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BMC Musculoskelet Disord. 2017 Dec 19;18(1):540. doi: 10.1186/s12891-017-1914-5.

Development and validation of a new tool to measure the facilitators, barriers and preferences to exercise in people with osteoporosis.

Author information

McMaster University School of Rehabilitation Science, 1400 Main Street Wm, IAHS 308, Hamilton, ON, L8S 4K1, Canada.
Department of Kinesiology, Waterloo University, 200 University Ave W, BMH 1100A/1102, Waterloo, ON, N2L 3G1, Canada.
Department of Medicine, McMaster University, 25 Charlton Ave. E Room 501, Hamilton, ON, L8N 1Y2, Canada.
St. Joseph's Healthcare Hamilton, 25 Charlton Ave. E Room 501, Ontario, Hamilton, L8N 1Y2, Canada.
Hand and Upper Limb Center Clinical Research Lab, 930 Richmond, St. London, ON, N6A 3J4, Canada.



Despite the widely known benefits of exercise and physical activity, adherence rates to these activities are poor. Understanding exercise facilitators, barriers, and preferences may provide an opportunity to personalize exercise prescription and improve adherence. The purpose of this study was to develop the Personalized Exercise Questionnaire (PEQ) to identify these facilitators, barriers, and preferences to exercise in people with osteoporosis.


This study comprises two phases, instrument design and judgmental evidence. A panel of 42 experts was used to validate the instrument through quantitative (content validity) and qualitative (cognitive interviewing) methods. Content Validity Index (CVI) is the most commonly used method to calculate content validity quantitatively. There are two kinds of CVI: Item-CVI (I-CVI) and Scale-level CVI (S-CVI).


Preliminary versions of this tool showed high content validity of individual items (I-CVI range: 0.50 to 1.00) and moderate to high overall content validity of the PEQ (S-CVI/UA = 0.63; S-CVI/Ave = 0.91). Through qualitative methods, items were improved until saturation was achieved. The tool consists of 6 domains and 38 questions. The 6 domains are: 1) support network; 2) access; 3) goals; 4) preferences; 5) feedback and tracking; and 6) barriers. There are 35 categorical questions and 3 open-ended items.


Using an iterative approach, the development and evaluation of the PEQ demonstrated high item-content validity for assessing the facilitators, barriers, and preferences to exercise in people with osteoporosis. Upon further validation it is expected that this measure might be used to develop more client-centered exercise programs, and potentially improve adherence.


Barriers; Checklist; Content validity; Exercise; Facilitators; Instrument development; Osteoporosis; Physical activity; Questionnaire; Survey

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