Understanding Exercise Dependence in Disabled Athletes: A Critical Evaluation of Measurement Reliability

Understanding Exercise Dependence in Disabled Athletes: A Critical Evaluation of Measurement Reliability | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Understanding Exercise Dependence in Disabled Athletes: A Critical Evaluation of Measurement Reliability Ayşenur Gökşen, Gonca İnce, Özgül Akın Şenkal This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6975623/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Jan, 2026 Read the published version in Sport Sciences for Health → Version 1 posted 7 You are reading this latest preprint version Abstract Purpose: The present study aims to examine the level of exercise addiction among individuals with disabilities, an issue that is often neglected in the literature. Furthermore, the research seeks to evaluate the validity and reliability of the Exercise Addiction Scale (EDS) within this specific population. Method: 80 disabled athletes (39 female, 41 male) who have been actively involved in sports clubs for at least three years were included in the study. The mean age of the participants was 29.33±11.17. The study was conducted using a cross-sectional scanning design within the framework of a descriptive research model, and the universe of the study consisted of all sports clubs serving disabled individuals in the Çukurova region. Tekkurşun et al.'s Exercise Addiction Scale (EAS), adapted to Turkish by the club trainers, was used to collect data. The scale was delivered to all participants through club trainers, and data was collected face-to-face. The first part of the data collection tool was the consent form, the second part was the form that questioned demographic information, disability status, and sports habits, and the third part was the Exercise Addiction Scale, consisting of 17 items. Cronbach's alpha (reliability coefficient) of the scale was found to be 0.796 (low); however, when some items that were not suitable for disabled individuals were removed, the Cronbach's alpha value was found to be 0.818 (sufficient). Findings: 46.3% of the participants stated that they started sports for professional or social reasons. Hearing-impaired individuals, unlike other disability groups, did not state social participation as the reason for starting sports. The average EBÖ score of disabled individuals, regardless of the type of disability, was found to be 47.02±8.02; this indicates that disabled individuals may experience exercise addiction. There was no significant difference in terms of exercise addiction between the disability groups (p=0.188). Conclusion: This study demonstrated that athletes with disabilities can develop exercise addiction; however, a revision to the current scale is necessary to evaluate exercise addiction in disabled individuals. Raising awareness of exercise addiction within disabled sports disciplines may contribute to the early identification and prevention of this emerging issue. Disability sports physical activity exercise dependence INTRODUCTION Sports and exercise are indeed important for people with disabilities in terms of social participation, personal health, and physical fitness. Physical activity promotes a sense of purpose in improving health, as it is an emotional motivator and a means for independence in society for individuals with disabilities. According to Aitchison et al., exercise is a crucial factor in the improvement of the quality of life of people with disabilities and the promotion of their integration into society [ 1 ]. Sports can give disabled individuals a sense of well-being and social integration, which may foster a strong interest in athletic activities [ 2 ]. Exercise is commonly viewed as a beneficial habit. However, it can potentially develop into an unhealthy and compulsive behaviour for certain individuals. The literature describes that this enthusiasm can occasionally become exercise dependence. Excessive physical activity, also known as exercise dependence or compulsive exercise, can negatively affect an individual's physical and mental health. While exercise is generally beneficial, it is important to recognize the potential risks associated with excessive physical activity, such as injuries, poor performance, and health problems. Although exercise is generally beneficial, it is important to recognize the potential risks associated with excessive physical activity, such as injuries, poor performance, and health problems. It is important for coaches who work closely with athletes to be aware of this issue and to evaluate athletes together with physiotherapists. When looking at the studies conducted on this subject, it is seen that the literature focuses on non-disabled athletes [ 2 , 3 ]. Exercise dependence in disabled individuals is a subject rarely examined in the literature [ 4 ]. Determining whether this issue has been overlooked or is simply less prevalent in this population is crucial. This study will provide valuable insights into the potential risks and challenges faced by disabled individuals with exercise dependence. Exercise addiction is an important factor that can affect the quality of life of individuals with disabilities, and this research constitutes an important step towards better understanding the relationship of individuals with disabilities with sports. The main objective of this research is to investigate the existence of exercise dependence in disabled individuals. This study examines the reliability of the exercise dependence scale used in the literature to evaluate exercise dependence in disabled individuals. It is important to ensure that the scale is accurate and effective in measuring exercise dependence in this population. A reliable scale could better understand exercise dependence in disabled individuals [ 2 , 3 ]. The main question of this research is to investigate the existence of exercise dependence in disabled individuals. On the other hand, another aim of this study is to question how reliable the exercise dependence measurement tool used in the literature to evaluate exercise dependence is for disabled individuals. The hypotheses of the study are as follows H1. There is exercise addiction in disabled individuals H2. The exercise addiction scale is a reliable method to assess the exercise addiction of disabled individuals MATERIALS AND METHODS Study Design and Participants This descriptive, cross-sectional study was conducted between March 2023 and February 2024. The target population comprised athletes with disabilities actively engaged in sports through organized clubs. To ensure accessibility and feasibility, the study was geographically limited to the Çukurova region. Participants were recruited via club coaches, and data collection was carried out using a cross-sectional survey design through face-to-face interviews. For visually and physically impaired participants, the survey items were read aloud and explained by the researcher. Hearing-impaired individuals, on the other hand, were provided with the questionnaire to complete independently. Support was received from coaches for the necessary explanations while filling out the scale for the hearing impaired. Ethical Considerations Ethical approval for the study was obtained from the Ethics Committee of XXX University, a public institution in Turkey (Decision Date: 03.11.2023; Decision Number: 45). Prior to participation, all individuals were informed about the aims and scope of the research, and written informed consent was obtained. For visually impaired participants, verbal consent was also secured in addition to the written documentation, ensuring ethical compliance and voluntary participation. Inclusion Criteria Participants were included in the study if they met all the following criteria: Aged between 18 and 45 years, Actively involved in a single branch of disabled sports in sports clubs within the Çukurova region for at least 3 years, Diagnosed with a single type of disability (visual, hearing, or physical), Not having multiple disabilities or cognitive impairments that could interfere with survey comprehension. Data Collection Tools Demographic form A structured data collection form was used to record participants’ demographic and physical characteristics, including age, gender, type of disability, duration of sports participation, and sport discipline. Exercise dependence was assessed using the Exercise Dependence Scale (EDS), which had been previously adapted and validated for use in the Turkish population by Tekkurşun et al. The scale evaluates behavioral components associated with exercise addiction. Exercise Dependence Scale The study employed the Exercise Dependence Scale, a validated and reliable instrument to assess exercise dependence [ 5 ]. This scale utilizes a 17-item Likert scale to distinguish between exercise dependence and the mere desire to exercise [ 6 ]. The survey comprises 17 items rated on a 5-point Likert scale. Its validity and reliability have been previously established among healthy athletes. According to this scale, a higher score indicates a more significant presence of symptoms related to exercise dependence. It is important to note that individuals can be categorized as at-risk for exercise dependence, showing symptoms independently or without any symptoms. Statistical analysis All statistical analyses were conducted using IBM SPSS Statistics version 21.0. Descriptive statistics (frequency, mean, standard deviation) were used to summarize the demographic and physical characteristics of the participants. The normality of continuous variables was assessed using the Shapiro-Wilk test and histogram visualizations. Qualitative variables were presented as frequencies and percentages. A significance level of 5% (p < 0.05) was adopted for all analyses. To assess the construct reliability of the Exercise Dependence Scale (EDS) among disabled athletes, internal consistency was evaluated using Cronbach’s alpha coefficient . Additionally, item-level analyses were conducted, including the calculation of “Corrected Item-Total Correlation” and “Cronbach’s Alpha if Item Deleted” for each scale item. Items with low item-total correlation (typically < 0.30) were critically reviewed for their contribution to internal consistency. The first analysis revealed that Item 1, Item 10, and Item 12 had particularly low correlations and alpha improvements if deleted, suggesting weak alignment with the overall construct. A second refined analysis further supported the internal consistency, with most items demonstrating moderate-to-strong item-total correlations. To explore differences in exercise dependence scores across disability groups (visual, hearing, physical), the Kruskal–Wallis test was used, as the data did not meet normality assumptions. Spearman correlation analysis was used to evaluate the relationships between exercise dependence and continuous variables (e.g., age, sports years). Where appropriate, chi-square tests and both parametric and non-parametric tests were applied based on distribution characteristics of the variables. All statistical tests were conducted with a 95% confidence interval. Power Analysis and Sample Size Determination Prior to data collection, a power analysis was conducted to determine the appropriate sample size for the study. Given the target population of disabled athletes in sports clubs in the Çukurova region, the required sample size was calculated to be 85 participants. This calculation was based on a statistical power of 0.80, a significance level of 5% (α = 0.05), and an expected medium effect size (Cohen’s d = 0.5) for the primary analysis. Power analysis was performed using G*Power 3.1 software to ensure sufficient power to detect meaningful differences and relationships among variables. RESULTS A total of 80 athletes with disabilities (39 women and 41 men) between the ages of 18 and 45 participated in the study. Twenty of the athletes had vision problems, 32 had auditory impairment, and 28 were physically disabled. The physical and demographic characteristics of the individuals participating in the study are presented in Table 1 . When the reasons for individuals with disability to start sports are examined, it is seen that 46.3% of them started sports to gain employment and socialise. It was concluded that auditory-impaired individuals started sports (50.0%) to change their appearance, unlike other types of disabilities (Table 2 ). The reliability of the scale was found to be 0.796. When the reliability of each statement was examined, it was determined that the scale's reliability increased when the statements EB1, EB10, and EB12 were deleted from the scale. For this reason, these statements were deleted from the scale, and the reliability analysis was conducted again. The results are shown in Table 3 below. When the expressions EB1, EB10, and EB12 were deleted from the scale, the reliability score of the scale increased to 0.814. However, it is understood from Table 3 that when the expression EB6 is deleted, this ratio will increase to 0.818. Therefore, EB6 expression was deleted, and the reliability analysis was performed again. The latest reliability score of the scale was found to be 0.818 (Table 4 ). As a result, when the Exercise Dependence Scale was applied to disabled individuals, four statements were removed from the 17-statement scale, and the result was found to be quite dependable. In the last version of the scale, 1–14 is normal; 15–28 is minimal risk; 29–42 is risky; 43–56 are dependents; and 57–60 is substantial risk. It has been found that disabled individuals have exercise dependence and that disabled individuals are addicted to exercise. (47.02 ± 8.02), Table 5 . It was found that exercise dependence was not related to disability status or sports year (Table 5 , 6 ), p > 0.05. Table 1 Demographic and physical characteristics Obstacle Type Visual İmpairment (n = 20) Auditory İmpairment (n = 32) Physical İmpairment (n = 28) Age (Mean ± SD) 29.33 ± 11.17 Gender Female 39 Male 41 BMI 23.77 ± 3.39 Sport Branch Goalball (n = 9) Athletics (n = 6) Football and amputee football (n = 22) Wheelchair basketball (n = 14) Wheelchair tennis (n = 1) Volleyball and Sitting Volleyball (n = 10) Judo-karate (n = 17) Swimming (n = 1) Sport year 8.30 ± 6.45 SD: Standard deviation; BMI: Body Mass Index; n: number Table 2 Reason for starting sports n (%) Obstacle Type p Reason for starting sport 80 (%100) Visual İmpairment Auditory İmpairment Physical İmpairment 0.09 Socialize 37 (%46.3) 9 (%45) 9 (%28.1) 19 (67.9) Change your appearance 25 (%31.3) 5 (%25) 16 (%50.0) 4 (14.3) Staying healthy, doctor's advice 18 (%22.5) 6 (%30) 7 (%21.9) 5 (%17.9) n: number; %: percent; p < 0.05, Kruskall Wallis Test Table 3 Descriptive statistics and internal consistency (expressed by Cronbach’s alpha). Scale Mean if Item Deleted Scale Variance if Item Deleted Corrected Item-Total Correlation Cronbach's Alpha if Item Deleted Item1 55.12 82.009 .045 .809 Item2 54.97 74.101 .541 .776 Item3 54.92 76.172 .533 .779 Item4 55.17 73.184 .624 .772 Item5 55.17 76.728 .360 .787 Item6 56.35 76.154 .309 .791 Item7 55.51 73.721 .446 .781 Item8 55.34 74.429 .396 .785 Item9 56.02 73.974 .399 .785 Item10 56.74 80.196 .181 .798 Item11 56.22 74.430 .442 .782 Item12 56.49 77.620 .222 .798 Item13 56.22 70.480 .564 .771 Item14 56.24 75.677 .363 .787 Item15 55.39 76.392 .376 .786 Item16 55.85 73.344 .526 .776 Item17 55.85 76.711 .342 .788 Reliability was done with alpha reliability analyses. Table 4 Descriptive statistics, internal consistency (expressed by Cronbach’s alpha) after item 1-10-12 removal. Scale Mean if Item Deleted Scale Variance if Item Deleted Corrected Item-Total Correlation Cronbach's Alpha if Item Deleted Item2 45.65 60.534 .590 .792 Item3 45.60 62.724 .567 .797 Item4 45.85 59.623 .682 .786 Item5 45.85 63.294 .379 .806 Item6 47.03 64.379 .238 .818 Item7 46.19 61.040 .435 .802 Item8 46.01 60.848 .432 .803 Item9 46.70 61.200 .392 .806 Item11 46.90 61.914 .418 .804 Item13 46.90 59.256 .490 .798 Item14 46.91 62.790 .353 .809 Item15 46.06 62.819 .406 .804 Item16 46.53 60.885 .503 .797 Item17 46.53 62.809 .389 .806 Reliability was done with alpha reliability analyses. The table shows the average variance and reliability values of the scale when the statements are deleted. Table 5 General score of exercise dependence symptoms. Mean ± SD p Total 47.02 ± 8.02 0.188 Visual disability 44.35 ± 8.51 auditory disability 47.31 physically disabled 48.60 SD: Standard deviation, 1–14 = normal; 15–28 = low risk; 29–42 = risky; 43–46 = high risk; 47–60 = dependent p < 0.05 Kruskall Wallis Test. Table 6 The relationship between sports years and exercise dependence Sports year Exercise dependence r p 0.002 0.98 p < 0.05. Spearmen Correlation Test. DISCUSSION Exercise dependence in disabled individuals is a subject rarely examined in the literature[ 7 ]. The present study aimed to examine exercise dependence in individuals with visual, hearing, and physical disabilities and to assess the reliability of the exercise dependence scale for disabled individuals. Past literature has mainly concentrated on exercise dependence in non-disabled athletes[ 8 ]. The present study aims to expand the understanding of exercise dependence in disabled individuals. Exercise dependence is a phenomenon that can be triggered by appearance anxiety and weight control in non-disabled athletes, as noted by Godoy-Izquierdo et al.[ 2 ]. Unfortunately, this dependence can lead to recurring injuries and prolong the athlete's recovery, as Maceri et al. highlighted[ 3 ]. Exercise dependence causes recurring injuries in the athlete and prolongs the recovery process[ 6 ]. Therefore, addressing exercise dependence in athletes is crucial to prevent these negative consequences. Research has not found a statistically significant difference between sports branches and exercise dependence[ 9 ]. Our literature review found that only studies that were about physically impaired athletes examined exercise dependence in disabled individuals. The results indicate that 46.3% of participants started sports to keep busy and socialize. Additionally, hearing-impaired individuals reported starting sports to change their appearance, which differs from other disability groups. Based on these results, it can be concluded that social participation presents fewer challenges for individuals with hearing impairments than other disability groups. Furthermore, it is important to note that the motivation for non-disabled adults to engage in sports is often related to appearance[ 10 ]. Physically and visually impaired individuals often engage in sports to enhance their social participation, while hearing-impaired individuals may participate in sports to improve their appearance, like non-disabled individuals. Visual and physical disabilities may reduce participation in social activities more than auditory impairments. Facial expressions are important in face-to-face interactions. In the case of a physical impairment, body image, self-confidence, and transportation problems may be more effective in restricting social participation. Compared to other disabilities, auditory impairment can be considered a more solvable and camouflaged disability group. Therefore, auditory-impaired individuals do not start sports with concerns about social participation. Although many scales in the literature evaluate exercise dependence [ 5 , 11 – 14 ]. It was determined that there is no scale specific to disabled individuals that evaluates the exercise dependence of disabled individuals[ 8 ]. It was also seen that the reliability of none of the scales in the literature has been studied on disabled individuals. Although the scale we used in the study was generally reliable for disabled individuals, we found that some items were unsuitable for disabled individuals. According to the evaluation results, the group in our sample was found to be addicted. All studies emphasize the importance of sports for disabled individuals [ 15 – 17 ]. There are also studies on the obstacles to exercise and sports participation in disabled individuals[ 17 – 19 ]. It is a known fact that there are many obstacles to disabled individuals participating in sports and social and community participation, and publications focus on this[ 20 ]. Perhaps because no scale is specific to the disabled, studies in this area are limited. Perhaps it could also be because disabled individuals participate less in sports. We received a response from a journal to which we had previously sent our article, saying that exercise addiction cannot be an issue in disabled individuals. Why not? disabled individuals are achieving very important success in sports, and many disabled individuals are becoming more visible thanks to sports. This alone can create a psychological motivation for exercise addiction [21]. The results of our research also show that exercise addiction can be seen among disabled athletes and should not be ignored. This study was the first to draw attention to exercise dependence in disabled individuals. The study indicates that there is no significant difference in dependence level or participation among disability groups. However, it is important to consider the individual characteristics, beliefs, and behaviours of disabled athletes, particularly in competitive sports, as these factors may affect their participation in sports regardless of their level of disability. Such factors may trigger dependence in some disabled athletes. Therefore, it is crucial to approach this issue with a balanced and informed perspective, considering the unique experiences and challenges disabled athletes face. Similarly, it has been reported that exercise dependence in non-disabled athletes is not related to the sports branch [ 9 ]. Another result obtained from the study is that there is no relationship between sports years and exercise dependence. This situation suggests that the individual characteristics of the athlete, rather than the sports branch may be more effective in preventing exercise dependence. Conclusions The results of this study show that exercise dependence can also be seen in disabled athletes. Although the current scale was generally found to be reliable, some of its items were not suitable for disabled individuals. Therefore, a scale that will improve exercise addiction in disabled athletes is needed. Coaches, athletes, and health personnel should develop awareness about exercise addiction in disabled individuals. The number of studies in this area is very limited. In this study, we investigated the presence of exercise addiction in disabled individuals. Future studies can examine the factors that affect this. We think that the factors that affect exercise addiction in non-disabled individuals and the factors that affect exercise addiction in disabled individuals will be different from each other. Limitations This study's limitations include a small sample size and the examination of athletes from many branches. Further research on the impact of individual characteristics of disabled athletes on their sports participation would be valuable in gaining insight into this issue. Declarations Conflict of Interest The authors declare no conflict of interest. Author Contributions Conceptualization: A.G.; Data Collection and Analysis: G.Ö., A.G.; Writing – Original Draft and Final Review: G.Ö., A.G. Human and Animal Rights/Ethics approval Human ethics approval Informed consent Yes References Aitchison B, et al. Experiences and perceived health benefits of individuals with a disability participating in sport: A systematic review protocol. BMJ Open. 2020;10(11):e038214. Godoy-Izquierdo D, et al. A systematic review on exercise addiction and the disordered eating-eating disorders continuum in the competitive sport context. Int J Ment Health Addict. 2023;21(1):529–561. Maceri RM, et al. Exercise addiction in long distance runners. Int J Ment Health Addict. 2021;19:62–71. Günata GP, Gonca İ. The effects of 12-week basic badminton training on the motor functions and reaction times of children aged 9–12. Int J Sport Res. 2011;3(1):1–10. Tekkurşun Demir G, Hazar Z, Cicioğlu H. Exercise Dependence Scale (EDS): Validity and reliability study. Kastamonu Educ J. 2018;26(3):933–944. Ogden J, Veale D, Summers Z. The development and validation of the Exercise Dependence Questionnaire. Addict Res. 1997;5(4):343–355. Colledge F, et al. Excessive exercise—a meta-review. Front Psychiatry. 2020;11:521572. Orhan S, et al. Investigation of the exercise dependence of athletes doing kickboxing, taekwondo, and muay thai. Sports (Basel). 2019;7(2):52. Bevan N, et al. The relationship between weight stigma, physical appearance concerns, and enjoyment and tendency to avoid physical activity and sport. Int J Environ Res Public Health. 2021;18(19):9957. Hausenblas HA, Downs DS. Exercise dependence scale-21 manual. 2002. Available from: http://www.personal.psu.edu/dsd11/EDS/EDS21Manual.pdf Hausenblas HA, Downs DS. How much is too much? The development and validation of the exercise dependence scale. Psychol Health. 2002;17(4):387–404. Terry A, Szabo A, Griffiths M. The exercise addiction inventory: A new brief screening tool. Addict Res Theory. 2004;12(5):489–499. Trott M, et al. The development and validation of the secondary exercise addiction scale. Eat Weight Disord. 2022;27(4):1427–1436. Afroozeh MS, et al. The sport and exercise experiences of physically disabled women in Iran: shame, stereotyping, and Goffman’s stigma. Disabil Soc. 2024. doi:10.1080/09687599.2024.2332900 Torabi F, Hormozi SA. Comparison of the Impact of Body Percussion Exercises on Executive and Balance Performance in Intellectually Disabled and Healthy Girls of Ramhormoz City. Int J Sport Stud Health. 2024;7(1):23–30. Rolfe DE, et al. Negotiating participation: how women living with disabilities address barriers to exercise. Health Care Women Int. 2009;30(8):743–766. Henderson KA, Bedini LA. “I have a soul that dances like Tina Turner, but my body can't”: Physical activity and women with mobility impairments. Res Q Exerc Sport. 1995;66(2):151–161. Barrera-Garcimartín A, Redondo-Fernández Á, Pérez-Tejero J. Factors influencing sport development among women with disabilities: a case study of a visually impaired Spanish Paralympic woman. Front Sports Act Living. 2025;6:1518489. Elipe-Lorenzo P, et al. Barriers faced by people with disabilities in mainstream sports: a systematic review. Front Sports Act Living. 2025;7:1520962. Tóth B, Máté T. Sports motivation and sports opportunities of people with physical disability: The case of Hungary. Soc Econ. 2025;47(1):104–125. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 05 Jan, 2026 Read the published version in Sport Sciences for Health → Version 1 posted Editorial decision: Accepted 17 Nov, 2025 Reviews received at journal 29 Oct, 2025 Reviewers agreed at journal 29 Oct, 2025 Reviewers invited by journal 14 Oct, 2025 Editor assigned by journal 26 Jun, 2025 Submission checks completed at journal 26 Jun, 2025 First submitted to journal 25 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6975623","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":535853654,"identity":"66f3bbcf-4e97-43a7-b4b8-ab55da0d24e0","order_by":0,"name":"Ayşenur 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16:14:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":911875,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6975623/v1/9de893a0-51c3-4346-8598-2aad893266a3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eUnderstanding Exercise Dependence in Disabled Athletes: A Critical Evaluation of Measurement Reliability\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eSports and exercise are indeed important for people with disabilities in terms of social participation, personal health, and physical fitness. Physical activity promotes a sense of purpose in improving health, as it is an emotional motivator and a means for independence in society for individuals with disabilities. According to Aitchison et al., exercise is a crucial factor in the improvement of the quality of life of people with disabilities and the promotion of their integration into society [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Sports can give disabled individuals a sense of well-being and social integration, which may foster a strong interest in athletic activities [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Exercise is commonly viewed as a beneficial habit. However, it can potentially develop into an unhealthy and compulsive behaviour for certain individuals. The literature describes that this enthusiasm can occasionally become exercise dependence. Excessive physical activity, also known as exercise dependence or compulsive exercise, can negatively affect an individual's physical and mental health. While exercise is generally beneficial, it is important to recognize the potential risks associated with excessive physical activity, such as injuries, poor performance, and health problems. Although exercise is generally beneficial, it is important to recognize the potential risks associated with excessive physical activity, such as injuries, poor performance, and health problems. It is important for coaches who work closely with athletes to be aware of this issue and to evaluate athletes together with physiotherapists. When looking at the studies conducted on this subject, it is seen that the literature focuses on non-disabled athletes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Exercise dependence in disabled individuals is a subject rarely examined in the literature [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Determining whether this issue has been overlooked or is simply less prevalent in this population is crucial. This study will provide valuable insights into the potential risks and challenges faced by disabled individuals with exercise dependence. Exercise addiction is an important factor that can affect the quality of life of individuals with disabilities, and this research constitutes an important step towards better understanding the relationship of individuals with disabilities with sports. The main objective of this research is to investigate the existence of exercise dependence in disabled individuals. This study examines the reliability of the exercise dependence scale used in the literature to evaluate exercise dependence in disabled individuals. It is important to ensure that the scale is accurate and effective in measuring exercise dependence in this population. A reliable scale could better understand exercise dependence in disabled individuals [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The main question of this research is to investigate the existence of exercise dependence in disabled individuals. On the other hand, another aim of this study is to question how reliable the exercise dependence measurement tool used in the literature to evaluate exercise dependence is for disabled individuals.\u003c/p\u003e\u003cp\u003eThe hypotheses of the study are as follows\u003c/p\u003e\u003cp\u003eH1. There is exercise addiction in disabled individuals\u003c/p\u003e\u003cp\u003eH2. The exercise addiction scale is a reliable method to assess the exercise addiction of disabled individuals\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Participants\u003c/h2\u003e\u003cp\u003eThis descriptive, cross-sectional study was conducted between March 2023 and February 2024. The target population comprised athletes with disabilities actively engaged in sports through organized clubs. To ensure accessibility and feasibility, the study was geographically limited to the \u0026Ccedil;ukurova region. Participants were recruited via club coaches, and data collection was carried out using a cross-sectional survey design through face-to-face interviews. For visually and physically impaired participants, the survey items were read aloud and explained by the researcher. Hearing-impaired individuals, on the other hand, were provided with the questionnaire to complete independently. Support was received from coaches for the necessary explanations while filling out the scale for the hearing impaired.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003e for the study was obtained from the Ethics Committee of XXX University, a public institution in Turkey (Decision Date: 03.11.2023; Decision Number: 45). Prior to participation, all individuals were informed about the aims and scope of the research, and written informed consent was obtained. For visually impaired participants, verbal consent was also secured in addition to the written documentation, ensuring ethical compliance and voluntary participation.\u003c/p\u003e\u003c/p\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cp\u003eParticipants were included in the study if they met all the following criteria:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAged between 18 and 45 years,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eActively involved in a single branch of disabled sports in sports clubs within the \u0026Ccedil;ukurova region for at least 3 years,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDiagnosed with a single type of disability (visual, hearing, or physical),\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNot having multiple disabilities or cognitive impairments that could interfere with survey comprehension.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eData Collection Tools\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eDemographic form\u003c/h2\u003e\u003cp\u003eA structured data collection form was used to record participants\u0026rsquo; demographic and physical characteristics, including age, gender, type of disability, duration of sports participation, and sport discipline. Exercise dependence was assessed using the Exercise Dependence Scale (EDS), which had been previously adapted and validated for use in the Turkish population by Tekkurşun et al. The scale evaluates behavioral components associated with exercise addiction.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eExercise Dependence Scale\u003c/h2\u003e\u003cp\u003eThe study employed the Exercise Dependence Scale, a validated and reliable instrument to assess exercise dependence [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This scale utilizes a 17-item Likert scale to distinguish between exercise dependence and the mere desire to exercise [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The survey comprises 17 items rated on a 5-point Likert scale. Its validity and reliability have been previously established among healthy athletes. According to this scale, a higher score indicates a more significant presence of symptoms related to exercise dependence. It is important to note that individuals can be categorized as at-risk for exercise dependence, showing symptoms independently or without any symptoms.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll statistical analyses were conducted using IBM SPSS Statistics version 21.0. Descriptive statistics (frequency, mean, standard deviation) were used to summarize the demographic and physical characteristics of the participants. The normality of continuous variables was assessed using the Shapiro-Wilk test and histogram visualizations. Qualitative variables were presented as frequencies and percentages. A significance level of 5% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) was adopted for all analyses. To assess the construct reliability of the Exercise Dependence Scale (EDS) among disabled athletes, internal consistency was evaluated using Cronbach\u0026rsquo;s \u003cb\u003ealpha coefficient\u003c/b\u003e. Additionally, \u003cb\u003eitem-level analyses\u003c/b\u003e were conducted, including the calculation of \u003cem\u003e\u0026ldquo;Corrected Item-Total Correlation\u0026rdquo;\u003c/em\u003e and \u003cem\u003e\u0026ldquo;Cronbach\u0026rsquo;s Alpha if Item Deleted\u0026rdquo;\u003c/em\u003e for each scale item. Items with low item-total correlation (typically\u0026thinsp;\u0026lt;\u0026thinsp;0.30) were critically reviewed for their contribution to internal consistency. The first analysis revealed that Item 1, Item 10, and Item 12 had particularly low correlations and alpha improvements if deleted, suggesting weak alignment with the overall construct. A second refined analysis further supported the internal consistency, with most items demonstrating moderate-to-strong item-total correlations. To explore differences in exercise dependence scores across disability groups (visual, hearing, physical), the \u003cb\u003eKruskal\u0026ndash;Wallis test\u003c/b\u003e was used, as the data did not meet normality assumptions. \u003cb\u003eSpearman correlation analysis\u003c/b\u003e was used to evaluate the relationships between exercise dependence and continuous variables (e.g., age, sports years). Where appropriate, \u003cb\u003echi-square tests\u003c/b\u003e and both \u003cb\u003eparametric\u003c/b\u003e and \u003cb\u003enon-parametric tests\u003c/b\u003e were applied based on distribution characteristics of the variables. All statistical tests were conducted with a 95% confidence interval.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePower Analysis and Sample Size Determination\u003c/h3\u003e\n\u003cp\u003ePrior to data collection, a power analysis was conducted to determine the appropriate sample size for the study. Given the target population of disabled athletes in sports clubs in the \u0026Ccedil;ukurova region, the required sample size was calculated to be 85 participants. This calculation was based on a statistical power of 0.80, a significance level of 5% (α\u0026thinsp;=\u0026thinsp;0.05), and an expected medium effect size (Cohen\u0026rsquo;s d\u0026thinsp;=\u0026thinsp;0.5) for the primary analysis. Power analysis was performed using G*Power 3.1 software to ensure sufficient power to detect meaningful differences and relationships among variables.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 80 athletes with disabilities (39 women and 41 men) between the ages of 18 and 45 participated in the study. Twenty of the athletes had vision problems, 32 had auditory impairment, and 28 were physically disabled.\u003c/p\u003e\u003cp\u003eThe physical and demographic characteristics of the individuals participating in the study are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. When the reasons for individuals with disability to start sports are examined, it is seen that 46.3% of them started sports to gain employment and socialise. It was concluded that auditory-impaired individuals started sports (50.0%) to change their appearance, unlike other types of disabilities (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The reliability of the scale was found to be 0.796. When the reliability of each statement was examined, it was determined that the scale's reliability increased when the statements EB1, EB10, and EB12 were deleted from the scale. For this reason, these statements were deleted from the scale, and the reliability analysis was conducted again. The results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e below. When the expressions EB1, EB10, and EB12 were deleted from the scale, the reliability score of the scale increased to 0.814. However, it is understood from Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e that when the expression EB6 is deleted, this ratio will increase to 0.818. Therefore, EB6 expression was deleted, and the reliability analysis was performed again. The latest reliability score of the scale was found to be 0.818 (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). As a result, when the Exercise Dependence Scale was applied to disabled individuals, four statements were removed from the 17-statement scale, and the result was found to be quite dependable. In the last version of the scale, 1\u0026ndash;14 is normal; 15\u0026ndash;28 is minimal risk; 29\u0026ndash;42 is risky; 43\u0026ndash;56 are dependents; and 57\u0026ndash;60 is substantial risk. It has been found that disabled individuals have exercise dependence and that disabled individuals are addicted to exercise. (47.02\u0026thinsp;\u0026plusmn;\u0026thinsp;8.02), Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. It was found that exercise dependence was not related to disability status or sports year (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e), p\u0026thinsp;\u0026gt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic and physical characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eObstacle Type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVisual İmpairment (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\u003cp\u003eAuditory İmpairment (n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e\u003cp\u003ePhysical İmpairment (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.33\u0026thinsp;\u0026plusmn;\u0026thinsp;11.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003e\u003cb\u003eSport Branch\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGoalball (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAthletics (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eFootball and amputee football (n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eWheelchair basketball (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eWheelchair tennis (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eVolleyball and Sitting Volleyball (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eJudo-karate (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSwimming (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSport year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.30\u0026thinsp;\u0026plusmn;\u0026thinsp;6.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eSD: Standard deviation; BMI: Body Mass Index; n: number\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eReason for starting sports\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eObstacle Type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReason for starting sport\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80 (%100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVisual İmpairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAuditory İmpairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePhysical İmpairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocialize\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37 (%46.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (%45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (%28.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (67.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChange your appearance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (%31.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (%25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (%50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (14.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStaying healthy, doctor's advice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (%22.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (%30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (%21.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (%17.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003en: number; %: percent; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Kruskall Wallis Test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive statistics and internal consistency (expressed by Cronbach\u0026rsquo;s alpha).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eScale Mean if Item Deleted\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScale Variance if Item Deleted\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCorrected Item-Total Correlation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCronbach's Alpha if Item Deleted\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.809\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.541\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.776\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76.172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.533\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.779\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.624\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.772\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76.728\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.360\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.787\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76.154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.791\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.721\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.446\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.781\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.429\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.396\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.785\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.974\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.399\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.785\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem10\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80.196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.798\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem11\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.430\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.442\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.782\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem12\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.620\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.798\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem13\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70.480\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.564\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.771\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem14\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75.677\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.787\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem15\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76.392\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.376\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.786\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem16\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.344\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.526\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.776\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem17\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76.711\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.342\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.788\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eReliability was done with alpha reliability analyses.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive statistics, internal consistency (expressed by Cronbach\u0026rsquo;s alpha) after item 1-10-12 removal.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eScale Mean if Item Deleted\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScale Variance if Item Deleted\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCorrected Item-Total Correlation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCronbach's Alpha if Item Deleted\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60.534\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.590\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.792\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.724\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.567\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.797\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59.623\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.682\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.786\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.379\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.806\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64.379\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.238\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.818\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.435\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.802\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60.848\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.803\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61.200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.392\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.806\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem11\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61.914\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.418\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.804\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem13\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59.256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.490\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.798\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem14\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.790\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.353\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.809\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem15\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.819\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.406\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.804\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem16\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60.885\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.503\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.797\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eItem17\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.809\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.389\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.806\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eReliability was done with alpha reliability analyses. The table shows the average variance and reliability values of the scale when the statements are deleted.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGeneral score of exercise dependence symptoms.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47.02\u0026thinsp;\u0026plusmn;\u0026thinsp;8.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.188\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVisual disability\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44.35\u0026thinsp;\u0026plusmn;\u0026thinsp;8.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eauditory disability\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ephysically disabled\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eSD: Standard deviation, 1\u0026ndash;14\u0026thinsp;=\u0026thinsp;normal; 15\u0026ndash;28\u0026thinsp;=\u0026thinsp;low risk; 29\u0026ndash;42\u0026thinsp;=\u0026thinsp;risky; 43\u0026ndash;46\u0026thinsp;=\u0026thinsp;high risk; 47\u0026ndash;60\u0026thinsp;=\u0026thinsp;dependent\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05 Kruskall Wallis Test.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe relationship between sports years and exercise dependence\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSports year\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eExercise dependence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003er\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Spearmen Correlation Test.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eExercise dependence in disabled individuals is a subject rarely examined in the literature[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The present study aimed to examine exercise dependence in individuals with visual, hearing, and physical disabilities and to assess the reliability of the exercise dependence scale for disabled individuals. Past literature has mainly concentrated on exercise dependence in non-disabled athletes[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The present study aims to expand the understanding of exercise dependence in disabled individuals. Exercise dependence is a phenomenon that can be triggered by appearance anxiety and weight control in non-disabled athletes, as noted by Godoy-Izquierdo et al.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Unfortunately, this dependence can lead to recurring injuries and prolong the athlete's recovery, as Maceri et al. highlighted[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Exercise dependence causes recurring injuries in the athlete and prolongs the recovery process[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, addressing exercise dependence in athletes is crucial to prevent these negative consequences. Research has not found a statistically significant difference between sports branches and exercise dependence[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Our literature review found that only studies that were about physically impaired athletes examined exercise dependence in disabled individuals. The results indicate that 46.3% of participants started sports to keep busy and socialize. Additionally, hearing-impaired individuals reported starting sports to change their appearance, which differs from other disability groups. Based on these results, it can be concluded that social participation presents fewer challenges for individuals with hearing impairments than other disability groups. Furthermore, it is important to note that the motivation for non-disabled adults to engage in sports is often related to appearance[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Physically and visually impaired individuals often engage in sports to enhance their social participation, while hearing-impaired individuals may participate in sports to improve their appearance, like non-disabled individuals. Visual and physical disabilities may reduce participation in social activities more than auditory impairments. Facial expressions are important in face-to-face interactions. In the case of a physical impairment, body image, self-confidence, and transportation problems may be more effective in restricting social participation. Compared to other disabilities, auditory impairment can be considered a more solvable and camouflaged disability group. Therefore, auditory-impaired individuals do not start sports with concerns about social participation. Although many scales in the literature evaluate exercise dependence [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. It was determined that there is no scale specific to disabled individuals that evaluates the exercise dependence of disabled individuals[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. It was also seen that the reliability of none of the scales in the literature has been studied on disabled individuals. Although the scale we used in the study was generally reliable for disabled individuals, we found that some items were unsuitable for disabled individuals. According to the evaluation results, the group in our sample was found to be addicted. All studies emphasize the importance of sports for disabled individuals [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. There are also studies on the obstacles to exercise and sports participation in disabled individuals[\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It is a known fact that there are many obstacles to disabled individuals participating in sports and social and community participation, and publications focus on this[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Perhaps because no scale is specific to the disabled, studies in this area are limited. Perhaps it could also be because disabled individuals participate less in sports. We received a response from a journal to which we had previously sent our article, saying that exercise addiction cannot be an issue in disabled individuals. Why not? disabled individuals are achieving very important success in sports, and many disabled individuals are becoming more visible thanks to sports. This alone can create a psychological motivation for exercise addiction [21]. The results of our research also show that exercise addiction can be seen among disabled athletes and should not be ignored. This study was the first to draw attention to exercise dependence in disabled individuals. The study indicates that there is no significant difference in dependence level or participation among disability groups. However, it is important to consider the individual characteristics, beliefs, and behaviours of disabled athletes, particularly in competitive sports, as these factors may affect their participation in sports regardless of their level of disability. Such factors may trigger dependence in some disabled athletes. Therefore, it is crucial to approach this issue with a balanced and informed perspective, considering the unique experiences and challenges disabled athletes face. Similarly, it has been reported that exercise dependence in non-disabled athletes is not related to the sports branch [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Another result obtained from the study is that there is no relationship between sports years and exercise dependence. This situation suggests that the individual characteristics of the athlete, rather than the sports branch may be more effective in preventing exercise dependence.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe results of this study show that exercise dependence can also be seen in disabled athletes. Although the current scale was generally found to be reliable, some of its items were not suitable for disabled individuals. Therefore, a scale that will improve exercise addiction in disabled athletes is needed. Coaches, athletes, and health personnel should develop awareness about exercise addiction in disabled individuals. The number of studies in this area is very limited. In this study, we investigated the presence of exercise addiction in disabled individuals. Future studies can examine the factors that affect this. We think that the factors that affect exercise addiction in non-disabled individuals and the factors that affect exercise addiction in disabled individuals will be different from each other.\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study's limitations include a small sample size and the examination of athletes from many branches. Further research on the impact of individual characteristics of disabled athletes on their sports participation would be valuable in gaining insight into this issue.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: A.G.; Data Collection and Analysis: G.\u0026Ouml;., A.G.; Writing \u0026ndash; Original Draft and Final Review: G.\u0026Ouml;., A.G.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman and Animal Rights/Ethics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHuman ethics approval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAitchison B, et al. Experiences and perceived health benefits of individuals with a disability participating in sport: A systematic review protocol. BMJ Open. 2020;10(11):e038214.\u003c/li\u003e\n\u003cli\u003eGodoy-Izquierdo D, et al. A systematic review on exercise addiction and the disordered eating-eating disorders continuum in the competitive sport context. Int J Ment Health Addict. 2023;21(1):529\u0026ndash;561.\u003c/li\u003e\n\u003cli\u003eMaceri RM, et al. Exercise addiction in long distance runners. Int J Ment Health Addict. 2021;19:62\u0026ndash;71.\u003c/li\u003e\n\u003cli\u003eG\u0026uuml;nata GP, Gonca İ. The effects of 12-week basic badminton training on the motor functions and reaction times of children aged 9\u0026ndash;12. Int J Sport Res. 2011;3(1):1\u0026ndash;10.\u003c/li\u003e\n\u003cli\u003eTekkurşun Demir G, Hazar Z, Cicioğlu H. Exercise Dependence Scale (EDS): Validity and reliability study. Kastamonu Educ J. 2018;26(3):933\u0026ndash;944.\u003c/li\u003e\n\u003cli\u003eOgden J, Veale D, Summers Z. The development and validation of the Exercise Dependence Questionnaire. Addict Res. 1997;5(4):343\u0026ndash;355.\u003c/li\u003e\n\u003cli\u003eColledge F, et al. Excessive exercise\u0026mdash;a meta-review. Front Psychiatry. 2020;11:521572.\u003c/li\u003e\n\u003cli\u003eOrhan S, et al. Investigation of the exercise dependence of athletes doing kickboxing, taekwondo, and muay thai. Sports (Basel). 2019;7(2):52.\u003c/li\u003e\n\u003cli\u003eBevan N, et al. The relationship between weight stigma, physical appearance concerns, and enjoyment and tendency to avoid physical activity and sport. Int J Environ Res Public Health. 2021;18(19):9957.\u003c/li\u003e\n\u003cli\u003eHausenblas HA, Downs DS. Exercise dependence scale-21 manual. 2002. Available from: http://www.personal.psu.edu/dsd11/EDS/EDS21Manual.pdf\u003c/li\u003e\n\u003cli\u003eHausenblas HA, Downs DS. How much is too much? The development and validation of the exercise dependence scale. Psychol Health. 2002;17(4):387\u0026ndash;404.\u003c/li\u003e\n\u003cli\u003eTerry A, Szabo A, Griffiths M. The exercise addiction inventory: A new brief screening tool. Addict Res Theory. 2004;12(5):489\u0026ndash;499.\u003c/li\u003e\n\u003cli\u003eTrott M, et al. The development and validation of the secondary exercise addiction scale. Eat Weight Disord. 2022;27(4):1427\u0026ndash;1436.\u003c/li\u003e\n\u003cli\u003eAfroozeh MS, et al. The sport and exercise experiences of physically disabled women in Iran: shame, stereotyping, and Goffman\u0026rsquo;s stigma. Disabil Soc. 2024. doi:10.1080/09687599.2024.2332900\u003c/li\u003e\n\u003cli\u003eTorabi F, Hormozi SA. Comparison of the Impact of Body Percussion Exercises on Executive and Balance Performance in Intellectually Disabled and Healthy Girls of Ramhormoz City. Int J Sport Stud Health. 2024;7(1):23\u0026ndash;30.\u003c/li\u003e\n\u003cli\u003eRolfe DE, et al. Negotiating participation: how women living with disabilities address barriers to exercise. Health Care Women Int. 2009;30(8):743\u0026ndash;766.\u003c/li\u003e\n\u003cli\u003eHenderson KA, Bedini LA. \u0026ldquo;I have a soul that dances like Tina Turner, but my body can\u0026apos;t\u0026rdquo;: Physical activity and women with mobility impairments. Res Q Exerc Sport. 1995;66(2):151\u0026ndash;161.\u003c/li\u003e\n\u003cli\u003eBarrera-Garcimart\u0026iacute;n A, Redondo-Fern\u0026aacute;ndez \u0026Aacute;, P\u0026eacute;rez-Tejero J. Factors influencing sport development among women with disabilities: a case study of a visually impaired Spanish Paralympic woman. Front Sports Act Living. 2025;6:1518489.\u003c/li\u003e\n\u003cli\u003eElipe-Lorenzo P, et al. Barriers faced by people with disabilities in mainstream sports: a systematic review. Front Sports Act Living. 2025;7:1520962.\u003c/li\u003e\n\u003cli\u003eT\u0026oacute;th B, M\u0026aacute;t\u0026eacute; T. Sports motivation and sports opportunities of people with physical disability: The case of Hungary. Soc Econ. 2025;47(1):104\u0026ndash;125.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sport-sciences-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssfh","sideBox":"Learn more about [Sport Sciences for Health](http://link.springer.com/journal/11332)","snPcode":"11332","submissionUrl":"https://submission.nature.com/new-submission/11332/3","title":"Sport Sciences for Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Disability, sports, physical activity, exercise dependence","lastPublishedDoi":"10.21203/rs.3.rs-6975623/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6975623/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePurpose: The present study aims to examine the level of exercise addiction among individuals with disabilities, an issue that is often neglected in the literature. Furthermore, the research seeks to evaluate the validity and reliability of the Exercise Addiction Scale (EDS) within this specific population.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethod: 80 disabled athletes (39 female, 41 male) who have been actively involved in sports clubs for at least three years were included in the study. The mean age of the participants was 29.33±11.17. The study was conducted using a cross-sectional scanning design within the framework of a descriptive research model, and the universe of the study consisted of all sports clubs serving disabled individuals in the Çukurova region. Tekkurşun et al.'s Exercise Addiction Scale (EAS), adapted to Turkish by the club trainers, was used to collect data. The scale was delivered to all participants through club trainers, and data was collected face-to-face. The first part of the data collection tool was the consent form, the second part was the form that questioned demographic information, disability status, and sports habits, and the third part was the Exercise Addiction Scale, consisting of 17 items. Cronbach's alpha (reliability coefficient) of the scale was found to be 0.796 (low); however, when some items that were not suitable for disabled individuals were removed, the Cronbach's alpha value was found to be 0.818 (sufficient).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFindings: 46.3% of the participants stated that they started sports for professional or social reasons. Hearing-impaired individuals, unlike other disability groups, did not state social participation as the reason for starting sports. The average EBÖ score of disabled individuals, regardless of the type of disability, was found to be 47.02±8.02; this indicates that disabled individuals may experience exercise addiction. There was no significant difference in terms of exercise addiction between the disability groups (p=0.188).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: This study demonstrated that athletes with disabilities can develop exercise addiction; however, a revision to the current scale is necessary to evaluate exercise addiction in disabled individuals. Raising awareness of exercise addiction within disabled sports disciplines may contribute to the early identification and prevention of this emerging issue.\u003c/p\u003e","manuscriptTitle":"Understanding Exercise Dependence in Disabled Athletes: A Critical Evaluation of Measurement Reliability","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-28 16:43:15","doi":"10.21203/rs.3.rs-6975623/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-11-17T09:13:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-29T09:17:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"9351289211121768436496241426922669835","date":"2025-10-29T08:52:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-14T13:40:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-26T08:39:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-26T08:35:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Sport Sciences for Health","date":"2025-06-25T13:56:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sport-sciences-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssfh","sideBox":"Learn more about [Sport Sciences for Health](http://link.springer.com/journal/11332)","snPcode":"11332","submissionUrl":"https://submission.nature.com/new-submission/11332/3","title":"Sport Sciences for Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"fa30f4d2-0c11-441d-939c-4b607fffadc3","owner":[],"postedDate":"October 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:06:57+00:00","versionOfRecord":{"articleIdentity":"rs-6975623","link":"https://doi.org/10.1007/s11332-025-01589-2","journal":{"identity":"sport-sciences-for-health","isVorOnly":false,"title":"Sport Sciences for Health"},"publishedOn":"2026-01-05 15:59:24","publishedOnDateReadable":"January 5th, 2026"},"versionCreatedAt":"2025-10-28 16:43:15","video":"","vorDoi":"10.1007/s11332-025-01589-2","vorDoiUrl":"https://doi.org/10.1007/s11332-025-01589-2","workflowStages":[]},"version":"v1","identity":"rs-6975623","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6975623","identity":"rs-6975623","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}