Dissertations / Theses on the topic 'Gymnasium based exercise programs'

Background: People who have experienced a moderate or severe traumatic brain injury (TBI) will most likely live with motor and cognitive deficits including balance and poor mobility. These deficits may lead to limitations in activity participation, life satisfaction, and may increase the risk of falls. Improving access to rehabilitation care in the chronic phase of recovery is essential to prevent ongoing health issues. However, geographical restrictions, cost of transportation, or recently the COVID-19 pandemic restrictions may limit access to rehabilitation services. Telerehabilitation could serve as an alternative method to provide rehabilitation care while increasing access. Objectives: The overall objective of this dissertation was to understand the implementation of high-intensity telerehabilitation exercise programs for people living with a moderate or severe TBI and their family partners. This was accomplished by 1) determining the feasibility of using telerehabilitation, 2) investigating the effectiveness of high-intensity home-based telerehabilitation exercise programs on physical activity, functional mobility and dynamic balance, 3) understanding the perspectives and lived experiences of completing a telerehabilitation program, and 4) exploring how interpersonal behaviours can influence practice and be perceived in a telerehabilitation setting. Methodology: Influenced by a people-centered approach and explained by the Self-Determination Theory, this dissertation followed a mixed-method alternating single-subject design methodology. Five dyads composed of five persons living with a moderate or severe TBI and their family partners completed two high-intensity telerehabilitation programs remotely supervised, daily and weekly. The feasibility and effectiveness of the telerehabilitation programs were measured from a quantitative and qualitative perspective to replicate the clinical realities and understand all perspectives. Results: In this dissertation, the feasibility of using telerehabilitation with this population was highlighted by reporting high adherence, high usability, active engagement and safety. The effectiveness on physical activity levels, functional mobility, dynamic balance and concerns with falling was also demonstrated with no differences between the daily and weekly remote supervision schedule. The dyads described being highly satisfied, engaged, and enjoyed the remotely supervised exercise programs. The individuals with the TBI perceived more supportive behaviours than thwarting behaviours from the physiotherapist. Conclusion: This dissertation advances knowledge on telerehabilitation implementation for people living with cognitive and motor deficits following a TBI. High-intensity home-based telerehabilitation programs were shown to be feasible and effective. I introduced the importance of assessing needs-supportive and needs-thwarting interpersonal behaviours in the telerehabilitation context. Integrating these novel telerehabilitation concepts within emerging telerehabilitation models of care could significantly impact long-lasting positive health outcomes for individuals living with a moderate or severe TBI.

The aging population and burden of chronic conditions have led researchers and practitioners to develop, implement, and evaluate evidence-based programs (EBPs) for older adults. The Healthy Aging Regional Collaborative (HARC) was established to make EBPs including Diabetes Self-Management Program, Chronic Disease Self-Management Program, Matter of Balance, and EnhanceFitness (EF) accessible in south Florida. According to the REAIM model, reach, effectiveness, adoption, implementation, and maintenance determine the impact of EBPs. Evaluation of HARC demonstrated widespread adoption of EBPs by community organizations that reached diverse participants and effectiveness among participants attending the recommended number of sessions, but only 19% of EBP participants were male, and only 25% of EF participants met attendance criteria for adherence. This mixed-methods dissertation explored program instructor and coordinator perspectives on barriers and strategies related to male participation in EBPs, examined predictors of short-term and long-term adherence to EF, and applied a theoretical framework to explore participant and instructor perspectives on factors influencing adherence to EF. Fourteen program coordinators participated in a focus group to identify barriers and strategies to improve male participation, and 49 instructors participated in a survey to triangulate findings. Themes among barriers to male participation included women outnumbering men in programs, incompatibility of programs with male gender roles, and preference for other activities. Themes among strategies included endorsement by male community leaders, advertisements featuring males, and content adaptation. Among 5,619 EF participants, logistic regression confirmed age, race/ethnicity, gender, and health status as significant predictors of adherence. The likelihood of short-term and long-term adherence increased with age and health. Black participants were less likely than whites to adhere short-term (OR=0.82, p=.05) but more likely to adhere long-term (OR=1.77, p=.000). Hispanics were more likely than whites to adhere short-term (OR=1.25, p=.008) and long-term (OR=1.30, p=.001). Men were more likely to meet the criteria for short-term (OR=1.47, p=.001) and long-term adherence (OR=1.19, p=.04). Interviews with 12 adherent EF participants and 10 instructors revealed cues to action, goals, beliefs, intentions, program factors, social factors, and benefits that supported adherence. Findings inform efforts to improve participation and adherence in EBPs and maximize their impact on health among older adults.

Background and Purpose: To investigate the effect of an individualized exercise program versus a generic group-based exercise program on balance, gait, and functional performance of older adults categorized as having mild balance dysfunction and living in residential care facilities. Methods: Single blind randomized control design. One hundred-twenty residents fulfilled screening criteria for mild balance dysfunction based on the BioSwayTM balance and the Multi-Directional Reach Test (MDRT) primary outcome measures. Secondary assessment was completed using the Modified Physical Performance Test (PPT), hand-held dynamometer (lower-limb muscle strength testing), and gait speed analysis. Sixty subjects received individualized treatment from physical therapists (8 weeks). Another sixty subjects received generic group-based exercises (8 weeks). All outcome measures were collected at baseline and post-intervention (ninth week); and BioSwayTM and PPT measures at follow-up (thirteenth week) for the individualized group. Results: Individualized group (n=60) showed significant improvement compared to the group-based group (n=60) on the two BioSwayTM scores (limits of stability, p < .001; and postural stability, p = .016), the MDRT scores (forward reach, p < .001; backward reach, p = .007; right lateral reach, p < .001; and left lateral reach p < .001), the strength scores (hip flexors, p = .010; knee extensors, p = .002; hip abductors, p = .009; and ankle dorsiflexors, p = .025), the PPT outcomes (p < .001), and the gait scores (p = .012). Effect sizes ranged from small to large, with the largest sizes for limits of stability and MDRT. There were no significant differences between groups for the mCTSIB (p = .538). However, 96.7% of subjects in the individualized group scored within one SD of the reference mean, relative to 75% in the group-based group. At follow-up, the individualized group showed significant differences over time with medium to large effect sizes on the PPT (p < .001), limits of stability (p < .001), postural stability (p < .001), and mCTSIB (p = .005) measures. Post-hoc analysis revealed retention of gains for all measures at follow-up, except the mCTSIB. Conclusion: The individualized group showed significant improvements in the areas of balance, strength, mobility, and functional outcomes.

This thesis involves a study of adolescent participation in gymnasium based exercise programs (GBEPs) in Australia. It investigates the problematic nature of, and the influences on their low levels of participation. Special attention is given to the significance of gymnasiums as spaces for adolescent exercise participation, and—in the light of both the prevailing regulatory context and operations of the Exercise and Fitness Industry (EFI)—the capacity of gymnasium businesses and their workers to appropriately cater for this cohort. The study used a triangulated mixed-method research design, with data sourced from semi-structured telephone interviews, a structured online questionnaire, and documents relating to the operations and conduct of the EFI in Australia. Interviews were conducted with 16 informants, including a government minister, government and industry association executives, and senior managers from gymnasium businesses. Also from across Australia, were 44 parents and/or guardians of adolescent children who completed the questionnaire. The document analysis incorporated independent industry reports and government regulations relevant to the EFI and the context of this study. In particular, industry codes in four state and self-governing mainland territories, which were the main and generally enforceable regulations specific to the EFI in Australia, were examined. The study was framed by stakeholder theory, with the data situated in an analytical setting guided by regulation theory. The findings suggested that gymnasium businesses generally discriminated against adolescents through informal exclusion and restrictive policies on gymnasium based exercise program (GBEP) participation, and it was clear that this customer segment was not given the attention it deserved. In addition, most stakeholders believed that there was a need for better educated and suitably qualified gymnasium instructors and personal trainers, able to provide appropriate supervision, guidance and exercise instruction. Also demonstrated was strong support for external EFI regulation, including mandatory gymnasium business and instructor accreditation, with interview informants, in the main, believing that it would result in better quality and safer industry practices, offering quality assurance. While the findings showed that gymnasiums were mostly viewed as appropriate spaces for adolescent exercise participation, some stakeholders felt that the prevailing levels of regulation of the EFI, as well as its internal practices, were unable to deliver Australia’s adolescents with equitable access and appropriate levels of support to participate effectively in GBEPs. The findings were used to formulate a number of recommendations—predominantly for the EFI—with special attention to advancing the participation of adolescents in GBEPs across Australia. Accordingly, the thesis culminates in the analysis of policy options and strategic opportunities to increase their participation, whilst ensuring equal gymnasium access. This includes the nationwide introduction of external industry regulation, mandatory gymnasium business and instructor accreditation, and a gymnasium access requirement which provides all adolescents with the opportunity to participate in GBEPs. The ensuing recommendations are to support both adolescent and adult GBEP participants, improve enterprise and industry performance, and potentially contribute to building a healthier and more active Australian population.

Background The optimal exercise load/intensity for exercise programs for individuals with metabolic syndrome (MetS) has not been investigated. One method of determining optimal exercise load is to measure the blood lactate transition threshold (BLTT), referred to as the anaerobic threshold (AT). The first part of this thesis (study 1) investigated the reproducibility of BLTT testing and the consequent determination of AT via the Mader method (Mader et al. 1986) and a modified form of the ADAPT method (Cheng et al. 1992) in patients with MetS. Furthermore, a comparison of the reproducibility of the AT determination using the Mader et al. (1986) method as opposed to the ADAPT method has not been investigated in MetS patients. The effect of specific exercise protocols on the different components of MetS has also not been investigated. Therefore, the second study in the thesis compared the effects on the components of the MetS of an exercise program that uses BLTT (specifically, the AT) to those of a comparable exercise program (not using AT) taken from the literature. The main aim of the study was to design an exercise program that optimized exercise responses and may thus improve metabolic characteristics in individuals with MetS. The third part of the thesis (study 3) focused on the relationship between cardiorespiratory fitness and the components of the metabolic syndrome. This study developed multiple regression models to find the principal variables that associated with peak vi oxygen consumption (VO2 peak) and AT in persons with MetS. Regression models were also developed to investigate whether these variables were associated with the individual metabolic and cardiovascular components of the metabolic syndrome. Methods In study 1, fifteen male patients diagnosed with MetS (age: 43.5 ± 7.52 years) and fifteen healthy, male participants (age: 44.1 ± 6.08 years) each performed a peak oxygen consumption and BLTT test simultaneously using an incremental protocol to exhaustion on a treadmill, at the same daily times, on three different days. Study 2 used three subject groups. One group consisted of ten participants (male, age: 48.3 ± 7.32 years) with MetS that exercised using the walking program of Leon et al. (1979) (MetSL). A second group consisted of ten participants (male, age: 40.8 ± 8.21 years) with MetS that exercised using velocity at AT to set training intensities (MetSV). A third group consisted of ten participants (male, age: 40.2 ± 7.90 years) without MetS that exercised using velocity at AT to set training intensities (Non-MetSV). Training durations and frequency varied from 20 – 90 minutes and 3 -5 days per week respectively. Height, body mass, waist circumference, blood pressure, fasting plasma triglyceride, total cholesterol, HDL-, LDL- cholesterol, insulin levels, VO2 peak and BLTT were measured in all groups before, during and after twenty weeks of exercise. In addition, oral glucose tolerance tests (OGTT) were administered to all participants. 0 min, 30 min and 2 hours plasma glucose and insulin levels were measured during the OGTT. HOMA-IR and insulinogenic indices were also calculated. Nutritional data were recorded at week 0, 8 and 20 of training. vii In study 3, thirty-one males diagnosed with MetS and twenty-four healthy male participants each performed a VO2 peak and a BLTT test. Height, mass, waist circumference, blood pressure, fasting plasma triglyceride, total cholesterol, HDLcholesterol and insulin levels were also measured. In addition, oral glucose tolerance tests (OGTT) were administered to all participants and HOMA indices were calculated. Results There was no significant difference in treadmill velocity at AT determined by the Mader method or the Modified ADAPT method within both groups of study 1 (p > 0.05). The mean treadmill velocity at AT was higher in the healthy compared to the MetS group using both the Mader and the ADAPT method. Regression analysis and ANCOVA in study 1 demonstrated that this difference was largely due to a higher VO2 peak in the healthy group. The study also found an association between VO2 peak and waist circumference. The coefficient of variation of repeat measurements for both the Mader method and the Adapt method was less than 4% indicating good reproducibility. This was confirmed by the typical error method of Hopkins (2000). Study 2 showed that body mass, BMI and waist circumference decreased significantly in all training groups with the training program using AT and the program not using AT showing similar outcomes in these variables among persons with MetS. Velocity at AT also improved in all training groups. While VO2 peak increased (p < 0.05) in both the MetS groups, it did not change significantly in the group without MetS. Similarly, the blood pressure response was favourable in the groups with MetS yet absent in the group viii without MetS. The training group with MetS that used AT was the only group to show significant, positive changes in any of the metabolic parameters (fasting insulin and HOMA). This group also showed the greatest change in the incidence of MetS. In study 3, presence of MetS, waist circumference and AT were found to associate with VO2 peak and VO2 peak was strongly correlated with AT. Age and body mass were found to correlate with fasting glucose, whilst only age correlated with HDL-cholesterol. Age and VO2 peak both correlated with systolic blood pressure but only VO2 peak had a significant association with diastolic blood pressure. Conclusions Study 1 demonstrated that BLTT tests are reproducible in persons with MetS. Study 2 demonstrated that an endurance exercise program using AT to set intensity is effective in eliciting favourable responses in individuals diagnosed with MetS. In addition, the training program using AT elicited the responses with a reduced exercise frequency and intensity. It also improved insulin sensitivity which was not affected by the walking program. The response to the exercise program that used AT was similar in persons with MetS and in persons without MetS, except in the central cardio-vascular adaptations of VO2 peak and in the metabolic parameters of fasting insulin and the HOMA index. Study 3 found that the lower VO2 peak of participants with MetS is associated with their higher waist circumference. The VO2 peak, in turn, was shown to correlate with anaerobic threshold. Therefore, reducing waist circumference in persons with MetS needs to be a focus of intervention programs for such a group. This study also found that both diastolic and systolic blood pressures were associated with cardio-respiratory fitness (VO2 peak). ix This further supports the benefit of increasing cardio-respiratory fitness in persons with MetS. The results of these studies showed that BLTT tests are simple, low-cost, reproducible ways of setting exercise intensity for persons with MetS that can be incorporated in the routine cardio-respiratory fitness assessment of an individual. Furthermore, the determination of AT from such tests can be used to design an individualized exercise program that can “reverse” the effects of MetS.

碩士
國立陽明大學
物理治療暨輔助科技學系
107
Background: patients with frozen shoulder (FS) often accompany pain and restricted shoulder range of motion, which influence their work, quality of life and increase tremendous treatment cost as well. Recently, studies have indicated that the smartphone app could potentially improve the home exercise adherence for patients with FS, and the sensor-based smartphone app could measure the range-of-motion(ROM) instantly as the treatment feedback. Nevertheless, the reliability and validity of the ROM assessment for patients with FS need to be investigated. Furthermore, no studies have evaluated the effect of the individualized home exercise programs. Purpose: First, develop the smartphone app for FS patients to conduct self-assessment and home exercise programs. Second, to investigate the reliability and validity of the smartphone application to measure shoulder ROM for FS patients. Third, to evaluate the efficacy of the smartphone-based individualized home exercise programs in patients with FS. Methods: the study developed the smartphone app for FS patients by using Android studio (version 3.1.2). 11 FS subjects (1 male, 10 female; age=50.4±6.1 y/o) were recruited in the reliability and validity test for 2 days. In the reliability and validity test, subjects conducted four active shoulder movement (flexion, abduction, external rotation and internal rotation). The smartphone was fixed at the hand with the armband. 10 FS subjects were randomly divided to two groups: a smartphone app group, and a paper hangout group. Each group was asked to conduct the home exercise programs over 4 weeks. The outcome measurements were evaluated after 4 weeks, including exercise adherence, pain and shoulder ROM. The usability of the application was also assessed using System Usability Scale(SUS). Intra-class correlation coefficient (ICC), Pearson’s correlation coefficient (PCC) and concordance correlation coefficient were used for reliability and validity analysis. Mann-Whitney U test was used to compare the outcomes between groups, and Wilcoxon matched-pairs signed rank test was used for within group comparisons. Significance level was set as α<0.05. Results: the smartphone app demonstrated high within-day and between-day reliability (ICC > 0.80) in FS subjects. The validity of the smartphone app showed significant correlation (PCC > 0.90) among four shoulder movement, except the external rotation for which the CCC values was 0.84. No significant intergroup difference was observed in all outcome measurements. In the smartphone app group, there was significant intragroup difference in external rotation ROM only. The SUS scores of the smartphone app group showed high usability for the smartphone app (mean=87.5±5.86). Conclusions: The developed smartphone app for FS shoulder ROM assessment demonstrated high reliability and validity, although the agreement in external rotation was low. The developed smartphone app could be a valid and reliable self-assessment tool for FS patients. The smartphone group showed improvement in pain and all shoulder ROM after 4 weeks but there was no intergroup significant difference in exercise adherence, pain and all shoulder ROM. The developed smartphone app showed acceptable usability as well. There was no difference between smartphone group using individualized home exercise programs and the paper hangout in terms of exercise adherence, pain and shoulder ROM.

Indiana University-Purdue University Indianapolis (IUPUI)
Intellectual disability (ID) is considered a high-incidence disability affecting approximately 1.2 million adults in America (Brault, 2012). Diagnosed before the age of 18, ID is characterized by poor intellectual functioning, difficulty with adaptive behaviors, and problems with activities of daily living. Adaptive behaviors include practical, social and conceptual skills. Individuals with ID may lack the ability to personally care for themselves, self-direct and display naïve decision-making capabilities. Activities of daily living, such as maintaining one’s health, are influenced by poor adaptive behaviors. Between the years of 1997 and 2008, the prevalence of developmental disabilities, including ID, has increased 2.2% and while there is research dedicated to determining the risk factors causing ID, there is a continued need to research adaptive behavior management (Boyle et al., 2011). Current research in adaptive behavior focuses on determining best practices in order to help adults with ID thrive in schools, the workplace, home, and in the community. Adaptive behaviors related to healthcare, self-direction, and personal care still continue to be an area of adversity for the population and research on prevalence of healthcare-related problems are growing (Ervin & Merrick, 2014). Health concerns increase with the severity of the ID as well as age (Moss et al., 1993; Schrojenstein et al., 1997). Over 40% of adults with ID will develop four or more chronic diseases with an increase in age (Hsieh, Rimmer, & Heller, 2012). In the typical population, there is a plethora of evidence demonstrating that regular physical activity (PA) reduces the risk for chronic diseases, specifically all-cause mortality, colon and breast cancer, hypertension, cardiovascular disease, obesity, and depression (American College of Sports Medicine, 2013). However, the number of adults with ID participating in regular PA is considerably lower than the typical population. This lack of participation increases individual risk for secondary health conditions. With diminished capabilities in adaptive behaviors, there are significant issues that affect this population’s ability for self-care and independence in health-related care. Additionally, there are limited opportunities for individuals to take steps to improve his or her ability for self-care. Improving the availability of quality instruction for PA and adherence may increase overall PA and reduce incidence and prevalence of chronic disease in adults with ID.

Purpose: Transitioning into retirement may be a suitable period to help adults establish an active lifestyle. One innovative approach to promote PA may be through multimedia-based programs. This experiment aimed to explore the feasibility DVD and videogame-based exercise programs in promoting physical activity (PA) in adults transitioning into retirement. Underlying motivations, functional fitness, quality of life, and elicited beliefs from participating in the exercise programs were also explored. Methods: Twenty-seven adults were randomized into either a nine-week exercise DVD (n = 9), exergame (n = 9), or waitlisted control group (n = 9). Main outcomes include adherence was based on attendance during the in-lab component and participant logs during the in-home component. PA levels were measured through accelerometery and assessed at baseline, four-, nine- and 12-weeks. Secondary outcomes related to motivation were assessed at baseline, three- and nine-weeks. Tertiary outcomes such as physiological/functional fitness and quality of life outcomes were assessed at pre- and post-intervention. Results: During the in-lab portion, t-tests showed that adherence was slightly higher in the exergame group than the DVD group (t16 = -0.06, p = .96; d = .31). Repeated measures of analysis showed that the group x time interaction for moderate-to-vigorous physical activity (MVPA) (F2,24 = 0.87, p = .52; η2 = .05), while overall PA saw negligible changes (F2,24 = 0.16, p = .85; η2 = .01). At the end of the intervention, overall adherence was similar between both exercise groups (t16 = -0.06, p = .96; d = .03). The group by time interaction effect yielded a moderate effect size for MVPA (F2,24 = 1.07, p = .36; η2 = .08) and overall PA (F2,24 = 1.11, p = .35; η2 = .08). Overall PA only increased in the exergame group (d = .74). The exergame group saw major decreases in instrumental attitude (d = .64), injunctive norm (d = .79), perceived behavioural control (d = .40) and intention (d = .90). Both exercise groups enhanced strength, mobility, and aerobic endurance outcomes (d = .33-.98), as well as several quality of life domains (d = .32-.89). At the post-intervention follow-up, both exercise groups were more active than the control group (d = .49-1.03). Two-thirds of the DVD group adopted DVD-based exercise, while a third of exergame group adopted videogame-based exercise. Conclusions: With a high adoption rate, DVD-based exercise programs may be a feasible and acceptable approach to promote PA levels. Participants in both groups were generally satisfied, indicating that the exercise program was enjoyable, comprehensive, and a simple and convenient way to exercise at home. Improvements to important functional and quality of life domains were also identified. Further research will be required to fully test the effectiveness of exercise DVDs and exergames on adherence and PA behaviour in adults transitioning into retirement.
Graduate
0384
christopher.yao7@gmail.com

博士
國立臺灣師範大學
體育學系
103
Taiwan is an aging society, with the amount and proportion of older citizens aged 65 and over increasing rapidly in recent years. Because of such population trend, a public health intervention that focuses on using exercise to promote health among older adults has become imperative. Although studies have shown that many Taiwanese older adults do spend quite amount of time participating in physical activities, the intensity and variety of such participation is often limited. Furthermore, although there are increasing numbers of exercise programs available to seniors, oftentimes programs are not designed by professionals or for sustained participation among the older generation. The purpose of this study is to examine the impacts of multi-component exercise training (MET) programs (i.e., flexibility exercise, resistance exercise, aerobic training, and balance training, etc.) among older adults, with a focus on whether adapting an ecological approach that delivers interventions at different levels (i.e., individuals, organizations, and communities) can affect seniors' functional fitness and leisure-time physical activity participation. The subjects were recruited from the “Recreation Hubs—Health promotion and consultation project” initiated by the Department of Health in Taipei, Taiwan in 2014. Using a quasi-experimental design, participants were selected into three study groups. The Experimental Group 1 (24 participants) received the ecological-based MET intervention, while the Experimental Group 2 (25 participants) received the MET and the Control Group (25 participants) received no interventions and continued participating in low-intensity physical activities. To evaluate the impacts, data were collected from all participants using the Senior Functional Fitness Test (SFT) and Leisure Time Physical Activity (LTPA) scale one week before the project started (0 week), one week after the project ended (13th week), and at the 25th week. Results from the independent t-tests, chi-square tests and two-way ANOVA repeated measures (α＜.05) suggested that: (1) Participation in low-intensity physical activities alone cannot lead to enhanced functional fitness among older adults; (2) Participation in MET, despite it's an ecological-based model or not, can effectively promote seniors' functional fitness and leisure time physical activity participation; (3) The ecological-based MET can maintain and promote seniors' functional fitness and their participation in leisure time physical activities more effectively than the general MET. Conclusion: MET programs, especially those based on the ecological model, can effectively maintain and promote seniors' functional fitness and leisure time physical activity participation. Because of the benefits, policy makers are encouraged to promote MET programs as an effective public health intervention for older adults.

This study systematically explored the outcomes and implementation processes of the School Sport Leadership Program (SSLP), which was integrated into some secondary schools in Melbourne, Australia. The main principle behind the SSLP was to train secondary school-aged students to become sport leaders, who deliver sporting activities to primary schools with the aim to encourage participation in sports and physical activities and develop their competencies. The overarching aim of this research was to evaluate the impact of the program utilising rigour methodology design, and to provide a comprehensive view of the developmental outcomes for the young people, as well as the program’s impact on the school community.