = Medium activity (Some increase in heart and breathing rate) H = Heavy activity (Large increase in heart and breathing rate) If you participated in other exercise activ- ities that are not included on this list, please write them in the spaces labeled "Other." Fill out the FREQUENCY, AVERAGE DURATION, and INTENSITY columns for each activity you add. -260- AVERAGE ACTIVITY FREQUENCY DURATION INTENSITY (number /week)| (minutes)| (L, M, H) Badminton STIMULUS ATTRIBUTES 1. The Weekly Activities Index requires individuals to provide information about the frequency, duration, and intensity of their participation in specific physical activities. The following specific physical activities are listed in the measure: badminton, baseball/softball, basket- ball, bicycling, bowling, calisthenics (general exer- cises), dancing, football, golf, handball/racquetball/ squash, hiking, jogging/running, judo/karate, rope skipping, rowing, skating, skiing, soccer, stretching, swimming, tennis, volleyball, walking (for exercise), weight training, wrestling, and yoga. Two spaces labeled "Other" are also be available. Respondents are instructed to use these spaces to list any additional activities in which they participated. RESPONSE ATTRIBUTES 1. 2. Three response columns (FREQUENCY, AVERAGE DURATION, INTENSITY) are provided to the right of each activity. Respondents are to use the FREQUENCY column to indicate the number of times they participated in an activity during the preceding week. Respondents are to use the AVERAGE DURATION column to indicate the average amount of time in minutes spent on an activity. Respondents are to use the INTENSITY column to indicate how strenuous their participation in an activity was, on average, using one of the following letters: L = Light activity (Small increase in heart and breathing rate) M = Medium activity (Some increase in heart and breathing rate) H = Heavy activity (Large increase in heart and breathing rate) -261- INTERPRETATION 1. The responses to the questionnaire should permit pro- gram personnel to assess the current exercise level of respondents in order to determine whether respon- dents maintain an activity level sufficient to promote cardiorespiratory endurance, muscular strength, muscular endurance and flexibility. The appropriate frequency, duration, and intensity of the cardiorespiratory endurance portion of an exercise program are as follows: 2. The frequency must be at least three sessions per week, b. The duration must be at least 20 minutes per session. Co The intensity must be vigorous, requiring large increases in heart and breathing rate, as reported by the individual. If a more precise estimate of an activity's intensity is desired, program personnel can use one of several procedures: a. The system described by Kenneth Cooper can be employed. This system assigns points according to the cardiorespiratory benefits from participa- tion in different activities. bh. The total amount of time spent during the week in activities at each level of intensity can be com- puted and converted to Kcal energy expenditure using standard values (e.g., 5 Kcal/min for light activities, 10 Kcal/min for strenuous activities.) Co, Respondents can be asked to indicate their heart rates immediately after they stop exercising and these rates can be interpreted in relation to a target or training heart rate that is 60 to 85% of an individual's maximal heart rate, according to the following formula: Training Heart Rate = (220 - age) x (% of maximal heart rate (per 10-sec. interval) 6 Responses can also be interpreted according to the extent to which selected activities promote muscular strength, muscular endurance or flexibility. -262- 5a The types of activities included in this measure and the goal(s) met by each are as follows: Badminton Baseball /softball Basketball Bicycling Bowling Calisthenics (general exercises) Dancing Football Golf Handball/racquetball/squash Hiking Jogging /running Judo/karate Rope skipping Rowing Skating Skiing (cross-country) Soccer Stretching Swimming Tennis Volleyball Walking (for exercise) Weight training Wrestling Yoga 6. If the questionnaire is also being used by program Cardio- respiratory Endurance X MoM MM OM i Muscular Strength Muscular Endurance HOM MM MoM MM wi Flexibility personnel to assist participants in planning and/or modifying personnel exercise program goals, then the appropriate level of physical activity for each indi- vidual should be determined, based upon an individual's age, sex, body composition, and health, as well as the individual's current level of fitness in each fitness component. -263- TEST SPECIFICATIONS FACTS ABOUT EXERCISE GENERAL DESCRIPTION Individuals are presented with statements about physiological, psychological, and sociological effects of exercise. Indi- viduals indicate whether each statement is true or false. SAMPLE ITEM This test consists of 20 statements about the effects of exercise. Some of the statements are true and some are false. If you think a statement is true, put a check in the column labeled TRUE. If you think a statement is false, put a check in the column labeled FALSE. TRUE FALSE 1. Regular exercise may increase the number of blood vessels that go to the skeletal muscles. STIMULUS ATTRIBUTES 1. A test item will consist of a single-sentence statement that the individual is to judge as true or false. This statement will contain information related to a poten- tial physiological, psychological or sociological effect of exercise. 2» All test items will be derived from the specifications supplement Facts About Exercise. This supplement presents statements about exercise which are based upon either empirical evidence or expert consensus. The statements are organized into sections, with each sec- tion containing information about one area of exercise effects. 3s Each statement on the supplement consists of one main idea related to the effects of exercise. A statement either (a) describes the nature or effects of a partic- ular subject, (b) compares two subjects with respect to a particular attribute, or (c) presents a correla- tional or causal relationship between two subjects. -264- A test item will be based on a single statement selected from the supplement. If the supplement statement con- tains multiple parallel elements, only one of the elements will be used in the test item. Example of a supplement statement with multiple parallel elements Regular exercise can strengthen the bones, ligaments, and tendons. A test item will present a supplement statement in either accurate or inaccurate form. An accurate test item can be created in one of the following two ways: a. Direct restatement: Reiterating a statement exactly as it appears on the supplement. b. Paraphrase: Rephrasing a supplement statement to communicate the same message in different words. This rephrasing may include substituting synonyms for words in the statement and/or reordering words within the statement. The quantitative portion of a supplement statement may not be paraphrased. Example of a test item created by paraphrase Supplement statement: In order to promote cardio- respiratory fitness and improve health, exercise must involve the heart muscle and other parts of the cardiorespiratory system. Test Item: Exercise needs to involve the heart muscle and other parts of the cardiorespiratory system in order to produce cardiorespiratory fit- ness and improve health. An inaccurate test item will be based on a supplement statement or a paraphrase of that statement. An inaccu- rate item can be created in one of the following two ways: a. Negation: Rewording a supplement statement to have the opposite meaning. If the statement is worded positively, negation is accomplished by adding a negative word or phrase to the statement. If the statement is worded negatively, negation is accom- plished by taking out a negative word or phrase. -265- Example of a test item created by negation Supplement statement: Regular exercise can improve the circulation of blood to the heart and the skeletal muscles. Test item: Regular exercise cannot improve the circulation of blood to the heart and the skeletal muscles. ’ Mutual exclusivity: Transforming a supplement statement to communicate a message that is mutually exclusive with the original message. This trans- formation can be accomplished by either (1) chang- ing a single verb, adjective, or adverb in the original statement to a word or phrase with a contradictory meaning, (2) changing a comparative statement to either reverse the direction of the comparison made or make both terms being compared equal, or (3) changing a quantitative value to one that is different than the one given. A quantita- tive change must result in a new value that makes the original statement false, rather than a value that allows the statement to remain true because it represents a subset of the original statement. A quantitative change must be expressed in the same terms as the original value. Examples of test items created by transformation to a mutually exclusive statement Supplement statement: Exercise increases the use of calories. Test item: Exercise decreases the use of calories. Supplement statement: Physically inactive indi- viduals are more likely than active individuals to have a heart attack. Test item: Physically inactive individuals are less likely than active individuals to have a heart attack. Supplement statement: The cardiovascular benefits of exercise occur only when the exercise program is of sufficient intensity to raise the heart rate to at least 60% of its maximum rate. Test item: The cardiovascular benefits of exercise occur only when the exercise program is of suffi- cient intensity to raise the heart rate to at least 90% of its maximum rate. -266- 7 A test item will contain a maximum of 30 words. These words will be no higher than an eighth grade reading level on the I0OX Basic Skills Word List. Technical terms not found on the word list may be used only if they are listed on the Technical Terms Supplement. A test will contain an approximately equivalent number of accurate and inaccurate test items. These items will be selected according to the following procedures: a. One item will be randomly selected from each section of the supplement. b, The rest of the items will be randomly selected from the supplement as a whole. Ce All of the items will be reviewed by content experts and modified as needed based upon this review. All of the procedures for creating accurate and inaccu- rate test items will be used as equally as possible, with the exception of negation of a positively-stated supplement statement. This type of change will be used only when no other transformation is possible, as it results in a test item which requires the respon- dent to recognize that a negatively-stated idea is not accurate, in effect creating a double negative. RESPONSE ATTRIBUTES 1. 2. Two response columns will be provided. One column will be labeled "TRUE" and the other will be labeled "FALSE." The correct answer to a question will be "TRUE" if the statement is accurate, or "FALSE" if the statement is inaccurate. -267- SPECIFICATIONS SUPPLEMENT FACTS ABOUT EXERCISE Exercise and Fitness 1. In order to promote cardiorespiratory fitness and to improve health, exercise must involve the heart muscle and other parts of the cardiorespiratory system. A person's physical fitness level refers to how well a person's heart, lungs, muscles, and other organs work, not to how the body looks. A person must exercise regularly in order to be physi- cally fit. Without exercise, the body begins to weaken and has a greater chance of developing certain diseases. Experts agree that regular, moderate exercise is a good form of preventive medicine. In general, middle-aged and older people benefit from regular exercise as much as young people do. Effects on the Cardiorespiratory System 7. 10. 11. 12. 13. Regular exercise can increase the number of blood vessels that go to the skeletal muscles and increase the amount of blood they can carry to certain parts of the body. Regular exercise can improve the circulation of blood to the heart and the skeletal muscles. Regular exercise can reduce the level of cholesterol in the blood, thereby keeping the blood vessel linings clear of fatty materials. Regular exercise can improve stroke volume, which is the amount of blood pumped with each beat of the heart. Regular exercise can decrease the resting blood pres- sure. Regular exercise reduces the heart rate at rest and allows an individual to exercise at near maximum rates for longer periods. Regular exercise improves the efficiency of breathing so that fewer breaths are needed to get the same volume of air. -268- 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. Regular exercise increases the maximum amount of oxygen that the body can process while exercising. Regular exercise can slow down the natural decline in lung capacity that normally occurs with age or inactivity. The cardiovascular improvement effects of exercise are generally greatest at the beginning of a fitness program. If the frequency, intensity, and/or duration of an exer- cise program are progressively increased, cardiovascular improvement may continue for several years. All the cardiovascular benefits that result from regular exercise are gradually lost if exercise is not continued. A single exercise session will have no lasting effect on the cardiovascular system. The cardiovascular benefits of exercise occur only when the exercise program is of sufficient intensity to raise the heart rate to at least 60% of its maximum rate. Physically inactive individuals are at greater risk of developing heart disease and high blood pressure than are active individuals. Physically inactive individuals are more likely than active individuals to have a heart attack. Physically inactive individuals are more likely than active individuals to die immediately after a heart attack. Regular exercise may be prescribed to help individuals with asthma and emphysema. Pulse or heart rate at rest is an accepted measure of cardiovascular fitness for most people. Pulse or heart rate can be measured at either the wrist or at one of the blood vessels in the neck. The effects of exercise on the respiratory system are determined by measuring the amount of air a person breathes to perform a standard amount of exercise. The maximum amount of oxygen the body can burn during hard exercise is called maximum oxygen consumption (VO, max). Maximum oxygen consumption levels are used as a measure of cardiorespiratory fitness. -269- Effects on the Muscular/Skeletal System Regular exercise can firm muscles, restore their tone, Regular exercise can reduce minor muscular aches, pains, Regular exercise can build the muscular strength and endur- ance necessary to carry on normal daily activities easily Regular exercise may help prevent and relieve lower back Regular exercise can correct some problems in posture. Body composition is defined as the amount of fat compared The percent of fat is a better indicator of appropriate Lean body weight refers to the amount of non-fat tissue The body will continue to use calories at an increased 30. and increase muscular strength and flexibility. 31. Muscles that are regularly exercised are better able to use fat to produce energy. 32. stiffness, and soreness. 33. and efficiently. 34. Regular exercise can strengthen the bones, ligaments, and tendons. 35. Muscles that are not exercised become smaller, but do not turn into fat. 36. People who are muscularly fit are not necessarily cardiovascularly fit. 37. muscle pain. 38. Regular exercise is sometimes prescribed by doctors to help problems due to arthritis. 39. Body Composition and Weight Reduction 40. to the amount of lean body weight. 41. body composition than is total body weight. 42, a person has. 43, Exercise increases the number of calories used by an individual. 44, rate for a short time after exercise has stopped. 45. An individual's lean body weight is usually unchanged by regular exercise. 46. Regular exercise can increase the body's ability to mobilize and use fat. -270- 47. 48. 49, 50. 51. 52. 53. 54. Regular exercise can help reduce excess body fat and total body weight. Weight loss through regular exercise maximizes fat loss and minimizes protein loss. There is little or no evidence that localized exercise or spot reducing can reduce fat in isolated areas of the body. Regular exercise combined with dieting is more effective than dieting alone for reducing body weight. The number of calories burned during exercise depends on the type of activity, the intensity and duration of the activity, and the individual's body weight. A heavier person uses more calories and fat than a lighter person during comparable exercise periods. The rate of weight loss may be estimated by determining caloric intake and the frequency, duration, and intensity of exercise. Underwater weighing and skinfold measurements are ways to determine an individual's body composition. Psychological and Sociological Effects 55. 56. 57. 58. 59. 60. 61. 62. Exercise is a socially acceptable way of reducing tension. Experts believe that regular exercise can reduce anxiety, stress, and depression. Experts believe that regular exercise is likely to increase a person's self-assertiveness and feelings of self-reliance. A relationship has been found between physical fitness, mental alertness, and emotional well-being. Regular exercise can improve an individual's self-image. Physical fitness has been positively associated with improved work performance and reduced time away from work or school. Exercise can provide the opportunity to meet new friends and spend time with family and friends. Participation in a regular exercise program can improve one's ability to fall asleep quickly and to sleep well. -271- TECHNICAL TERMS SUPPLEMENT FACTS ABOUT EXERCISE arthritis asthma cardiorespiratory cardiovascular cholesterol duration emphysema expenditure intensity ligament protein self-assertiveness stress tendon tension BIBLIOGRAPHY FACTS ABOUT EXERCISE Cooper, K. Aerobics. New York: Evans and Company, 1968. Exercise and the cardiovascular system. The Physician and Sportsmedicine, September, 1979, 7(9). Folkins, C.H., & Sime, W.E. Physical Fitness Training and Mental Health. American Psychologist, April 1981, 36(4) 373-389. Morehouse, L.E., & Miller, A.T., Jr. Physiology of exercise, (5th ed.). Saint Louis: The C.V. Mosbey Company, 1967. President's Council on Physical Fitness Adult physical fitness. Washington, D.C.: U.S. Government Printing Office, 1980. Sharkey, B.J. Physiology of fitness: prescribing exercise for fitness, weight control, and health. Champaign, Ill.: Human Kinetics Publishers, 1979. -272-~ BIBLIOGRAPHY (Cont.) FACTS ABOUT EXERCISE U.S. Department of Health and Human Services Exercise and your heart, (National Institutes of Health Publication No. 81-1677). Washington, D.C.: U.S. Government Printing Office, 1981. Wilmore, J. Athletic training and physical fitness: physiological principles and practices of the conditioning process. Boston: Allyn and Bacon, 1977. Wilmore, J. The Wilmore fitness program: a personalized guide to total fitness and health. New York: Simon and Schuster, 1981. -273- TEST SPECIFICATIONS EXERCISE FACTS GENERAL DESCRIPTION Children are presented with statements about physical, psycho- logical, and social effects of exercise. Children indicate whether each statement is true or false. SAMPLE ITEM This test has 15 statements about exer- cise. If the sentence is true, put a check under the word TRUE. If the sen- tence is false, put a check under the word FALSE. TRUE FALSE 1. Regular exercise can give a person more blood vessels and more blood. STIMULUS ATTRIBUTES 1, A test item will consist of a single-sentence statement that the individual is to judge as true or false. This statement will contain information related to a poten- tial physical, psychological or social effect of exercise. 2. All test items will be derived from the specifications supplement Exercise Facts. This supplement presents statements about exercise which are based upon either empirical evidence or expert consensus. The statements are organized into sections, with each section contain- ing information about one area of exercise effects. 3. Each statement on the supplement consists of one main idea related to the effects of exercise. A statement either (a) describes the nature or effects of a partic- ular subject, (b) compares two subjects with respect to a particular attribute, or (c) presents a ‘correla- tional or causal relationship between two subjects. -274- 4. A test item will be based on a single statement selected from the supplement. If the supplement statement con- tains multiple parallel elements, only one of the elements will be used in the test item. Example of a supplement statement with multiple parallel elements Regular exercise improves the circulation of blood to the heart and muscles. A test item will present a supplement statement in either accurate or inaccurate form. An accurate test item can be created in one of the following two ways: a. Direct restatement: Reiterating a statement exactly as it appears on the supplement. b. Paraphrase: Rephrasing a supplement statement to communicate the same message in different words. This rephrasing may include substituting synonyms for words in the statement and/or reordering words within the statement. The quantitative portion of a supplement statement may not be paraphrased. Example of a test item created by paraphrase Supplement statement: In order to improve fitness in the heart and lungs, exercise must make use of the heart and breathing system. Test Item: Exercise needs to involve the heart and breathing system in order for fitness in the heart and lungs to occur. An inaccurate test item will be based on a supplement statement or a paraphrase of that statement. An inaccu- rate item can be created in one of the following two ways: a. Negation: Rewording a supplement statement to have the opposite meaning. If the statement is worded positively, negation is accomplished by adding a negative word or phrase to the statement. If the statement is worded negatively, negation is accom- plished by taking out a negative word or phrase. Example of a test item created by negation Supplement statement: Regular exercise can strengthen the bones and body tissues. Test item: Regular exercise does not strengthen the bones or body tissues. -275- be. Mutual exclusivity: Transforming a supplement statement to communicate a message that is mutually exclusive with the original message. This trans- formation can be accomplished by either (1) chang- ing a single verb, adjective, or adverb in the original statement to a word or phrase with a contradictory meaning, or (2) changing a compara- tive statement to either reverse the direction of the comparison made or make both terms being com- pared equal. Examples of test items created by transformation to a mutually exclusive statement Supplement statement: Regular exercise strengthens the bones. Test item: Regular exercise weakens the bones. Supplement statement: Muscles that are not exer- cised become smaller but do not turn into fat. Test item: Muscles that are not exercised become larger but do not turn into fat. A test item will contain a maximum of 22 words. These words will be no higher than a fourth grade reading level on the I0X Basic Skills Word List. Technical terms not found on the word list may be used only if they are listed on the Technical Terms Supplement. A test will contain an approximately equivalent number of accurate and inaccurate test items. These items will be selectzd according to the following procedures: a. One item will be randomly selected from each section of the supplement. bh. The rest of the items will be randomly selected from the supplement as a whole. Cos All of the items will be reviewed by content experts and modified as needed based upon this review, All of the procedures for creating accurate and inaccu- rate test items will be used as equally as possible, with the exception of negation of a positively-stated supplement statement. This type of change will be used only when no other transformation is possible, as it results in a test item which requires the respon- dent to recognize that a negatively-stated idea is not accurate, in effect creating a double negative. -276- RESPONSE ATTRIBUTES 1. Two response columns will be provided. One column will be labeled "TRUE" and the other will be labeled "FALSE." 2. The correct answer to a question will be "TRUE" if the statement is accurate, or "FALSE" if the statement is inaccurate. =277- SPECIFICATIONS SUPPLEMENT EXERCISE FACTS Exercise and Fitness 1. In order to improve fitness in the heart and lungs, exercise must make use of the heart and breathing system. Fitness means how well a person's heart and other parts of the body work, not how the person's body looks. A person must exercise regularly in order to be physi- cally fit. Without exercise, a person's body begins to weaken, and the person is more likely to become sick. Experts agree that exercise helps keep a person from becoming sick. A person does not need to be athletic to exercise regularly. In general, regular exercise is good for people of all ages. A regular exercise program does not need to take a great deal of time. Effects on the Cardiorespiratory System De 10. 11. 12. 13. 14. 15. Regular exercise can give a person more blood vessels. Regular exercise can improve the circulation of blood to the heart and muscles. Regular exercise helps the heart to beat more slowly at rest and to have more time between beats. Regular exercise helps to keep the blood vessels free of fats that can slow down the flow of blood. Regular exercise can make the heart pump more blood with each heartbeat. Regular exercise can give a person lower blood pressure. Regular exercise makes the heart stronger so it can be exercised for longer periods of time. -278- 16. 17. 18. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31, Regular exercise allows a person to take fewer breaths to get the same amount of air. Regular exercise allows the body to use more oxygen while exercising. Regular exercise can help keep the lungs healthy as a person gets older. Exercise generally helps the heart and blood circulation most at the beginning of an exercise program. Improvements in the fitness of the heart and blood circulation may continue for several years if a person keeps exercising more often, harder, or longer. If regular exercise is stopped, the heart and blood circulation will no longer be helped and they will return to the way they were. Exercising only once will not help the heart or blood circulation. In order to help the heart, lungs, and circulation, exercise must be done often enough, hard enough, and long enough. People who do not exercise are more likely than people who exercise to have heart disease and high blood pressure. People who do not exercise are more likely than people who exercise to have a heart attack. People who do not exercise are more likely than people who exercise to die right after a heart attack. Doctors often tell people with breathing problems to exercise regularly. A person's pulse or heart rate at rest can be used to measure heart and blood circulation fitness. The pulse or heart rate can be measured at either the wrist or neck. A person can tell how exercise helps the lungs by measur- ing the amount of oxygen the body uses during an exer- cise program, The greatest amount of oxygen the body can use during hard exercise is used to measure the fitness of the lungs and breathing system. -279- Effects on the Muscular/Skeletal System 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. Regular exercise can make muscles stronger and more flexible. Muscles that are regularly exercised are better able to use fat to give a person energy. Regular exercise can help a person feel less muscular ache, pain, stiffness, and soreness. Regular exercise can strengthen the bones and body tissues. Muscles that are not exercised become smaller, but do not turn into. fat. People who have strong muscles do not necessarily have heart, lung, or circulation fitness. Regular exercise may help a person avoid lower back pain. Doctors often tell people with arthritis to exercise in order to have less pain. Regular exercise can sometimes correct posture problems and is necessary for good posture. Good posture as a child can keep a person from having back pains as an adult. Effects on Body Composition and Weight Reduction 42. 43. 44, 45. 46. 47. 48. Body composition has to do with the amount of fat and muscle a person has. The amount of fat in the body is better than total weight to figure out a person's lean body weight. Lean body weight is the amount of non-fat tissue a person has. Exercise causes the body to use up more calories. The body will use more calories than usual for a short time after exercise has stopped. Regular exercise helps a person lose fat and lose weight. When a person loses weight by exercising, the person loses fat but not muscle. -280- 49. 50. 51. 52. 53. Regular exercise along with dieting is better than just dieting for losing weight. The number of calories used up during exercise depends on the type of exercise, how hard and long the person exercises, the person's weight, and the person's level of fitness. A heavier person uses more calories than a lighter person during the same exercise periods. It is possible to tell how fast a person will lose weight by knowing how much a person eats and how often, how long, and how hard the person exercises. Weighing a person underwater and measuring the amount of fat under the skin are ways to measure a person's body composition. Psychological and Sociological Effects 54. 55. 56. 57. 58. 59. 60. Being fit helps a person reduce tension. Experts believe that regular exercise helps a person feel stronger and more able to do things. People who are fit are usually also quick, active, and happy. Regular exercise can make people feel better about themselves. People who are fit usually miss less school or work and do better work. Exercise can help a person to meet new friends and to spend more time with family and friends. Regular exercise can help a person fall asleep quickly and sleep well. TECHNICAL TERMS SUPPLEMENT EXERCISE FACTS arthritis dieting oxygen athletic energy posture blood pressure heart disease pulse body composition heart rate tension breathing system lungs tissue calories muscle vessel circulation muscular -281- BIBLIOGRAPHY EXERCISE FACTS Antonacci, R.J., & Barr, J. Physical fitness for young champions. New York: McGraw-Hill, 1975. Cooper, K. Aerobics. New York: Evans and Company, 1968. Craig, M. Miss Craig's growing-up exercises. New York: Random House, 1973. Exercise and the cardiovascular system. The physician and sportsmedicine, September 1979, 7(9). Folkins, C.H., & Sime, W.E. Physical fitness training and mental health. American Psychologist, April 1981, 36(4), 373-389. Grawunder, R., & Steinmann, M. Life and health (3rd ed.). New York: Random House, 1980. Morehouse, L.E., & Miller, A.T., Jr. Physiology of exercise (5th ed.). St. Louis: The C.V. Mosbey Company, 1967. President's Council on Physical Fitness. Adult physical fitness. Washington, D.C.: U.S. Government Printing Office, 1980. Sharkey, B.J. Physiology of fitness: Prescribing exercise for fitness, weight control, and health. Champaign, Ill: Human Kinetics Publishers, 1979. U.S. Department of Health and Human Services. Exercise and your heart. (National Institutes of Health Publication No. 81-1677). Washington, D.C.: U.S. Government Printing Office, 1981. Wilmore, J.H. Athletic training and physical fitness: physio- logical principles and practices of the conditioning process. Boston, Allyn and Bacon, 1977. Wilmore, J.H. The Wilmore fitness program: a personalized guide to total fitness and health. New York: Simon and Schuster, 1981. -282- TEST SPECIFICATIONS DESIGNING AN EXERCISE PROGRAM GENERAL DESCRIPTION Individuals are presented with statements about exercise program components and the factors relating to activity selection and implementation. Individuals indicate whether each statement is true or false. SAMPLE ITEM This test consists of 20 statements about exercise program design. Some of the statements are true and some are false. If you think a statement is true, put a check in the column labeled TRUE. If you think a statement is false, put a check in the column labeled FALSE. TRUE FALSE 1. Different sports and activities provide different benefits. STIMULUS ATTRIBUTES 1. A test item will consist of a single-sentence statement that the individual is to judge as true or false. This statement will contain information related to an aspect of exercise program design. All test items will be derived from the specifications supplement Designing an Exercise Program. This supple- ment presents statements about exercise program design which are based upon either empirical evidence or expert consensus. The statement are organized into sections, with each section containing information about one aspect of exercise program design. Each statement on the supplement consists of one main idea related to exercise program design. A statement either (a) describes the nature or effects of a partic- ular subject, (b) compares two subjects with respect to a particular attribute, or (c) presents a correla- tional or causal relationship between two subjects. -283- 4. A test item will be based on a single statement selected from the supplement. If the supplement statement con- tains multiple parallel elements, only one of the ele- ments will be used in the test item. Example of a supplement statement with multiple parallel elements Individuals who have heart or blood vessel trouble, uncontrolled high blood pressure, bone or joint prob- lems, a family history of premature coronary artery disease, or who are over age 30 and not accustomed to vigorous exercise, should consult a doctor before start- ing an exercise program. A test item will present a supplement statement in either accurate or inaccurate form. An accurate test item can be created in one of the following two ways: a. Direct restatement: Reiterating a statement exactly as it appears on the supplement. bh, Paraphrase: Rephrasing a supplement statement to communicate the same message in different words. This rephrasing may include substituting synonyms for words in the statement and/or reordering words within the statement. The quantitative portion of a supplement statement may not be paraphrased. Example of a test item created by paraphrase Supplement statement: The intensity of exercise can be monitored by measuring the heart rate. Test Item: The heart rate can be used to monitor the intensity of exercise. An inaccurate test item will be based on a supplement statement or a paraphrase of that statement. An inaccurate item can be created in one of the follow- ing two ways: a. Negation: Rewording a supplement statement to have the opposite meaning. If the statement is worded positively, negation is accomplished by adding a negative word or phrase to the statement. If the statement is worded negatively, negation is accom- plished by taking out a negative word or phrase. -284- Example of a test item created by negation Supplement statement: Bowling will not improve one's cardiorespiratory endurance capacity. Test item: Bowling will improve one's cardio- respiratory endurance capacity. b. Mutual exclusivity: Transforming a supplement statement to communicate a message that is mutually exclusive with the original message. This trans- formation can be accomplished by either (1) chang- ing a single verb, adjective, or adverb in the original statement to a word or phrase with a contradictory meaning, (2) changing a quantitative value to one that is different than the one given. A quantitative change must result in a new value that makes the original statement false, rather than a value that allows the statement to remain true because it represents a subset of the original statement. A quantitative change must be expressed in the same terms as the original value. Examples of test items created by transformation to a mutually exclusive statement Supplement statement: Cardiorespiratory endurance activities are the most important part of any health- focused exercise program. Test item: Cardiorespiratory endurance activities are the least important part of any health-focused exercise program. Supplement statement: The target level for a healthy person for building cardiorespiratory endurance is 60 to 85% of one's maximum heart rate. Test item: The target level for a healthy person for building cardiorespiratory endurance is 30 to 50% of one's maximum heart rate. 7. A test item will contain a maximum of 25 words. These words will be no higher than an eighth grade reading level on the I0X Basic Skills Word List. Technical terms not found on the word list may be used only if they are listed on the Technical Terms Supplement. 8. A test will contain an approximately equivalent number of accurate and inaccurate test items. These items will be selected according to the following procedures: -285- a. One item will be randomly selected from each section of the supplement. b. The rest of the items will be randomly selected from the supplement as a whole. Coe All of the items will be reviewed by content experts and modified as needed based upon this review. All of the procedures for creating accurate and inaccu- rate test items will be used as equally as possible, with the exception of negation of a positively-stated supplement statement. This type of change will be used only when no other transformation is possible, as it results in a test item which requires the respon- dent to recognize that a negatively-stated idea is not accurate, in effect creating a double negative. RESPONSE ATTRIBUTES 1. 2. Two response columns will be provided. One column will be labeled "TRUE" and the other will be labeled "FALSE." The correct answer to a question will be "TRUE" if the statement is accurate, or "FALSE" if the statement is inaccurate. -286- SPECIFICATIONS SUPPLEMENT DESIGNING AN EXERCISE PROGRAM Program Design/Activity Selection 1. 10. 11. Selecting an exercise program without proper guidance or participating in an activity program where everyone exercises at the same level of intensity can be dangerous or ineffective. The selection of activities for an exercise program should be based on the following characteristics: the individual's health, physical fitness level, age, desired benefits, preference for individual or team activities, preference for indoor or outdoor activities, and available time, money, and equipment. An individual's exercise program should specify recom- mended types of activities, frequency of participation, intensity of effort, length of each session, and length of total program. An individual does not need to be athletic to participate in an exercise program. A regular exercise program does not need to take a great deal of time. Cardiorespiratory endurance activities are the most important part of any health-focused exercise program. A conditioning program can be designed to build either cardiorespiratory endurance and/or muscular strength. A maintenance program maintains and possibly improves the fitness levels obtained through conditioning activities. Different sports and activities provide different benefits. The benefits of exercise depend upon the following factors: the type of activity, the number of days per week a person exercises (frequency), the level of effort at which an activity is performed (intensity), and the length of each exercise session (duration). Individuals who exercise regularly will reach a point where their fitness level no longer increases unless the frequency, duration, and/or intensity of their activity program is increased. -287- Medical Evaluation and Clearance for Exercise 12. 13. 14. Individuals who have heart or blood vessel trouble, uncontrolled high blood pressure, bone or joint problems, a family history of coronary artery disease, or who are over 30 years old and not accustomed to vigorous exer- cise, should consult a doctor before starting an exer- cise program. Individuals who experience pains in the chest during or after exercising, fainting spells, or extreme breath- lessness after mild exercise should consult a doctor before starting or continuing an exercise program. The need for a medical examination before an individual begins an exercise program depends on the age and health of the individual and the type of activity pro- gram planned. Exercise Program Components 15. 16. 17. 18. 19. 20. 21. 22. An exercise program should include a warm-up and stretch- ing period, an endurance period, a cool-down period, and, if desired, a strength conditioning period. The warm-up amd stretching period of an exercise session should last from 5 to 15 minutes. The warm-up and stretching period of an exercise session may consist of easy stretching exercises and calisthenics. Warm-up and stretching exercises increase muscular flexibility and gradually prepare the body for endurance conditioning. Beginning each exercise session with a warm-up and stretching period will help decrease the muscle and joint soreness often felt when first starting an exercise program, A cool-down period helps the blood return to the heart. Cool-down activities help relieve current soreness and prevent future soreness. Cool-down exercises usually consist of easy jogging or walking and should last from 5 to 10 minutes. -288- Cardiorespiratory Conditioning 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. Cardiorespiratory endurance refers to the ability of the body to sustain prolonged rhythmical exercise and to efficiently produce and distribute energy. In order to provide the most benefit, cardiorespiratory endurance activities must be repeated at least three times per week. An exercise program must allow time for muscle recovery by controlling the frequency of activity. Cardiorespiratory endurance activities should maintain the heart rate at its target level for at least 20 minutes. The target level for a healthy person building cardio- respiratory endurance is 60 to 85 percent of one's maximum heart rate. The intensity of cardiorespiratory exercise can be monitored by measuring the heart rate. A person's target heart rate is the heart rate at which that individual should exercise to obtain the greatest cardiovascular benefit. Everyone does not have the same target heart rate. Individuals exercising below their target heart rates show little improvement in cardiorespiratory fitness. Exercising at 85 percent or more of one's maximum heart rate may be dangerous unless an individual is in excel- lent physical condition. Brisk walking, skipping rope, race walking, running, uphill hiking, swimming, bicycling, cross-country skiing, ice hockey, and rowing will improve one's cardiorespiratory endurance capacity. If played vigorously and without interruption, hand- ball, racquetball, squash, badminton, tennis, and basketball will improve one's cardiorespiratory endurance capacity. Baseball, bowling, football, golf, softball, and volleyball will not improve one's cardiorespiratory endurance capacity. -289- Muscular Endurance and Strength Conditioning 36. 37. 38. 39. 40. 41. Muscular endurance refers to the ability of a particular muscle or muscle group to sustain prolonged exercise. Muscular endurance can be promoted by repeating activ- ities which require strength. Muscular strength is the ability of a particular muscle group to exert force or move a heavy weight one time. Muscular strength can be promoted through activities which require muscle groups to exercise against heavy resistance. Bicycling, handball, racquetball, squash, running, skating, skiing, swimming, tennis, walking, calisthenics, and weight training can improve some muscular strengths and endurances. Individuals should perform muscular strength and endur- ance activities a minimum of two days a week to maintain these elements of fitness. Flexibility Conditioning 42. 43. 44. 45. Flexibility is the ability to move a particular joint in the body through its full range of motion. Flexibility is most safely promoted through activities which require a joint to move slowly through its full range of motion. Calisthenics, judo, karate, swimming, and yoga can improve muscular flexibility. Individuals should perform flexibility activities daily to maintain flexibility. TECHNICAL TERMS SUPPLEMENT DESIGNING AN EXERCISE PROGRAM calisthenics intensity cardiorespiratory judo cardiovascular karate conditioning maximum heart rate coronary artery disease muscular duration target zone gymnastics yoga -290- BIBLIOGRAPHY DESIGNING AN EXERCISE PROGRAM Cooper, K. Aerobics. New York: M. Evans and Company, 1968. Sharkey, B.J. Physiology of fitness: Prescribing exercise for fitness, weight control, and health. Champaign, Ill: Human Kinetics Publishers, 1979. Strauss, R. (Ed.). Sports medicine and physiology. Philadelphia: W. B. Saunders Company, 1979. U.S. Department of Health and Human Services Exercise and your heart. (National Institutes of Health Publication No. 81-1677). Washington, D.C.: U.S. Government Printing Office, 1981. Wilmore, J.H. The Wilmore fitness program: A personalized guide to total fitness and health. New York: Simon and Schuster, 1981. -291- TEST SPECIFICATIONS INJURY PREVENTION GENERAL DESCRIPTION Individuals are presented with statements about exercise- related health risks and injury prevention strategies asso- ciated with cardiovascular, muscular/skeletal, and environ- mental problems. Individuals indicate whether each statement is true or false. SAMPLE ITEM This test consists of 20 statements about exercise and injury prevention. Some of the statements are true and some are false. If you think a statement is true, put a check in the column labeled TRUE. If you think a statement is false, put a check in the column labeled FALSE. TRUE FALSE 1. Heat stroke occurs when the body is unable to regulate its rising temperature. STIMULUS ATTRIBUTES 1. A test item will consist of a single-sentence statement that the individual is to judge as correct or incorrect. This statement will contain information about the nature of exercise-related health risks or the prevention of cardiovascular, muscular/skeletal, and temperature induced injuries caused by exercise. All test items will be derived from the specifications supplement Injury Prevention. This supplement presents statements about exercise-related health risks and injury prevention strategies which are based upon either empirical evidence or expert consensus. The statements are organized into sections, with each section con- taining information about one aspect of injury preven- tion, -292- Each statement on the supplement consists of one main idea related to an exercise health risk or injury preven- tion strategy. A statement either (a) describes the nature or effects of a particular subject, (b) compares two subjects with respect to a particular attribute, or (c) presents a correlational or causal relationship between two subjects. A test item will be based on a single statement selected from the supplement. If the supplement statement con- tains multiple parallel elements, only one of the elements will be used in the test item. Example of a supplement statement with multiple paraliel elements Environmental factors that increase the risk of heat stress include high air temperature, high humidity, little air movement, and a lack of cloud cover. A test item will present a supplement statement in either accurate or inaccurate form. An accurate test item can be created in one of the following two ways: a. Direct restatement: Reiterating a statement exactly as it appears on the supplement. Do Paraphrase: Rephrasing a supplement statement to communicate the same message in different words. This rephrasing may include substituting synonyms for words in the statement and/or reordering words within the statement. Example of a test item created by paraphrase Supplement statement: Dehydration or the loss of body fluids is the major cause of heat disorders. Test Item: The primary cause of heat disorders is dehydration, or the body's loss of fluids. An inaccurate test item will be based on a supplement statement or a paraphrase of that statement. An inaccu- rate item can be created in one of the following two ways: a. Negation: Rewording a supplement statement to have the opposite meaning. If the statement is worded positively, negation is accomplished by adding a negative word or phrase to the statement. If the statement is worded negatively, negation is accom- plished by taking out a negative word or phrase. -293- Example of a test item created by negation Supplement statement: Exercise in low temperatures can lead to frostbite and hypothermia. Test item: Exercise in low temperatures cannot lead to frostbite and hypothermia. bh. Mutual exclusivity: Transforming a supplement statement to communicate a message that is mutually exclusive with the original message. This trans- formation can be accomplished by either (1) chang- ing a single verb, adjective, or adverb in the original statement to a word or phrase with a contradictory meaning, (2) changing a comparative statement to either reverse the direction of the comparison made or make both terms being compared equal. Examples of test items created by transformation to a mutually exclusive statement Supplement statement: Heat cramps are the least serious of the heat disorders. Test item: Heat cramps are the most serious of the heat disorders. Supplement statement: Exercising in cold tempera- tures is generally less of a health risk than exer- cising in hot weather. Test item: Exercising in hot weather is generally less of a health risk than exercising in cold temper- atures. Ts A test item will contain a maximum of 25 words. These words will be no higher than an eighth grade reading level on the IOX Basic Skills Word List. Technical terms not found on the word list may be used only if they are listed on the Technical Terms Supplement. 8. A test will contain an approximately equivalent number of accurate and inaccurate test items. These items will be selected according to the following procedures: Bo One item will be randomly selected from each section of the supplement. De. The rest of the items will be randomly selected from the supplement as a whole. -294- Co All of the items will be reviewed by content experts and modified as needed based upon this review. All of the procedures for creating accurate and inaccu- rate test items will be used as equally as possible, with the exception of negation of a positively-stated supplement statement. This type of change will be used only when no other transformation is possible, as it results in a test item which requires the respon- dent to recognize that a negatively-stated idea is not accurate, in effect creating a double negative. RESPONSE ATTRIBUTES 1. 2. Two response columns will be provided. One column will be labeled "TRUE" and the other will be labeled "FALSE." The correct answer to a question will be "TRUE" if the statement is accurate, or "FALSE" if the statement is inaccurate. -295- SPECIFICATIONS SUPPLEMENT INJURY PREVENTION Exercise in the Heat Much of the heat produced by the body during exercise is lost through evaporation of sweat. During exercise in humid weather, sweat evaporates slowly and body temperature begins to rise. Heat stress can occur when. the body can no longer Environmental factors that increase the risk of heat stress include high air temperature, high humidity, little air movement, and a lack of cloud cover. Individual factors influencing the development of heat stress include the intensity and duration of exercise, the extent of previous exposure to similar environmental conditions, and the amount of fluid intake both before Each person responds differently to exercising in the heat because of differences in amounts of body fat, the number of sweat glands, and fitness level. Physically fit individuals have fewer problems than unfit individuals during exercise in hot surroundings because the bodies of fit individuals are better able to regulate body temperature. Heavily muscled individuals and overweight individuals lose the most water during exercise in hot surroundings and are especially in danger of developing serious heat Dehydration or the loss of body fluids is the major Heat cramps, heat exhaustion, and heat stroke are heat disorders which occur when the body cannot adapt to Heat cramps are the least serious of the heat disorders. 1. 2. 3 regulate its temperature. 4, 5, and during exercise. 6. 7. 8. problems. Heat Related Disorders 9. cause of heat disorders. 10. heat stress. 11. 12. Heat cramps are usually a direct result of salt and water loss from dehydration. -296- 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. Heat cramps are painful spasms of skeletal muscles, occuring most commonly in the calf muscle. Heat exhaustion occurs when the amount of sweat produced decreases. Heat exhaustion is the first sign that the body is beginning to lose its ability to regulate temperature and cope with heat stress. Heat exhaustion is characterized by extreme weakness, breathlessness, dizziness, rapid pulse, and a body temperature around 101°F., Heat stroke occurs when the body is unable to regulate its rising temperature. Heat stroke is characterized by hot dry skin, a body temperature of 105°F or higher, a failure to sweat, increasing confusion, and eventual unconsciousness. If not treated immediately, heat stroke can lead to permanent brain damage or death. The early warning symptoms of heat disorders include goose bumps on the chest and upper arms, chills, throbbing pressure in the head, unsteadiness, nausea, and dry skin. Heat cramps, exhaustion, and stroke are less likely to occur if an individual drinks enough liquids to replace those lost in exercising. An individual should drink large quantities of liquids before, during, and following exercise in the heat. Body fluids lost during exercise can be replaced by drinking either water, juice, soda, or electrolyte solutions. Individuals who work or exercise for long hours in the heat may need to replace body salts lost in sweating. Individuals should stop exercising as soon as they feel symptoms of heat stress. Individuals can avoid heat disorders on hot and humid days by exercising in the cooler parts of the day, exer- cising less than normal, and wearing light, loose fit- ting clothes. The chances of developing heat disorders increase if an individual wears rubberized or plastic suits, sweat shirts, or sweat pants while exercising in hot weather. -297-~ Exercise in the Cold Cold stress occurs when the body begins to lose heat Cold stress is a result of low environmental temperatures, the wind chill factor, and either very high or very Exercising in cold temperatures is generally less of a health risk than exercising in hot weather. Exercise in low temperatures can lead to frostbite and Hypothermia is the reduction of internal body tempera- ture which can lead to confusion, loss of consciousness, Individuals who exercise outdoors on cold days should wear several layers of clothing, keep their hands RE: faster than it is produced. 29. low humidity. 30. Cold Related Disorders 31. hypothermia. 32. and death. 33. covered, and wear a hat. 34. Individuals exercising in extreme cold should wear tightly woven clothes and thermal underwear, Exercise at High Altitudes 35. 36. 37. Exercise at high altitudes reduces performance capa- bilities until the individual adapts to the altitude. Symptoms of altitude sickness include headache, short- ness of breath, rapid heartbeat, and loss of appetite. Individuals unaccustomed to high altitudes should lower the duration and intensity of their cardiorespiratory activities while at high altitudes. Muscular/Skeletal Disorders 38. 39. 40. Muscular injuries caused by exercise include muscle soreness, muscle cramps, muscle bruises, and torn muscles. Skeletal injuries caused by exercise include bone bruises, broken bones, shin splints, and stress frac- tures. Tendinitis, bursitis, and blisters, are common joint and skin injuries caused by exercise. -298- 41. 42. 43. 44, 45. 46. 47. 48. Muscular, skeletal, joint, and skin injuries often occur when an individual either is not properly trained for a particular level or type of stress or uses improper techniques or equipment. Pains in the joints, feet, ankles, or legs indicate that an individual should stop or reduce exercising. Muscular and skeletal injuries due to improper equip- ment can be prevented if the equipment used for specific exercise activities is properly designed, con- structed, and fitted. Learning the rules of a game and the proper ways to move and position the body during play can help prevent muscular and skeletal injuries. Warm-up and stretching exercises stretch and limber the muscles, increase body temperature, and speed up blood flow to the heart, lungs, and muscles. Warm-up and stretching exercises help prevent muscle, tendon, and ligament strains. Cool-down exercises continue the circulation of the blood to the muscles. Cool-down exercises guard against the pooling of blood in the legs and reduce the risk of muscle cramps. Cardiovascular Problems 49. 50. 51. 52. Individuals who have been inactive and who are starting an exercise program should do so gradually, beginning with less vigorous activities. Being in the proper physical condition to handle the physical stress associated with a particular exercise program can help prevent the onset of cardiovascular problems. During an exercise session individuals should gradually increase the intensity of activity and cool down slowly to prevent the possible onset of cardiovascular problems. Individuals should call a doctor immediately if they unusual shortness of breath, discomfort or pain in the left or midchest area, or discomfort or pain in the left neck, shoulder, or arm during or just after exer- cising. -299- TECHNICAL TERMS SUPPLEMENT INJURY PREVENTION bursitis cardiovascular dehydration electrolyte solutions hypothermia ligament spasms tendinitis tendon BIBLIOGRAPHY INJURY PREVENTION American Red Cross. Standard first aid and personal safety. (2nd ed.). Garden City, N.Y.: Doubleday, 1979. Sharkey, B.J. Physiology of fitness: prescribing exercise for fitness, weight control, and health. Champaign, I11: Human Kinetics Publishers, 1979. U.S. Department of Health and Human Services. Exercise and your heart. (National Institutes of Health, Publication No. 81-1677). Washington, D.C.: U.S. Government Printing Office, 1981. Wilmore, J.H. The Wilmore fitness program: a personalized guide to total fitness and health. New York: Simon and Schuster, 1981. -300- TEST SPECIFICATIONS AVOIDING INJURY GENERAL DESCRIPTION Children are presented with statements about the nature of exercise-related health risks and injury prevention stra- tegies associated with cardiovascular, muscular/skeletal, and environmental problems. Children indicate whether each statement is true or false. SAMPLE ITEM This test has 15 sentences. Read each one. If the sentence is true, put a check under the word TRUE. If the sen- tence is false, put a check under the word FALSE. TRUE FALSE 1, Frostbite is the freezing of a part of the body, usually the fingers or toes. STIMULUS ATTRIBUTES 1. A test item will consist of a single-sentence statement that the child is to judge as correct or incorrect. This statement will contain information about the nature of exercise-related health risks or the prevention of cardiovascular, muscular/skeletal, and temperature induced injuries caused by exercise. 2. All test items will be derived from the specifications supplement Avoiding Injury. This supplement presents statements about exercise-related health risks and injury prevention strategies which are based upon either empirical evidence or expert consensus. The statements are organized into sections, with each section contain- ing information about one aspect of injury prevention. 3. Each statement on the supplement consists of one main idea related to an exercise health risk or injury preven- tion strategy. A statement either (a) describes the nature or effects of a particular subject, (b) compares -301- two subjects with respect to a particular attribute, or (c) presents a correlational or causal relationship between two subjects. A test item will be based on a single statement selected from the supplement. If the supplement statement con- tains multiple parallel elements, only one of the elements will be used in the test item. Example of a supplement statement with multiple parallel elements Some signs of altitude sickness are headache, breath- lessness, fast heart beat, and not being hungry. A test item will present a supplement statement in either accurate or inaccurate form. An accurate test item can be created in one of the following two ways: a. Direct restatement: Reiterating a statement exactly as it appears on the supplement. b. Paraphrase: Rephrasing a supplement statement to communicate the same message in different words. This rephrasing may include substituting synonyms for words in the statement and/or reordering words within the statement. Example of a test item created by paraphrase Supplement statement: Dehydration or the loss of too much water from the body is the greatest cause of heat problems. Test Item: The major cause of heat problems is dehydration, or the loss of too much water from the body. An inaccurate test item will be based on a supplement statement or a paraphrase of that statement. An inaccu- rate item can be created in one of the following two ways: a, Negation: Rewording a supplement statement to have the opposite meaning. If the statement is worded positively, negation is accomplished by adding a negative word or phrase to the statement. If the statement is worded negatively, negation is accom- plished by taking out a negative word or phrase. -302- Example of a test item created by negation Supplement statement: Exercise or play in very cold temperatures can cause frostbite. Test item: Exercise or play in very cold tempera- tures cannot cause frostbite. Db. Mutual exclusivity: Transforming a supplement statement to communicate a message that is mutually exclusive with the original message. This trans- formation can be accomplished by either (1) chang- ing a single verb, adjective, or adverb in the original statement to a word or phrase with a contradictory meaning, (2) changing a comparative statement to either reverse the direction of the comparison made or make both terms being compared equal. Examples of test items created by transformation to a mutually exclusive statement Supplement statement: Heat cramps are the least dangerous of the heat problems. Test item: Heat cramps are the most dangerous of the heat problems. Supplement statement: Playing or exercising in cold weather is usually less dangerous than playing or exercising in hot weather. Test item: Playing or exercising in hot weather is usually less dangerous than playing or exercising in cold weather. A test item will contain a maximum of 20 words. These words will be no higher than a fourth grade reading level on the IOX Basic Skills Word List. Technical terms not found on the word list or above a fourth grade reading level may be used only if they are listed on the Technical Terms Supplement. A test will contain an approximately equivalent number of accurate and inaccurate test items. These items will be selected according to the following procedures: a. One item will be randomly selected from each section of the supplement. b. The rest of the items will be randomly selected from the supplement as a whole. -303- Ce All of the items will be reviewed by content experts and modified as needed based upon this review. All of the procedures for creating accurate and inaccu- rate test items will be used as equally as possible, with the exception of negation of a positively-stated supplement statement. This type of change will be used only when no other transformation is possible, as it results in a test item which requires the respon- dent to recognize that a negatively-stated idea is not accurate, in effect creating a double negative. RESPONSE ATTRIBUTES 1. 2. Two response columns will be provided. One column will be labeled "TRUE" and the other will be labeled "FALSE." The correct answer to a question will be "TRUE" if the statement is accurate, or "FALSE" if the statement is inaccurate. -304- SPECIFICATIONS SUPPLEMENT AVOIDING INJURY Nature of Exercise in the Heat I. 2 Heat Much of the heat built up by the body during play or exercise escapes as sweat. During play or exercise in damp weather, sweat dries up slowly and body temperature begins to rise. Heat problems can result when the body can no longer control its temperature. High temperature, dampness in the air, and lack of wind or clouds are things which can lead to heat problems. How long and how hard a person exercises, and how much water the person drinks before and during play or exercise can make a difference in whether or not the person gets heat problems. Each person reacts differently to exercising in the heat. Physically fit people have fewer problems playing or exercising in the heat because their bodies are better able to control body temperature. People with big muscles or people who are overweight lose the most water while playing or exercising in the heat and are in danger of developing heat problems. Related Disorders O., lu, 1%. 12. 13. Dehydration, or the loss of too much water from the body, is the greatest cause of heat problems. Heat cramps, heat exhaustion, and heat stroke are heat problems. Heat cramps are the least dangerous of the heat problems. Heat cramps usually happen when salt and water are lost from the body through dehydration. A heat cramp is a painful tightening of a muscle, often in the lower leg. -305- 14. 15. 16. 17. 18. 23. 24. 25. 26. Heat exhaustion can happen when the body begins to sweat less than it needs to. Heat exhaustion is the first sign that the body is becoming less able to control its temperature. Some signs of heat exhaustion are weakness, breathless- ness, dizziness, fast heart beat, and a body temperature of around 101°F, Heat stroke can happen when the body is unable to control its rising temperature. Some signs of heat stroke are hot, dry skin, a body temperature of 105°F or higher, no sweat, great confu- sion, and unconsciousness. If not treated by a doctor right away, heat stroke can lead to brain damage and death. Some early warning signs of heat problems are goose bumps on the chest and upper arms, chills, pounding in the head, unsteadiness, nausea, and dry skin. People should stop playing or exercising as soon as they feel any signs of heat problems. Heat problems are less likely if a person drinks enough liquids to take the place of water lost during exercise or hard play. A person should drink plenty of liquids before, during, and after playing or exercising in the heat. Body water lost during play or exercise can be put back into the body by drinking either water or other liquids such as juice or soda. People who play or exercise for a long time in the heat may need to put back body salts lost in sweating. People can avoid heat problems on hot and damp days by playing or exercising in the cooler parts of the day, exercising less than usual, and wearing light, loose- fitting clothes. The chances of having heat problems become greater if people wear rubber or plastic suits, sweat shirts, or sweat pants while exercising in hot weather. -306- Exercise in the Cold 28. 29. 30. Cold 31. 32. 33. Cold problems can happen when the body begins to lose heat faster than it can be built up. Cold problems are a result of exercising in very low temperatures and are made worse by wind or damp air. Playing or exercising in cold weather is usually less dangerous than playing or exercising in hot weather. Related Disorders Exercising or playing in very cold temperatures can cause frostbite. Frostbite is the freezing of a part of the body, usually the fingers or toes. People who play or exercise outdoors on cold days should wear several pieces of clothing on each part of their body, keep their hands covered, and wear a hat. Exercise at High Altitudes 34. At high altitudes, play and exercise can be more diffi- cult until the person gets used to the altitude. Some signs of altitude sickness are headache, breath- lessness, fast heart beat, and not being hungry. People who are not used to high altitudes should cut down on how long and how hard they exercise or play. Muscle, Bone, and Skin Problems 37. 38. 39, Muscle, bone, joint, and skin problems can happen when a person either is not trained well enough for a certain type of exercise or play or uses the wrong techniques or equipment. Sunburn can usually be avoided by wearing sunscreen lotion and a hat, or by avoiding long periods of exer- cise or play in the sun. Pain in the joints, feet, ankles, or legs mean that a person should stop or reduce exercising or playing. -307- 40. 41. 42. 43. 44, 45. 46. 47. 48. Problems caused by injuries using the wrong equipment can be avoided if the equipment used for exercise or play is correctly chosen, built, fitted, and used. Following the rules of a game, using equipment the right way, and learning the right ways to move during exercise and play can help a person avoid getting hurt. Warm-up and stretching exercises are important because they stretch and loosen the muscles, raise the body temperature, and speed up blood flow to the heart, lungs, and muscles. Warm-up and stretching exercises help protect against muscle and bone damage. Cool-down exercises are important because they continue the flow of blood to the muscles. Cool-down exercises help to avoid some muscle problems. Being in good physical shape can help a person avoid heart and lung problems. During exercise or play, a person should slowly build up to the highest level of activity and then cool down slowly to avoid heart and lung problems. A person should call a doctor right away if there is pain in the left side or middle of the chest, or in the left neck, shoulder, or arm during or just after exer- cising. TECHNICAL TERMS SUPPLEMENT AVOIDING INJURY altitude muscular ankle nausea confusion physical dehydration plastic dizziness radiation equipment stroke exhaustion sunburn frostbite sunscreen lotion joint sweat liquid technique lung unconsciousness muscle -308- BIBLIOGRAPHY AVOIDING INJURY American Red Cross. Standard first aid and personal safety. (2nd ed.). Garden City, N.Y.: Doubleday, 1979. Sharkey, B.J. Physiology of fitness: prescribing exercise for fitness, weight control, and health. Champaign, Ill: Human Kinetics Publishers, 1979. U.S. Department of Health and Human Services. Exercise and your heart. (National Institutes of Health Publication No. 81-1677). Washington, D.C.: U.S. Government Printing Office, 1981. Wilmore, J.H. The Wilmore fitness program: a personalized guide to total fitness and health. New York: Simon and Schuster, 1981. -309- TEST SPECIFICATIONS SELECTING AN EXERCISE PROGRAM GENERAL DESCRIPTION Individuals are presented with personal physical fitness goals for fictitious persons. Individuals are asked to select from among four possible plans the exercise program most appropriate to each described person's physical fitness goal. The correct choice will be an exercise program that consists of activities that are appropriate in type, dura- tion, frequency, and intensity to attain the personal physical fitness goal for the person described. SAMPLE ITEM This test presents descriptions of indi- viduals who want to select an exercise program that will meet their personal physical fitness goals. All individuals have their doctor's approval to start such a program. Read each description. Then put a check ( yy) in the box under the plan that is most appropriate to achieve the fitness goal given. 1. Name: Roy Garvey Age: 28 Fitness goal: cardiorespiratory endurance and flexibility Put a check 1n the box under the plan that is most appropriate for Roy: PLAN A PLAN B PLAN C PLAN D Cardiorespiratory activity: Running Swimming Tennis Bicycling Number of sessions per week: 3 4 2 4 Length of each session: 20 min. 10 min. 20 min. 25 min. Target heartrate (for 10 seconds): 20-26 19-24 21-25 14-17 Other activities: Calis- —- Yoga. - thenics (Check answer here) (correct) (insufficient (insufficient (insufficient duration) frequency) intensity and inappropriate intensity) -310- STIMULUS ATTRIBUTES 1. A test item will consist of information about a hypo- thetical individual and four proposed exercise plans for the individual. The information will have three entries: name, age, and fitness goal. The four pro- posed exercise plans will be displayed in a boxed form and have five entries: cardiorespiratory activity, number of sessions per week, length of each session, target heartrate (for 10 seconds), and other activ- ities. The following directive will precede the pro- posed plans: "Put a check in the box under plan that is most appropriate for (name of individual):" The directions will indicate that the individuals have their doctor's approval to start an exercise program. The fitness goal entry will always contain the goal of cardiorespiratory endurance and may also include the goal of muscular strength, muscular endurance or flexibility. The entries for the exercise plans will include the following: as Cardiorespiratory activity - one activity that might plausibly meet the goal of cardiorespiratory endurance be. Number of sessions per week - a number between 1 and 7 Cis Length of each session - a time interval between 10 and 60 minutes 4d. Target heartrate (for 10 seconds) - a range span- ning three to eight consecutive numbers between 10 and 35 e. Other activities - one activity other than the activity listed in the cardiorespiratory entry or a dash indicating that no other activity is included in the exercise plan Approximately one-third of the items on a test form will include a double fitness goal. Test items will be selected to sample the age range 16-70. -311- RESPONSE ATTRIBUTES 1. Four answer choices will follow each test item: Plan A, Plan B, Plan C, and Plan D. An answer choice will identify a proposed activity program of appropriate type, duration, intensity, and frequency to attain the physical fitness goal stated in the description. De The types of activity eligible for use in the exercise plans and the goal(s) met by each activity are as follows: Cardio- \ respiratory Muscular Muscular Activity Endurance Strength Endurance Flexibility Badminton X Baseball/Softball Basketball x Bicycling X X X Bowling Calisthenics X x (general exercise) Dancing x Xx Football Golf Handball/racquetball/ squash xX Hiking X Jogging /running > HoH MX Judo/karate x Rope skipping Rowing Skating Skiing (cross-country) HoM XW MN HoH MN Soccer Stretching X Swimming > wi Tennis Volleyball Walking X X Weight training Xx Wrestling Xx X X Yoga X -312- The a the c¢ progr ae b. Age 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 Each will ae ppropriate duration, frequency, and intensity of ardiorespiratory endurance portion of an exercise am are as follows: The duration must be at least 20 minutes per session. The frequency must be at least three sessions per week. The intensity must increase the individual's heart rate to a target or training heart rate that is 60 to 85% of the individual's maximal heart rate. Training heart rates are calculated based upon an individual's age, using the following formula: Formula: £220 - age) x (% 2! maximal heart rate) Training Heart Rate per 10-second interval (60-85% of maximal heart rate) 20 - 29 19 - 28 19 - 27 19 - 27 18 - 26 18 - 25 17 - 25 17 - 24 16 - 23 16 - 23 15 - 22 of the three incorrect answer choices for an item fall into one or more of the following categories: An exercise program that is not of sufficient duration, frequency, and/or intensity to achieve cardiorespiratory fitness - the program is not vigorous enough to develop adequate cardiores- piratory endurance. The values for the program's duration, frequency, and/or intensity fall below the recommended values. Such a program may be of insufficient intensity because the activity selected does not promote cardiorespiratory endurance and hence does not raise the target heartrate to an acceptable level, -313- b. An exercise program that is of excessive intensity for the individual - the program exceeds the recom- mended values for the individual's training heart rate. Such a program potentially could be : physically harmful. Ce An exercise program that does not meet the fitness goal - the type of activity suggested does not meet the fitness goal stated in the item. -314- TEST SPECIFICATIONS PREVENTING AND CARING FOR INJURIES GENERAL DESCRIPTION Individuals are presented with brief descriptions of situa- tions in which a person wants to act to prevent or care for an exercise-related injury. Individuals select from among three possible options an appropriate course of action or indicate that none of the suggested options is appropriate. SAMPLE ITEM This test presents descriptions of indi- viduals who want to prevent or care for exercise-related injuries. Read each description. Circle the letter of the appropriate action for the individual to take. If there is no choice presented that is appropriate, circle Choice D, "None of the above." Le Roger plays basketball on Saturdays with some friends. He wants to avoid spraining his ankles. An appropriate action for Roger to take would be to: (A) Tape his ankles and wear shoes with adequate support. (correct) (B) Perform cool-down exercises for five to ten minutes after playing ball. (ineffective) (C) Apply heat and cold to his ankles both before and after playing. (ineffective) (D) None of the above. (incorrect) STIMULUS ATTRIBUTES i. A test item will consist of a brief description of a person's participation in a specific exercise activity, followed by a statement of that person's goal. This goal will be either to prevent a specific injury commonly associated with the form of exercise or to care for an injury by reacting appropriately to it. The directive, "An appropriate action for (name of person) to take would be to" will follow. -315- For test items in which the person's goal is to prevent injury, the injury presented will be selected from one of the four categories described below: a. Trauma - injury caused by single or repeated blows to a bone, muscle, tendon, or ligament. Common traumatic injuries include strains, sprains, dislocations, fractures, contusions, abrasions, and lacerations. Overuse - injury caused either by exercising at a level of stress beyond that for which one is trained or by using improper techniques. Common overuse injuries include tendinitis, bursitis, blisters, calluses, and stress fractures. Environment - injury caused by exercising under environmental conditions to which one is not acclimated or against which one is not adequately protected. Such conditions include heat, cold, water, and high altitudes. Common environment- related injuries include frostbite, hypothermia, sunburn, heat disorders, and skin, ear, and eye infections. Illness - adverse physical condition brought on or aggravated by exercising. Common exercise- induced illnesses include stress reactions, cardio- vascular problems, and viral infection of the heart muscle. For test items in which the person's goal is to care for an injury, the injury or illness symptoms described will be selected from one of the four categories described below: ae b. Trauma injuries (1) Strain, slight sprains, and contusions (2) Abrasions and lacerations (3) Serious sprains, dislocations and fractures Overuse injuries (1) Blisters (2) Tendinitis and bursitis (3) Stress fractures -316- Ca Environment-related injuries (1) (2) (3) (4) (5) Frosthite Hypothermia Sunburn Heat disorders Skin, ear, and eye infections d. Illness symptoms (1) (2) (3) (4) (5) (6) Abnormal heart activity, including irregular pulse (missed beats or extra beats); fluttering, jumping, or palpitations in the chest or throat; sudden burst of rapid heartbeats; or a sudden slowing of a rapid pulse rate. Pain or pressure in the center of the chest, arm, or throat, during or immediately follow- ing exercise. Dizziness, lightheadedness, sudden lack of coordination, confusion, cold sweating, glassy stare, pallor, blueness, or fainting. Nausea or vomiting after exercise. Extreme breathlessness lasting more than 10 minutes after the cessation of exercise. Prolonged fatigue up to 24 hours following exercise, or insomnia not present before start- ing the exercise program. 4, A test item will be no longer than 40 words in length and will contain no words above an eighth grade level on the IOX Basic Skills Word List. Technical terms not found on the word list may be used only if they are listed on the Technical Terms Supplement. 5. On a given form of the test, injury prevention and injury care will be represented approximately equally. RESPONSE ATTRIBUTES 1. Four answer choices will follow each test item. The first three answer choices will describe a plausible action that an individual might take in order to prevent -317- or care for the injury described in the item. The fourth answer choice will be "None of the above." This choice will be used to indicate that none of the first three choices is an appropriate action to take in order to prevent or care for the injury. For items testing prevention of injury, the correct answer choice either will describe a preventive action that is appropriate to the injury described or, if all of the choices given describe inappropriate responses, will be "None of the above." Appropriate preventive actions for each category of injury are as follows: a. Trauma (1) Perform warm-up exercises to guard against muscle, tendon, and ligament strains. (2) Use equipment that is properly designed, constructed, and fitted. ) (3) Wear protective clothing to guard against blows to the body. (4) Exercise in an environment that is free of obstacles and slippery areas and that has proper lighting and other safety features. (5) Follow the rules of a game and use proper techniques for moving and positioning the body during play. b. Overuse (1) Stop or reduce exercising at the onset of pains in the joints, feet, ankles, or legs. (2) Perform warm-up exercises to stretch and limber the muscles. (3) Use proper techniques for moving and position- ing the body during play. (4) Exercise at the individual's accustomed level. Co Environment (1) Lessen the duration and intensity of exercise in heat or at high altitudes. (2) Replace liquids and salt lost through sweating. -318- (3) Exercise at those times of the day when adverse environmental effects are likely to be least extreme. (4) Use appropriate equipment, clothing, and protective creams. (5) Acclimate gradually to extreme environmental conditions. (6) Stop exercising at the onset of symptoms of heat, cold, altitude, or water problems. Ad. Illness (1) Be in the proper physical condition to handle the physical stress associated with a particular exercise program. (2) Use appropriate warm-up and cool-down proce- dures. (3) Build up slowly to the target fitness level. (4) Stop exercising at the onset of symptoms of cardiovascular problems. (5) Avoid exercising during and immediately follow- ing a viral infection or illness. For items testing care of injury, the correct answer choice either will describe an appropriate reaction to the injury or illness symptoms described or, if all of the choices given describe inappropriate responses, will be "None of the above." Appropriate reactions for each eligible injury or set of illness symptoms are as follows: Symptoms Appropriate Reactions a. Trauma injuries (1) Strains, slight Immobilize, elevate, and sprains, and ice the injured area. contusions Unless advised not to by a physician, take aspirin or aspirin substitute to reduce pain and inflammation. Resume exercising at a reduced level when the in- jured area is fully restored and movement is pain-free. -319- (2) Abrasions and For minor injuries, remove lacerations foreign material, wash with soap and water, and bandage. For serious injuries, ele- vate a severely bleeding limb, apply pressure to the wound to stop bleeding, and consult a physician imme- diately for treatment. (3) Serious sprains, Immobilize and consult a dislocations, and physician immediatel fractures for treatment. : b. Overuse injuries (1) Blisters Cushion the injured area with moleskin or bandage. For advanced cases, release blister fluid with a sterilized needle, treat with antiseptic, cover with gauze, circle with foam rubber, and resume activity. (2) Tendinitis and Rest and ice the injured area. bursitis Unless advised not to by physician, take aspirin or aspirin substitute to reduce pain and inflammation. Con- sult a physician if the injury persists. (3) Stress fractures Immobilize and elevate the injured area. Consult a physician. Cs Environmental-related injuries (1) Frostbite Warm the injured area by exposing it to skin, air, wet cloths, or water at room temperature. Exercise the rewarmed parts and then cover gently and elevate. (2) Hypothermia Warm the body rapidly by wrapping in warm blankets or placing in warm water. Give hot liquids by mouth. -320- (3) (4) (5) Sunburn Heat disorders Skin, ear, and eye infections A. Illness symptoms (1) (2) Abnormal heart activity, includ- ing irregular pulse, fluttering, jumping, or palpi- tations in the chest or throat, sudden burst of rapid heartbeats, or a sudden slow- ing of a rapid pulse rate Pain or pressure in the center of the chest, arm, or throat, during or immediately following exer- cise Dizziness, light- headedness, sudden lack of coordina- tion, confusion, cold sweating, glassy stare, pallor, blueness, or fainting -321- Apply cool water initially. When area is no longer hot to the touch, apply sunburn ointment. Protect from additional sun exposure. Stop exercising. Cool the body quickly by moving to a cool location and rest- ing, sponging with cool water, applying cool wet towels, or immersing in cool water. Massage muscle cramps and give victim sips of salt water. Give the victim large quantities of plain water or other fluids. If victim vomits, take victim to hospital for intra- venous salt solution. Consult a physician for treatment. Stop exercising and call a physician immediately. See a physician before resuming. (The. symptoms can be warning signs of cardiovascular problems.) Stop exercising and call a physician immediately. See a physician before resuming. (The symptoms can be warnings signs of cardiovascular problems.) Stop exercising and call a physician immediately. See a physician before resuming. (The symptoms can be warning signs of cardiovascular problems.) (4) Nausea or vomit- Reduce the intensity of the ing after exer- activity and prolong the cise cool-down period. Avoid eating for at least two hours prior to the exercise session. (5) Extreme breath- Reduce the intensity of the lessness lasting activity to a level that more than 10 allows speaking during minutes after the exercise. cessation of exercise (6) Prolonged fatigue Reduce the intensity of the up to 24 hours activity. Reduce the dura- following exercise, tion of the total workout or insomnia not session if this symptom present before persists. Consult a physi- starting exercise cian if these self-correct- program ing techniques do not remedy the situation. Incorrect responses will be plausible actions that are likely to be ineffective in preventing or caring for the injury described in the item. "None of the above" will also be an incorrect response if a correct response is provided as one of the other response options. Incorrect responses that are ineffective in preventing or caring for the injury described will be selected from the following: Be Direct violation of an appropriate action, as described in Response Attributes #2 and 3. be. Responding in a manner which is generally related to the situation described, but which is ineffective in preventing or caring for the injury described. The response option, "None of the above," will be the correct response for approximately one-fourth of the test items. Answer choices will be no longer than 18 words in length and will contain no words above an eighth grade level of the IOX Basic Skills Word List. Technical terms not found on the word list may be used only if they are listed on the Technical Terms Supplement. -322- TECHNICAL TERMS SUPPLEMENT PREVENTING AND CARING FOR INJURIES bursitis cardiovascular duration hypothermia intensity lukewarm tendinitis viral influenza -323- TEST SPECIFICATIONS EXERCISING SAFELY GENERAL DESCRIPTION Children are presented with brief descriptions of situations in which a person should act to prevent or care for an exercise-related injury. Children select from among three possible options the best action for the person to take. SAMPLE ITEM This test tells about people who want to prevent or care for an exercise injury. Read each question. Then circle the letter of the best action for the person to take. i. Roger plays basketball on Saturdays with some friends. He wants to avoid spraining his ankles. The best action for Roger to take is to: (A) Wear shoes with good support. (correct) (B) Do cool-down exercises for five to ten minutes after playing ball. (ineffective) (C) Put hot and cold cloths on his ankles both before and after playing. (ineffective) STIMULUS ATTRIBUTES 1. A test item will consist of a brief description of a young person's participation in a specific exercise activity, followed by a statement of that person's goal. This goal will be either to prevent a specific injury commonly associated with the form of exercise or to care for an injury by reacting appropriately to it. The directive, "The best action for (name of person) to take is to" will follow. For test items in which the person's goal is to prevent injury, the injury presented will be selected from one of the four categories described below: -324- Trauma - injury caused by one or more blows to a bone, muscle, tendon, or ligament. Common trau- matic injuries include strains, sprains, disloca- tions, breaks, bruises, scrapes, and cuts. Overuse - injury caused by exercising too hard or by using incorrect methods. Common overuse injuries include inflammation, blisters, calluses, and stress fractures. Environment - injury caused by exercising under environmental conditions to which one is not adjusted or against which one is not well protected. Such conditions include heat, cold, water, and high altitudes. Common environment-caused injuries include frostbite, cold exposure, sunburn, heat exposure, and skin, ear, and eye infections. Illness - poor health condition brought on or aggravated by exercising. Common exercise-caused illnesses include cardiovascular problems and viral infection of the heart muscle. For test items in which the person's goal is to care for an injury, the injury or illness symptoms described will be selected from one of the four categories described below: a. b. Trauma injuries (1) Strain, slight sprains, and bruises (2) Scrapes and cuts (3) Serious sprains, dislocations and breaks Overuse injuries (1) Blisters (2) Inflammation (3) Stress fractures Environment-related injuries (1) Frostbite (2) Cold exposure (3) Sunburn -325- 4, 5. (4) Heat exposure (5) Skin, ear, and eye infections a. Illness symptoms (1) Unusual heart beats, such as unsteady pulse (missed beats or extra beats), fluttering, jumping, or throbbing in the chest or throat, sudden burst of fast heartbeats, or a sudden slowing of a fast pulse. (2) Pain or pressure in the center of the chest, arm, or throat, during or right after exer- cise. (3) Dizziness, lightheadedness, sudden clumsiness, confusion, cold sweating, glassy stare, pale- ness, blueness, or fainting. (4) Nausea or vomiting after exercise. (5) Extreme breathlessness lasting more than 10 minutes after exercise. (6) A very tired feeling lasting up to 24 hours following exercise, or sleeplessness not present before starting the exercise program. A test item will be no longer than 35 words in length and will contain no words above a fourth grade level on the I0X Basic Skills Word List. Technical terms not found on the word list may be used only if they are listed on the Technical Terms Supplement. On a given form of the test, injury prevention and injury care will be represented approximately equally. RESPONSE ATTRIBUTES 1. Three answer choices will follow each test item. Each answer choice will describe a plausible action that an individual might take in order to prevent or care for the injury described in the item. For items testing prevention of injury, the correct answer choice will describe a preventive action that is appropriate to the injury described. Appropriate preventive actions for each category of injury are as follows: -326- Trauma (1) Perform warm-up exercises to guard against muscle, tendon, and ligament strains. (2) Use equipment that is properly designed, made, and fitted. (3) Wear protective clothing to guard against blows to the body. (4) Exercise in an area that is clear and not slippery and that has good lighting and other safety features. (5) Follow the rules of a game and use correct techniques for moving and placing the body during play. Overuse (1) Stop or reduce exercising at the start of pains in the joints, feet, ankles, or legs. (2) Perform warm-up exercises to make the muscles stretch easily. (3) Use correct methods for moving and placing the body during play. (4) Exercise at the person's usual level. Environment (1) Exercise for less time and less vigorously in heat or at high altitudes. (2) Take in liquids and salt to make up for what is lost through sweating. (3) Exercise at those times of the day when environmental conditions are likely to be best. (4) Use correct equipment, clothing, and protec- tive creams. (5) Get used to new environmental conditions slowly. (6) Stop exercising as soon as there are signs of heat, cold, altitude, or water problems. -327- d. Illness (1) Be in the correct physical condition to handle the physical stress that goes with the exer- cise program. (2) Perform warm-up and cool-down exercises. (3) Build up slowly to the target fitness level. (4) Stop exercising as soon as there are signs of cardiovascular problems. (5) Do not exercise during and immediately after a viral infection or illness. For items testing care of injury, the correct answer choice will describe an appropriate reaction to the injury or illness symptoms described. Appropriate reac- tions for each eligible injury or set of illness symptoms are as follows: Symptoms a. Trauma injuries (1) Strains, slight sprains, and bruises (2) Scrapes and cuts (3) Serious sprains, dislocations, and breaks -328- Appropriate Reactions Hold motionless, raise, and ice the injured area. Take aspirin or aspirin substitute to reduce pain unless advised not to by a physician. For small injuries, remove dirt, wash with soap and water, and bandage. For bad injuries, raise an arm or leg that is bleeding a lot, press on the wound to stop bleeding, and see a doctor immediately for treatment. Hold motionless and see a doctor immediately. b. Overuse injuries (1) Blisters Pad the injured area with moleskin or bandage. For water-filled blisters, let out blister fluid with a sterilized needle, put on antiseptic, cover with gauze, circle with foam rubber, and continue activity. (2) Inflammation Rest and ice the injured area. Take aspirin or aspirin substitute to reduce pain unless advised not to do so by a physician. (3) Stress fractures Immobilize and elevate the injured area. Consult a doctor. Ce Environmental-related injuries (1) Prostbite Warm the injured area slowly by touching it with skin, air, wet cloths, or water at room temperature. Exercise the warmed parts and then cover them gently and raise them. (2) Cold exposure Warm the body quickly by wrapping in warm blankets or placing in warm water. Give hot liquids by mouth. (3) Sunburn Put cool water on the area. Sunburn ointment may be used if the area is not hot to the touch. Protect from more sun. (4) Heat exposure Stop exercising. Cool the body quickly by moving to a cool place and resting, putting on cool water or cool wet towels, or putting the person in cool water. Massage muscle cramps and give victim sips of salt water. Give the victim plenty of water or other liquids. If victim vomits, take victim to hospital. -329- (5) Skin, ear, and eye infections de. Illness symptoms (1) (2) (3) (4) (5) (6) Unusual heart beats, such as unsteady pulse, fluttering, jump- ing, or throbbing in the chest or throat, sudden burst of fast heartbeats, or a sudden slow- ing of a fast pulse Pain or pressure in the center of the chest, arm, or neck, during or right after exercise Dizziness, light- headedness, sudden clumsiness, con- fusion, cold sweating, glassy stare, paleness, blueness, or fainting Nausea or vomit- ing after exer- cise Extreme breath- lessness lasting more than 10 minutes after exercise A very tired feel- ing lasting up to 24 hours following exercise, or sleep- lessness not present before starting exercise program -330- See a doctor for treatment. Stop exercising. Call a doctor right away. See a doctor before exercising again. (The symptoms can be signs of cardiovascular problems.) Stop exercising. Call a doctor right away. See a doctor before exercis- ing again. (The symptoms can be warning signs of cardiovascular problems.) Stop exercising. Call a doctor right away. See a doctor before exercising again. (The symptoms can be signs of cardio- vascular probmems.) Exercise less vigorously and make the cool-down period longer. Do not eat for at least two hours before the exercise session. Exercise less vigorously so that speaking during exercise is possible. Exercise less vigorously. Exercise for a shorter period of time. See a doctor if the changes in exercise do not stop the symptom. Incorrect responses will be plausible actions that are likely to be ineffective in preventing or caring for the injury described in the item. Incorrect responses that are ineffective in preventing or caring for the injury described will be selected from the following: a. Direct violation of an appropriate action, as described in Response Attributes #2 and 3. b. Responding in a manner which is generally related to the situation described, but which is ineffective in preventing or caring for the injury described. Answer choices will be no longer than 18 words in length and will contain no words above a fourth grade level on the IOX Basic Skills Word List. Technical terms not found on the word list may be used only if they are listed on the Technical Terms Supplement. TECHNICAL TERMS SUPPLEMENT EXERCISING SAFELY blister exposure frostbite hike scrape skateboard soccer sprain sunburn swelling uncover volleyball -331- TEST SPECIFICATIONS DECISION-MAKING GENERAL DESCRIPTION Individuals are presented with fictional descriptions of people who are attempting to make decisions in a health- related context. Individuals are asked to select from among four options the next step to be followed using a systematic approach to decision-making. SAMPLE ITEM This test presents descriptions of people who are trying to make decisions that may affect their health or the health of others. Read each item. Circle the letter of the next step that the person should take in order to be making decisions using a systematic approach. George has a drinking problem. His boss has told George that he will be fired if he can't control his drinking. Because George has been unable to deal with his alcohol problem by himself, he recognizes that he needs professional help. He realizes, therefore, that he needs to choose the particular type of help that will be best for him. He discusses the problem with his wife. Together they identify three possible approaches: (1) a self-help clinic operated by reformed alcoholics, (2) a private physician who treats alcoholism with drugs, and (3) a one-week alcoholism program operated by a private com- pany. What is the best thing for George to do next in order to use the systematic decision-making approach? A. Select one of the three approaches. (skipped step) -332- B. Identify the decision he needs to make. (repeated step) Co Talk to his doctor to get information about each approach. (correct) D. Ask his boss which approach seems best. (ineffec- tive implementation of correct step) STIMULUS ATTRIBUTES 1. A test item will begin with a description of an indi- vidual who is attempting to reach a decision in a health- related context. The description will be followed by the question, "What is the best thing for (name of individual) to do next in order to use the systematic decision-making approach?" The context will be related to one of the following health areas: alcohol and substance abuse, diabetes, exercise, immunization, nutrition, smoking, or stress. The described situations will not require immediate decisions. The individual will have adequate time to use the five steps of the systematic decision-making process described in the specifications supplement. The individual will either (a) have completed one or more steps of the systematic decision-making model, or (b) be confronted with a situation in which the system- atic decision-making model should be used. If the individual has already completed any steps in the systematic decision-making model, these steps will have been completed in the proper sequence and with no clear violations of the criteria for effective implemen- tation described in the specifications supplement. The descriptions will be no more than 200 words in length and will contain no words above an eighth grade level on the IOX Basic Skills Word List, with the exception of the following words: diabetes, immunize, marijuana, stress, systematic. Sentences will not exceed 20 words in length. RESPONSE ATTRIBUTES 1. Four answer choices will follow each test question. Each choice will describe a plausible action that the described decision-maker might possibly take. -333- The correct answer will be a description of an action that: 2s clearly represents the appropriate next step for the decision-maker in following the systematic decision-making model described in the specifica- tions supplement. Be is consistent with the effectiveness criteria asso- ciated with the correct step as described in the specifications supplement. An incorrect answer choice will be an action that is plausible but inappropriate at the point in the deci- sion-making sequence described in the item. Incorrect answer choices will be one of the following violations of the systematic decision-making process described in the specifications supplement. a. Skipped Step: An action representing one of the decision-making steps that occurs after the correct step. This action should not violate the effective- ness criteria for that step. b. Repeated Step: An action representing one of the decision-making steps that has already occurred. This action should not violate the effectiveness criteria for that step. Cs Ineffective Implementation of Correct Step: An action representing the correct step in the deci- sion-making sequence, but in violation of one or more of that step's effectiveness criteria. d. Ineffective Implementation of Incorrect Step: An action representing an incorrect step in the decision-making sequence that is also in violation of one or more of the step's effectiveness criteria. e. Deflective Action: An action that is unrelated to effective decision-making and may deflect the decision-maker from taking an action necessary for systematic decision-making. Answer choices will be no longer than 20 words in length and will contain no words above an eighth grade level on the IOX Basic Skill Word List with the excep- tion of the following words: marijuana, stress. -334- SPECIFICATIONS SUPPLEMENT DECISION-MAKING A SYSTEMATIC DECISION-MAKING MODEL Although the decision-making process has been concep- tualized in many ways, the following steps reflect a systematic approach to decision-making. Criteria that are required to effectively implement the specified step are provided for each step of the decision-making process. No step should be taken before adequately completing all pre- ceding steps. Earlier steps should be repeated only in light of additional information that makes it clear that recycling is warranted. . Step 1: Identifies/clarifies the decision to be made. The decision-maker, recognizing that a decision must be reached, isolates the decision to be made. Effectiveness Criteria: (1) (2) Step 2: The The decision to he made should be clearly related to the situation. The decision to be made should be at an appro- priate level of specificity (neither too general nor too specific) so that making the decision should impact on the precipitat- ing situation. Identifies possible decision options. decision-maker isolates a range of potential courses of action, that is, decision options. One of these decision options may be to do nothing. Effectiveness Criteria: (1) (2) Step 3: The More than one potential course of action must be identified. The identified options must be relevant to the decision at issue. Gathers/processes information. systematic decision-maker gathers informa- tion about (a) each decision option and (b) the decision- maker's values (including preferences) that may be relevant to the decision. -335- Effectiveness Criteria: (1) (2) (3) Step 4: Information should be sought regarding the advantages and disadvantages of each decision option. The information should be obtained only from sources that are likely to have access to accurate information. Values should be considered during this step. Makes/implements the decision. The systematic decision-maker makes a decision on the basis of the information gathered about deci- sion options and values, then implements that decision. Effectiveness Criteria: (1) (2) Step 5: The decision should be consistent with the information about the options. Decision-makers should make the decisions for themselves and should not expect or request that other individuals make the decisions. Evaluates the decision. The systematic decision-maker judges the effect(s) of the implemented decision. Effectiveness Criteria: (1) (2) (3) (4) The decision-maker considers whether the implementation of the decision has the desired impact on the situation. The decision-maker considers the effective- ness of decision effects in relationship to the decision-maker's values. The decision-maker should not persist in behavior that has not had the desired impact or that is inconsistent with the decision- maker's values. The decision-maker resumes, or is prepared to resume, the decision-making process if the decision has not had the desired impact or if the decision's effect is inconsistent with the decision-maker's values. The decision-maker should not implement a new decision with- out repeating the systematic decision-making process. -336- TEST SPECIFICATIONS SYSTEMATIC DECISION-MAKING GENERAL DESCRIPTION Individuals are presented with fictional descriptions of people who are making decisions in a health-related context. Individuals are asked to indicate whether the decision- makers correctly use the systematic decision-making process. If individuals indicate that the decision-making process is carried out incorrectly, they are then asked to describe the nature of the error. SAMPLE ITEM This test presents descriptions of people who are making decisions that may affect their health or the health of others. Each person has either completed the entire decision-making process correctly or has made one mistake im this process. Read each item. Circle Yes or No to indi- cate whether the person correctly completed each step in the decision-making process. If you circle No, briefly describe what the person did wrong. George has a drinking problem. His boss has told George that he will be fired if he can't control his drinking. Because George has been unable to deal with his alcohol problem by himself, he recognizes that he needs professional help. He realizes, therefore, that he needs to choose the particular type of help that will be best for him. He discusses the problem with his wife. Together they identify three possible approaches: (1) a self-help clinic operated by reformed alcoholics, (2) a private physician who treats alcoholism with drugs, and (3) a one-week alcoholism program operated by a private com- pany. George decides to try the week-long alcoholism program and enrolls in it the following week. Several weeks later, George thinks again about his decision to enroll in the alcoholism program. He's pleased with his choice because he feels he is effec- tively handling his drinking problem. -337- A. Did George correctly complete each of the steps in the decision-making process? Circle One: Yes No B. If No, what did George do wrong? STIMULUS ATTRIBUTES 1. A test item will begin with a description of an indi- vidual who is making a decision in a health-related context. The description will be followed by two questions: "A. Did (name of individual) correctly complete each of the steps in the decision-making process? Circle Ome: Yes No B. If No, what did (name of individual) do wrong?" The context will be related to one of the following health areas: alcohol and substance abuse, diabetes, exercise, immunization, nutrition, smoking, or stress. The individual will either (a) have correctly completed all of the steps in the systematic decision-making " process, or (b) have made one error in the decision- making process described in the specifications supple- ment. If the individual has made one error in the systematic decision-making process, the error will be either (a) skipping one step, or (b) completing a step incor- rectly by violating one of the step's effectiveness criteria as described in the specifications supplement. The descriptions will be no more than 200 words in length and will contain no words above an eighth grade level on the IOX Basic Skills Word List, with the excep- tion of the following words: diabetes, immunize, marijuana, stress. Sentences will not exceed 20 words in length. RESPONSE ATTRIBUTES 1. Two response opportunities will be available, a Yes/No response and a constructed response. Respondents will -338- use the Yes/No option to identify whether the individual described in the test item correctly completed each step in the systematic decision-making process. If respon- dents answer No, they are then to describe what the individual did incorrectly. A correct answer will be either (a) a Yes response, if the individual described in the test item correctly completed all of the steps in the decision-making process, or (b) a No response and an accurate descrip- tion of the error made in the decision-making progess, if the individual did not correctly complete all of the steps in the systematic decision-making process. An accurate description will either (a) indicate which step is omitted in the decision-making process if one of the decision-making steps is skipped in the test item, or (b) indicate which step is done incorrectly if one of the decision-making steps is completed in a way that violates that step's effectiveness criteria as described in the specifications supplement. For both types of errors, the respondent may indicate either what the individual described in the test item did wrong or what the individual should have done to correctly use the decision-making process. Steps in the decision-making process can be identified as either: a. general descriptions or labels of the step (e.g., gathers/processes informations), or b. specific actions that exemplify the step (e.g., talks to his doctor to get information about each approach) An incorrect answer will be: 1 a No response with or without a constructed response when a Yes response is appropriate, that is, when the individual described in the test item has correctly completed all steps in the systematic decision-making process. b, a Yes response when a No response is appropriate, that is, when the individual described in the test item does not correctly complete all steps in the decision-making process. Co a No response without an accurate constructed response, according to the criteria described in Response Attribute 3. -339- SCORING AND INTERPRETATION 1. The rationale underlying this measure is that iandi- viduals who understand the systematic decision-making process for health-related decisions can identify whether or not described individuals have correctly completed the systematic decision-making process in health-related contexts. Individuals can also describe the nature of the error when one of the decision-making steps has been omitted or completed incorrectly. Point values are assigned as follows: 1 point - Correct responses as described in Response Attributes 2 and 3 0 points - Incorrect responses as described in Response Attribute 5 High scores indicate better ability to use systematic decision-making in health-related contexts. -340- SPECIFICATIONS SUPPLEMENT SYSTEMATIC DECISION-MAKING A SYSTEMATIC DECISION-MAKING MODEL Although the decision-making process has been concep- tualized in many ways, the following steps reflect a system- atic approach to decision-making. Criteria that are required to effectively implement the specified step are provided for each step of the decision-making process. No step should be taken before adequately completing all preceding steps. Earlier steps should be repeated only in light of additional information that makes it clear that recycling is warranted. Step 1: Identifies/clarifies the decision to be made. The decision-maker, recognizing that a decision must be reached, isolates the decision to be made. Effectiveness Criteria: (1) The decision to be made should be clearly related to the situation. (2) The decision to be made should be at an appro- priate level of specificity (neither too general nor too specific) so that making the decision should impact on the precipitat- ing situation. Step 2: Identifies possible decision options. The decision-maker isolates a range of potential courses of action, that is, decision options. One of these decision options may be to do nothing. Effectiveness Criteria: (1) More than one potential course of action must be identified. (2) The identified options must be relevant to the decision at issue. Step 3: Gathers/processes information. The systematic decision-maker gathers informa- tion about (a) each decision option and (b) the decision-maker's values (including preferences) which may be relevant to the decision. -341- Effectiveness Criteria: (1) (2) (3) Step 4: Information should be sought regarding the advantages and disadvantages of each decision option. The information should be obtained only from sources that are likely to have access to accurate information. Values should be considered during this step. Makes/implements the decision. The systematic decision-maker makes a decision on the basis of the information gathered about deci- sion options and values, then implements that decision. Effectiveness Criteria: (1) (2) Step 5: The decision should be consistent with the information about the options. Decision-makers should make the decisions for themselves and should not expect or request that other individuals make the decisions. Evaluates the decision. The systematic decision-maker judges the effect(s) of the implemented decision. Effectiveness Criteria: (1) (2) (3) (4) The decision-maker considers whether the implementation of the decision has the desired impact on the situation. The decision-maker considers the effective- ness of decision effects in relationship to the decision-maker's values. The decision-maker should not persist in behavior that has not had the desired impact or that is inconsistent with the decision- maker's values. The decision-maker resumes, or is prepared to resume, the decision-making process if the decision has not had the desired impact or if the decision's effect is inconsistent with decision-maker's values. The decision-maker should not implement a new decision with- out repeating the systematic decision-making process. -342- TEST SPECIFICATIONS MAKING DECISIONS GENERAL DESCRIPTION Children are presented with fictional descriptions of young people who are attempting to make decisions in a health- related context. Children are asked to select from among three options the next step to be followed using a system- atic approach to decision-making. SAMPLE ITEM This test is about young people who are trying to make decisions. Read each story. Circle the letter of the next thing that the person should do in order to be making a decision in the best way. Carrie is going to her cousin Rick's house on Friday. Rick has told Carrie that his parents will be out and that they can drink some of his parents’ wine. He says that they won't get caught because his parents will be out until very late. Carrie knows that she must decide what she will do when she is with Rick. Carrie talks to her friend and they think about what Carrie can do. Carrie can either (1) tell Rick she doesn't want to drink with him, or (2) drink wine with Rick on Friday. What should Carrie do next in order to be making a decision in the best way? A. Drink just a little wine with Rick. (skipped step) Be. Read about drinking in her health book. (correct) C. Tell Rick that she can't go to his house on Friday. (deflective action) -343- STIMULUS ATTRIBUTES : A test item will begin with a description of an indi- vidual who is attempting to reach a decision in a health-related context. The description will be followed by the question, "What should (name of individual) do next in order to be making a decision in the best way?" The context will be related to one of the following health areas: alcohol and substance abuse, diabetes, exercise, nutrition, smoking, or stress. The described situations will not require immediate decisions. The individual will have adequate time to use the five steps of the systematic decision-making process described in the specifications supplement. The individual will either (a) have completed one or more steps of the systematic decision-making model, or (b) be confronted with a situation in which the systematic decision-making model should be used. If the individual has already completed any steps in the systematic decision-making model, these steps will have been completed in the proper sequence and with no clear violations of each step as described in the specifications supplement. The descriptions will be no more than 200 words in length and will contain no words above a fourth grade level on the IOX Basic Skills Word List, with the excep- tion of the following words: cigarette, decision, diabetes, diet, marijuana, physical education. Sen- tences will not exceed 20 words in length. RESPONSE ATTRIBUTES 1. Three answer choices will follow each test question. Each choice will describe a plausible action that the described decision-maker might possibly take. The correct answer will be a description of an action that clearly represents the appropriate next step for the decision-maker in following the systematic decision- making model described in the specifications supplement. -344- An incorrect answer choice will be an action that is plausible but inappropriate at the point in the deci- sion-making sequence described in the item. Incorrect answer choices will be one of the following violations of the systematic decision-making process described in the specifications supplement. a. Skipped Step: An action representing one of the decision-making steps that occurs after the correct step. This action should not violate that step as described in the specifications supplement. b, Repeated Step: An action representing one of the decision-making steps that has already occurred. This action should not violate that step as described in the specifications supplement. Ca Ineffective Implementation of a Step: An action representing a step in the decision-making sequence that is in clear violation of that step as described in the specifications supplement. d. Deflective Action: An action that is unrelated to effective decision-making and may deflect the decision maker from taking an action necessary for systematic decision-making. Answer choices will be no longer than 20 words in length and will contain no words above a fourth grade level on the I0X Basic Skill Word List, with the excep- tion of the following words: cigarette, decision, diet, marijuana. -345~ SPECIFICATIONS SUPPLEMENT MAKING DECISIONS A SYSTEMATIC DECISION-MAKING MODEL Although the decision-making process has been concep- tualized in many ways, the following steps reflect a systematic approach to decision-making. No step should be taken before adequately completing all preceding steps. Earlier steps should be repeated only in light of additional information that makes it clear that recycling is warranted. Step 1: Identifies the decision to be made. The decision-maker understands that a decision must be reached and identifies the decision to be made. The decision to be made should be clearly related to the situation presented. Step 2: Identifies possible decision options. The decision-maker identifies at least two possible courses of action, that is, decision options. One of these decision options may be to do nothing. All decision options must be related to the decision being made. Step 3: Gathers/thinks about information. The decision-maker gathers information about the advantages and disadvantages of each decision option. The information should be obtained only from sources that are likely to have access to accurate information. The decision-maker thinks about the decision options in light of values and preferences that may be related to the decision. Step 4: Makes/carries out the decision. The decision-maker either (1) makes a decision, or (2) has a knowledgeable, responsible, unbiased person (e.g., parent, teacher) make the decision, when appropriate. The decision should be consistent with the information gathered about decision options and values. The decision-maker then carries out that decision. Step 5: Evaluates the decision. The decision-maker judges the decision by consider- ing whether it has the desired impact on the situation and if its effects are consistent with the decision-maker's values. The decision-maker repeats, or is prepared to repeat, the systematic decision-making process if necessary. -346- TEST SPECIFICATIONS MAKE A DECISION GENERAL DESCRIPTION Children are presented with fictional descriptions of young people who are attempting to make decisions in a health- related context. Children are then asked to write a description of the next step to be followed using a system- atic approach to decision-making. SAMPLE ITEM This test is about young people who are trying to make decisions. Read each story. Then write what the person should do next in order to be making a decision in the best way. Carrie is going to her cousin Rick's house on Friday. Rick has told Carrie that his parents will be out and that they can drink some of his parents’ wine. He says that they won't get caught because his parents will be out until very late. Carrie knows that she must decide what she will do when she is with Rick. Carrie talks to her friend and they think about what Carrie can do. Carrie can either (1) tell Rick she doesn't want to drink with him, or (2) drink wine with Rick on Friday. What should Carrie do next in order to be making a decision in the best way? -347-~ STIMULUS ATTRIBUTES 1. A test item will begin with a description of an indi- vidual who is attempting to reach a decision in a health-related context. The description will be followed by the question, "What should (name of individual) do next in order to be making a decision in the best way? The context will be related to one of the following health areas: alcohol and substance abuse, diabetes, exercise, nutrition, smoking, or stress. The described situations will not require immediate decisions. The individual will have adequate time to use the five steps of the systematic decision-making process described in the specifications supplement. The individual will either (a) have completed one or more steps of the systematic decision-making model, or (b) be confronted with a situation in which the decision-making model should be used. If the individual has already completed any steps in the systematic decision-making model, these steps will have been completed in the proper sequence and with no clear violations of each step as described in the specifications supplement. The descriptions will be no more than 200 words in length and will contain no words above a fourth grade level on the IOX Basic Skills Word List, with the excep- tion of the following words: cigarette, decision, diabetes, diet, marijuana, physical education. Sen- tences will not exceed 20 words in length. RESPONSE ATTRIBUTES 1. An answer will be an open-ended description of an action that the decision-maker could take using the systematic decision-making model. A correct answer will be a description that correctly identifies the appropriate next step in the decision- making model as described in the specification supple- ment. If the last step in the decision-making process -348- described in the stimulus is either Step 2 (Identifies possible decision options) or Step 3 (Gathers/thinks about information), a correct answer may also be a con- tinuation of that step (e.g., the decision-maker identi- fies additional possible options.) Repetition of earlier steps will be correct only if the respondent provides a rationale that is consistent with systematic decision-making. Steps in the decision-making process can be identified as either: (1) general descriptions or labels of the step (e.g., gathers/thinks about information), or (2) specific actions that exemplify the step (e.g., ask a doctor for information about the effects of alcohol.) An incorrect answer will be any action that is inappro- priate at the point in the decision-making sequence described in the item. Incorrect answer choices may come from one of the following violations of the syste- matic decision-making process described in the specifi- cations supplement. a. Skipped Step: An action representing one of the decision-making steps that occurs after the correct step. b. Repeated Step: An action representing one of the decision-making steps that has already occurred, where no acceptable rationale for the action is provided. Co Ineffective Implementation of a Step: An action representing a step in the decision-making sequence that is in clear violation of that step as described in the specifications supplement. d. Deflective Action: Any action that is unrelated to effective decision-making and may deflect the decision-maker from taking an action necessary for systematic decision-making. -349- SCORING AND INTERPRETATION 1. The rationale underlying this measure is that children who understand the systematic decision-making process will be ahle to provide a description of the appropriate next step for individuals to take in order to make systematic decisions in health-related contexts. Point values are assigned to answers as follows: 1 point - Correct responses as described in Response Attribute 2. 0 points - Incorrect responses including, but not limited to, those described in Response Attribute 4. High scores indicate better ability to use systematic decision-making in health-related contexts. -350- SPECIFICATIONS SUPPLEMENT MAKE A DECISION A SYSTEMATIC DECISION-MAKING MODEL Although the decision-making process has been concep- tualized in many ways, the following steps reflect a system- atic approach to decision-making. No step should be taken before adequately completing all preceding steps. Earlier steps should be repeated only in light of additional infor- mation that makes it clear that recycling is warranted. Step 1: Identifies the decision to be made. The decision-maker understands that a decision must be reached and identifies the decision to be made. The decision to be made should be clearly related to the situation presented. Step 2: Identifies possible decision options. The decision-maker identifies at least two possible courses of action, that is, decision options. One of these decision options may be to do nothing. All decision options must be related to the decision being made. Step 3: Gathers/thinks about information. The decision-maker gathers information about the advantages and disadvantages of each decision option. The information should be obtained only from sources that are likely to have access to accurate information. The decision-maker thinks about the decision options in light of values and preferences that may be related to the decision. Step 4: Makes/carries out the decision. The decision-maker either (1) makes a decision, or (2) has a knowledgeable, responsible, unbiased person (e.g., parent, teacher) make the decision when appropriate. The decision should be consistent with the information gathered about decision options and values. The decision-maker then carries out that decision. Step 5: Evaluates the decision. The decision-maker judges the decision by consider- ing whether it has the desired impact on the situation and if its effects are consistent with the decision-maker's values. The decision-maker repeats, or is prepared to repeat, the systematic decision-making process, if necessary. -351- TEST SPECIFICATIONS EFFECTS OF EXERCISE GENERAL DESCRIPTION This inventory is a Likert scale in which respondents are asked to register their degree of agreement with a series of statements about the possible effects of exercise on a person's body image, sexuality, coordination, strength, social acceptability, personal adjustment, self-concept, ability to manage stress, and health. SAMPLE ITEM This survey describes some possible effects of regular exercise. Please respond to all the state- ments in the survey. Read each statement. Decide the extent to which you agree with it. Circle the appropriate letter to the left of the statement. Use the following scale: SA Strongly Agree Agree Uncertain Disagree Strongly Disagree al A U D S D SA" A 0 .-D "8D 1. Exercise is helpful in reducing feelings of anxiety. STIMULUS ATTRIBUTES 1. An item will consist of a statement about a possible effect of exercise. These effects will pertain to the areas of body image, sexuality, coordination, strength, social acceptability, personal adjustment, self-concept, ability to manage stress, and health. 2. The inventory will contain a proportionate number of items about each of the possible effects, with equal representation of the possibilities of exercise having a positive consequence and exercise having no impact or a negative effect. -352- Each statement will be 25 words or less in length. The words used will not exceed the eighth grade level on the IOX Basic Skills Word List with the exception of the following words: coordination, stress. RESPONSE ATTRIBUTES 1. The following five response options will be available for each item: SA = Strongly Agree A = Agree U = Uncertain D = Disagree SD = Strongly Disagree Respondents are to use the response options to indicate the extent to which their beliefs about the effects of exercise are properly represented in an item's statement. Respondents circle the letter of their response to the left of each item. SCORING AND INTERPRETATION i. The rationale underlying this measure is that respondents who believe in the positive effects of exercise on body image, sexuality, coordination, strength, social acceptability, personal adjustment, self-concept, ability to manage stress, and health will more frequently (a) agree with statements which describe a positive consequence of exercise and (b) disagree with statements which describe exercise as having no impact or a negative effect. Point values are assigned to items according to whether the consequence of exercise is seen as positive or non- positive (i.e., neutral or negative). Items which describe a positive effect of exercise are assigned the following values: SA = 5 points, A = 4 points, U = 3 points, D = 2 points, SD = 1 point. Items which describe a non-positive effect of exercise are assigned the following values: SA = 1 point, A = 2 points, U = 3 points, D = 4 points, SD = 5 points. High scores indicate a strong belief in the positive effects of exercise on hody image, sexuality, coordina- tion, strength, social acceptability, personal adjust- ment, self-concept, ability to manage stress, and health. -353- MEASURE FORMAT 1. The following plan indicates the key characteristics of the "Effects of Exercise" inventory developed from these test specifications. Exercise Perceived Item Area of Effect as Positive 1 Stress management Yes 2 Sexuality Yes 3 Coordination No 4 Health Yes 5 Strength No 6 Social acceptability No 7 Self-concept Yes 8 Sexuality No 9 Strength Yes 10 Body image Yes 11 Personal adjustment Yes 12 Social acceptability Yes 13 Stress management No 14 Body image No 15 Coordination Yes 16 Self-concept No 17 Health No 18 Personal adjustment No -354- TEST SPECIFICATIONS EXERCISE AND PEOPLE GENERAL DESCRIPTION This inventory is a Likert scale in which children are asked to register their degree of agreement with a series of statements about the possible effects of exercise on a person's body image, coordination, strength, social accept- ability, self-concept, ability to manage stress, and health. SAMPLE ITEM The statements below are about what exer- cise might do. Circle the word that shows if you agree with each statement. YES = 1 agree MAYBE = 1 am not sure if I agree NO = I do not agree YES MAYBE NO 1. Exercise helps people feel less anxious. STIMULUS ATTRIBUTES il. An item will consist of a statement about a possible effect of exercise. These effects will pertain to the areas of body image, coordination, strength, social acceptability, self-concept, ability to manage stress, and health. 2. The inventory will contain a proportionate number of items about each of the possible effects, with equal representation of the possibilities of exercise having a positive consequence and exercise having no impact or a negative effect. 3. Each statement will be 18 words or less in length. The words used will not exceed the fourth grade level on the IOX Basic Skills Word List, except for the follow- ing words: awkward, clumsy. -355- RESPONSE ATTRIBUTES 1. The following three response options will be available for each item: YES = 1 agree 3 MAYBE = I am not sure if I agree NO = I do not agree Children are to use the response options to indicate the extent to which their beliefs about the effects of exercise are properly represented in an item's statement. Children circle their response to the left of each item. SCORING AND INTERPRETATION Te The rationale underlying this measure is that children who believe in the positive effects of exercise on body image, coordination, strength, social accept- ability, self-concept, ability to manage stress, and health will more frequently (a) agree with statements which describe a positive consequence of exercise and (b) disagree with statements which describe exercise as having no impact or a negative effect. i Point values are assigned to items according to whether the consequence of exercise is seen as positive or non- positive (i.e., neutral or negative). Items which describe a positive effect of exercise are assigned the following values: YES = 2 points, MAYBE = 1 point, NO = 0 point. Items which describe a non-positive effect of exercise are assigned the following values: YES = 0 point, MAYBE = 1 point, NO = 2 points. High scores indicate a strong belief in the positive effects of exercise on body image, coordination, strength, social acceptability, self-concept, ability to manage stress, and health. MEASURE FORMAT 1. The following plan indicates the key characteristics of the "Effects of Exercise" inventory developed from these test specifications. -356- Item ft QVOVONCUbhWN HH = = a a wn Area of Effect Stress management Coordination Health Strength Social acceptability Self-concept: Strength.. Body image Social acceptability Stress management Body image Coordination Health Self-concept " wB Exercise Perceived as Positive Yes No Yes No No Yes Yes Yes Yes No No Yes No No TEST SPECIFICATIONS EXERCISING REGULARLY GENERAL DESCRIPTION This measure is designed to assess individuals' perceived self-efficacy in being able to exercise regularly. Indi- viduals are presented with a series of situations which might promote or serve as barriers to regular exercise and asked to indicate if they can exercise regularly in each situation. If they indicate that they can exercise regularly, then they are asked to estimate, on a 10 to 100 numerical scale, how confident they are of their ability to exercise regularly in that situation. SAMPLE ITEM This survey is about exercising regularly in various situations. Regular exercise requires 20 minutes or more of strenuous activity at least three times per week. Read each statement. Circle YES or NO to show if you could exercise regularly in that situation. If you circle YES, then use the Confidence Scale to show how certain you are of your answer. The following examples show how the Confidence Scale is used. IF YES, CAN YOU HOW CERTAIN Physical Strength Examples DO THIS? ARE YOU? You can lift a 50 pound weight. (ESyNO 70 You can lift a 200 pound weight. YES{NO) Confidence Scale 10 20 30 40 50 60 70 80 90 100 Very Somewhat Very Uncertain Certain Certain IF YES, CAN YOU HOW EXERCISE CERTAIN REGULARLY? ARE YOU? x. You are on a vacation. YES/NO -358- STIMULUS ATTRIBUTES 1. An item will describe a situation which might either promote or serve as a barrier to regular exercise. The item will be written in second person and will refer to someone's participation or feelings in a situa- tion, for example, "You feel overworked." The situations presented in test items will involve, directly or indirectly, time or financial constraints, availability of facilities or equipment, fear of injury, perceived lack of knowledge or ability, change in routine, social support, environmental conditions, or emotional or physical state. Situations will be selected to be applicable to most individuals. For example, a situation describing an individual's being busy because of a job will not be used because potential respondents might not hold jobs. Situations in which individuals are generally busy, however, would be appropriate. Each item will be 20 words or less in length. The words used will not exceed the eighth grade level of the I10X Basic Skills Word List. RESPONSE ATTRIBUTES 1. 2. For each item, two response opportunities are available, a YES/NO answer and a confidence rating. Respondents are to use the YES/NO option to indicate whether they can exercise regularly in the situation given. If respondents answer YES to an item, they are then to indicate how confident they are that they can exercise regularly in the situation described by selecting a number from the following confidence scale: Confidence Scale 10 20 30 40 50 60 70 80 20 100 Very Somewhat Very Uncertain Certain Certain -359- SCORING AND INTERPRETATION 1. The rationale underlying this measure is that the more often respondents indicate that they can, with a high degree of confidence, exercise regularly, the stronger the perceived self-efficacy of those respondents in being able to exercise regularly. This inventory can be scored in several ways, two of which are described here. In the first procedure, the number of YES responses is used as a gross index of an individual's perceived ability to exercise regularly. The more YES responses, the more situations in which individuals believe that they can exercise regularly. A combined analysis of YES/NO responses and confidence ratings allows for a more complete assessment of program effectiveness, as it incorporates both sources of infor- mation in a single index. This analysis is accomplished by computing the mean strength of the rated ability across all items; that is, by dividing the sum of the confidence ratings made in conjunction with "YES" res- ponses by the number of items in the questionnaire. High scores reflect a strong perceived ability to exercise regularly across a variety of settings, along with a high level of confidence in that ability. -360- TEST SPECIFICATIONS EXERCISE SURVEY GENERAL DESCRIPTION This measure is designed to assess the extent to which indi- viduals intend to exercise regularly. Individuals are asked whether they intend to exercise regularly for the next 12 months, If individuals indicate that they intend to exer- cise regularly for the next 12 months, then they are asked to estimate, on a 10 to 100 numerical scale, the strength of their intention. SAMPLE ITEM This survey asks about your intention to exercise regularly. Regular exercise requires 20 minutes or more of strenuous activity at least three times per week. Please answer Question 1. If your answer to Question 1 is "YES," please answer Question 2. i 1. Do you intend to exercise regularly for the next 12 months? (Circle One) YES NO STIMULUS ATTRIBUTES 1. This measure consists of two items that, in conjunction, elicit whether respondents intend to exercise regularly for the next 12 months and, if so, the strength of that intention. ND The words used will not exceed the eighth grade level on the I0X Basic Skills Word List. RESPONSE ATTRIBUTES 1. Respondents circle YES or NO to indicate whether they intend to exercise regularly for the next 12 months. -361- If respondents indicate that they intend to exercise regularly for the next 12 months, they are then to indi- cate the strength of their intention, using the follow- ing scale: 10 20 30 40 50 60 70 80 90 100 Very Very Weak Strong Individuals circle the appropriate response to each question.’ SCORING AND INTERPRETATION 1. The rationale underlying this measure is that respon- dents who indicate they have a strong intention to exercise regularly are more likely to engage in activi- ties that promote physical fitness. Point values are assigned to items according to the degree of intention of respondents to exercise regularly, as follows: YES = 1, NO = 0. Point values on the strength of intention .scale are the numerical values of the responses. High scores indicate a strong intention to exercise regularly. -362~ TEST SPECIFICATIONS IDEAS ABOUT SYSTEMATIC DECISION-MAKING GENERAL DESCRIPTION This inventory is a Likert scale in which respondents are asked to register their degree of agreement with a series of statements about making decisions systematically. SAMPLE ITEM This survey is about making decisions systematically. Please respond to all the statements in the survey. Read each statement. Decide the extent to which you agree with it. Circle the appropriate letter to the left of the statement. Use the following scale: SA = Strongly Agree A = Agree U = Uncertain D = Disagree SD = Strongly Disagree SA A UD SD 1, Systematic decision-making takes too much time. STIMULUS ATTRIBUTES 1. 2. The inventory will contain an equal which systematic decision-making is and items in which systematic decision-making is seen as negative or as being of no advantage. An item will consist of a statement about the utility of making decisions systematically. Each statement will be 25 words or less in length. words used will not exceed the eighth grade level on the IOX Basic Skills Word List, ing word: systematic. -363- number of items in seen as positive except for the follow- RESPONSE ATTRIBUTES 1. The following five response options will be available for each item: SA = Strongly Agree A = Agree U = Uncertain D = Disagree SD = Strongly Disagree Respondents are to use the response options to indicate the extent to which their beliefs about systematic decision-making are properly represented in an item's statement. Respondents circle the letter of their response to the left of each item. SCORING AND INTERPRETATION 1. The rationale underlying this measure is that respondents who believe in the utility of making decisions systematic- ally will more frequently (a) agree with positive statements about systematic decision-making and (b) disagree with negative statements about systematic decision-making or statements that describe it as being of no advantage. Point values are assigned to items according to whether systematic decision-making is seen as positive or non- positive (i.e., neutral or negative). Items that present a positive statement about systematic decision- making are assigned the following values: SA = 5 points, A = 4 points, U = 3 points, D = 2 points, SD = 1 point. Items that present a non-positive statement about systematic decision-making are assigned the following values: SA = 1 point, A = 2 points, U = 3 points, D = 4 points, SD = 5 points. High scores indicate a strong belief in the utility of making decisions systematically. -364- MEASURE FORMAT 1s The following plan indicates the key characteristics of the "Ideas About Systematic Decision-Making" inventory developed from these test specifications. Systematic Item Decision-Making i Yes 2 No 3 Yes 4 No 5 No 6 Yes 7 No 8 Yes 9 No 10 Yes 11 No 12 Yes 33 Yes 14 No 15 No 16 Yes 17 No 18 Yes 19 Yes 20 No -365- TEST SPECIFICATIONS IDEAS ABOUT DECISIONS GENERAL DESCRIPTION This inventory is a Likert scale in which children are asked to register their degree of agreement with a series of statements about systematic decision-making. SAMPLE ITEM The statements below are about making decisions. Circle the word that shows how much you agree with each statement. YES = I agree MAYBE = I am not sure if I agree NO = I do not agree YES MAYBE NO 3. It is worth the time to make decisions carefully. STIMULUS ATTRIBUTES 1s An item will consist of a statement about the utility of making decisions systematically. 2. The inventory will contain an equal number of (a) items in which systematic decision making is seen as positive and (b) items in which systematic decision-making is seen as negative or as being of no advantage. 3. Each statement will be 20 words or less in length. The words used will not exceed the fourth grade level on the IOX Basic Skills Word List, except for the follow- ing word: decision. RESPONSE ATTRIBUTES 1; The following three response options will be available for each item: YES = I agree MAYBE = I am not sure if I agree NO = I do not agree -366- Children are to use the response options to indicate the extent to which their beliefs about systematic decision-making are properly represented in an item's statement. Respondents circle the word of their response to the left of each item. SCORING AND INTERPRETATION 1. The rationale underlying this measure is that respon- dents who believe in the utility of making decisions systematically will more frequently (a) agree with positive statements about systematic decision-making and (b) disagree with negative statements about system- atic decision-making or statements that describe it as being of no advantage. Point values are assigned to items according to whether systematic decision-making is seen as positive or non-positive (i.e., neutral or negative). Items that present a positive statement about systematic decision- making are assigned the following values: YES = 2 points, MAYBE = 1 point, NO = 0 points. Items which present a non-positive statement about systematic decision-making are assigned the following values: YES = 0 points, MAYBE = 1 point, NO = 2 points. High scores indicate a strong belief in the utility of making decisions systematically. MEASURE FORMAT 1. The following plan indicates the key characteristics of the "Ideas About Decisions" inventory developed from these test specifications. Systematic Item Decision-Making Yes No Yes No No No Yes No Yes Yes CQO WN — -367- TEST SPECIFICATIONS WOULD YOU USE SYSTEMATIC DECISION-MAKING? GENERAL DESCRIPTION This measure is designed to assess the extent to which indi- viduals intend to use systematic decision-making. Indi- viduals are asked whether they would use systematic decision- making in a variety of situations. If individuals indicate that they would use systematic decision-making, they are asked to estimate, on a 10 to 100 numerical scale, how confident they are of their intention. SAMPLE ITEM This survey describes situations in which people might use systematic decision-making. Read each statement. Circle Yes or No to indicate whether you would use systematic decision-making im the situation described in the item. If you circle Yes, then use ‘the Confidence Scale to show how certain you are that you would use systematic decision-making in that situation. The following examples show how the Confidence Scale is used. WOULD YOU USE IF YES, SYSTEMATIC HOW DECISION- CERTAIN MAKING? ARE YOU? 1. You are deciding on a career. NO q0 2. You are choosing where to eat lunch. (IES)NO Jo 3. You are swerving to avoid a car accident. YESINO) Confidence Scale 10 20 30 40 50 60 70 80 920 100 Very Somewhat Very Uncertain Certain Certain WOULD YOU USE IF YES, SYSTEMATIC HOW CERTAIN SITUATION DECISION-MAKING? ARE YOU? i. You are deciding whether to start an exercise program. YES/NO -368- STIMULUS ATTRIBUTES 1. 2. A test item will consist of a description of a situa- tion in which a decision is being made. Situations will involve either health-related decisions (e.g., choosing a diet), or situations in which there is external pressure to make a decision (e.g., being rushed by others to make a decision). All situations will be applicable to most individuals. For example, an item describing an individual's making a decision while busy because of a job will not be used because potential respondents might not hold jobs. Items in which individuals are generally busy, however, would be appropriate. Each item will be written in the second person and will be 20 words or less in length. The words used will not exceed the eighth grade level of the IOX Basic Skills Word List, except for the following word: stress. RESPONSE ATTRIBUTES 1s 2. For each item, two response opportunities are available, a YES/NO answer and a confidence rating. Respondents are to use the YES/NO option to indicate whether they intend to use systematic decision-making in the situation described in the item. If respondents answer YES to an item, they are then to indicate how confident they are that they would use systematic decision-making in the situation, using the following Confidence Scale: Confidence Scale 10 20 30 40 50 60 70 80 20 100 Very Somewhat Very Uncertain Certain Certain SCORING AND INTERPRETATION iz The rationale underlying this measure is that the more situations in which respondents indicate that they intend, with a high degree of confidence, to use system- atic decision-making, the stronger the overall intention of those respondents to use systematic decision-making. -369- This measure can be scored in several ways, two of which are described here. In the first procedure, the number of YES responses is used as a gross index of an individual's intention to use systematic decision- making. The more YES responses, the more situations in which an individual intends to use systematic decision-making. A combined analysis of YES/NO responses and confidence ratings allows for a more complete assessment of program effectiveness, as it incorporates both sources of infor- mation in a single index. This analysis is accomplished by computing the mean strength of the confidence ratings across all items, that is, by dividing the sum of the confidence ratings made in conjunction with "YES" responses by the number of items in the measure. High scores reflect a strong intention to use systematic decision-making in a variety of situations. -370- TEST SPECIFICATIONS WOULD YOU MAKE CAREFUL DECISIONS? GENERAL DESCRIPTION Children are asked whether they would make a careful deci- sion in a variety of situations. They are then asked to select the response that best describes their intentions. SAMPLE ITEM Read each question. Then put a check ( Vv) under the answer that best tells if you would make a careful decision. Would you make a careful deci- CERTAINLY PROBABLY PROBABLY CERTAINLY sion when... YES YES MAYBE NOT NOT i. ese yOu are deciding how to relax? STIMULUS ATTRIBUTES de An item will specify a situation in which a decision is being made, and will require children to indicate if they would make a careful decision in that situation. 2. Situations will involve either health-related decisions (e.g., deciding whether to smoke cigarettes), or situa- tions in which there is external pressure to make a decision (e.g., being rushed to decide quickly). 3 Activities will be selected to be applicable to most children. For example, an activity such as choosing a team sport to play will not be used because potential respondents might not enjoy team sports. Activities in which individuals are choosing a way to exercise, however, would be appropriate. -371- Each item will be 15 words or less in length. The words used will not exceed the fourth grade level of the IOX Basic Skills Word List, except for the follow- ing words: alcohol, cigarettes, drugs, relax. RESPONSE ATTRIBUTES 1. The following five response options will be available for each item: CERTAINLY YES, PROBABLY YES, MAYBE, PROBABLY NOT, and CERTAINLY NOT. Children are to use the response options to indicate their intention to make a careful decision in the specified situation. Respondents place a check in the appropriate space to the right of each item. SCORING AND INTERPRETATION 1. The rationale underlying this measure is that the more situations in which children indicate that they intend to make careful decisions, the stronger the overall intention of those children to use systematic decision- making. Point values are assigned to items according to the certainty with which respondents indicate that they intend to make careful decisions, as follows: CERTAINLY YES = 5, PROBABLY YES = 4, MAYBE = 3, PROBABLY NOT = 2, CERTAINLY NOT = 1. High scores indicate a strong intention to use system- atic decision-making in a variety of situations. -372-~ TEST SPECIFICATIONS MY BODY GENERAL DESCRIPTION This measure is designed to assess children’s respect for their bodies. Children are asked to indicate whether they would engage in activities that are healthful and avoid activities that are harmful to the body. SAMPLE ITEM Read each question. Then put a check ( Vv) under the answer that best tells what you are willing to do to take care of your body. In order to take care of your body, are you willing CERTAINLY PROBABLY PROBABLY CERTAINLY tO eee YES YES MAYBE NOT NOT ie «ss Exercise several times each week? STIMULUS ATTRIBUTES 1. An item will specify a healthful activity or the avoid- ance of a harmful activity. Individuals are to indicate if they would be willing to take care of their bodies even if it means engaging in the healthful activity or avoiding the harmful activity. 2. The activities presented in the test items will be important to maintaining healthy bodies. These activ- ities will include exercising; getting adequate rest; avoiding cigarettes, alcohol, and unnecessary drugs; following doctor's orders; seeing a doctor regularly; obtaining immunizations; eating properly; and avoiding unnecessary stress. -373- Each item will be 10 words or less in length. The words used will not exceed the fourth grade level on the IOX Basic Skills Word List, except for the follow- ing words: alcohol, cigarettes, diseases, immunizations. RESPONSE ATTRIBUTES 1. The following five response options will be available for each item: CERTAINLY YES, PROBABLY YES, MAYBE, PROBABLY NOT, and CERTAINLY NOT. Children are to use the response options to indicate their willingness to take care of their bodies in the specified manner. Respondents are to place a check in the appropriate space to the right of each item. SCORING AND INTERPRETATION 1. The rationale underlying this measure is that the more often children indicate that they are willing, with certainty, to take care of their bodies by engaging in healthful activities and avoiding harmful ones, the stronger their respect for their bodies. Point values are assigned to items according to the certainty of the children in being willing to take care of their bodies, as follows: CERTAINLY YES = 5 points, PROBABLY YES = 4 points, MAYBE = 3 points, PROBABLY NOT = 2 points, CERTAINLY NOT = 1 point. High scores indicate a strong respect for one's body, as evidenced by a willingness to engage in activities that are healthful and to avoid those that are not. -374- ANNOTATED EVALUATION BIBLIOGRAPHY (1) American Psychological Association. Ethical principles in the conduct of research with human participants. Washington, D.C.: Author, 1973. Thie treatise focuses on the appropriateness of carry- ing out various types of research investigations with human subjects. Because the American Psychological Association has had a long-standing concern about ethical issues in the conduct of research investiga- tions, this publication will be of interest to numerous evaluators of health education programs. (2) American Psychological Association, American Educational Research Association, National Council on Measure- ment in Education. Standards for educational and psychological tests. Washington, D.C.: Author, 1974. This soon~to-be-revised volume presents the most widely used set of standards for psychological and educational tests. Frequently cited by users of educational tests, the standards have recently been employed in numerous Judicial deliberations. Relatively brief, the standards should be consulted by health educators who employ assessment devices regularly. (3) Anderson, L.W. Assessing affective characteristics in the schools. Boston: Allyn and Bacon, 1981. Anderson provides an excellent set of practical sugges- tions for the creation of affective assessment instru- ments. He includes ome of the most easily understood expositions of various scaling procedures including Likert, Thurstone, and Guttman scales. (4) Berk, R.A. (Ed.) Criterion-referenced measurement: the state of the art. Baltimore: The Johns Hopkins University Press, 1980. This collection of essays consists of papers presented at the first Johns Hopkins University National Symposium on Educational Research. The authors treat many of the important problems, both conceptual and technical, facing developers and users of eriterion-referenced measures. -375- (5) Berk, R.A. (Ed.). Handbook of methods for detecting test bias. Baltimore: The Johns Hopkins University Press, 1982. Thies collection of individual essays offers the reader an up-to-date depiction of methods currently available to detect the presence of bias in tests. (6) Campbell, D.T., & Stanley, J.C. Experimental and quasi-experimental designs for research. Chicago: Rand McNally, 1966. This volume, originally a chapter in a larger volume, has had substantial impact on the fields of research and evaluation. Evaluators of health education programs will wish to consider this truly classic treat- ment of data-gathering designs suitable for experimental and quasi-experimental settings. (7) Churchill, G.A., Jr. Marketing research: methodological foundations (2nd ed.). Hinsdale, Ill: The Dryden Press, 1979. Although written in the context of marketing research, this textbook covers several topics of vital importance in evaluation. Topics such as research design, data collection, sampling, and data analysis are covered in a readily understandable yet accurate way. An excellent resource. (8) Cohen, J. Statistical power analysis for the behavioral sciences (Rev. ed.). New York: Academic Press, 1977. Cohen offers a useful treatment of factors whieh should be considered when one draws samples for use in research or evaluation activities. Of special interest is the set of easy-to-use guidelines he offers for determining the estimated sample size necessary to detect differences between groups. (9) Cook, T.D., % Campbell, D.,T. The design and conduct of quasi-experiments and true experiments in field settings. In M.D. Dunnette (Ed.), Handbook of industrial and organizational psychology. Chicago: Rand McNally, 1976. This is an updated version of the famous exposition of quasi-experimental and experimental data-gathering designs by Donald T. Campbell and Julian C. Stanley (see Reference No. 6). An excellent discussion of four types of validity is featured in this essay. -376- (10) Cook, T.D., & Campbell, D.T. Quasi-experimentation: design & analysis issues for field settings. Chicago: Rand McNally, 1979. This widely cited volume provides a comprehensive treat- ment of quasi-experimental investigations in settings of substantial relevance to the concerns of health educators. There are excellent discussions of internal and external validity, including the various threats to both types of validity. A systematic consideration of the commonly used data-gathering designs is offered, including an extended appraisal of interrupted time- series designs. (11) Cronbach, L.J. Course improvement through evaluation. Teachers College Record, May 1963, 64, 672-683. An early piece, presenting the virtues of what would later be termed "formative" evaluation. This article rings as true today as it did nearly two decades ago, and it applies as much to evaluation in health education as it does to more traditional evaluation. Emphasizing the role of evaluation in gathering information that can improve programs, this article is well worth reading. (12) Cronbach, L.J., and associates. Toward reform of program evaluation. San Francisco: Jossey-Bass, 1981. A recent publication, this book considers the function of evaluation in a pluralistic society and presents 95 theses on the role of evaluators and evaluations. In addition to providing a contemporary conception of evaluation, it provides a historical and multidiscipli- nary perspective on the field. This volume will be of considerable interest to those evaluating health educa- tion programs. (13) Cronbach, L.J., et al. Analysis of covariance in nonrandomized experiments: parameters affecting bias. Unpublished occasional paper, Stanford Evaluation Consortium, Stanford University, 1977. A highly technical piece on the complications associated with using analysis of covariance, this article 18 recommended only for those prepared to handle a eritical problem in a sophisticated way. -377- (14) Cronbach, L.Jd., % Furby, L. How should we measure 'change' - or should we? Psychological Bulletin, 1970, 74, 68-80. A technical treatise on the dangers associated with using gain scores. A very significant piece, but recommended only for those with some psychometric training. (15) Ebel, R.L. Essentials of educational measurement (3rd ed.). Englewood Cliffs, N.J.: Prentice-Hall, 1979. This is a standard, easily read introductory text, covering important topics in the field of educational testing. Ebel, a prominent leader of traditional educational testing practices, provides a lucid treatment of a wide range of measurement topics. (16) Green, L.W. Research methods translatable to the practice setting: from rigor to reality and back. In S. Cohen (Ed.) New directions in patient com- pliance. Lexington, Mass.: Lexington Books, 1979. Green deals with a practical dilemma facing those who evaluate health education programs, namely, the necessity to make trade-offs between validity and feasibility in field settings. Six strategies for coping with evaluation under adverse circumstances are described. (17) Green, L.W., & Figé&-Talamanca, I. Suggested designs for evaluation of patient education programs. Health Education Monographs, September 1974, 2 (1). In thie essay Green and Figda-Talamanca suggest data- gathering designs for conducting evaluations of patient education programs. The authors also explore several igsues related to evaluations of this variety. (18) Hambleton, R.K. et al. Criterion-referenced testing and measurement: a review of technical issues and development. Review of Educational Research, Winter 1978, 48 (1), 1-48. This is a comprehensive review of the field of eriterion- referenced testing. Hambleton and his colleagues do a masterful job of isolating the key issues in criterion- referenced testing, then deseribing results of research investigations bearing on those issues. Somewhat technical at times, this review is ome of the more widely cited essays dealing with criterion-referenced testing. -378- (19) Hays, W.L. Statistics for the social sciences (2nd ed.). New York: Holt, Rinehart, and Winston, 1973. A comprehensive text dealing with basic and advanced statistical considerations. Somewhat technical at points, Hays nonetheless provides an excellent set of step-by-step guidelines to statistical practice. (20) Hull, C., & Nie, N.H. Statistical packages for the social sciences (SPSS). New York: McGraw-Hill, 1978. This is a widely used, well organized set of "eanned" computer analysis programs for use in the social sciences. Health educators who have occasion to uge computer analyses will find the SPSS manual most helpful. (21) Joint Committee on Standards for Educational Evaluation. Standards for evaluations of educational programs, projects, and materials. New York: McGraw-Hill, 1981, The development of these evaluation standards was spearheaded by a joint committee of the American Educational Research Association, the American Pgychological Association, and the National Council on Measurement in Education. Thirty standards are presented, addressing issues related to deciding whether to evaluate, defining the evaluation problem, designing the evaluation, budgeting for the evaluation, collecting and analyzing data, and reporting the evalua- tion. Intended for both consumers of evaluation and individuals conducting evaluations, this reference may be of most use to evaluators who are relatively new to the field. (22) Levin, H.M. Cost-effectiveness analysis in evaluation research. In M. Guttentag & E.L. Struening (Eds.), Handbook of evaluation research (Vol. 2). Beverly Hills, CA.: Sage, 1975. This essay probes the important considerations involved in determining cost-effectivenecss of programs in the con- text. of educational evaluations. Theoretical as well as practical guidelines are provided. -379- (23) Linn, R.L., & Slinde, J.A. The determination of the significance of change between pre- and post- testing periods. Review of Educational Research, 1977, 47, 121-150. This article reviews many of the major issues in the measurement of change from pretesting to posttesting periods and suggests possible alternatives. These authors share the general sentiment of many others in the field that, "more is expected from gain scores than they can reasonably be expected to provide.” (24) Lord, F.H. Elementary models for measuring change. In C.W. Harris (Ed.), Problems in measuring change. Madison: Wisconsin Press, 1963. An early treatise on the problems associated with measuring change. Although this chapter rapidly becomes very technical, the early sections provide an intuitive explanation of the difficulties with using gain scores. (25) Oakland, T. (Ed.) Psychological and educational assessment of minority children. New York: Brunner /Mazel, 1977. This collection of essays provides a series of useful suggestions for those who would become more sensitive to the possible bias present in educational tests. (26) Popham, W.J. Educational evaluation. Englewood Cliffs, N.J.: Prentice-Hall, 1975. This is an introductory text, written in fairly non- technical language, about the field of educational evaluation. Evaluators of health education programs will find it simple to translate the book's contents to their own specialties. (27) Popham, W.J. Modern educational measurement. Englewood Cliffs, N.J.: Prentice-Hall, 1981, This is an up-to-date treatment of varied topics in the field of educational measurement. Norm-referenced measurement and eriterion-referenced measurement are both considered, with the special applications of eriterion-referenced assessment emphasized. Chapters on the relationship of testing to teaching and the measurement of affect will be of special interest Bo health educators. -380- (28) Popham, W.J., & Sirotnik, K.A. Educational statistics: use and interpretation (2nd ed.). New York: Harper and Row, 1973. Thie 18 an easily read introductory text dealing with the fundamental types of statistical considerations needed by program evaluators. It is intended for those who are not particularly comfortable with mathematical approaches to statistics. (29) Riecken, H.W., & Boruch, R.F. Social experimentation: a method for planning and evaluating social inter- vention. New York: Academic Press, 1971. This significant contribution to our thinking about large- scale social interventions, their design and appraisal, provides a useful analysis of the ways that the experi- mental method can be defensibly employed in connection with major social programs. (30) Rivlin, A.M., & Timpane, P.M. (Eds.). Ethical and legal issues in social experimentation. Washington, D.C.: Brookings Institution, 1975a. Rivlin and Timpane explore the sorts of legal and ethical issues to which evaluators of health education programs must attend. (31) Scriven, M. The methodology of evaluation. In R.E. Stake and others (Eds.), Perspectives on curriculum evaluation. Chicago: Rand McNally, 1967. This seminal article was the first essay in which Seriven distinguished between the now commonly accepted formative and summative roles of evaluators. Seriven ranges over a wide variety of topics, emphasizing the importance of comparative appraisals of two or more programs' merits. (32) Scriven, M. Prose and cons about goal-free evaluation. Evaluation Comment, 1972, 3, 1-4. In this essay Seriven offers goal-free evaluation as an antidote to excessive preoccupation with the program staff's expressed objectives. Seriven argues that evaluators should attend to the results produced by a program, not the rhetoric of its program goals. -381- (33) Siegel, S. Nonparametric statistics for the behavioral sciences. New York: McGraw-Hill, 1956. This 18 the classic treatment of nonparametric statistical techniques. Although a bit out of date these days, Siegel's text offers the most easily understood treatment of nonparametric statistical procedures. Because of the author's admitted zealousness im support of nomparametric techniques, those using Siegel's text should also consult a eritique of it by Robert Savage, Journal of American Statistical Association, 52 (September 1957): 331-344. (34) Suchman, E.A. Evaluative research: principles and practice in public service and social action programs. New York: Russell Sage Foundation, 1967. In this volume, Suchman provides extensive coverage of the application of the experimental research model in conduct- ing evaluations. Although evaluation has come a long way since thie book wag written, the volume provides a clear description of the predominant conceptualization of evalua- tion in the past decade. (35) Tukey, J.W. Exploratory data analyses. Reading, Mass.: Addison-Wesley, 1977. Creative approaches to displaying and understanding data are provided by Tukey in this excellent demystification of data analysis. (36) Webb, E.J., Campbell, D.T., Schwartz, R.D., Sechrest, L., & Grove, J.B. Nonreactive measures in the social sciences (2nd ed.). Dallas: Houghton Mifflin, 1981. This charming volume provides readers with a series of powerful and clever tactics to secure data, particularly of an affective nature, without sensitizing respondents to the evaluator's purposes. (37) Weiss, C.H. Evaluation research: methods of assessing program effectiveness. Englewood Cliffs, N.dJ.: Prentice-Hall, 1972. Weiss offers a pithy overview of prominent program evalua- tion considerations including the formulation of questions to be addressed, the design of the evaluation study, and the utilization of evaluation results. A paperback, thie brief book (160 pp.) offers an excellent introduction to what Weiss refers to as "evaluation research.” -382- (38) Worthen, B.R., & Sanders, J.R. Educational evaluation: theory and practice. Worthington, Ohio: C.A. Jones 1973. This volume was one of the earliest compilations of various program evaluation models applied to education. Evalua- tion theorists whose views are presented in this book inelude Stake, Cronbach, Seriven, Tyler and others. Worthen and Sanders have authored sections of the book and have included a series of original chapters by a number of evaluation specialists. While focused on educational evaluation in general, the volume is of substantial rele- vance to program evaluation of health education programs. (39) Zdep, S.M., & Rhodes, I.N. Making the randomized response technique work. (Reprinted from The Public Opinion Quarterly, Winter 1976-1977, 41.) Thie easily read essay describes the randomized response technique, a procedure used to obtain sensitive informa- tion from respondents more accurately than if respondents were directly asked about sensitive information. -383- -384- INDEX OF HANDBOOK MEASURES Page AAHPER Cooperative Physical Education Tests 213 Avoiding Injury 85 Canada Fitness Survey - Physical Activities 186 Decision-Making 111 Designing an Exercise Program 77 Effects of Exercise 153 Exercise and People 157 Exercise Facts 74 Exercise Questionnaire 251 Exercise Survey 165 Exercising Regularly 161 Exercising Safely 106 Facts About Exercise 70 Health Attitudes 253 Ideas About Decisions 172 Ideas About Systematic Decision-Making 168 Injury Prevention 81 Make A Decision 146 Making Decisions ; 139 Marten's Physical Education Attitude Scale 245 Measuring the Body's Energy Needs 212 My Body 182 Physical Activity Monitor 197 Preventing and Caring for Injuries 99 Questionnaire on Exercise 191 Selecting an Exercise Program 89 Seven Day Physical Activity Recall 199 Standardized Test of Fitness (STF) 214 Systematic Decision-Making 122 University of Pennsylvania Alumni Health Questionnaire 193 Weekly Activities Index 67 Would You Make Careful Decisions? 179 Would You Use Systematic Decision-Making? 175 -385- 11.5. 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