Content uploaded by J.D. Benítez Sillero
Author content
All content in this area was uploaded by J.D. Benítez Sillero on Sep 15, 2020
Content may be subject to copyright.
Available via license: CC BY 4.0
Content may be subject to copyright.
International Journal of
Environmental Research
and Public Health
Review
Physical Fitness, Exercise Self-Efficacy, and Quality of
Life in Adulthood: A Systematic Review
María del Rocio Medrano-Ureña 1, Rosario Ortega-Ruiz 2and Juan de Dios Benítez-Sillero 3, *
1Faculty of Education Sciences, University of Córdoba, Avenida San Alberto Magno, s/n, 14071 Córdoba,
Spain; z62meurm@uco.es
2
Psychology Department, Faculty of Education Sciences, University of C
ó
rdoba, Avenida San Alberto Magno,
s/n, 14071 Córdoba, Spain; ortegaruiz@uco.es
3Department of Specifics Didactics, Faculty of Education Sciences, University of Córdoba Avenida San
Alberto Magno, s/n, 14071 Córdoba, Spain
*Correspondence: eo1besij@uco.es; Tel.: +34-652249669
Received: 28 July 2020; Accepted: 26 August 2020; Published: 31 August 2020
Abstract:
Background: The aim of the present work is the elaboration of a systematic review of existing
research on physical fitness, self-efficacy for physical exercise, and quality of life in adulthood. Method:
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement
guidelines, and based on the findings in 493 articles, the final sample was composed of 37 articles,
which were reviewed to show whether self-efficacy has previously been studied as a mediator in the
relationship between physical fitness and quality of life in adulthood. Results: The results indicate that
little research exists in relation to healthy, populations with the majority being people with pathology.
Physical fitness should be considered as a fundamental aspect in determining the functional capacity
of the person. Aerobic capacity was the most evaluated and the 6-min walk test was the most used.
Only one article shows the joint relationship between the three variables. Conclusions: We discuss the
need to investigate the mediation of self-efficacy in relation to the value of physical activity on quality
of life and well-being in the healthy adult population in adult life.
Keywords: physical fitness; exercise self-efficacy; quality of life; adulthood
1. Introduction
Today’s developed society is subject to great changes, not always of a positive nature, some of
which seem to impact health, well-being, and especially the prolongation of life. Staying healthy is
important and has an impact on healthy lifestyle [1].
1.1. Quality of Life in Adulthood
Adulthood is a period of the life cycle that differs widely due to socio-economic, labor, and cultural
conditions. Although it can cover a wide range of ages, current scientific convention specifies an age
span that begins between the ages of 40–45 and ends between the ages of 60–65, at which point we
can speak of the beginning of old age [
2
,
3
]. During the process of adult maturity, important body
changes take place or have already taken place, such as menopause and andropause, which involve
diverse psychological impacts and, frequently, physiological changes. A loss of bone mass, for example,
reduces the strength of the body, making it more vulnerable an injury or disease in daily life [
4
,
5
].
People are not always aware of these changes [
6
–
10
]. Recently, although there seems to be some
interest among the population in understanding the keys to maintaining health and quality of life and
to face the decline or deterioration that occurs in old age with better physical and mental health [
11
],
the sedentary life continues to affect a wide range of the adult population [12].
Int. J. Environ. Res. Public Health 2020,17, 6343; doi:10.3390/ijerph17176343 www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2020,17, 6343 2 of 19
1.2. Active Life as a Quality of Life Enhancer
A review study [
13
] indicated that moderate and systematic physical activity is one of the factors
that most affects quality of life. During childhood and adolescence, physical activity is academically
programmed, and the habit of physical activity is regulated by schooling, with varying degrees of
effectiveness and quality. In old age, health systems and community medicine usually incorporate
guidelines that recommend moderate physical activity, with advice on the value of walking, swimming,
or going to gyms and social health centers. These efforts, sometimes, are not always successful.
However, during the mature adult years [
14
] that precede old age, the adult population seems to be
under pressure from work and family responsibilities, leaving little time for personal attention to
preventive health and well-being needs. Some research [
15
] has revealed the challenge of practicing
physical activity or sport in this period of the life cycle. The responsibilities of early adulthood are
self-regulated by the experience and years of mature adulthood, and it is at this stage that the practice
of physical activity and/or sport for optimal fitness becomes a challenge, because it is known to benefit
the individual’s overall health [16,17].
1.3. Physical Fitness as an Indicator of Quality of Life
Related to active living and physical exercise is the concept of physical fitness, a well-known
and powerful health marker [
18
–
20
] among middle-aged populations, it is even more powerful than
physical activity [
7
] but we must understand physical fitness as a concept broader than one related
exclusively to biological health; it can be defined as the ability to carry out daily tasks with vigor and
liveliness, without excessive fatigue, and with enough energy remaining to enjoy leisure time or to cope
with unexpected emergencies [
21
]. Therefore, in addition to being related to biological health, physical
fitness is also closely related to psychosocial factors on the human spectrum and has been found to
influence fitness parameters [
22
]. However, few studies present data associating physical fitness in
adults with it is psychosocial benefits. It is known that, as a method of achieving general well-being,
physical fitness has a large regulated role in the negative relationship between the sedentary life and
quality of life [
23
]. Thus, knowing the levels of physical fitness can be an important tool in providing
specific advice to the population in relation to their well-being [24].
However, although it is known that physical activity and improved physical fitness generate
benefits and play a fundamental role in both biological and psychological well-being [8,10], it cannot
be taken for granted that adults currently incorporate it into their daily routines [8,10].
1.4. The Role of Self-Efficacy in Maintaining an Active Life
The self-evaluation that is carried out on one’s own activities is called self-efficacy [
25
].
Expectations of self-efficacy refer to beliefs about personal abilities and the ability to satisfactorily carry
out the necessary demands in different situations [
26
]. Losses inherent to the aging process, such as
those related to physical functioning, can affect how one believes in one’s control, or loss of control of
self-efficacy [
2
]. Fortunately, the practice of physical exercise can alleviate these consequences [
19
].
However, even though people understand the beneficial effects of healthy habits on their own bodies
and on their overall well-being and health, we are not sure if there is reciprocity between this knowledge
and the integration of physical exercise into their life routines [
27
].This may seem a paradox in relation
to classical theories of motivation towards physical exercise, which emphasize the role of rationality
in the decision-making process [
28
]. It is here that the concept of self-efficacy for physical exercise
becomes important, since it determines in part one’s motivation to practice physical activity and is one
of its most powerful predictors [29].
1.5. The Present Study
As a result of these considerations, empirical evidence suggests the important role that the
relationship between self-efficacy and the practice of physical activity and exercise performance can
Int. J. Environ. Res. Public Health 2020,17, 6343 3 of 19
play; however, the relationship and influence between self-efficacy and quality of life in terms of
physical fitness during mid-life remains relatively limited and therefore does not provide clarifying
results. Furthermore, this relationship appears to be very important if we consider that physical
fitness is a factor intimately related to well-being and quality of life, as well as a quantitative aspect of
each person’s physical functioning—functioning that declines as one ages, therefore, analysis of the
relationship between these constructs appears to be an interesting hypothesis for a systematic review.
To this end, the general objective of this study was to carry out an exhaustive review of the existing
literature delve deeper into this topic. In particular, a specific objective that was established, review the
measurement instruments for the specific variables.
2. Material and Methods
We selected articles in the PubMed, Scopus, Web of Science, PsycINFO, database presenting
research results on the relationship between quality of life, physical fitness, and exercise self-efficacy
in the adult population. They were chosen because they are the largest and most recognized base of
abstracts and bibliographic references in the scientific literature worldwide. This search and analysis
was conducted from March to October to July 2020.
We used a pattern of argument follow-up based on the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) protocol [
30
], which is recommended for the development
of bibliographies, systematic reviews, and meta-analyses, where all works included in the journals
in the Journal Citation Report (quartiles 1, 2, 3) and the SCImago Journal Rank (quartiles 1 and 2)
were examined.
The exhaustive review of each of the articles was managed according to author, title of article, year of
publication, language, URL and/or DOI of publication, indexation of the journal, publication location,
city or region of the study, number and type of sample, average age of participants, objective(s),
methodology, analyses performed, measuring instruments, and techniques used.
The search terms used were: “Exercise” and “Physical Fitness” and “Self Concept” and
“Self Efficacy” and “Quality of Life”, and a combination of these with the Boolean operator “AND”
under the guidelines of PubMed and with the filter belonging to the PubMed database itself, limiting the
age stage to “middle-aged”. The following search combinations were used: “Exercise and Physical
Fitness and Self Concept and Quality of Life”, “Exercise and Physical Fitness and Self Efficacy and
Quality of Life”, “Exercise and Exercise Test and Self Concept and Quality of Life”, “Exercise and
Exercise Test and Self Efficacy and Quality of Life”. Criteria for the inclusion of articles were: (a) the
average age of participants was within the range of 40–70 years (in the case of articles that included
this data, the criterion <70 years was accepted); (b) that they were empirical articles, or (c) they were
articles from bibliographical reviews. The screening of articles was done manually, and the selected
papers were included in a general table (see Table 1).
Table 1. Description of the item selection process.
A total of 493 articles were identified in PubMed.
455 articles were excluded: 420 were duplicates; 35 did not meet the inclusion criteria:
-Having an average age of 40 to 70 years old.
-The standard deviation marked the ages between 30–80 years old.
-They are within JCR (Q1, Q2, Q3) and SJR (Q1, Q2) magazines.
-Any language of publication
37 articles were considered for detailed evaluation.
3. Results
Figure 1presents all the articles that were selected for this systematic review. Of the 37 articles
reviewed focused on clarifying the relationship between fitness parameters and exercise self-efficacy,
32 articles were focused on populations with some type of pathology [
6
,
31
–
61
]. Five articles focused
Int. J. Environ. Res. Public Health 2020,17, 6343 4 of 19
on the pathology-free middle-aged population [
62
–
66
]. The results obtained from the articles included
in this review are shown in the Table 2section below.
Int. J. Environ. Res. Public Health 2020, 17, x 4 of 21
Figure 1. Flow diagram of article selection for the systematic review.
3.1. Results of Studies Assessing Overall Physical Fitness
Assessing physical fitness was the main objective for 12 articles, while it was secondary in 12
articles. In relation to the measurement of the instruments used, different tests have been found for
the evaluation of physical fitness, of which some are general and others, specific. On 24 occasions,
the test used was “The 6-Min Walk Test” (6MWT) that assesses aerobic endurance Self-perceived
physical fitness was assessed on 14 occasions [6,34,37,39,40,43,47,53,56,58,59,61,65,66]. “The Foot Up
and Go” test was used on six occasions [34,42,48,54,55,62]; “The Sit to Stand Test” [34,39,46,57,61,62];
“The Handgrip forced test” was used to evaluate the strength of the upper and lower body, agility
in the face of possible falls, flexibility of the upper and lower body, and dynamic balance
[39,42,46,57,61,63]. In five occasions “Treadmill Test” was used [6,45,60,63,64]. “The 10-Min Walk
Test” (10MWT) assessing endurance was used on three occasions [40,48,50]. On two occasions the
VO
2
peak was evaluated with “The Borg Rating of Perceived Exertion Scale” [45,54]; “The Naughton
Protocol” [6,47]. the “Arm Curl Test” [39,62]. In two examples these tests were used: “The test “Sit
and Reach” [62,63]; “The Grip Strength Test” [53,57]; The Activities-Specific Balance Confidence
Scale” (ABC Scale) [42,50]. On one occasion, the VO
2
peak was assessed with “the Balke Protocol”
[65]; “The Bicycle Ramp Protocol” [54]; “The Discontinuous Arm Crank” [38]; “The Submaximal
Bicycle Ergometer” [46]; “1-Repetition Maximum Free Weight Bench Press” [38]; “The Timed Stair
Climbing” [43]; “Hip Flexibility” [63]; “Functional Aerobic Impairment” (FAI) [6]; “50 Foot Flat
Surface Walking Test” [43]; “Berg Balance Scale” (BBS) [48]; “The 14-item Mini Balance Evaluation
Systems Test” (Mini-BESTest) [42]; “Well bench” [61].
3.2. Results of Studies Assessing Self-Efficacy
In 15 articles, self-efficacy was assessed as a secondary objective. On three occasions, the
following instruments were used: “The Arthritis Self- Efficacy Scale” [34,43,53]; “The 16-items
Cardiac Exercise Self-Efficacy” [6,54,55]; “ABC Scale” [42,50,66]. Furthermore, the following
instruments were used one two occasions: “The Exercise Self-Efficacy Scale” [45,46]. On one occasion
“The Self-Efficacy Questionnaire-Walking” (SEQ-W) [49] and “The chronic obstructive pulmonary
disease (COPD) Self-Efficacy Scale” [52] were used. On one occasion, the following instruments were
used: “The New General Self-Efficacy Scale” [63]; “8-ítems measure of beliefs capabilities” [65]; “The
Physical Activity Self-Efficacy” [64]; “Self-efficacy in Leisure-Time Physical Activity” (LIVAS) [39];
“Self-Rated Abilities for Health Practices Scale” (SRAHP) [38]; “Fear of Falling Efficacy Scale” (FFES)
[48]; “Self-Monitor Exercise Behavior” (SMEB) [31]; Likert Scales [62]; “General Self Efficacy Scale”
(GSES) [56]; 16-Item Heart Disease Self Efficacy Scale (HDSE) [60].
Figure 1. Flow diagram of article selection for the systematic review.
Table 2. Characteristics of the selected studies.
Participants Variables Instruments Results
Collins et al., 2004 [6]
Individuals with heart failure
N=31
Group 1: Aerobic Exercise
Program
Group 2: Control group
Age Mean: 64 ±10
Physical Fitness Variables:
Peak oxygen consumption; Functional
aerobic impairment.
Psychic Variables:
Exercise Self-efficacy: Confidence in
designated change towards exercise
behavior.
Quality of Life: Self-perceived physical
fitness; General health; Vitality; Mental
health; Physical role; Emotional role;
Social function; Body pain.
Physical Fitness: Functional Aerobic
Impairment (FAI); Naughton Treadmill Test
(TNT).
Self-Perceived Physical Fitness: SF-36
Health Questionnaire.
Significant gains in fitness levels are shown
for those who maintained exercise for 24 to
36 weeks. The exercise group has higher
levels of self-perceived fitness. After the
intervention, the group that maintained
physical exercise showed significant
improvements at 24 weeks in self-perceived
physical fitness levels.
Higher levels of self-efficacy for the
intervention group after the program.
These improvements are maintained in the
subjects who maintained the exercise.
No relationships between physical fitness
parameters and self-efficacy and/or quality
of life are found.
Exercise Self-Efficacy:
The 16-item Cardiac
Exercise Self-Efficacy.
Quality of Life: The Medical Outcomes
36-Items Short Form (SF-36).
Bailey et al., 2016 [31]
Pre-diabetic and type 2 diabetes
participants
N=13
Group 1: Standard care (CON
condition).
Grupo 2: Self-monitoring
intervention (SM condition).
Age Mean: 61.14 ±8.38
Physical Fitness Variables
Cardiovascular fitness
Psychic Variables
Exercise Self-efficacy: Adherence to the
exercise routine.
Quality of Life: self-perceived physical
fitness; General Health; Vitality; Mental
Health; Physical Role; Emotional Role;
Social Function; Body Pain.
Physical Fitness: The 6-Min Walk Test
(6MWT).
The group 2 shows great effects due to the
intervention. Levels of self-efficacy increase.
Significant improvement in both behavior
and exercise adherence.
Quality of life increases in all groups
throughout the intervention and follow-up.
There is a significant increase in the 6MWT
test in both groups.
They do not refer to the relationships
between physical fitness parameters and
self-efficacy and/or quality of life.
Exercise Self-Efficacy: Self-Monitor
Exercise Behavior (SMEB).
Quality of Life: The Short Form 36 Health
Survey.
Baptista et al., 2012 [32]
Patients with Fibromyalgia
N=80
Group 1: Dance group
Group 2: Control group
Age Mean
Group 1: 49.5
Group 2: 49.1
Physical Fitness Variables
Functional capacity
Psychic Variables
Quality of Life: Self- perceived physical
fitness; General health; Vitality; Mental
health; Physical role; Emotional role;
Social function; Body pain; Physical
function and Severity of symptoms.
Physical Fitness: The 6-Min Walk Test
(6MWT).
The intervention was followed by
improved physical fitness and increased
quality of life for the experimental group.
No correlation is reported between the
6MWT test and quality of life parameters.
Quality of Life: The Quality of Life Short
Form 36 (SF-36); Fibromyalgia Impact
Questionnaire (FIQ).
Belza et al., 2001 [33]
People with chronic obstructive
pulmonary
disease (COPD)
N=63 patients
Age Mean: 65.4 ±8.0
Physical Fitness Variables
Functional capacity
Psychic Variables
Exercise Self-efficacy: self-perceived
functional capacity.
Quality of Life: Dyspnea; Fatigue;
Emotional function; Mastery; Generic
health status.
Physical Fitness: The 6-Min Walk Test
(6MWT). The 6MWT is positively and significantly
correlated with walking self-efficacy (r =
0.68) and with SF-36 physical Subscale (r =
0.67) but not with mental subscale.
SEQ-W is positively and significantly
correlated with SF-36 physical subscale
(r =0.67).
Exercise Self-Efficacy: The Self-Efficacy
Questionnaire-Walking (SEQ-W).
Quality of Life: The Chronic Respiratory
Disease Questionnaire (CRQ); SF-36 Health
Questionnaire.
Int. J. Environ. Res. Public Health 2020,17, 6343 5 of 19
Table 2. Cont.
Participants Variables Instruments Results
Bieler et al., 2017 [34]
Participants with hip
osteoarthritis
N=152
Group 1: Nordic WalkingGroup
2: strength training
Group 3: Home-based exercise
Age Mean
Group 1: 70.0 ±6.3
Group 2: 69.6 ±5.4
Group 3: 69.3 ±6.4
Physical Fitness Variables
Functional performance:
Endurance capacity; muscle strength,
muscle function.
Psychic Variables
Self-perceived Physical Fitness:
physical function.
Exercise Self-efficacy: Self-efficacy for
climbing stairs; Pain; self-perceived
physical fitness and other symptoms.
Quality of Life: Self-perceived physical
fitness; General health; Vitality; Mental
health; Physical role; Emotional role;
Social function; Body pain.
Physical Fitness:
The 30-s Chair Stand Test
(30Scs); Timed Stair Climbing Test (TSC);
8-Foot Up and Go Test;15-Sencond
Marching on the Spot Test; 6-Min Walk Test
(6MWT).
Self-Perceived Physical Fitness: The
Arthritis Self-Efficacy Scale (ASES).
The Nordic Walking groupgets the most
important improvements in terms of
physical fitness. Self-efficacy and quality of
life also improve the most in this particular
group in terms of mental health levels. The
improvement in the hours spent in the most
vigorous physical activity during the
follow-up period is maintained.
The strength training group improves
functional performance and quality of life
factors at 12 months, more than group 3.
Quality of life improves more in group 1
and group 2 than in group 3.
They do not refer to the relationships
between physical fitness parameters and
self-efficacy and/or quality of life.
Self-efficacy: Task-Specific Self-Efficacy;
The Arthritis Self-Efficacy Scale (ASES).
Quality of Life: The Danish SF36 Health
Survey.
Cameron-Tucker et al., 2014 [35]
Outpatients with chronic
obstructive pulmonary disease
(COPD).
N=84
Group 1: Chronic Disease
Self-Management Program
(CDSMP)+exercise.
Group 2: (CDSMP)-only.
Age Mean: 65.8 ±9.35
Group 1: 64.5 ±9.13
Group 2: 67.1 ±9.41
Physical Fitness Variables
Physical capacity
Psychic Variables
Exercise self-efficacy: Confidence to
exercise behaviour.
Quality of Life: Self-perceived physical
fitness; General health; Vitality; Mental
health; Physical role; Emotional role;
Social function; Body pain.
Physical Fitness: The 6-Min Walk Test
(6MWT).
There was a significant improvement in the
6MWT test for both groups. No difference
in the comparison between groups.
There was no change in both groups in
self-efficacy. Physical fitness and the role
and physical component of quality of life
increased in the exercise group with no
difference in treatment.
They found no significant correlation
between the 6MWT test and self-efficacy
and quality of life. Moderate exercise and
self-efficacy explained 7.9% of the variation
in 6MWT in a multiple linear regression
model.
Exercise Self-efficacy: Exercise
Self-Efficacy Scale.
Quality of Life: The Short-Form 36
Questionnaire, version 2 (SF-36).
Donesky-Cuenco et al., 2009 [
36
]
People with chronic obstructive
pulmonary disease (COPD)
N=29
Group 1: Yoga Program
Group 2: Usual care Control
Age Mean
Group 1: 72.2 ±6.5
Group 2: 67.7 ±11.5
Physical Fitness Variables:
Muscle endurance; Muscle strength;
Exercise performance.
Psychic Variables:
Quality of Life: Self-physical fitness;
General health; Vitality; Mental health;
Physical role; Emotional role; Social
function; Body pain.
Dyspnea; Fatigue; Mastery, Emotional
function.
Physical Fitness: The 6-Min Walk Test
(6MWT); Symptom-Limited Test; Isokinetic
muscle testing.
After 3 months of intervention with a yoga
program, significant improvements are
obtained in the 6MWT test for the
experimental group.
But they do not refer to the relationships
between the parameters of physical fitness
and quality of life.
Quality of Life: SF-36 Health
Questionnaire; The Chronic Respiratory
Disease Questionnaire (CRQ).
Feldstain et al., 2016 [37]
Advanced cancer patients
N=80
Group 1: Quasi-experimental
Average age: 64.04 ±12.50
Physical Fitness Variables
Maximal oxygen uptaken
Psychic Variables
Self-efficacy: Self-perceived physical
fitness and general self-efficacy.
Physical Fitness: The 6-Min Walk Test
(6MWT).
Self-perceived physical condition:
General Self-efficacy Scale.
The intervention helps to increase exercise
levels and reinforce beliefs of self-efficacy.
They do not study the changes that occur
with 6MWT results.
Self-efficacy is the only factor in the
intervention that helps reduce depressive
symptoms. Exercise and physical
endurance are not significant in relation to
depression.
They do not refer to the relationships
between physical fitness parameters and
self-efficacy.
Froehlich-Grobe et al., 2014 [38]
Wheelchair users
N=128
Group 1: The StaffSupported
Intervention group
Group 2: Self-Guide
Comparison Group
Age Mean
Group 1: 46.0 ±12.1
Group 2: 42.9 ±13
Physical Fitness Variables
Maximal strength; Aerobic capacity.
Psychic Variables
Exercise Self-efficacy: Exercise;
Nutrition; Responsible health practice;
Psychological well-being.
Quality of Life: Self-perceived physical
fitness; General health; Vitality; Mental
health; Physical role; Emotional role;
Social function; Body pain.
Physical Fitness: 1-Repetition Maximum
Free Weight Bench Press;Discontinuous
Arm Crank Test with SciFit Pro I ergometer.
Group 1 increased their physical exercise
practice more than group 2, but there were
no significant differences in the aerobic
capacity or strength.
Exercise Self-efficacy improved for the
self-guided group. There are no changes in
quality of life associated with body pain.
But they do not refer to the relationships
between physical fitness parameters and
self-efficacy and/or quality of life.
Self-efficacy: Self-Rated Abilities for
Health Practices Scale (SRAHP).
Quality of Life: SF-36 Health
Questionnaire.
Hospes et al., 2009 [39]
Patients with chronic obstructive
pulmonary disease (COPD)
N=35
Group 1: Exercise Counseling
Group 2: Usual Care
Age Mean
Group 1: 63.1 ±8.3
Group 2: 61.2 ±9.1
Physical Fitness Variables
Leg strength; Arm strength; Grip force;
Cardiorespiratory endurance.
Psychic Variables
Exercise Self-efficacy: Perceived
flexibility; Reaction time; Perceived
general strength; Self-perceived
physical condition; Smooth movements;
Climbing stairs; Perceived strength in
hand; Perceived speed of walking;
Change in exercise behavior; Perceived
balance; Perceived general activity.
Quality of Life: Symptoms; Activity;
Impacts. Symptoms; Functional state;
Mental state.
Physical Fitness: The Chair-Stand-Test;
The arm curl Test; The 6-Min Walk Test
(6MWT); Handheld Dynanometer.
Self-Perceived Physical Fitness:
Self-efficacy in Leisure-Time Physical
Activity (LIVAS)
The program carried out was effective,
increasing adherence to daily physical
exercise. The experimental group presented
significant improvements in leg and arm
strength, self-efficacy and quality of life.
They do not refer to the relationships
between physical fitness parameters and
self-efficacy and/or quality of life.
Exercise Self-Efficacy: Self-efficacy in
Leisure-Time Physical Activity (LIVAS).
Quality of Life: The St. George
Respiratory Questionnaire (SGRQ-TS); The
Clinical COPD Questionnaire.
Int. J. Environ. Res. Public Health 2020,17, 6343 6 of 19
Table 2. Cont.
Participants Variables Instruments Results
Kersten et al., 2015 [40]
People with sclerosis and stroke
N=20
Group 1: Experimental
Group 2: Control
Age Mean
Group 1: 57(53–70)
Group 2: 54(51–67)
Physical Fitness Variables
Aerobic capacity
Psychic Variables
Self-perceived physical fitness:
Self-reported mobility.
General Self-efficacy: The stable feeling
of personal competence to effectively
handle a wide variety of stressful
situations. Symptom control; Role
function; Emotional functioning and
communication with physicians.
Quality of Life: Mastery; Physical;
Psychological; Social; Environmental
Physical Fitness: The 10-Min Walk Test
(10MWT)
Self-perceived physical fitness:
Rivermead Mobility Index
The experimental group walks faster than
the control group and these values are
maintained throughout 12 months of
follow-up. There are no significant changes
in mobility outcomes for any of the groups.
The experimental group obtains better
levels of self-efficacy although the values
are balanced with the control group over 12
months of follow-up.
Quality of life levels are increasing
in both groups.
No reference is made to the relationships
between physical fitness parameters and
self-efficacy and/or quality of life.
General Self-Efficacy: The General
Self-Efficacy Scale; The Self-efficacy for
Chronic Diseases Scales.
Quality of Life: The World Health
Organization Quality of Life questionnaire
(WHOQOL-BREF).
Hea-Young, 2006 [41]
People with disabilities
N=40
Group 1: Experimental
Group 2: Control
Age Mean: 53.7
Group 1: 55.1 ±13.68
Group 2: 52.29 ±12.11
Physical Fitness Variables:
Maximum muscle strength of the knee;
Grip force; flexibility.
Psychic Variables:
Exercise self-efficacy: Performance
achievements, indirect experience,
verbal persuasion and physiological
states. (Bandura, 1977). Locus of
control; Personal control; Social desire;
Ego strength; Interpersonal competence
and self-esteem. Sherer and Maddux,
(1982) and (1994).
Quality of Life: Self-perceived physical
fitness; General health; Vitality; Mental
health; Physical role; Emotional role;
Social function; Body pain.
Physical Fitness: Lafayette instrument
company (United Stated of America).
After the intervention, the experimental
group shows better levels of maximum
muscle strength of the extensors and flexors
of the knee and better levels of flexibility, in
addition there are improvements in the
level of self-efficacy towards exercise and in
the levels of quality of life regarding the
control group.
They do not refer to the relationships
between physical fitness parameters and
self-efficacy and/or quality of life.
Exercise Self-efficacy: Bandura
Self-Efficacy Scale 1997; Sherer & Maddux
Self-Efficacy Scale (1982) and (1994).
Quality of life: The Short Form-36 Health
Survey (version 2).
Liao et al., 2016 [42]
Chronic stroke participants
N=84
Group1: Low Intensity Body
Vibration
Group 2: Hight Intensity Body
Vibration
Group 3: Control
Age Mean: 61.2 ±9.2
Physical Fitness Variables
Muscle strength; Balance; Walking
endurance; Functional mobility.
Psychic Variables
Balance Self-efficacy: Confidence in the
performance of specific
outpatient activities.
Quality of Life: Self-perceived physical
fitness; Physical Role; Body Pain;
General Health; Vitality; Social
Function; Emotional Role;
Mental Health.
Physical Fitness: Dynamometer; The
14-item Mini Balance Evaluation Systems
Test (Mini-BESTest); The 6-Min Walk Test
(6MWT); Timed Up and Go (TUG).
The results showed a significant increase
between groups in the parameters of
physical fitness, self-efficacy and quality of
life with respect to effect size.
There are no appreciable differences
between group 1 and group 2 in relation to
the variables evaluated. The programs are
not effective in their purpose.
No results are presented for the
relationships between physical fitness,
self-efficacy and quality of life.
Balance Self-efficacy: The
Activities-Specific Balance Confidence Scale
(ABC Scale).
Quality of Life: Short-Form Health
Questionnaire SF-12.
McKay et al., 2012 [43]
Patients undergoing total knee
arthroplasty
N=22
Group 1: Intervention
Group 2: Control
Age Mean
Group 1: 63.5 ±4.93
Group 2: 60.58 ±8.05
Physical Fitness Variables
Quadriceps strength; Mobility; Balance.
Psychic Variables
Self-efficacy: Pain; Self-perceived
physical function; other symptoms.
Quality of life: Physical function;
General health; Vitality; Mental health;
Physical role; Emotional role; Social
function; Body pain.
Physical Fitness: Isometric Strength
Assessment; 50-Feet Flat Surface Walking
Test; Stair Ascent-Descent.
Self-Perceived Physical fitness: The
Arthritis Self-Efficacy Scale.
The intervention affects the improvement of
quadriceps strength levels and significantly
improves self-efficacy and quality of life for
the experimental group. But they do not
refer to relationships between physical
fitness parameters and self-efficacy and/or
quality of life.
Self-efficacy: The Arthritis Self-Efficacy
Scale.
Quality of Life:
The Short Form 36 (SF-36).
Int. J. Environ. Res. Public Health 2020,17, 6343 7 of 19
Table 2. Cont.
Participants Variables Instruments Results
Moy et al., 2009 [44] Persons
with severe chronic obstructive
pulmonary disease (COPD)
N=1621 patients.
Age Mean: 66 ±6
Physical Fitness Variables
Exercise capacity
Psychic Variables
Quality of Life: Self-perceived physical
fitness; Physical role; Body pain;
General health Perceptions; Vitality;
Social function; Emotional role;
Mental health.
Physical Fitness: The 6-Min Walk Test
(6MWT).
Physical fitness values are positively related
to quality of life. The self-perception of
being disabled is significantly associated
with the quality of life.
Quality of life: The Medical Outcomes
Study 36-Item Short Form (The MOS SF-36);
The St. George’s Respiratory Questionnaire
Total Score (SGRQ-TS); Self-Administered
Quality of-Well-Being Scale (QWB-SA).
Nam et al., 2012 [45]
People with type 2 diabetes
N=140
Group 1: Exercise
Group 2: control
Age Mean
Group 1: 57.24 ±6.08
Group 2: 55.53 ±6.49
Physical Fitness Variables
Maximum oxygen consumption;
Muscle strength.
Psychic Variables
Exercise Self-efficacy: Self-perceived
ability to perform arm and leg tasks
before and after training.
Quality of Life: Self-perceived physical
fitness; General health; Vitality; Mental
health; Physical role; Emotional role;
Social function; Body pain.
Physical Fitness: Peak Oxygen Uptake
(VO2) with Treadmill Walking Test. The
Borg Rating of Perceived Exertion Scale;
1-Repetition Maximum of 7 Exercises. Subjects who participated in the exercise
group dropped out of the activity to a
greater extent than in the control group;
those who dropped out had lower levels of
self-efficacy in lifting and less
physical fitness.
It does not relate physical fitness variables
to self-efficacy and quality of life.
Exercise Self-Efficacy: The Exercise
Self-Efficacy Scale.
Quality of Life: Short-form 36 Item Health
Survey.
Nordgren et al., 2015 [46]
Rheumatoid arthritis patients
N=220
Group 1: Completed the
program
Group 2: They didn’t complete
the program.
Age Mean
Group 1: 58 ±9.9
Group 2: 60 ±8.4
Physical Fitness Variables
Maximal aerobic capacity; Lower limb
function
Maximum and average grip strength.
Psychic Variables
Exercise Self-Efficacy: Social support
(family, friends) for exercise behavior;
Expected long-term health; Beliefs to
avoid fear.
Quality of Life: Self-care; Pain;
Discomfort;
Anxiety; Depression.
Physical Fitness: Submaximal Bicycle
Ergometer; The Timed-Stands Test; The
Grippit Device.
The results showed significant changes
before and after the intervention programs
for the two groups. Levels of physical
fitness, self-efficacy and quality of life were
significantly improved at one year and
greater adherence to the training program
was shown, resulting in improved
perception of health and self-efficacy
towards exercise.
No reference is made to the relationships
between physical fitness parameters and
self-efficacy and/or quality of life
Exercise Self-efficacy: The Exercise
Self-efficacy Test.
Quality of Life: The EuroQol
Five-Dimensions Questionnaire (EQ-5D).
Oka et al., 1999 [47]
Patients with heart failure
N=40 patients
Age Mean: 56 ±12
Physical Fitness Variables
Functional capacity
Psychic Variables
Self-efficacy: Confidence to carry out
the behavior; Average strength;
Expectations of self-efficacy for
each behavior.
Physical Fitness: VO2Peak Naughton
Protocol; The 6-Min Walk Test (6MWT).
Self-Perceived physical fitness: 5-Item
Physical Condition Questionnaire.
There are positive correlations between
physical fitness through the 6-Min test with
the walking and stair-climbing self-efficacy
scales. Perceived physical fitness was
associated with emotional wellbeing.
No correlation was found between
self-efficacy and quality of life.
Self-Perceived physical fitness:
Individual perception of various aspects
of physical condition.
Quality of Life: Energy; Fatigue;
Wellbeing.
Exercise Self-efficacy: The Self- Efficacy
Expectation Scales for Walking, Stair
climbing and General Activities.
Quality of life: The Medical Outcomes
Study 36-Item Short Form (SF-36).
Pilleri et al., 2015 [48]
People with Parkinson disease
N=20
Group 1: (robot assisted gait
training)
Age Mean: 64.5 (45–71)
Physical Fitness Variables
Aerobic capacity; Balance.
Psychic Variables
Self-efficacy: Fear of falling during daily
activities.
Quality of Life: Activities of daily life;
Attention and work memory;
Communication; Depression; Quality of
life; Social relationship.
Physical Fitness: Timed Up and go Test
(TUG); The 10-Min Walk Test (10-MWT);
Berg Balance Scale (BBS).
After the intervention, aerobic capacity and
balance improve, indicating an
improvement in perceived stability. It also
reflects improved levels of self-efficacy and
quality of life.
No relationships are expressed between the
variables of physical fitness, self-efficacy
and quality of life.
Self-Efficacy: The Fear of Falling Efficacy
Scale (FFES)
Quality of Life: The Parkinson’s Disease
Questionnaire-8 (PDQ-8).
Int. J. Environ. Res. Public Health 2020,17, 6343 8 of 19
Table 2. Cont.
Participants Variables Instruments Results
Ries et al., 2003 [49]
Patients with chronic lung
disease
N=172
Group 1: Experimental
maintenance program
Group 2: Standard care control
group
Age Mean: 67.1 ±8.2
Physical Fitness Variables
Maximum distance possible in 6 Mins.
Psychic Variables
Exercise self-efficacy: Change in
behavior toward exercise (range of
activity; general effort in moving things;
lifting; climbing stairs; tolerating stress;
tolerating anger).
Quality of Life: Self-perceived physical
fitness; mental function; fatigue;
dyspnea; mastery.
physical Functioning; body pain; role
limitations due to physical health
problems; role limitations due to
personal or emotional problems;
general mental health; social
functioning; energy; fatigue; general
health perceptions.
Physical Fitness: The 6-Min Walk Test
(6MWT). The experimental group shows
improvements after the intervention in the
6MWT test; in walking self-efficacy and in
quality of life levels.
Follow-up over 1 and 2 years shows that
the levels of resistance, self-efficacy and
quality of life of the experimental group
tend to be balanced with the levels of the
control group.
They do not refer to the relationships
between physical fitness parameters and
self-efficacy and/or quality of life.
Exercise Self-Efficacy: The Self Efficacy
Questionnaire Walking (SEQ-W).
Quality of life: The Quality of Well-Being
Scale (QWB); The Chronic Respiratory
Questionnaire (CRQ); The Rand 36-ítem
Health Survey.
Sullivan et al., 2014 [50]
Participants with chronic stroke
N=11
Group 1: Podometer-Monitored,
community-based intervention
Age Mean: 60.4 ±12.1
Physical Condition Variables
Walking endurance.
Psychic Variables
Self-efficacy: Confidence in performing
specific outpatient activities.
Quality of Life: Strength; hand function;
activities of daily living/instrumental
activities of daily living; mobility.
Physical Condition: The 6-Min Walk Test
(6MWT); The 10-Meter Walk Test (10MWT).
The increase in the number of steps
correlates with an increase in Self-perceived
physical fitness and this in turn correlates
with moderate changes in the 6MWT and
quality of life. In addition, barriers to
physical exercise are minimized. There are
no significant changes in the group over the
measurement time.
Self-Efficacy: The Activities-Specific
Balance Confidence Scale (ABC Scale).
Quality of Life: Stroke Impact Scale-16
(SIS-16).
Tang et al., 2017 [51]
Patients with chronic kidney
disease
N=84
Group 1: Experimental
Group 2: Control
Age Mean
Group 1: 46.26 ±15.61
Group 2: 43.90 ±12.44
Physical Fitness Variables
Endurance; Function of lower body
muscle strength
Psychic Variables
Exercise Self-efficacy: Self-perceived
ability to perform arm and leg tasks
before and after training.
Quality of Life: List of
symptoms/problems; Effects of kidney
disease; Burden of kidney disease;
Physical component; Mental
component; Physical function; General
health; Vitality; Mental health; Physical
role; Emotional role; Social role;
Body pain.
Physical Fitness: The 6-Min Walk Test
(6MWT); 10 Repetition of Sit to Stand Test
(STS10).
No results are presented for the
relationships between physical fitness,
self-efficacy and quality of life.
Group 1 improves their physical fitness,
self-efficacy and quality of life.
Improvements in 6MWT and STS10 helped
to achieve the reported quality of life
improvements.
The exercise program is effective in
improving the physical fitness and quality
of life in these patients.
Exercise Self-Efficacy:
The Self-Efficacy for
Exercise Scale (SEE).
Quality of Life: The Kidney Disease
Quality of Life (KDQOL-36); SF-12 Health
Questionnaire.
Tu et al., 1997 [52]
Patients with chronic obstructive
pulmonary disease (COPD)
N=203
Grupo 1: Subjects with unstable
conditions
Grupo 2: Subjects with stable
conditions
Group 3: Lung education
subjects
Age Mean: 70 years old
Physical Fitness Variables
Functional exercise capacity.
Psychic Variables
Self-efficacy: Negative effect; intense
arousal
emotional; physical effort;
climate/environment
environment; and behavioral risk
factors.
Quality of life: Self-perceived physical
fitness; General health;
Vitality; Mental health; Physical role;
Emotional role; Social
function; Body pain.
Physical Fitness: The 6-Min Walk Test
(6MWT).
Self-perceived physical fitness scale of
SF-36 is more correlated with 6MWT than
with emotional function. The physical
fitness scale of SF-36 shows a moderate
correlation between the physical fitness
parameters and the physical fitness scale.
Self-Efficacy: Chronic Pulmonary Disease
Self-Efficacy Scale (CSES).
Quality of Life: The Medical Outcomes
Study Short Form 36 (SF-36).
Int. J. Environ. Res. Public Health 2020,17, 6343 9 of 19
Table 2. Cont.
Participants Variables Instruments Results
Wang et al., 2018 [53]
Adult with fibromyalgia
N=226
Group 1: Tai chi
Group 2: Aerobic exercise
Age Mean
Group 1: 52.1 ±13.3
Group 2: 50.9 ±12.5
Physical Fitness Variables
Physical function; Muscle strength and
power; Balance.
Psychic Variables
Self-efficacy: Pain; self-perceived
physical fitness and other symptoms.
Quality of Life: Self- perceived physical
fitness; General health; Vitality; Mental
health; Physical role; Emotional role;
Social function; Body pain.
Physical Fitness: The 6-Min Walk Test
(6MWT), Balance Test; The Chair Stand Test;
Leg Press.
Self-Perceived Physical Fitness: The
Arthritis Self-Efficacy Scale (ASES).
No results are presented for the
relationships between physical fitness,
self-efficacy and quality of life. The group 1
obtains equal or better results in
self-efficacy and quality of life after 24
weeks and greater adherence compared to
group 2. Psychological benefits may be
associated with longer exercise practice
affecting mental health and physical fitness.
Self-efficacy: The arthritis self-efficacy
scale (ASES).
Quality of Life: The Short Form Health
Survey
Yeh et al., 2011 [54]
Patients with chronic heart
failure
N=100
Group 1: Tai chi group
Group 2: Education group
Age Mean
Group 1: 68.1 ±11.9
Group 2: 66.6 ±12.1
Physical Fitness Variables
Aerobic capacity; Agility.
Psychic Variables
Exercise Self-efficacy: confidence in the
designated change towards exercise
behavior.
Quality of Life: Swelling in the ankles;
Difficulty climbing stairs; Fatigue;
Depressive feelings; Monetary expense;
Health-related treatment.
Physical Fitness: Bicycle Ramp Protocol
(Borg scale); The 6-Min Walk Test (6MWT);
Timed Up and Go.
The intervention group after the Tai chi
program significantly improves the levels
of quality of life and self-efficacy towards
exercise in comparison with the control
group.
There is improvement in the 6MWT test for
the intervention group although there are
no relevant differences between groups.
There are no relationships between physical
fitness parameters with self-efficacy and/or
quality of life.
Exercise Self-Efficacy:
The 16-Item Cardiac
Exercise Self-Efficacy.
Quality of Life: Minnesota Living with
Heart Failure Questionnaire (MLHFQ).
Yeh et al., 2016 [55]
Patients with heart failure
N=100
Group 1: Tai chi
Group 2: Education
Age Mean
Group 1: 69
Group 2: 66
Physical Fitness Variables
Aerobic capacity; Agility.
Psychic Variables
Exercise Self-efficacy: Confidence in the
designated change towards exercise
behavior
Quality of Life: self-perceived physical
fitness; Physical Role; Body Pain;
General Health; Vitality; Social
Function; Emotional Role; Mental
Health; Ankle swelling; Difficulty
climbing stairs; Fatigue; Depressive
feelings; Money spent;
Health-related treatment
Physical Fitness: Bicycle Ramp Protocol;
The 6-Min Walk Test (6MWT); Timed Up
and Go.
There was no improvement in
physical fitness.
Group 1 shows significant improvements in
self-efficacy over 1 year in comparison with
group 2.
Quality of life levels are higher in group 1
compared to group 2.
The Tai chi program was effective in
improving self-efficacy and quality of life
with respect to the other group in this type
of patient.
The 6MWT test is associated with change in
self-efficacy.
Exercise Self-Efficacy:
The 16-item Cardiac
Exercise Self-Efficacy.
Quality of Life: Minnesota Living with
Heart Failure Questionnaire (MLHFQ);
SF-12v2 Short Form Health Survey.
Zanaboni et al., 2016 [56]
Patients with chronic obstructive
pulmonary disease (COPD)
N=120
Group 1: telerehabilitation
Group 2: Treadmill
Group 3: control
Age Mean: Between
40-80 years old
Physical Fitness Variables
Functional exercise capacity
Psychic Variables
Exercise Self-efficacy: maintenance of
exercise; maintenance of
self-management routines.
Quality of Life: self-care; pain;
discomfort; anxiety; depression.
Physical Fitness: 6-Min Walking Distance
(6MWD). No results are presented for the
relationships between physical fitness,
self-efficacy and quality of life.
The physical fitness and quality of life in
group 1 improves over one year compared
to the other two groups.
Telerehabilitation can prevent deterioration,
improve physical performance, health
status and quality of life.
Self-Efficacy:
The Generalized Self-Efficacy
Scale
(GSES).
Quality of Life: The EuroQol
Five-Dimensional Questionnaire (EQ-5D).
Int. J. Environ. Res. Public Health 2020,17, 6343 10 of 19
Table 2. Cont.
Participants Variables Instruments Results
Cheong et al., 2018 [57]
Colorectal cancer patients
N=75
Age Mean: 58.27 ±11.74
Physical Fitness Variables
Physical performance
Upper extremity muscle strength
Psychic Variables
Overall health status; area of
functioning; area of symptoms.
Physical Fitness:
The grip strength test; 30 s CST; the 2-min
walk test (2MWT). Hand-held
dynamometer.
The lower extremity strength and
cardiorespiratory endurance was
significantly improved. There are no
relationships between physical fitness
parameters with quality of life.
Quality of life: European Organization for
Research and Treatmentof Cancer Quality
of Life Questionnaire C30 (EORTC
QLQ-C30).
Coelho et al., 2017 [58].
Asthmatic women
N=66; Age Mean
Asthma group: 45.8 ±12.3
Control Group: 44.3 ±11.6
Physical Fitness Variables
Submaximal exercise capacity
Psychic Variables
Limitation of usual activities;
symptoms; emotional function;
environmental stimuli.
Physical Fitness: The 6MWT.
Daily life physical activity correlated with
QoL and 6MWT. There are no relationships
between physical fitness parameters with
quality of life.
Quality of life:
The Asthma Quality of Life
Questionnaire (AQLQ).
Costa et al., 2018 [59]
Schizophrenia patients
N=114
Age Mean: 44.25 ±9.72
Physical Fitness Variables
Functional exercise capacity
Psychic Variables
Physical; psychological; social
relationship; environment.
Physical Fitness
The 6MWT
QoL correlated with physical activity.
Active behaviours could improve QoL.
There are no relationships between physical
fitness parameters with quality of life.
Quality of life
WHOQOL-BREF
Moreno-Suarez et al., 2020 [60]
Patients with Left
Ventricular Assist Device and
Patient
Chronic Heart Failure
N=32
Age Mean
LVAD Group: 59.1±10.8
CHF Group: 58.3 ±8.7
Physical Fitness Variables
Cardiopulmonary exercise testing
Psychic Variables
Self-Efficacy: The strength of efficacy
beliefs
Quality of life: Self-perceived physical
fitness; general health; vitality; mental
health; physical role; emotional role;
social function; body pain.
Physical Fitness
Treadmill exercisetest
Patients with LAVD reported better QoL.
There are no relationships between physical
fitness parameters with self-efficacy and/or
quality of life.
Self-efficacy
16 item Heart Disease Self-Efficacy Scale
(HDSE)
Quality of life
SF-36
Rosa et al., 2018 [61]
Hemodialysis patients
N=52
Age Mean: 55.7 ±14.03
Physical Fitness Variables
Physical capacity and strength; leg and
back flexibility.
Psychic Variables
Self-perceived physical fitness; general
health; vitality; mental health; physical
role; emotional role; social function;
body pain.
Physical Fitness
The 6MWT; Hand grip dynamometry; Sit to
stand test (STS10); Wells bench.
The program increases leg lean mass and
STS10 performance. There are no
relationships between physical fitness
parameters with self-efficacy and/or quality
of life.
Quality of life
SF-36
Damush et al., 2006 [62]
Breast cancer survivors. Group
1: Experimental
N=34 patients
Age Mean: 59.6 ±6.6
Physical Fitness Variables
Aerobic capacity, Lower body strength;
Agility; flexibility; health.
Psychic Variables
Exercise for self-efficacy: Perceived
barriers; Benefits and enjoyment of
physical activity.
Quality of Life: Depression; Fatigue;
Physical functioning; Psychosocial
functioning.
Physical Fitness: Senior Fitness Test
Battery (2 Min Step Test; The 30s Chair
Stand; The Arm Curl; The Chair sit and
reach; Back scratch; 8ft Get Up and Go).
This program improves perceived barriers to
exercise and physical fitness by improving
endurance and strength levels, and quality
of life.
They do not refer to the relationships
between physical fitness parameters and
self-efficacy and/or quality of life.
Exercise Self-Efficacy:
The Self-Efficacy for
Exercise Scale (SEE).
Quality of Life: The Kidney Disease
Quality of Life (KDQOL-36); SF-12 Health
Questionnaire.
Int. J. Environ. Res. Public Health 2020,17, 6343 11 of 19
Table 2. Cont.
Participants Variables Instruments Results
Gregg et al., 2016 [63]
Homeless male participants
N=18
Age Mean: 41.05 ±11.32
Physical Fitness Variables
Cardiorespiratory Fitness; Lower back
hamstring; Hip flexibility; General
muscle strength.
Psychic Variables
Self-efficacy: Dimension of the
self-efficacy feature.
Quality of Life: Well-being;
Relationship with Others; Social
Community; Vivid Involvement;
Personal Development; Compliance.
Physical Fitness: 1-Mille Treadmill Walk
Test; A Sit-and-Reach Test; A Grip Strength
Test.
Self-efficacy is positively correlated with
quality of life. There is no correlation
between self-efficacy and quality of life with
the physical fitness parameters studied.
Self-Efficacy: The New General
Self-Efficacy Scale (NGSE).
Quality of Life: The Quality of Life Scale.
Ligibel et al., 2012 [64]
Cancer survivors
N=61
Group 1: Telephone-Based
Exercise Intervention
Group 2: Usual Care Control
Age Mean: 50.0 ±12.0
Group 1: 53.1 ±10.8
Group 2: 55.5 ±10.6
Physical Fitness Variables Functional
exercise capacity
Psychic Variables
Exercise Self-efficacy: Precontemplation;
Contemplation; Preparation; Action;
Maintenance; Relaxation.
Quality of Life: Global quality of life;
Pain; Insomnia.
Physical Fitness: The 6-Min Walk Test
(6MWT); Cycle Ergometer and Treadmill
Based Exercise.
Exercise Self-Efficacy: The Physical
Activity Self-Efficacy Questionnaire.
The increase in the amount of weekly
physical activity, the improvement in
physical fitness, self-perceived physical
fitness, and self-efficacy due to the
intervention process for group 1.
They do not refer to the relationships
between physical fitness parameters and
self-efficacy and/or quality of life.
Quality of life: The European
Organization for Research and Training,
Quality of Life Questionnaire - Core 30,
Version 3.0 (The EORTC QLQ-C30).
McAuley et al., 2005 [65]
Older sedentary adults
N=174
Grupo 1: Aerobic Activity
Program (Walking or Stretching)
Group 2: Toning Program
Age Mean: 66.71 ±5.35
Group 1: 67.42 ±5.24
Group 2: 66.02 ±11.48
Physical Fitness Variables Aerobic
capacity
Psychic Variables
Self-perceived physical fitness: Physical
fitness; Physical strength.
Exercise Self-efficacy: Self-perceived
physical fitness and self-efficacy to
exercise; Perceptions of the ability to
overcome barriers to exercise.
Physical Fitness: VO2Peak Balke Protocol.
Self-perceived physical fitness: The
Perceived Importance Profile. Eight-Item
Measure of Beliefs in Capabilities. Self-efficacy is inversely related to positive
well-being after the implementation of the
program.
But these do not refer to the relationships
between the parameters of physical fitness
and self-efficacy.
Exercise Self-efficacy: Eight-Item Measure
of Beliefs.
Awad et al., 2019 [66]
Community-dwelling
individuals
N=40
Age Mean: 58.4 ±1.6
Physical Fitness Variables
Cardiovascular capacity
Psychic Variables
Balance confidence
Physical Fitness: The 6MWT; The 6MWT
The 6MWTotal and ABC score wereeach
bivariately correlated with steps/d.
Self-efficacy score was not significant
independent predictor.
Self-efficacy:
Activities-specific Balance Confidence
(ABC Scale)
3.1. Results of Studies Assessing Overall Physical Fitness
Assessing physical fitness was the main objective for 12 articles, while it was secondary in
12 articles. In relation to the measurement of the instruments used, different tests have been found for
the evaluation of physical fitness, of which some are general and others, specific. On 24 occasions,
the test used was “The 6-Min Walk Test” (6MWT) that assesses aerobic endurance Self-perceived
physical fitness was assessed on 14 occasions [
6
,
34
,
37
,
39
,
40
,
43
,
47
,
53
,
56
,
58
,
59
,
61
,
65
,
66
]. “The Foot Up
and Go” test was used on six occasions [
34
,
42
,
48
,
54
,
55
,
62
]; “The Sit to Stand Test” [
34
,
39
,
46
,
57
,
61
,
62
];
“The Handgrip forced test” was used to evaluate the strength of the upper and lower body, agility in the
face of possible falls, flexibility of the upper and lower body, and dynamic balance [
39
,
42
,
46
,
57
,
61
,
63
].
In five occasions “Treadmill Test” was used [
6
,
45
,
60
,
63
,
64
]. “The 10-Min Walk Test” (10MWT) assessing
endurance was used on three occasions [
40
,
48
,
50
]. On two occasions the VO
2
peak was evaluated with
“The Borg Rating of Perceived Exertion Scale” [
45
,
54
]; “The Naughton Protocol” [
6
,
47
]. the “Arm Curl
Int. J. Environ. Res. Public Health 2020,17, 6343 12 of 19
Test” [
39
,
62
]. In two examples these tests were used: “The test “Sit and Reach” [
62
,
63
]; “The Grip
Strength Test” [
53
,
57
]; The Activities-Specific Balance Confidence Scale” (ABC Scale) [
42
,
50
]. On one
occasion, the VO
2
peak was assessed with “the Balke Protocol” [
65
]; “The Bicycle Ramp Protocol” [
54
];
“The Discontinuous Arm Crank” [
38
]; “The Submaximal Bicycle Ergometer” [
46
]; “1-Repetition
Maximum Free Weight Bench Press” [
38
]; “The Timed Stair Climbing” [
43
]; “Hip Flexibility” [
63
];
“Functional Aerobic Impairment” (FAI) [
6
]; “50 Foot Flat Surface Walking Test” [
43
]; “Berg Balance Scale”
(BBS) [
48
]; “The 14-item Mini Balance Evaluation Systems Test” (Mini-BESTest) [
42
]; “Well bench” [
61
].
3.2. Results of Studies Assessing Self-Efficacy
In 15 articles, self-efficacy was assessed as a secondary objective. On three occasions, the following
instruments were used: “The Arthritis Self- Efficacy Scale” [
34
,
43
,
53
]; “The 16-items Cardiac Exercise
Self-Efficacy” [
6
,
54
,
55
]; “ABC Scale” [
42
,
50
,
66
]. Furthermore, the following instruments were used
one two occasions: “The Exercise Self-Efficacy Scale” [
45
,
46
]. On one occasion “The Self-Efficacy
Questionnaire-Walking” (SEQ-W) [
49
] and “The chronic obstructive pulmonary disease (COPD)
Self-Efficacy Scale” [
52
] were used. On one occasion, the following instruments were used: “The New
General Self-Efficacy Scale” [
63
]; “8-
í
tems measure of beliefs capabilities” [
65
]; “The Physical Activity
Self-Efficacy” [
64
]; “Self-efficacy in Leisure-Time Physical Activity” (LIVAS) [
39
]; “Self-Rated Abilities
for Health Practices Scale” (SRAHP) [
38
]; “Fear of Falling Efficacy Scale” (FFES) [
48
]; “Self-Monitor
Exercise Behavior” (SMEB) [
31
]; Likert Scales [
62
]; “General Self Efficacy Scale” (GSES) [
56
];
16-Item Heart Disease Self Efficacy Scale (HDSE) [60].
3.3. Results of Studies Assessing Quality of Life
Quality of life has been evaluated with different instruments, 13 articles used “The SF-36 Health
Questionnaire” [
6
,
31
,
32
,
35
,
36
,
38
,
41
,
43
–
45
,
53
,
60
,
61
]; On three occasions, the following were used:
The SF-12 Health Questionnaire” [
42
,
51
,
55
]; “The Medical Outcomes Study 36-Item Short Form”
(The MOS SF36) [
44
,
47
,
52
]. On two occasions “Minnesota Living with Heart Failure Questionnaire”
(The MLHFQ) [
54
,
55
]; “The EuroQol Five-Dimensions Questionnaire” (EQ-5D) [
46
,
56
]; “The St. George
Respiratory Questionnaire” (SGRQ-TS) [
39
,
44
]; “Chronic Respiratory Questionnaire”(CRQ) [
36
,
49
];
“The European Organization for Research and Training, Quality of Life Questionnaire—Core 30”
(The EORTC QLQ-C30) [
57
,
64
]; “The World Health Organization Quality of Life questionnaire”
(WHOQOL-BREF) [40,59] were evaluated.
On one occasion we used: “Self-Administered Quality of-Well-Being Scale” (The QWB-SA) [
44
];
“Cancer Rehabilitation Evaluation System-Short Form” (CARES-SF) [
62
]; “The Fibromyalgia Impact
Questionnaire” (FIQ) [
32
]; “Stroke Impact Scale–16” (SIS-16) [
50
]; “The Parkinson’s Disease
Questionnaire-8” (PDQ-8) [
48
]; “The Kidney Disease Quality of Life” (KDQOL-36) [
51
]; “The Quality
of Well-Being Scale” (QWB) [49]; “The Asthma Quality of Life Questionnaire” [58].
4. Discussion
To find the relationship between physical fitness, the role of self-efficacy in physical exercise and
physical exercise, and quality of life in the middle-aged population, the systematic review analyzed
in detail works published on physical fitness, self-efficacy, and quality of life from 1997 to July 2020.
The minimum age of the subjects was 30 years and the maximum age was 80, since there were studies
whose age is between these values, even though the average age of the subjects studied was between
40 and 70 years old. A systematic search of the literature was carried out and 37 articles focusing
on explaining these relationships were identified. Our results allow us to confirm that there is a
relationship between the three explored constructs (physical fitness, quality of life, and self-efficacy in
terms of improved health and healthy habits, although the relationship between the three variables in
a related way is not entirely clear.
The results have shown that, although there is scientific production that attends to the relationship
between the three variables, in most cases the population evaluated is a population with some pathology.
Int. J. Environ. Res. Public Health 2020,17, 6343 13 of 19
Only in some cases was the evaluated population free of pathologies [
62
–
66
] that a variation of the
levels of physical fitness affects to the behavior in relation to the barriers towards the physical exercise
and of the style of life of the population in consonance as they indicate authors as [
50
,
62
]. This is
especially relevant since identifying the pathology-free population that regularly exercises and tries to
achieve and/or maintain good levels of physical fitness that is one of the main objectives of the current
study [
67
]. All this, together with the novelty of the subject of analysis, means that this subject of study
has yet to be clarified and delimited, hence its importance.
On a methodological level, the samples used for the studies was somewhat small: only one
study [
44
] used a sample of 1631 participants, while the others had samples of fewer than 250 subjects.
This is due mainly to the fact that these studies were interventions or programs development studies
of populations with very specific characteristics; fewer descriptive studies analyze the relationships
between the variables under study. This requires us to be cautious when considering the results of the
reviewed studies.
The assessment, through evidence, of the capacities that support the physical fitness should be
considered as a fundamental aspect in determining the functional capacity of the person. The physical
fitness represents a significant influence on the quality of life associated with health, this being a
key component in the quality of life [
18
–
20
]. In relation to the physical fitness variables studied,
30 articles assessed aerobic endurance, and 24 of these used the resistance test called The 6 Min
Walk Test. Cardiorespiratory capacity is the main indicator of the subject’s state of physical fitness,
with maximum oxygen consumption (VO2peak) being the physiological variable that best defines it in
terms of cardiovascular capacity. It has been shown that a low level of physical fitness constitutes a
major cardiovascular risk factor [
67
,
68
] and is a strong and independent factor in all causes of death [
69
].
In relation to strength, the following were evaluated: general muscle strength; lower body strength;
maximum muscle strength of the muscles that mobilize the hand, knee, and elbow; grip strength;
maximum strength; maximum grip strength; knee strength; muscle power. It should be noted that
various transversal and longitudinal studies have verified that strength decreases with age [
70
,
71
],
and this decrease is significant starting in the 50s for women and in the 30s or 40s for men [
72
,
73
].
It would therefore be advisable to introduce strength exercises into physical activity programs to slow
down the process of loss of muscle mass.
On the other hand, given that many of the gestures of daily life require extensive articular paths,
this capacity facilitates the functional independence of the person. For this reason, flexibility should be
included in recommendations for physical exercise in this phase of life. Flexibility has been evaluated in
a small number of studies, although flexibility of the lower and upper body was also assessed [
41
,
61
–
63
].
General mobility, walking and leg mobility, and agility have also been evaluated [
34
,
40
,
42
,
43
,
48
,
50
,
54
,
62
].
Static and dynamic equilibrium, which are affected by the progressive loss of sensory-motor function
caused by increasing age, were assessed in several studies [42,43,48,53,55,66].
In summary, several studies in this review focused their efforts on understanding what makes a
person more consistent in their active exercise behaviors. Many of these, through different types of
intervention programs, have shown how increased health perception is linked to increased awareness of
personal health status and associated with improved levels of physical fitness [
46
,
50
], improved behavior
and enhanced adherence [
31
,
39
,
46
,
53
], and tolerance of sports behavior [
6
]. Therefore, knowledge of
fitness levels can be an important tool in providing specific advice to the population [
45
]. Being aerobic
capacity the most valued capacity and the 6-Min Walk Test the most used.
4.1. Self-Efficacy, Fitness, and Quality of Life
Empirical evidence supports the link between exercise self-efficacy and predictions of a variety of
health-related behaviors [
74
,
75
]. The importance of physical inactivity for public health in the adult
population underscores the importance of identifying those physical activity mediators and moderators
that can be targeted for interventions to increase physical activity levels [
76
], being self-efficacy a
powerful mediator between physical abilities and physical activity performance [
66
]. In this review,
Int. J. Environ. Res. Public Health 2020,17, 6343 14 of 19
four articles focused on showing the relationship between physical fitness and exercise self-efficacy,
three of which showed a positive relationship between both variables [
33
,
47
,
55
], while on one occasion
no relationship was shown between the two [
35
]. Showing therefore greater tendency that supports the
assertions of Bandura [
77
] that the actual performance of a skill is partially dependent on the perceived
ability of the individual to undertake and persist in the achievement of that skill. For example,
by limiting the barriers to physical exercise that lead to abandonment or non-participation [
50
].
These results are consistent with the findings of other studies in which exercise self-efficacy is
postulated as a powerful indicator of measures of functional and reflex change in an individual’s
physical fitness. It is also a determinant in the relationship between physical activity and various
aspects of quality of life, including physical and mental health status and life satisfaction [
23
,
66
,
78
,
79
].
It is therefore desirable to understand in greater depth how to improve self-efficacy towards physical
exercise [55].
One’s general sense of well-being—being aware of and feeling healthy and adjusted to one’s
environmental conditions—seems to be an important requirement for developing self-awareness and
a satisfying quality of life. Three studies in this review corroborated the relationships between the
physical fitness variable and the quality of life variable [
33
,
35
,
50
]. Only Cameron-Tucker’s [
35
] study
showed an absence of association between physical fitness and quality of life. These relationships
are important because physical condition is a powerful marker of health and quality of life [
20
] and
well-being [
24
], so it would be very interesting to learn more about these relationships, which have been
little studied in the literature. For example, in subjects with chronic stroke, the increase in the number
of steps correlates with increases in perceived physical function as a measure of quality of life [
50
].
On the other hand, if we take into account the importance of the dimensions evaluated for quality of
life in middle age and in relation to the other variables analyzed, it should be noted that middle-aged
women present more work-family complications and less social support as their perceived benefits of
physical fitness increase [
80
]. It was also found that, among men, low mobility was associated with
a lower quality of life in the psychological health domain. This is very important because increased
dependence on others and reduced work capacity can be a major challenge for many men [81].
In the studies analyzed, no results have been found that analyze the relationships between the three
variables, only the relationships between them two to two, and simply in one [
33
], the relationships
between a measure of exercise self-efficacy and quality of life are analyzed, finding relationships
between the 6MWT physical condition test is positively and significantly correlated with walking
self-efficacy and with SF-36 physical Subscale but not with mental subscale. But it has not been
analyzed, for example, the mediating role that self-efficacy or physical condition can have in relation to
quality of life.
4.2. Review of Instruments and Measures
In relation to the instruments used in this review, 18 articles evaluated self-efficacy for physical
exercise; these focus primarily on evaluating pre-behavioral processes such as change of behavior
towards exercise [
33
,
39
,
49
], confidence in designated change towards exercise behavior [
6
,
45
,
47
,
54
,
55
],
self-perceived capacity to develop sports behavior [
45
,
51
], confidence in designated change towards
exercise behavior [
6
,
54
,
55
], social support for exercise behavior [
46
], and self-perceived barriers to
exercise behavior [
62
,
65
]. Specifically, all of these results are related to Pender contributions, which link
healthy behavior to the likelihood of engaging in it and one’s sense of self-efficacy. He proposed that
self-efficacy for physical exercise has a decisive influence on health behavior, perceived barriers, and
commitment to a plan of action [
82
]. During adulthood there is a slight decline in levels of self-efficacy
and mastery, and these influence the perception that there are obstacles to achieving new goals [
83
].
Therefore, it is essential to improve beliefs about the effectiveness of physical exercise and to promote
healthy behavior in the long term.
Quality of life was evaluated with different instruments. Eleven articles used “the SF-36 Health
Survey”, a questionnaire that provides a clear understanding of what is being measured, how it is
Int. J. Environ. Res. Public Health 2020,17, 6343 15 of 19
used, and the implications for future use. It includes most of the essential concepts for the evaluation
of the general health status. It has also proved to be suitable for cross-cultural applications but may be
too long for clinical use. In addition, its scoring method is more complicated. The Chronic Respiratory
Questionnaire (CRQ), which is one of the available instruments to measure the general health-related
quality of life in patients with chronic respiratory condition, and which has been translated into
different languages [
84
]. On 3 occasions the SF-12 Health Questionnaire was evaluated. The SF-12
represents a plausible alternative to the SF-36 for measuring health status, showing only a minimal
loss in measurement accuracy in comparation with SF-36 [
85
]. Other questionnaires analyzed in the
results have been used on fewer occasions [46,54–56].
A relevant and conclusive aspect of our review is that a large variety of articles included intervention
processes, the results of which focused on checking the possible effects of such interventions on the
variables of physical fitness, self-efficacy, and quality of life. These results allow us to assume that,
in most cases, the interventions that encourage on physical exercise programs offer benefits for physical
fitness, self-efficacy, and quality of life when compared with the control groups, even throughout the
follow-up time.
5. Conclusions
One of the main conclusions of this work is that the important role played by physical fitness and
self-efficacy for physical exercise in achieving levels of well-being and quality of life in middle-aged
and senior adults. Although one article [
33
] showed a positive relationship between the three reviewed
constructs, the relationships between them are not completely clear. While there is no unanimity on
the effects of these variables, it has been found that they are clear predictors of health, they benefit
behavioral change, and they have a close relationship that can be mutually influenced. Since current
research should try to identify variables that measure and moderate the practice of physical activity in
the adult population, these data provide us with vital information that will allow us to deal with the
serious problem of physical inactivity in favor of public health [76].
With the objective of promoting integral health, we should raise awareness that prevention should
begin before disease appears [
86
]. However, one of the difficulties among the middle-aged population
is lack of time, which undermines this link between personal cultivation and healthy habits. As for the
limitations of the study, we should highlight the large age range of the samples examined—a result
of the scarcity of studies dealing with this vital period. Likewise, most of the studies we examined
referred to subjects with some kind of pathology. Finally, we would add that physical fitness and
self-efficacy show a positive relationship, which is important in well-being at this age.
Author Contributions:
Conceptualization, R.O.-R., and M.d.R.M.-U.; methodology, M.d.R.M.-U., J.d.D.B.-S.,
R.O.-R.; article search and screening, M.d.R.M.-U., validation, J.d.D.B.-S., R.O.-R.; writing—original draft
preparation, M.d.R.M.-U., J.d.D.B.-S., R.O.-R.; writing—review and editing, J.d.D.B.-S., R.O.-R., M.d.R.M.-U.;
visualization, J.d.D.B.-S.; supervision, R.O.-R.; funding acquisition, R.O.-R. All authors have read and agreed to
the published version of the manuscript.
Funding: This research received no external funding.
Conflicts of Interest: There is no conflict of interests.
References
1.
Caldas de Almeida, J.M.; Mateus, P.; Frasquilho, D.; Parkkonen, J. EU COMPASS for Action on Mental Health
and Wellbeing; European Commission: Brussels, Belgium, 2016; pp. 1–31.
2.
Lachman, M.E.; Jette, A.; Tennstedt, S.; Howland, J.; Harris, B.A.; Peterson, E. A cognitive-behavioural model
for promoting regular physical activity in older adults. Psychol. Health Med. 1997,2, 251–261. [CrossRef]
3.
Lachman, M.E.; Lewkowicz, C.; Marcus, A.; Peng, Y. Images of midlife development among young,
middle-aged, and older adults. J. Adult Dev. 1994,1, 201–211. [CrossRef]
Int. J. Environ. Res. Public Health 2020,17, 6343 16 of 19
4.
Gonz
á
lez-Mec
í
as, J.S.; Mar
í
n, F.; Vila, J.; D
í
ez-
Á
lvarez, A.; Abizanda, M.;
Á
lvarez, R.O.; Gimeno, A.S.;
Pegenaute, E. Prevalencia de factores de riesgo de osteoporosis y fracturas osteopor
ó
ticas en una serie de
5.195 mujeres mayores de 65 años. Med. Clín. 2004,123, 85–89.
5.
Tenover, J.L. Testosterone replacement therapy in older adult men. Int. J. Androl.
1999
,22, 300–306.
[CrossRef] [PubMed]
6.
Collins, E.; Langbein, W.E.; Dilan-Koetje, J.; Bammert, C.; Hanson, K.; Reda, D.; Edwards, L. Effects of
exercise training on aerobic capacity and quality of life in individuals with heart failure. Heart Lung J. Acute
Crit. Care 2004,33, 154–161. [CrossRef] [PubMed]
7.
Dionne, I.J.; Ades, P.A.; Poehlman, E.T. Impact of cardiovascular fitness and physical activity level on health
outcomes in older persons. Mech. Ageing Dev. 2003,124, 259–267. [CrossRef]
8.
Jürgens, I. Pr
á
ctica deportiva y percepci
ó
n de calidad de vida. Rev. Int. Med. Y Cienc. Act. F
í
sica Y Deporte
2006,6, 62–74.
9.
Pressman, S.D.; Matthews, K.A.; Cohen, S.; Martire, L.M.; Scheier, M.; Baum, A.; Schulz, R. Association
of enjoyable leisure activities with psychological and physical well-being. Psychosom. Med.
2009
,71,
725–732. [CrossRef]
10.
Rejeski, W.J.; Brawley, L.R.; Shumaker, S.A. Physical activity and health-related quality of life. Exerc. Sport
Sci. Rev. 1996,24, 71–108. [CrossRef]
11.
McPhee, J.S.; French, D.P.; Jackson, D.; Nazroo, J.; Pendleton, N.; Degens, H. Physical activity in older age:
Perspectives for healthy ageing and frailty. Biogerontology 2016,17, 567–580. [CrossRef]
12.
Lavie, C.J.; Ozemek, C.; Carbone, S.; Katzmarzyk, P.T.; Blair, S.N. Sedentary Behavior, Exercise,
and Cardiovascular Health. Circ. Res. 2019,124, 799–815. [CrossRef] [PubMed]
13.
Ramirez-V
é
lez, R. Actividad f
í
sica y calidad de vida relacionada con la salud: Revisi
ó
n sistem
á
tica de la
evidencia actual. Rev. Andal. Med. Deporte 2010,3, 110–120.
14.
Cornachione Larrinaga, M.A.A. Psicolog
í
a Del Desarrollo Adultez: Aspectos Biol
ó
gicos, Psicol
ó
gicos y Sociales,
1st ed.; Brujas: Córdoba, Argentina, 2006; p. 298.
15.
Cattanach, L.; Tebes, J.K. The nature of elder impairment and its impact on family caregivers’ health and
psychosocial functioning. Gerontologist 1991,31, 246–255. [CrossRef]
16.
Gillis, A.J. Determinants of a health-promoting lifestyle: An integrative review. J. Adv. Nurs.
1993
,18,
345–353. [CrossRef] [PubMed]
17.
Sweeney, A.M.; Wilson, D.K.; Lee Van Horn, M. Longitudinal relationships between self-concept for physical
activity and neighbourhood social life as predictors of physical activity among older African American
adults. Int. J. Behav. Nutr. Phys. Act. 2017,14, 67. [CrossRef] [PubMed]
18.
Häuser, W.; Bernardy, K.; Arnold, B.; Offenbächer, M.; Schiltenwolf, M. Efficacy of multicomponent treatment
in fibromyalgia syndrome: A meta-analysis of randomized controlled clinical trials. Arthritis Care Res.
2009
,
61, 216–224. [CrossRef]
19.
Li, F.; Harmer, P.; McAuley, E.; John Fisher, K.; Duncan, T.E.; Duncan, S.C. Tai Chi, Self-Efficacy, and Physical
Function in the Elderly. Prev. Sci. 2001,2, 229–239. [CrossRef]
20.
Wiskemann, J.; Hummler, S.; Diepold, C.; Keil, M.; Abel, U.; Steindorf, K.; Beckhove, P.; Ulrich, C.M.;
Steins, M.; Thomas, M. POSITIVE study: Physical exercise program in non-operable lung cancer patients
undergoing palliative treatment. BMC Cancer 2016,16, 499. [CrossRef]
21.
Caspersen, C.J.; Powell, K.E.; Christenson, G.M. Physical Activity, Exercise and Physical Fitness Definitions
for Health-Related Research. Public Health Rep. 1985,100, 126–131.
22.
Taylor, D.L.; Nichols, J.F.; Pakiz, B.; Bardwell, W.A.; Flatt, S.W.; Rock, C.L. Relationships between
cardiorespiratory fitness, physical activity, and psychosocial variables in overweight and obese breast
cancer survivors. Int. J. Behav. Med. 2010,17, 264–270. [CrossRef]
23.
McAuley, E.; Konopack, J.F.; Motl, R.W.; Morris, K.S.; Doerksen, S.E.; Rosengren, K.R. Physical activity
and quality of life in older adults: Influence of health status and self-efficacy. Ann. Behav. Med.
2006
,31,
99–103. [CrossRef]
24.
Est
é
vez-L
ó
pez, F.; Gray, C.M.; Segura-Jim
é
nez, V.; Soriano-Maldonado, A.;
Á
lvarez-Gallardo, I.C.;
Array
á
s-Grajera, M.J. Independent and combined association of overall physical fitness and subjective
well-being with fibromyalgia severity: The al-
Á
ndalus project. Qual. Life Res.
2015
,24, 1865–1873.
[CrossRef] [PubMed]
25. Bandura, A. Self-Efficacy; Ramachaudran, V.S., Ed.; Academic Press: New York, NY, USA, 1994; pp. 71–81.
Int. J. Environ. Res. Public Health 2020,17, 6343 17 of 19
26. Bandura, A. Self-efficacy mechanism in human agency. Am. Psychol. 1982,37, 122–147. [CrossRef]
27.
Zhou, X.; Krishnan, A. What Predicts Exercise Maintenance and Well-Being? Examining The Influence of
Health-Related Psychographic Factors and Social Media Communication. Health Commun.
2019
,34, 589–597.
[CrossRef] [PubMed]
28.
Ekkekakis, P.; Dafermos, M. Exercise is a Many-Splendored Thing, but for Some It Does Not Feel So Splendid:
Staging a Resurgence of Hedonistic Ideas in the Quest to Understand Exercise Behavior; American Psychological
Association: Washington, DC, USA, 2012; pp. 295–333.
29.
Du, H.; Everett, B.; Newton, P.J.; Salamonson, Y.; Davidson, P.M. Self-efficacy: A useful construct to promote
physical activity in people with stable chronic heart failure. J. Clin. Nurs. 2012,21, 301–310. [CrossRef]
30.
Urr
ú
tia, G.; Bonfill, X. PRISMA declaration: A proposal to improve the publication of systematic reviews
and meta-analyses. Med. Clínica 2010,135, 507–511.
31.
Bailey, K.J.; Little, J.P.; Jung, M.E. Self-Monitoring Using Continuous Glucose Monitors with Real-Time
Feedback Improves Exercise Adherence in Individuals with Impaired Blood Glucose: A Pilot Study.
Diabetes Technol. Ther. 2016,18, 185–193. [CrossRef]
32.
Baptista, A.S.; Villela, A.L.; Jones, A.; Natour, J. Effectiveness of dance in patients with fibromyalgia:
A randomised, single-blind, controlled study. Clin. Exp. Rheumatol. 2012,30 (Suppl. 74), 18–23.
33.
Belza, B.; Steele, B.G.; Hunziker, J.; Lakshminaryan, S.; Holt, L.; Buchner, D.M. Correlates of Physical Activity
in Chronic Obstructive Pulmonary Disease. Nurs. Res. 2001,50, 195–202. [CrossRef]
34.
Bieler, T.; Siersma, V.; Magnusson, S.P.; Kjaer, M.; Christensen, H.E.; Beyer, N. In hip osteoarthritis, Nordic
Walking is superior to strength training and home-based exercise for improving function. Scand. J. Med.
Sci. Sports 2017,27, 873–886. [CrossRef]
35.
Cameron-Tucker, H.L.; Wood-Baker, R.; Owen, C.; Joseph, L.; Walters, E.H. Chronic disease self-management
and exercise in COPD as pulmonary rehabilitation: A randomized controlled trial. Int. J. Copd
2014
,9,
513–523. [CrossRef] [PubMed]
36.
Donesky-Cuenco, D.A.; Nguyen, H.Q.; Paul, S.; Carrieri-Kohlman, V. Yoga therapy decreases dyspnea-related
distress and improves functional performance in people with chronic obstructive pulmonary disease: A pilot
study. J. Altern. Complement. Med. 2009,15, 225–234. [CrossRef] [PubMed]
37.
Feldstain, A.; Lebel, S.; Chasen, M.R. An interdisciplinary palliative rehabilitation intervention bolstering
general self-efficacy to attenuate symptoms of depression in patients living with advanced cancer.
Support. Care Cancer 2016,24, 109–117. [CrossRef] [PubMed]
38.
Froehlich-Grobe, K.; Lee, J.; Aaronson, L.; Nary, D.E.; Washburn, R.A.; Little, T.D. Exercise for everyone:
A randomized controlled trial of project workout on wheels in promoting exercise among wheelchair users.
Arch. Phys. Med. Rehabil. 2014,95, 20–28. [CrossRef] [PubMed]
39.
Hospes, G.; Bossenbroek, L.; Ten Hacken, N.H.T.; Van Hengel, P.; de Greef, M.H.G. Enhancement of daily
physical activity increases physical fitness of outclinic COPD patients: Results of an exercise counseling
program. Patient Educ. Couns. 2009,75, 274–278. [CrossRef]
40.
Kersten, P.; McPherson, K.M.; Kayes, N.M.; Theadom, A.; McCambridge, A. Bridging the goal intention-action
gap in rehabilitation: A study of if-then implementation intentions in neurorehabilitation. Disabil. Rehabil.
2015,37, 1073–1081. [CrossRef]
41.
Lee, H.Y. Effects of a rehabilitation nursing program on muscle strength, flexibility, self-efficacy and health
related quality of life in disabilities. J. Korean Acad. Nurs. 2006,36, 484–492. [CrossRef]
42.
Liao, L.R.; Ng, G.Y.; Jones, A.Y.; Huang, M.Z.; Pang, M.Y. Whole-Body Vibration Intensities in Chronic Stroke:
A Randomized Controlled Trial. Med. Sci. Sports Exerc. 2016,48, 1227–1238. [CrossRef]
43.
McKay, C.; Prapavessis, H.; Doherty, T. The Effect of a Prehabilitation Exercise Program on Quadriceps
Strength for Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Pilot Study. PM&R
2012
,
4, 647–656.
44.
Moy, M.L.; Reilly, J.J.; Ries, A.L.; Mosenifar, Z.; Kaplan, R.M.; Lew, R.; Garshick, E. Multivariate models of
determinants of health-related quality of life in severe chronic obstructive pulmonary disease. J. Rehabil.
Res. Dev. 2009,46, 643–654. [CrossRef]
45.
Nam, S.; Dobrosielski, D.A.; Stewart, K.J. Predictors of exercise intervention dropout in sedentary individuals
with type 2 diabetes. J. Cardiopulm. Rehabil. Prev. 2012,32, 370–378. [CrossRef] [PubMed]