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Table 2 Original lymphedema-specific exercise barriers self-efficacy subscale

From: Exercise barriers self-efficacy: development and validation of a subcale for individuals with cancer-related lymphedema

Using the scale from 0-100%, indicate how confident you are that you could exercise in each of the following situations. Even if you are not currently exercising, please read and respond to each question by circling one number for each situation.
  Not at all confident Slightly confident Moderately confident Very confident Extremely confident
When I am worried about my appearance. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
When my affected body segment feels heavy. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
When my affected body segment is painful. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
When my affected body segment is numb or tingling. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
When I fear making my lymphoedema worse. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
When I am unsure what exercise advice to follow. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
When I am not certain if I am doing an exercise correctly. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
When I am lifting/moving heavy objects a few times. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
When I am lifting/moving light objects repetitively. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%