Dissertations / Theses on the topic 'Physical activity promotion'

Physical inactivity is a major public health problem worldwide and is the second highest risk factor for chronic disease. Physiotherapists are primary care providers who have the knowledge and skills to provide physical activity advice and tailor programs to individual needs. The primary aim of this thesis is to investigate the feasibility of physiotherapists providing “non treatment-related” physical activity intervention for better health, as an adjunct to their clinical treatment roles. A second aim is to establish the current level of evidence of the effectiveness of physiotherapists in providing non treatment physical activity intervention for better health. A survey of practices and perceptions of physiotherapists and physiotherapy students indicated that some physiotherapists were already incorporating physical activity advice into their usual practice. Physiotherapists and physiotherapy students identified few barriers to incorporating physical activity advice into usual practice. A systematic review to determine whether physiotherapists are effective in increasing physical activity behaviour demonstrated that there is limited evidence suggesting that physiotherapists may be effective in promoting physical activity to improve health. Physiotherapists are primary care providers with a relatively untapped potential to contribute to public health strategies to increase physical activity for the prevention of chronic disease.

Australian physiotherapists promote non-treatment physical activity, which is physical activity used to improve or maintain general health, to patients with musculoskeletal conditions. However, it is unclear how physiotherapists promote non-treatment physical activity and the behaviour change techniques they use to do this. This thesis used four studies to: (i) review the efficacy of physiotherapist-led physical activity interventions; (ii) investigate the factors that influence physiotherapists’ choice to promote non-treatment physical activity; and (iii) identify the behaviour change techniques that private practice and outpatient physiotherapists use to promote non-treatment physical activity. Two systematic reviews identified that physiotherapist-led physical activity interventions are efficacious. However, effects were small and not maintained. Additionally, physiotherapists only used a small number of behaviour change techniques when promoting physical activity. National survey and interview studies were used to identify the factors that influence physiotherapists’ choice to promote non-treatment physical activity. The survey found that having poor knowledge of how to promote non-treatment physical activity, prioritising other patient problems before non-treatment physical activity and using promotion methods that were not compatible with daily practice significantly and independently reduced the odds of physiotherapists promoting non-treatment physical activity. Interpretative phenomenological analysis was used to design interviews that showed that having a perceived inability to motivate an unmotivated patient and believing that patients expect hands-on therapy instead of non-treatment physical activity promotion complicated treatment choices. The behaviour change techniques Australian physiotherapists used to promote non-treatment physical activity were compared to those used to encourage adherence to rehabilitation exercises in the survey too. The survey found that physiotherapists used similar behaviour change techniques to promote non-treatment physical activity and encourage adherence to rehabilitation exercises. This thesis provides clinicians and researchers with an understanding of the factors that influence Australian physiotherapists’ decision to promote non-treatment physical activity and the behaviour change techniques they use.
Doctor of Philosophy

Objectives: This study specifically focused on health promotion and physical activity in midlife women. Health promotion in midlife women was examined to determine if exercise could improve the menopausal symptoms and health status in midlife women and if a multi-modal intervention might improve the level of activity in midlife women. The objectives of the study included 1) To identify the relationship between physical activity, menopausal symptoms and health status in midlife women, and 2) To determine the effect of a multi-modal intervention on increasing levels of exercise in midlife women. Methods: The study was conducted in two phases. The first phase included a secondary data analysis of 886 women who took part in the Queensland Midlife Women Health Survey (QMWHS) aged 45-60 years, who were randomly selected from South-East Queensland. In the second phase a randomised, controlled study was conducted on a subset of women who participated in the QMWHS. Women who were allocated to the intervention group (n=47) received an intervention, which combined a multi-modal program of physical activity with health education. Women in the control group continued their normal physical activities (n=66). Results: Findings of this study indicated that increasing exercise was associated with lower psychological and somatic symptoms in midlife women. The study found that exercise was associated with decreasing menopausal symptoms. In the area of health status, significant differences were found between exercise and mental health, vitality, general health and physical function. This study revealed that a multi modal intervention could increase the level of activity in midlife women. There were significant differences in monthly exercise and vigorous activity between the intervention and control groups 3 months after the intervention. Women stated that they felt physical and mentally better and the program motivated them into being more active. They mentioned that the program was easy to understand and follow and the concept of the program was well organized and useful for them. Conclusion: This study showed that exercise might provide a wider health effect on midlife women's health by decreasing menopausal symptoms and improving health status. Exercise counselling is an essential component of healthcare, especially among middle-aged women who are experiencing physical, emotional, and social changes. Health professionals and nurses are in a good position to assist midlife women through providing information about the health effect of exercise. Physical activity should be encouraged for the prevention and reduction of risks for chronic disease and the improvement of health in midlife women. The multi-modal program was effective in increasing levels of activity in midlife women. This is an important finding as exercise is difficult health behaviour to change. Study implications suggest that this type of intervention may provide an effective, clinically manageable therapy for women who choose a self-directed approach to increase their level of activity. This program may offer implications for designing and implementing exercise interventions in further studies.

Objectives: This study specifically focused on health promotion and physical activity in midlife women. Health promotion in midlife women was examined to determine if exercise could improve the menopausal symptoms and health status in midlife women and if a multi-modal intervention might improve the level of activity in midlife women. The objectives of the study included 1) To identify the relationship between physical activity, menopausal symptoms and health status in midlife women, and 2) To determine the effect of a multi-modal intervention on increasing levels of exercise in midlife women. Methods: The study was conducted in two phases. The first phase included a secondary data analysis of 886 women who took part in the Queensland Midlife Women Health Survey (QMWHS) aged 45-60 years, who were randomly selected from South-East Queensland. In the second phase a randomised, controlled study was conducted on a subset of women who participated in the QMWHS. Women who were allocated to the intervention group (n=47) received an intervention, which combined a multi-modal program of physical activity with health education. Women in the control group continued their normal physical activities (n=66). Results: Findings of this study indicated that increasing exercise was associated with lower psychological and somatic symptoms in midlife women. The study found that exercise was associated with decreasing menopausal symptoms. In the area of health status, significant differences were found between exercise and mental health, vitality, general health and physical function. This study revealed that a multi modal intervention could increase the level of activity in midlife women. There were significant differences in monthly exercise and vigorous activity between the intervention and control groups 3 months after the intervention. Women stated that they felt physical and mentally better and the program motivated them into being more active. They mentioned that the program was easy to understand and follow and the concept of the program was well organized and useful for them. Conclusion: This study showed that exercise might provide a wider health effect on midlife women's health by decreasing menopausal symptoms and improving health status. Exercise counselling is an essential component of healthcare, especially among middle-aged women who are experiencing physical, emotional, and social changes. Health professionals and nurses are in a good position to assist midlife women through providing information about the health effect of exercise. Physical activity should be encouraged for the prevention and reduction of risks for chronic disease and the improvement of health in midlife women. The multi-modal program was effective in increasing levels of activity in midlife women. This is an important finding as exercise is difficult health behaviour to change. Study implications suggest that this type of intervention may provide an effective, clinically manageable therapy for women who choose a self-directed approach to increase their level of activity. This program may offer implications for designing and implementing exercise interventions in further studies.

The purpose of this doctoral dissertation was to investigate the relationships between mental health and physical activity participation of medical students, as well as their confidence, motivation and frequency in recommending physical activity in future medical practice. Moreover, this thesis involved the implementation and evaluation of a peer support walking intervention aimed at improving the mental health and physical activity participation of medical students. Two separate studies were conducted, including a cross-sectional correlational survey administered to medical students in all four years at three Canadian Universities (Study One; Articles One, Two and Three) and a single-subject study testing the impact of a two-month peer support walking intervention delivered to first and second year medical students at two Canadian universities (Study Two; Articles Four and Five). Article One examined relationships between physical activity, including mild and moderate-to-vigorous physical activity (MVPA), and mental health profiles in a sample of Canadian medical students using latent profile analysis. Three distinct mental health profiles emerged (low, moderate and high ratings of mental health) and individuals in the high mental health profile reported engaging in more mild physical activity than MVPA. Article Two investigated the underlying mechanism(s) contributing to frequency in recommending physical activity, to provide insight into how we can increase physical activity recommendations in future practice as physicians. Findings showed positive relationships between medical students’ physical activity levels and their frequency recommending physical activity to patients. Results also revealed that medical students are significantly more motivated than they are confident to recommend physical activity to patients and only 52% of student participants were aware of and accurately able to recall the Canadian physical activity guidelines. Article Three examined demographic differences in medical students’ motivation and confidence to recommend physical activity to future patients. Results revealed differences according to gender, year of study and academic background. For instance, second year students were more motivated to assess a patients’ level of physical activity compared to third and fourth year students. Article Four evaluated the impact of a two-month peer support walking intervention aimed at improving the mental health and physical activity participation of first and second year medical students using the RE-AIM framework. Findings showed that the peer support walking intervention was delivered as intended and may be an important proactive strategy for maintaining mental health and physical activity levels of medical students during stressful situations, including the COVID-19 pandemic. Finally, Article Five offered evidence-based strategies for conducting mental health research in medical professionals to optimize recruitment, engagement and retention. Ten strategies were provided to help inform the planning of future research aiming to support the mental health of medical professionals, including students. Taken altogether, findings from this dissertation show that peer support and incorporating mild physical activity may be an effective strategy to offer within medical student wellness programs. Additionally, results highlight the need to expand the medical curriculum to include physical activity education in order to prepare students to recommend physical activity to patients in future medical practice as an important preventive and therapeutic strategy for several chronic illnesses.

Background: Physical inactivity is identified as a leading risk factor for global mortality. Physical activity benefits have been extensively demonstrated. Being physically active is essential for healthy ageing; with regular physical activity reported as the most effective strategy to prevent and reduce disability and maintain functional independence among older adults. Nonetheless, an overwhelming majority of people aged 65 years and above do not meet physical activity recommendations. Physiotherapists in out-patient rehabilitation settings are well placed to assist older adults to achieve an active lifestyle by incorporating physical activity into care plans and transitioning patients from a therapeutic to a healthier lifestyle focus. However, it is not known whether physiotherapists actively plan for this transition and incorporate this aspect of care into out-patient rehabilitation programs for older adults. The overall aim of this research program was to investigate current physiotherapy practice of physical activity promotion to older adults attending an out-patient rehabilitation program. Method: Pragmatism is the theoretical perspective that underpins this program of research. A multimethod approach was taken to answer the research questions for this research program. Two studies, a quantitative and a qualitative study, were undertaken to gain valuable insights in the promotion of physical activity to older adults attending out-patient rehabilitation. Study 1 comprised an audit of physiotherapists’ documentation in medical records of older adults who attended an out-patient rehabilitation program at a tertiary hospital. Study 2, a qualitative study, comprised three focus groups with a total of 16 physiotherapists involved in the delivery of rehabilitation to older adults. Data were analysed using reflexive thematic analysis. Results: In Study 1, 56 medical records were reviewed. Mean age (SD) of participants was 79 (7) years. No documentation was found on the use of validated tools to assess physical activity levels of older adults. Prescription of physical activity was documented in 55/56 (98%) medical records. Seven (12.5%) medical records included documentation on goal setting regarding physical activity participation. Advice on regular physical activity post-discharge from the rehabilitation program was documented in 28/56 (50%) medical records. Formal referral to community-based physical activity programs was documented in 4/56 (7%) medical records. In Study 2, four themes were identified: 1. Patient-centred approach; 2. Support required; 3. Exercise program targeting impairments versus physical activity for health, and 4. Inadequate community follow-up systems. Participants described a patient-centred approach when promoting physical activity to older adults attending out-patient rehabilitation. Participants identified the importance of getting patients engaged and willing to participate in physical activity by setting patient-centred goals and finding activities that are enjoyable, meaningful and relevant. Physiotherapist support was identified as a crucial factor to facilitate engagement in physical activity. Education, therapeutic rapport, encouragement and motivation were topics often discussed by participants. Physical activity assessment was rarely reported by participants in this study. Participants acknowledged focusing on the primary goal of restoring older adults’ functional capacity by treating physical impairments, and concomitantly promoting an active lifestyle for health benefits. Participants perceived that inadequate community follow-up was a major barrier to transition older adults to an active lifestyle post discharge from rehabilitation. Conclusion: The findings from this research program suggest that physiotherapists are not widely applying evidence-based practice to the promotion of physical activity to older adults attending out-patient rehabilitation. Increasing physical activity is a global priority, with the World Health Organisation Global Action Plan on Physical Activity (GAPPA) 2018-2030, ‘More active people for a healthier world’, calling for a systems-wide approach to patient assessment and counselling on physical activity across all primary health care settings. Physiotherapists are ideally placed to be actioning this strategy, though there is scope for improvement in physical activity promotion to older adults attending out-patient rehabilitation. Furthermore, the establishment of tailored physical activity programmes and services to support older adults starting and maintaining regular physical activity is recommended. Implementation research providing a guiding pathway to support physiotherapists promoting physical activity to older adults is warranted. Physiotherapists working in out-patient rehabilitation settings can and should drive older adults’ transition from a restorative and therapeutic context to a self-managed active lifestyle in the community, by integrating physical activity promotion into routine practice.

The use of group dynamics principles such as group goal-setting, distinctiveness and cohesion has been the basis of a burgeoning area of physical activity (PA) promotion. Recent reviews of literature suggest that these interventions are robust and increase PA in a wide variety of populations. Still, a number of questions remain unanswered in the areas of theory development, intervention implementation, and translation of research into practice. This dissertation includes a series of manuscripts that focus on research, theory, and practice of group dynamics interventions intended to promote PA. Within research, a systematic review of literature explores group dynamics-based PA interventions in terms of generalizability (through RE-AIM evaluation) and the degree to which the interventions use research techniques that are more pragmatic (reflect typical practice) or more explanatory (testing under optimal conditions). This exploration is based on an initial review of 17 interventions that employ group dynamics strategies to increase PA, fitness, and/or adherence. The results suggest that this body of literature includes a range of pragmatic and explanatory trials, but still has gaps in reporting related to external validity. Embedded within the context of a PA promotion program for minority women, the second manuscript addresses a theory-based questionâ to what degree do group-interaction variables (cooperation, communication, and competition) differentially predict group cohesion over time. The results suggest that friendly competition is the strongest and most consistent predictor of different dimensions of group cohesion while task and socially related communication are consistent predictors of task and socially related cohesion, respectively. Two manuscripts are included in addressing the use of group dynamics principles within practice settings. The first practice manuscript details a small pilot study in which obese, limited income women successfully (p<0.05) limited gestational weight gain to the Institute of Medicine (2009) recommendation of 11-20 pounds. This study attempted to integrate a group dynamics approach into a group visit model for pregnant women. The quantitative findings were promising, but qualitative findings indicated a number of difficulties in implementation. The purpose of the final manuscript was to determine the attributes of the program agents consider when deciding to adopt a PA and fruit and vegetable promotion program and their understanding of key strategies related to group dynamics theory. Delivery agents were able to identify key underlying principles and propose adaptations that align with those principles.
Ph. D.

Kinesiology
Ph.D.
Physical activity promotion in schools is a critical component of adolescent health. The main purpose of this study was to test the efficacy of a school-based program to increase the physical activity of 6th grade students. A total of 113 students in a large suburban public middle school participated in the 11 week study. A quasi-experimental design was used. Physical education (PE) classes served as the unit of randomization. Six PE classes were assigned to the control condition and six PE classes to the experimental condition. Control group students were asked to wear unsealed pedometers throughout the day in school and at home and to record their daily step-counts in school. Experimental group students also wore unsealed pedometers throughout the day and logged their daily step-counts in school, but additionally received a 10,000 step per day goal, were asked to attain an increased step-count goal during PE class, and received an enhanced PE curriculum. Pre- and post-test data were gathered for all dependent measures including average daily step-counts by week, GPA, attendance, tardiness, attitude and self-efficacy toward physical activity, and Presidential Physical Fitness Tests. The data analysis was completed using analyses of variance (ANOVAs), analysis of covariance (ANCOVA), paired sample t-tests, and independent sample t-tests. Results revealed significant gains in physical activity for both treatment conditions. Both groups demonstrated significantly increased step-counts relative to their baseline step-counts. The intervention did not produce significant changes in attitude or self-efficacy. There were some significant improvements in physical fitness and the scholastic measures, but these changes were not attributed to the intervention. Very low attrition, a high compliance rate, and favorable participant feedback were also noted. Overall, this study revealed that, in the short-term, it is possible to significantly improve physical activity without changing an adolescent's self-efficacy or attitude. An important finding of this study was that multi-faceted self-monitoring was the most critical factor that contributed to increased physical activity.
Temple University--Theses

Masters of Science - Msc (Physiotherapy)
Studies have demonstrated that physical inactivity has been recognised as a major cause of death and disability, and it has been linked to the onset of noncommunicable diseases and risk factors such as high blood pressure, diabetes, and heart diseases. Several studies have revealed that regular physical activity is essential to the physical, mental, health and wellbeing of people of all ages. Health care professionals such as physiotherapists are in a position to promote physical activity through development of a plan for physical fitness, the promotion of health and wellness, health education and physical conditioning. This study sought to investigate the physiotherapy students' perception of their role in the promotion of physical activity. A mixed method design was used in this study, and data was collected by means of a self-administrated questionnaire and a focus group discussion. The questionnaire assessed knowledge, role perception, level of confidence, barriers, feasibility, and self-efficacy regarding physical activity promotion, while the focus group discussion explored the experience of the physiotherapy students in the promotion of physical activity.

Physical inactivity has become a global health concern and is among the 10 leading causes of death and disability. This has led to increased concern for chronic diseases of lifestyle (CDL). 
Studies have revealed that regular physical activity is effective in combating several CDL such as cardiovascular disease, diabetes, cancer, hypertension and obesity. Physiotherapists are in a 
position to combat inactivity and effectively promote physical activity to their clients. Studies however have shown that participation in physical activity among physiotherapists could have an 
impact on the promotion of physical activity and their health practices. This study therefore sought to establish the relationship between physical activity levels of physiotherapists and their 
physical 
activity promotion strategies and barriers to promoting physical activity. Sequential Mixed Method Design was used in this study. Data was collected by means of a self administered 
questionnaire and a total of 92 physiotherapists voluntarily answered the questionnaire. A focus group discussion comprising of 10 purposively selected physiotherapists was conducted. The 
questionnaire assessed physical activity levels 
and physical activity promoting strategies of the participants while the focus groupdiscussion looked at the barriers to promoting physical 
activity. The Statistical Packages for Social Sciences (SPSS) version 18 was used for data capturing and analysis. Descriptive statistics were employed to summarize demographic information 
as means, standard deviation, frequencies and percentages. Inferential statistics (chi-square) was used to test the associations between different categorical variables (p<
0.05). For the qualitative data, focus group discussions were used to collect data. Tape recorded interviews were transcribed verbatim, field notes typed, sorting and arranging data was done and themes 
 
were generated. Thematic analysis was then done under the generated themes. Ethical issues pertaining to informed consent, anonymity, confidentiality and the right to withdraw from the 
study were respected in this current study. The findings in the current study revealed that a big number of the participants were physical active both at work and recreation domains. However, 
there was no statistically significant association between physical activity and the demographicvariables. The results in this study revealed that the majority of participants were good 
physical activity promoting practices, although there was no significant association between physical activity levels and the physical activity promoting practices. The finding in this study revealed that discussing physical 
activity and giving out information regarding physical activity to their clients were the most common methods used in promoting physical activity. However, participants also highlighted barriers they 
ace in promotion of physical activity such as policies on physical activity, cultural influence, nature of work, time management as well as environmental barriers. The study demonstrates the 
need for all stakeholders to come up with solutions to break the barriers to promotion of physical activity. In return it will bring about enormous health 
benefits to the general population.

Physical activity is important for children as many children are considered overweight or obese. The benefits of exercise have been demonstrated in empirical studies across all age ranges (Horne, Hardman, Lowe, & Rowlands, 2009; Kelly et al., 2004; Louie & Chan, 2003; Southard & Southard, 2006). In the current study, a multiple baseline design across participants was used to assess the effectiveness of goal setting, reinforcement contingencies, and pedometers that provide feedback to increase step count of 5 participants. During baseline each participant wore a sealed pedometer to assess the average steps the participants took per day. After baseline, each participant, researcher, and parent set a reasonable goal of steps to achieve per day in order to receive a specific reinforcer chosen by the parent and participant. A behavioral contract stated the specific goal number of steps for the day and the specific reinforcer they would receive. At the end of each day before the child went to bed, the parent recorded the number of steps and provided the child with feedback about whether reinforcement was earned. Data collection for four of the five participants showed a mean increase in steps taken per day during intervention 1 in comparison to baseline levels. Participants met their goal step counts during intervention 1 on 12%, 35%, 50%, 71% and 76% of days. All three participants that participated in intervention 2 increased their mean count from both baseline and intervention 1 levels. Participants met their goal step counts during intervention 2 on 62%, 100%, and 100% of days. Two participants participated in the follow up phase of the study; both participants maintained their goals from intervention 2 and completed their goal step count on 100% of days.

Aim of study: To compare the effectiveness of two contrasting communication styles with a no-intervention control group on self reported physical activity at 12 months follow up. Study Design: 1-year randomised controlled trial. Setting: Two large primary care medical centres in middle England. Subjects: 1, 658, 45-64 year old, insufficiently active men and women. Interventions: Thirty minutes of brief negotiation or direct advice, face-to-face, followed by 6 telephone contacts over 6 months. Main outcome measures: Self reported physical activity at 12 months. Secondary outcome measures were change in blood pressure and body mass index. Results: Both intervention groups and the control group significantly increased their physical activity over baseline (p<0.05). Intention to treat analyses revealed no between group differences for the combined intervention groups vs control and for brief negotiation vs direct advice. In treatment received analysis, the mean proportion change in physical activity for the brief negotiation group was 24% (95% CI 7 to 44) greater than controls with no significant difference between direct advice and controls. There was no change over baseline for body mass index in any group. Both the brief negotiation and the direct advice group reduced systolic blood pressure at 12 months but there were no between group differences. The brief negotiation group produced a -2.3 mmHg (95% CI-3.8 to -0.8) greater reduction in diastolic blood pressure than direct advice. Conclusion: For patients already attending primary care for conditions that might benefit from increased physical activity, it would be worthwhile delivering approximately 20 minutes of brief negotiation to increase their physical activity. It would also be better to avoid instructing them about the need to change. It would seem to be a waste of limited resources to specifically invite patients into primary care for no other reason than to try to intervene in their level of physical activity.

The purpose of this thesis was to explore socially constructed discursive barriers to physical activity for people with physical disabilities. This research was informed by a critical disability studies framework. Eight interviews were conducted, split between end-users and stakeholders. The end-user article discusses their perspectives with regard to their own PA participation, their use of PA resources, and their views of how disability is constructed. The stakeholder article deals with their views with regard to Canada’s progress in creating inclusive PA guidelines, the research process as it effects people with physical disabilities, and how disability is constructed. The results showed awareness among both groups of the social model of disability, but that the medical model is still firmly rooted. Work is needed to create inclusive promotional materials and disseminate them effectively. An effective advocacy and lobbying effort was suggested as one avenue towards a possible solution to this issue.

Though the benefits of physical activity are numerous and well-known, very few adolescents are meeting physical activity recommendations. Moreover, past research shows that physical activity declines with increasing age with this decline beginning in adolescence. One approach to promote physical activity is through mobile technology such as a mobile phone. Since mobile phone ownership is relatively high (77%) and there is no digital divide by race/ethnicity or socioeconomic status, mobile phones may be suitable for physical activity promotion. Few studies have promoted PA using a mobile phone and those studies showed increased physical activity outcomes. However, more research is needed to explore the effectiveness of mobile phone physical activity promotion especially in more health disparate populations.  The purpose of this research was to develop and test smartphone game application for physical activity promotion in adolescents. The first study included various user-centered approaches (e.g. qualitative data, idea sessions) to get feedback on what was desired from the adolescents in terms of game development and design. The second study examined the degree to which mobile health studies reported on internal and external validity indicators. The last study evaluated the smartphone game applications through a mixed-methods approach. The results of this research showed that physical activity while playing smartphone game applications can yield moderate physical activity intensity. Moreover, adolescents had moderate perceptions of the games and recommended specific changes to the games. Likewise, the data suggest that smartphone physical activity game applications can be enjoyable if they are aesthetically appealing, easy to use, and foster social peer interactions. Overall, this research demonstrated that smartphone games that were developed and designed based on adolescents\' preferences and persuasive technology design principles could increase physical activity in adolescents and provides a tool for further exploration.
Ph. D.

Doctor of Philosophy
Department of Human Nutrition
Sara Rosenkranz
This dissertation examined the impact of wellness-promotion interventions on health-related behaviors in youth, including dietary intake and physical activity (PA) levels. Additionally, the impact of wellness-promotion interventions on health-promoting opportunities for youth in an out-of-school setting was investigated. In study 1 (Chapter 2), the feasibility and preliminary impact of a 12-week, home-based wellness coaching intervention for changes in behavioral, psychosocial, and biomedical outcomes in normal-weight female children was evaluated. The two intervention conditions included a general health education condition, and one that implemented skills-building components in the areas of PA and healthy eating. Results showed that both intervention conditions were feasible and well-accepted by participants. There were no changes in the behavioral outcomes of PA levels or fruit and vegetable (FV) consumption, but girls who received the skills-building coaching condition showed an increase in emotional quality of life and a reduction in body fat percentage. Findings suggested that a home-based wellness coaching intervention was feasible and was potentially effective for impacting psychosocial and biomedical outcomes in normal-weight female children. Study 2 (Chapter 3) examined the impact of Girl Scout leader wellness training on implementation of wellness-promoting practices and opportunities for girls during troop meetings. This study compared the effectiveness of in-person versus online leader wellness training, specifically assessing opportunities for wellness-promoting behaviors, including FV consumption and PA during meetings. Study results indicated that leaders who received the wellness training in person increased their implementation of wellness-promoting practices significantly more than those who received the wellness training in an online format. Analyses regarding dissemination revealed that adoption of wellness-training principles occurred in approximately 43% of troop leaders, and that lower-income leaders were more interested in receiving the wellness training, as compared to higher-income leaders. Overall, results indicated that in-person wellness training was effective for improving wellness-promoting opportunities for girls, but a more cost-effective and further-reaching training method was needed for a larger public health impact. Therefore, study 3 (Chapter 4) evaluated the impact of online, video-based wellness training on Girl Scout leaders’ wellness-promotion self-efficacy, intention, and knowledge. These factors are established determinants of behavior change, including offering opportunities in the areas of PA and FV consumption. Results showed that leaders who received the video-based wellness training had a significant increase in self-efficacy for overcoming barriers related to PA and FV practices, as well as increased self-efficacy for offering vegetables during troop meetings. Both groups showed increased intention for offering both fruit and vegetable opportunities during upcoming meetings. These results showed that online, video-based wellness training was effective for impacting determinants of behavior change in Girl Scout troop leaders, which may improve the wellness opportunities for girls during troop meetings. Overall, the findings from this dissertation collectively contribute to the existing literature by providing evidence regarding effective interventions for improving wellness-promoting opportunities and experiences for youth. If disseminated and implemented widely, evidence-based interventions and practices similar to those discussed within this dissertation may lead to improvements in health-related behaviors among youth, increased wellness-promoting opportunities, and ultimately have a positive impact on population health.

Thesis (M.S.)--University of North Texas, 2001.
Includes bibliographical references (leaves 26-32). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

This thesis by publication included seven manuscripts that advanced contemporary understanding of the association between physical activity and wellness among adolescents. The findings suggested that due to potential interrelatedness between various aspects of wellness, changes in physical activity may also influence co-existing wellness domains; highlighting the potential for physical activity interventions to have a broad range of benefits among youth. These findings also added to the body of literature supporting the potential inclusion of physical activity as a component within multifaceted youth wellness programs. Findings reported in this thesis have implications for those seeking to initiate youth wellness interventions.

Recent research clearly demonstrates that a decrease of physical activity has occurred among young people. Hence, the purpose of this study was to examine the impact of external motivation on physical activity. Drawn from self-determination theory, the specific research question examined if academic incentives effectively motivated 7th grade students to participate in a 3-week fitness program. A quasi-experimental pre-post design examined treatment and control groups drawn from a sample of 24 students from three physical education classes. The treatment group received academic incentives whereas the control group received no external incentives but were asked to complete the same fitness Program. Independent-sample t-test of the physical activity section of the 2005 Youth Risk Behavior System Survey (YRBS) revealed no group differences on the posttest. Dependent-sample tests indicated little pretest-posttest change in YRBS scores, leading to the conclusion the academic incentive had no major effect on students' motivation to be physically active outside the school environment. This research contributes to positive social change by provided additional insight into what motivates or does not motivate 7th graders to be physically active.

The purpose of this investigation was to examine the effects of vitamin E supplementation on lipid peroxidation, muscle damage, muscle soreness and physical performance following repeated bouts of whole body resistance exercise. Eighteen active males were randomly assigned to receive either vitamin E (1200 IU per day) or placebo for 31 days. Following 21 days of supplementation, subjects engaged in 3 resistance exercise sessions, separated by 3 days rest (EX-1, EX-2 and EX-3 on days 22, 25 and 28, respectively). Plasma malondialdehyde concentrations did not peak until the morning prior to EX-3 in the vitamin E (VE) group (10.0 ± 0.6 µmol/L) and the day following EX3 in the placebo (P) group (9.6 ± 0.9 µmol/L), with no significant differences between groups. Creatine kinase activity was significantly elevated the day following EX-1 in both groups. The VE group had a near 2-fold greater CK peak as compared to the P group the day following EX-1 (404 ± 49 and 214 ± 60 U/L, respectively), but the two groups had similar CK values by day 31 (113 ± 35 and 107 ± 36 U/L, respectively). Muscle soreness was significantly increased for each group the day after EX-1 with no significant differences between groups.Furthermore, there were no significant differences between groups in muscle strength, power or endurance. The results of the present study do not indicate any positive effect of vitamin E supplementation against lipid peroxidation, muscle damage or muscle soreness as a result of repeated days of resistance exercise. In addition, vitamin E did not have an effect on muscular performance.
Fisher Institute for Wellness and Gerontology

The Land-Grant University Cooperative Extension (herein: Extension) system has been an underutilized resource for physical activity programming. With the recent addition of physical activity as a focus of Extension work, efforts are needed improve dissemination and implementation of evidence-based physical activity interventions. Improving implementation requires overcoming limitations including institutional support and perceptions of Extension health educators who could develop, deliver, and evaluate these programs. A participatory approach that includes input at all delivery levels (program participants, delivery agents, and administrators) can aid implementation through considering program acceptability, appropriateness, and feasibility from the beginning. This dissertation includes three manuscripts that explore the Extension's role in promoting physical activity in older adults, both in the United States and abroad. Manuscript 1 detailed a systematic review of community-based older adult physical activity programs that was conducted in order to determine the characteristics of effective older adult physical activity programs and the extent to which programs implemented in Extension systems nationwide employ these characteristics. The results indicated notable differences between peer-reviewed literature and Extension programs as well as presented an opportunity for Extension programs to more effectively use evidence-based program characteristics, including behavioral theories and group dynamics. The results also suggested that Extension programs could more effectively report their findings through peer-reviewed sources so that effective programs can be disseminated to reach a broader population. Manuscript 2 was an exploratory study conducted as a first step in bringing older adult physical activity programming to Ghana through Extension. Results of the mixed-methods study suggested that older adults in Ghana have mostly positive perceptions of physical activity and would be receptive to an in-person physical activity program. In particular, without specific prompting on principles of group dynamics, across all focus groups, participants mentioned aspects of groupness ranging from the need for accountability to the enjoyment of exercising with others. The results also indicated a need for education on Ministry of Health physical activity recommendations and how to meet them. These findings can be used as the first step to adapting and delivering an evidence-based intervention in Ghana through an integrated research-practice partnership. This approach includes community-level decision making to ensure the resultant program is a good fit in the intended delivery system. Manuscript 3 detailed the translation of an evidence-based older adult physical activity program to an Extension system in a rural state (population 585,501). Results suggested that Extension health educators have overall positive perceptions of physical activity programming, but they experience barriers in delivering these programs. While the program has the potential to reach a representative sample of the population, the adoption rate among Extension health educators was low, and system-wide changes may be needed to improve physical activity program adoption rates among educators. Overall, results of the three manuscripts provided evidence and recommendations for Extension professionals to improve physical activity program implementation through using evidence-based interventions and characteristics, considering perceptions of end users prior to program implementation, and considering system-level changes that promote physical activity program adoption.
Ph. D.

Regular moderate-vigorous physical activity (MVPA) is associated with significant physiological and psychological health benefits (Department of Health, DoH, 2004). However, many children are not undertaking recommended levels of physical activity (PA) (DoH, 2009). This research examined relationships between physiological health parameters, psychological determinants and PA levels in 10-14 year old schoolchildren (N = 249) and assessed the influence of three school-based PA interventions on these constructs in the context of the Health And Physical activity Promotion in Youth (HAPPY) study. Study 1 revealed that sedentary behaviours, moderate PA (MPA), vigorous PA (VPA) and MVPA levels were higher on weekdays than weekend days (p < .001). However, schoolchildren’s PA is often difficult to measure accurately. The self-report measure utilised in study 2 underestimated total MVPA versus accelerometry for both sexes on weekdays and girls on weekend days (p < .01). However, study 3 highlighted a lack of agreement between two RT3® triaxial accelerometer cut-offs for all activity categories. The importance of VPA for promoting health was highlighted in the updated PA guidelines (DoH, 2011). Study 4 reported that cardiorespiratory fitness (CRF) was positively associated with VPA but not MPA (β = .27, p < .01) and inversely correlated with measures of body composition (% body fat; body mass index; waist circumference) (r = -.74, r = -.60, r = -.39, p < .001). Knowing the health benefits of regular MVPA and VPA, it is important to understand the determinants of PA intentions and behaviours to more effectively promote PA in less active children (studies 5 and 6). An exploratory analysis of the constructs in the Revised Theory of Planned Behaviour and the Modified Social Learning Theory for children predicted PA intentions (R2 = .38, F(5, 171) = 20.19, p < .001; R2 = .13, F(6, 147) = 3.4, p < .01, respectively) but the constructs in either model were unable to predict PA. Recognising the need to promote PA levels, study 7 investigated the effectiveness of three school-based interventions (vs. control) on outcome variables included in studies 1, and 4-6. The Health Education and Psychology Health Promotion conditions produced significant positive change scores between data collection 2 and 3 for CRF (vs. control) whereas the Youth-Led condition produced significant change scores between baseline and data collection 2 for generalised self-efficacy (vs. control). No significant change scores were reported for PA, the RTPB constructs or intentions. In conclusion, this research has emphasised the importance of employing a multidisciplinary approach to aid understanding of schoolchildren’s PA levels. Specific highlights include low weekend day PA as a possible future PA promotion target, although it is vital that accelerometry cut-points are standardised, and the relevance of VPA and body composition in predicting CRF. The psychological models identified some important determinants of PA intentions, but a prominent intention-behaviour gap and a need for more intensive interventions to promote PA levels was apparent.

This study was designed to identify possible risk factors about physical activity in middle-aged disabled African American women (AAW) aged 45 to 64 years. Disabled middle-aged AAW has a disproportionate prevalence of obesity and chronic illness than nondisabled women. Most disabled middle-aged AAW leads a sedentary lifestyle, and they do not meet the recommended physical activity (PA) guidelines. Little is known about this group, and a social ecological model was used to explain PA patterns. Data were extracted from the 2009 Behavioral Risk Factor Surveillance System (N = 1,599) for women who responded yes to indicate that they needed specialized equipment. This cross-sectional quantitative study used univariate and multivariate analysis to assess the relationship between age, education, and income among middle-aged disabled AAW. A general linear model revealed younger disabled AAW (ages 45 to 54) engaged in more physical activity time per week than did their older counterparts (estimate = 76.012, p = .001). Individuals with less education reported more minutes of physical activity than college graduates (estimate = 142.522, p = .001). Respondents with annual incomes from $35,000-$49,999 (estimate = 184.590, p = .000) were more physically active than their more affluent counterparts. Smoking, demographic variables, and emotional well-being did not affect minutes of moderate physical activity. This research may contribute to positive social change by suggesting that programs intended to increase physical activity among disabled AAW be targeted toward those who are older, are more educated, and have higher incomes.

Adult physical activity is important for prevention of chronic diseases and to minimize health issues; therefore, the motivational influences of sociodemographic variables on participation in organized physical activity events warrant an investigation. The purpose of this quantitative study was to investigate differences in motivational influences between various sociodemographic variables as related to physical activity events in organized settings. The theoretical framework that guided this research study consisted of the theory of reasoned action (TRA), and the health belief model (HBM). The TRA was applied to study the intention of health behavior, while the HBM was used to investigate individuals' motivation to engage in organized physical activity events. A cross-sectional study design in which an online survey consisting of the 40 item Physical Activity and Leisure Motivation Scale was used to collect data from adults who participated in an organized 5K or 10K running or walking event. The inferential statistical tests of the independent t test, one-way ANOVA, and ordinal logistic regression were used to determine the statistical relationships. The main research finding suggested that 6 motivational influences showed statistically significant relationship with organized physical activity events, which consisted of others' expectations (p = .025), competition/ego (p = .001), appearance (p = .001), affiliation (p = .034), mastery (p = .001), and psychological condition (p = .002) as it relates to their age group and gender. The research findings may be used to influence engagement in future organized physical activity events by understanding the sociodemographic variables relating to participation rates that may result in increased physical activity behavior within the community.

Colorectal cancer (CRC) is a deadly and costly cancer, especially among African Americans. The purpose of this quantitative, retrospective, cross-sectional study was to examine African Americans' health behaviors that may have an association with CRC. The Health Belief Model was used to guide this study. The study addressed whether there is a statistical association between fruit intake, vegetable intake, and physical activity, and the occurrence of CRC while controlling for confounders, such as body mass index, smoking status, and income level. After conducting an overall analysis, the final research question examined if the association varied by race. In this study, data from 14,451 people in the Health Information National Trends Survey database were analyzed using binary logistic regression analysis. There was no association between the intake of fruits and vegetables and the occurrence of CRC in this population. Physical activity had a statistically significant association with CRC, with physical activity being protective against the occurrence of CRC among the whole sample population (adjusted OR = .671, 95% CI = [.458-983], p = .040). When stratified by race the association between Physical activity and CRC was only significant among Whites. The findings of this study have positive social change implications for practitioners designing CRC prevention programs, who should focus on increasing physical activity levels yielding healthier living in general. Future research should focus on addressing other possible risk factors in the African American population including genetic predispositions and gene-environment interactions.

Research suggests that Black women living in the United States are not engaging in sufficient physical activity, which is a major factor negatively impacting their health outcomes. Black Girls Run (BGR) is a targeted national health movement using the capacity of social networking technology as a tool to interact with and inspire Black women to live healthy through running. Literature lacked the voice and perspective of Black women who were embracing the innovation of technology to positively improve their health behaviors. The purpose of this qualitative phenomenological study was to gain a better understanding of the composite experiences of women in BGR and how they utilize social networking technology to improve their physical activity. Social cognitive theory provided the theoretical framework. Semistructured interviews were conducted with 13 women participants of BGR, who were selected using purposive sampling technique. Data were transcribed, organized, analyzed, and coded into common themes with the support of Nvivo 11 software. The findings revealed that social networking served as a tool that the women in BGR used to connect, encourage, and motivate physical activity, and it thereby helped to support their social and physical well-being. Study findings may contribute to positive social change by increasing knowledge and awareness of how technology can be used to promote healthy behaviors among Black women. This study may also provide useful information to stakeholders interested in health promotion strategies and programs to reduce the health disparity gap for Black women in the United States.

Southern Africa has the highest prevalence of Human Immunodeficiency Virus (HIV) infection in the world. With a high prevalence of HIV, as well as a rising incidence of chronic diseases of lifestyle (CDLs), South Africa is faced with the dual burden of infectious diseases and CDLs. Health promoting behaviours (HPBs), including physical activity (PA), maintaining good nutrition and taking responsibility for personal health, play an important role in managing the symptoms of HIV infection and the side effects of antiretroviral (ARV) use. Additionally HPBs improve health-related quality of life (HRQOL) in people living with HIV (PLWHIV). Furthermore, research indicates that HPBs should be encouraged among university students as they will become the future decision and policy makers in their places of employment. This study sought to determine the PA levels, HPBs and HRQOL of university students living with HIV, in order to better promote PA participation and HPBs in this population. Additionally, participants‘ perceptions of and attitudes towards exercise participation were investigated, as were barriers that mitigated against PA participation and HPBs. This study was exploratory-descriptive in nature and utilised a mixed methods design. The University Campus Health Clinic (CHC) staff recruited 29 HIV positive students (HIVPS) between the ages of 18 and 25 through purposive sampling. In the quantitative portion of the study the HIVPS completed a demographic questionnaire as well as three self-administered questionnaires, namely: the International Physical Activity Questionnaire (IPAQ), the Health-promoting Lifestyle Profile (version 2, HPLP-II) and the World Health Organisation Quality of Life Brief Questionnaire (WHOQOL-HIV-BREF) to determine PA levels, health-promoting lifestyle behaviours and HRQOL, respectively. Height and weight, as well as the most recent CD4 count were also recorded.

Physical activity is a critical factor in preventing obesity and other chronic illnesses. African American women experience higher rates of physical inactivity than the general population. As a key figure in the family, African American mothers should model healthy behaviors to the family, especially their children. This qualitative study explored the physical activity attitudes of African American mothers who frequently visit a recreation center in the Columbus, Ohio, area. The research questions focused on the possible barriers and motivators for physical activity engagement. The theory of planned behavior, which emphasizes behaviors, intentions, and attitudes when exploring health behaviors, guided the study. Purposeful sampling was applied to recruit a sample of 17 African American mothers over the age of 18 from 5 recreation centers. Participants who met inclusion criteria participated in a semi-structured one-on-one interview. Data were analyzed by hand coding and NVivo to capture and analyze themes, including (a) physical movement, (b) physical health, (c) environment, (d) schedule, (e) physical appearance, and (f) well-being. The findings indicated that African American mothers are aware of the value of physical activity for themselves and their families. However, personal responsibilities may prevent them from engaging in regular physical activity. The study contributes to social change by providing community center directors and public health professionals with information that they can use to create more culturally sensitive physical activity interventions.

Insufficient physical activity detracts from healthy living and has a disparate impact on African American women and their female children. The extensive body of prior research addressing preventable chronic disease and other consequences of insufficient physical activity includes limited information specific to African American single mothers. The purpose of this descriptive phenomenological study was to gain an understanding of African American single mothers' perceptions of physical activity. Specifically investigated were African American women's familial influences and potential effects of these influences on their children's health behaviors. The health belief model served as the theoretical framework for this study and provided a contextual lens to explore research questions to elicit African American single mothers' perceptions of physical activity. Six African American single mothers participated in semistructured interviews that produced data for this study. Use of Colaizzi's data analysis method revealed thematic single mother reports of healthy lifestyle, social support, resources/education, body/self-image, stress management, fear and embarrassment, motivation/inspiration, and injury/illness as factors affecting their engagement in physical activity. Future research opportunities include exploring multilevel interventions specific to African American single mothers and using common weight-related terminology. Study findings could benefit health educators, administrators, and providers. Positive social implications include improved physical activity and health outcomes for African American single mothers with ultimate decreased health care costs for the U.S. society.

Introducció L'obesitat és, actualment, el problema nutricional més freqüent als països industrialitzats i que més comorbiditat associa, a curt i llarg termini, convertint-se en un dels problemes de salut pública més greus del segle XXI. Segons l'OMS, en el 2012 hi havia 42 milions de nens amb sobrepès al món. D'aquests, 35 milions viuen en països en vies de desenvolupament. Espanya no és aliena al problema. Del primer estudi en el 1984, PAIDOS, al segon en el 2000, Enkid, la prevalença de l'obesitat va augmentar del 5 al 15%. En l'estudi Aladino, realitzat l'any 2011, va situar en un 31.4% la prevalença d'excés de pes (17.6% d'obesitat infantil) en territori espanyol en nens d'entre 6 i 9 anys. L'any 2012, segons una enquesta realitzada pel Ministeri de Sanitat, Serveis Socials i Igualtat el 25.9% de nens i el 31.6% de nenes entre els 2 i 5 anys no realitzaven exercici físic. Les xifres milloraven entre la població de 6 a 10 anys, on un 7.9% dels nens i un 12.7% de les nenes asseguraven no realitzar cap tipus d'exercici físic. A Catalunya, l'any 2013, el 28.8% de la població de 6 a 14 anys havia participat cada dia o gairebé cada dia del mes en activitats o jocs d'esforç físic o esports, en contrast amb el 20.9% que declarava no haver participat cap dia o gairebé cap dia. Contingut de la investigació Donat el gran impacte sanitari de l'obesitat, es fa imperativa la creació de programes específics per a la prevenció i el tractament de l'obesitat infantil on treballin de forma integrada els professionals de diferents àmbits. Nombroses publicacions han demostrat que la modificació d'hàbits és una estratègia vàlida i ha de ser l'eina principal per combatre el sobrepès i l'obesitat infantil. Els programes d'intervenció han de tenir com a finalitat promoure hàbits saludables des de l'educació nutricional i l'exercici físic. El missatge d'aquests programes ha de ser comprensible i la proposta assolible, afavorint d'aquesta manera l'adhesió. L'objectiu general d'aquesta tesi doctoral va ser la creació i el desenvolupament de programes d'educació nutricional (INFADIMED) i de promoció de l'activitat física (ACTIVA’T) per incidir en la prevalença del sobrepès infantil. Conclusió La prevalença d'excés de pes infantil (sobrepès + obesitat) a Vilafranca del Penedès a l'inici de l'estudi INFADIMED i a la franja d'edat de 3 a 7 anys era del 21.9%. En separar la població intervinguda, es va obtenir un grup control amb una prevalença del 20.8% d'excés de pes i un grup intervenció amb una prevalença del 22.9%. En finalitzar el programa d'intervenció, tres anys després, el grup control va augmentar la prevalença del sobrepès infantil en 8.4 punts (percentatge final: 29.2%), mentre que el grup intervenció va descendir 6.3 punts (percentatge final: 16.6%). La població de l'estudi ACTIVA’T, dividit en dos grups, un que va rebre educació nutricional i va realitzar exercici físic més de 5 hores a la setmana durant 6 mesos, i un altre grup que va rebre la mateixa educació nutricional i va realitzar menys de 3 hores a la setmana en el mateix període de temps, també va millorar la prevalença d'excés de pes, essent el primer grup el que va obtenir millors resultats, demostrant el paper important que juga l'activitat física en l'excés de pes. El perfil lipídic en una subpoblació de l'estudi ACTIVA’T també va millorar substancialment després dels 6 mesos d'intervenció dietètica i dietètica combinada amb el programa d'exercici físic. L'educació nutricional va millorar els hàbits alimentaris dels participants, en el context d'una major adherència a la dieta mediterrània, millorant sobretot en el que al desdejuni es refereix i incrementant el consum de fruites i verdures.
Introducción La obesidad es, actualmente, el problema nutricional más frecuente en los países industrializados y que más comorbilidad asocia, a corto y largo plazo, convirtiéndose en uno de los problemas de salud pública más graves del siglo XXI. Según la OMS, en el 2012 había 42 millones de niños con sobrepeso en el mundo. De éstos, 35 millones viven en países en vías de desarrollo. España no es ajena al problema. Del primer estudio en 1984, PAIDOS, al segundo en 2000, Enkid, la prevalencia de la obesidad aumentó del 5 al 15%. En el estudio Aladino, realizado en el año 2011, situó en un 31.4% la prevalencia de exceso de peso (17.6% de obesidad infantil) en territorio español en niños de entre 6 y 9 años. En el año 2012, según una encuesta realizada por el Ministerio de Sanidad, Servicios Sociales e Igualdad el 25.9% de niños y el 31.6% de niñas entre los 2 y 5 años no realizaban ejercicio físico. Las cifras mejoraban entre la población de 6 a 10 años, donde un 7.9% de los niños y un 12.7% de las niñas aseguraban no realizar ningún tipo de ejercicio físico. En Cataluña, en el año 2013, el 28.8% de la población de 6 a 14 años había participado cada día o casi cada día del mes en actividades o juegos de esfuerzo físico o deportes, en contraste con el 20.9% que declaraba no haber participado ningún día o casi ningún día. Contenido de la investigación Dado el gran impacto sanitario de la obesidad, se hace imperativa la creación de programas específicos para la prevención y el tratamiento de la obesidad infantil donde trabajen de forma integrada los profesionales de diferentes ámbitos. Los programas de intervención deben tener como finalidad promover hábitos saludables desde la educación nutricional y el ejercicio físico. El mensaje de estos programas debe ser comprensible y la propuesta alcanzable, favoreciendo de este modo la adhesión. El objetivo general de esta tesis doctoral fue la creación y el desarrollo de programas de educación nutricional (INFADIMED) y de promoción de la actividad física (ACTIVA’T) para incidir en la prevalencia del sobrepeso infantil. Conclusión La prevalencia de exceso de peso infantil (sobrepeso + obesidad) en Vilafranca del Penedès al inicio del estudio INFADIMED y en la franja de edad de 3 a 7 años era del 21.9%. Al separar la población intervenida, se obtuvo un grupo control con una prevalencia del 20.8% de exceso de peso y un grupo intervención con una prevalencia del 22.9%. Al finalizar el programa de intervención, tres años después, el grupo control aumentó la prevalencia del sobrepeso infantil en 8.4 puntos (porcentaje final: 29.2%), mientras que el grupo intervención descendió 6.3 puntos (porcentaje final: 16.6%). La población del estudio ACTIVA’T, dividido en dos grupos, uno que recibió educación nutricional y realizó ejercicio físico más de 5 horas a la semana durante 6 meses, y otro grupo que recibió la misma educación nutricional y realizó menos de 3 horas a la semana en el mismo periodo de tiempo, también mejoró la prevalencia de exceso de peso, siendo el primer grupo el que obtuvo mejores resultados, demostrando el papel importante que juega la actividad física en el exceso de peso. El perfil lipídico en una subpoblación del estudio ACTIVA’T también mejoró sustancialmente después de los 6 meses de intervención dietética y dietética combinada con el programa de ejercicio físico. La educación nutricional mejoró los hábitos alimentarios de los participantes, en el contexto de una mayor adherencia a la dieta mediterránea, mejorando sobre todo en lo que al desayuno se refiere e incrementando el consumo de frutas y verduras.
Introduction Obesity is currently the most common nutritional problem in industrialized countries as well as high comorbidity shows in short and long term, becoming one of the most serious public health problems of the XXIst century. According to WHO, in 2012 there were 42 million overweight children worldwide. Of these, 35 million live in developing countries. Spain is not strange to the problem. From PAIDOS in 1984, the first study, to ENKID in 2000, the second one, the prevalence of obesity increased from 5 to 15%. Aladdin study, conducted in 2011, stood at 31.4% prevalence of overweight (17.6% of child obesity) in Spain in children aged 6 to 9 years. In 2012, according to a survey conducted by the Spanish Ministry of Health, Social Services and Equality, 25.9% of boys and 31.6% girls aged between 2 and 5 years old showed no physical exercise. These figures improved among the population aged 6 to 10, where 7.9% of boys and 12.7% girls claimed not to perform any kind of physical exercise. In Catalonia, in 2013, 28.8% of the population aged 6 to 14 years old had participated every day or almost every day of the month in physical activities or sports games, in contrast to 20.9% who did not participate any day or almost any day. Research content Given the great health impact of obesity, it is imperative to create specific programs for the prevention and treatment of childhood obesity on the integrated work of professionals from various fields. Numerous publications have shown that changing habits is a valid strategy and should be the main tool to fight against overweight and obesity in children. Intervention programs should be aimed at promoting healthy habits from nutritional education and physical exercise. The message of these programs should be understandable and achievable proposal, thereby increasing membership. The overall objective of this thesis was the creation and development of nutritional education (INFADIMED) and promoting physical activity (ACTIVA’T) programs to influence on the prevalence of overweight children. Conclusion At the beginning of the INFADIMED study, the prevalence of excessive weight (overweight + obesity) in 3-to 7-year-old children in Villafranca del Penedès was 21.9%. The INFADIMED population was divided in a control group with a 20.8% prevalence of excessive weight and an intervention group with a prevalence of 22.9%. Three years later, at the end of the intervention program, the prevalence of excessive weight increased in the control group by 8.4 points (29.2%), while decreased by 6.3 points (16.6 %) in the intervention group. In the ACTIVA’T study, the population was also divided into two groups, one that received nutritional education and performed physical exercise more than 5 hours a week for six months, and the other group received the same nutrition education and performed within 3 hours a week in the same period. The first group decreased their prevalence of excessive weight, demonstrating the important role that physical activity plays in the excessive weight. In a subpopulation of the study ACTIVA’T, the lipid profile also improved substantially after 6 months of diet and exercise program. In both studies, the nutritional education program increased the adherence to the Mediterranean Diet of the participants. The results indicated a mainly positive effect on breakfast habits and also an increased on fruit and vegetable consumption.

Physical activity is one of the key factors in strengthening health. Yet, in Lithuania as well as in the whole world, the physical activity among youngsters is insufficient. The sudden decrease of physical activity during this period is becoming a huge issue of the society with indisputably harmful consequences (Cairney et al., 2012; Kahn et al., 2008; Bobrova, Grajauskas, 2005); hence the promotion of physical activity of youngsters during this period of their life is becoming one of the most important and urgent issues of the healthcare of the society (Sirard, Barr-Anderson, 2008). Evidently, the period of youngsters is critical; at this time, it is crucial to take extra measures of promotion of physical activity (Schneider, Cooper, 2011). In the activity of physical education, when promoting physical activity of students of senior grades, a new method of educational counseling was brought into practice which is based on Solution focused brief therapy as developed by de Schazer (1985). The pioneer of Lithuanian pedagogical science A.Maceina developed a concept of the agility of a trainee in practice; in the present research, this objective is sought by applying educational counseling. The student is attributed the functions of a trainee, a unique creative and developing personality (Tijūnėlienė, Kavaliauskienė, 2008). Educational counseling also provides presuppositions for the universality of education as an important element of the educational process by developing the... [to full text]
Fizinis aktyvumas yra vienas iš svarbiausių sveikatą stiprinančių veiksnių. Tačiau visame pasaulyje, taip pat ir Lietuvoje, jaunuolių fizinis aktyvumas yra nepakankamas. Labai staigus fizinio aktyvumo mažėjimas tarp vyresniųjų klasių mokinių tampa didžiule visuomenės problema, kurios pasekmės yra žalingos (Cairney et al., 2012; Kahn et al., 2008; Bobrova, Grajauskas, 2005). Todėl vienas svarbiausių ir aktualiausių visuomenės sveikatos priežiūros uždavinių – skatinti jaunuolių fizinį aktyvumą (Sirard, Barr-Anderson, 2008). Akivaizdu, kad vyresniųjų klasių mokinių amžius yra kritinis, taigi šiuo laikotarpiu būtina taikyti papildomas priemones paauglių fiziniam aktyvumui skatinti (Schneider, Cooper, 2011). Išsakytieji teiginiai rodo, kad derėtų ieškoti naujų kūno kultūros pamokų formų. Vykstant ugdymo paradigmų kaitai (Bitinas, 2005), turinčiai įtakos mokyklinei kūno kultūrai, siekiant asmenybės sveikatos ir geros fizinės būklės per visą gyvenimą, ir toliau ieškoma naujų formų bei metodų paauglių fiziniam aktyvumui skatinti. Ugdant vyresniųjų klasių mokinių fizinį aktyvumą, kūno kultūros veikloje pritaikytas naujas tokioje ugdymo praktikoje edukacinio konsultavimo metodas, pagrįstas trumpalaikiu į sprendimus sutelktu konsultavimu (angl. Solution focused brief therapy; de Schazer, 1985). Darbe keliami šie probleminiai klausimai: • Ar ugdytojas, kalbėdamas apie ugdytinio stiprybes ir gerąsias savybes, bet vengdamas analizuoti jo problemą, padeda paaugliui rasti tinkamą fizinio... [toliau žr. visą tekstą]

Youth sport has been advocated as a vehicle through which more physically active lifestyles can be encouraged among children and adolescents. Employing objective assessments of physical activity (PA), the purpose of this thesis was to investigate the value of youth sport as a context for PA promotion and obesity prevention. Results from Study 1 indicated 37% of youth sport football participants did not meet recommended levels of moderate-to-vigorous PA (MVPA) during their youth sport engagement. Study 2 demonstrated negative associations between daily PA levels of grassroots footballers and obesity linked health outcomes, with the reverse true for sedentary time (ST). Guided by self-determination theory (Deci & Ryan, 1987), findings from Studies 3 and 4 revealed perceptions of coach provided autonomy support were positively associated with sport related autonomous motivation, and in turn, higher MVPA participation (daily MVPA as well as PA accrued during youth sport) and lower ST. This thesis underlines the value of youth sport as a setting through which levels of PA can be increased, and ST reduced among youth. Research described within also points to the important role of the coach-created environment and player motivation in predicting variability in PA engagement and ST among young grassroots footballers.

Background There are concerns over the low proportion of young people in the Kingdom of Saudi Arabia [KSA] who regularly participate in physical activity [PA] (Al-Hazzaa, 2004; Al-Hazzaa, et al., 2011). Schools have a unique opportunity to promote PA and provide adequate PA opportunities for young people via the formal/informal curriculum, school sports programmes, and out-of-hours PA (Dobbins et al., 2009). However, implementing effective PA promotion programmes in schools is a challenge and requires consideration of a range of factors. In Saudi Arabia context, the secondary boys school PE programme comprises two main elements: 1) the PE curriculum which is compulsory for all students and includes one 45 minute PE lesson per week; 2) the extra-curricular programme which is optional and comprises the Internal Physical Activity Programme (IPAP) and the External Physical Activity Programme (EPAP). The IPAP activities occur during breaks between lessons whilst the EPAP takes place after school. Both are delivered by PE teachers. Research Aims The aims of this study were: 1) To investigate the nature and extent of the promotion of PA in boys secondary schools in Saudi Arabia. 2) To explore physical education teachers perspectives on the promotion of PA in boys secondary schools in Saudi Arabia. 3) To identify the factors that influence the promotion of PA in boys secondary schools in Saudi Arabia. Theoretical Framework The theoretical framework for the study was based on Social Cognitive Theory (Bandura, 1997) which presumes that PA behaviour is influenced by: personal characteristics; behavioural factors; and environmental factors. In addition, the Active School model (Cale, 1997; Cale & Harrris, 2005) was utilised as a conceptual framework, guiding the investigation of PA promotion within schools and the analysis of data. Methodology In order to investigate the research questions, a two phased mixed method (Creswell, 2009) research project was carried out. Phase one involved a detailed survey questionnaire, informed by the Active School model, which was designed to gather information about PE teachers policies, practices and views with respect to the promotion of PA. The questionnaire s validity was enhanced via a number of Saudi experts who confirmed its appropriateness for use in the Saudi context. Moreover, a pilot study was undertaken to obtain valuable feedback relating to the format, content and clarity of both the survey questionnaire and interview schedule before the main study. The questionnaire was distributed to all secondary boys schools in Riyadh in KSA (N=181 schools). The response rate was 52%. The Statistical Package for Social Sciences (SPSS) version 17 was employed in the analysis of the data. Phase two involved semi-structured interviews. Prior to conducting these, the interview schedule was piloted at one secondary school. Six PE teachers drawn from the survey sample were interviewed and the interview data were then transcribed and analysed using MAXQD10 software. Research Findings The survey revealed that two thirds of the secondary boys schools had a plan or policy for the promotion of PA, and almost 70% of PE teachers thought that their school significantly contributed to the promotion of PA. Games activities (e.g. football) dominated the PE curriculum, and the majority of schools also organised inter-school games competitions (e.g. league). In contrast, exercise and fitness-related activities (e.g. circuit training) were less common within the schools PE curricula. The PE curriculum was viewed by the teachers as the most important avenue to promote PA, followed by the IPAP and EPAP (95%, 91% and 73% respectively). Sports/activity facilities varied between schools, particularly in terms of indoor facilities, and over half of the PE teachers considered their indoor and outdoor facilities to be inadequate for promoting PA (54% and 57% respectively). The vast majority (90.3%) of the schools did not offer PA opportunities to parents/families. Furthermore, three quarters of the teachers expressed a need for professional development specifically in the area of PA promotion. On a positive note, headteachers and local PE supervisors were reported to be supportive of efforts to promote PA in the schools and provided support for both the IPAP and EPAP. All PE teachers, who were interviewed, considered the time allocated to PE programme to be insufficient for promoting PA amongst pupils. Further, some teachers viewed PE lessons as time off from serious school subjects and entertaining time . Most teachers reported that parents considered PE as unimportant and/or playtime . Discussion/Conclusion PE teachers views on role of schools in the promotion of PA were generally positive. The ways in which the teachers practiced the promotion of PA varied and maybe have been due to their narrow understanding of the whole school approach to PA promotion. The teachers focused on the PE curriculum and the PE extra-curricular programmes as the main avenues through which to promote PA within their schools, and gave less attention to other avenues such as the whole school environment. Almost all of the teachers had a sporting philosophy for PE leading them to privilege competitive sports. Although the teachers reported to have support from head teachers and local PE supervisors, many schools were not as conducive to PA promotion as they could be due to the narrow range of physical opportunities on offer, and the teachers lack of relevant professional development, the limited sports facilities and the insufficient maintenance of these. In addition, the status of, and time allocated to PE were found to be an issue influencing the promotion of PA in schools. It was concluded that actions could be taken to broaden PA promotion within Saudi schools. For example, policy update and development for PA promotion could be improved to address clothing and changing, traffic/transport, and playground bullying; establish links with outside sports agencies and professionals; and increase PA opportunities before or after school, or at weekends. The findings suggest that if the descriptor comprehensive which is widely used to distinguish whole school approaches from curriculum-only models of PA promotion is to be fully realised, schools need to make a clear and explicit effort to promote PA within the social/cultural environment. Further that research is needed on the social and cultural values, norms and perspectives affecting PA promotion in schools.

This thesis comprised of six critical studies divided into three phases, which evaluated the context, explored available alternatives to exercise and sought to improve the unsettling scenario of “sedentary” lifestyles among individuals with spinal cord injury (SCI). In the first phase, descriptive information on moderate to vigorous exercises and its associated barriers to participation were extracted among community-dwelling SCI. The approach used non-invasive instruments (validated questionnaires) which allowed description of activities and the associated barriers in large epidemiological studies. The second phase, sought to explore and provide a scientifically grounded alternative to exercise termed “exergaming” (a combination of exercise and gaming with body movements) for this population in the form of a systematic review and a pilot study. The third and final phase of the thesis involved comparing exergaming to conventional exercise counterparts whilst finding directions for improvement.

Understanding of beliefs, attitudes, and behaviors toward health issues, such as physical inactivity, within certain populations are often studied to design programs and interventions specific to communities. A total of six elementary schools were chosen in the Mississippi Delta, two elementary schools within three school districts, to provide a deeper understanding of barriers to physical activity. Forty-four parents and guardians of elementary aged children participated in focus groups to discuss current physical activity levels and factors impacting and limiting local childrens physical activity levels. The most frequently reported barriers were environmental issues such as fear of childrens safety, lack of resources, and individual and social constraints such as time, parental influences, and television viewing. Concerns about safety and violence were the most frequently mentioned issues among participants. Collection through other methods of research is needed to further understand and assess the problems faced in this region.

Brain injury (i.e., traumatic brain injury, stroke) is a considerable public health issue due to complicated outcomes of the injury, increasing incidence, and high costs linked with medical treatment. Rehabilitation centers are challenged to help individuals manage the resultant associated conditions and prevent secondary and chronic conditions. Research has shown that health promotion programs (HPP) that incorporate education about physical activity (PA) are one mode of rehabilitation that can improve the health of individuals with disabilities. However, PA is not included in the rehabilitation program for individuals with a brain injury, indicating a gap in the services provided. Consequently, the purpose of this study was to create and implement a physical activity centered education (PACE) program within an outpatient rehabilitation program. PACE consisted of an 8-week (16 session) program which aimed to (1) increase PA self-efficacy, (2) increase intention to change PA behaviors, (3) increase amount of PA completed regularly, and (4) promote positive rehabilitation outcomes. Based on previous research it was hypothesized that participation in PACE would result in (1) increased PA self-efficacy, (2) forward progression in intention to change PA behaviors, (3) increased amount of PA completed, and (4) improved rehabilitation outcomes (i.e., abilities, adjustment, participation). The PACE program resulted in an average increase of 16.1% in participants’ PA self-efficacy (effect size [ES] = 0.41), an increase from three of nine participants at pre-test to six of nine participants at post-test reporting to be in a stage of change in which they are most likely to be successful in regular PA participation (i.e., action or maintenance), and a comparable improvement in MPAI-4 scores (rehabilitation outcomes) after discharge to a rehabilitation program without a PA education component. In conclusion, the PACE program can improve PA self-efficacy, intention to change PA behaviors, and short-term rehabilitation outcomes.

Research confirms inactivity increases in adolescence and that unfit youth are at risk of acquiring cardiovascular diseases, diabetes, obesity, or other significant physical disorders later in life. Thus, the purpose of this phenomenological study was to describe the experience of chronically inactive children who were exposed to an exercise intervention program. The specific focus of the research was to better understand the essential educational needs of the participants and the effective elements of the program, Moving for Fun (MFF), a 7-week after-school fitness intervention program designed to modify chronic inactivity. Open-ended interviews and 3 observations were conducted with 8 middle school students (4 males and 4 females) identified as scoring low on a standardized assessment protocol of health-related physical fitness. Interview data were transcribed and coded using a combination of open and a priori coding to extract significant statements that were analyzed into clusters of meaning that described key elements of the students' experience. Video-taped observations were analyzed to use behaviors during MFF activities as a means of checking interpretations of the interview data. Interpretation of the final structural analysis suggested that students did not have a good understanding health-related fitness or how it is achieved; however they enjoyed participating in inclusive physical activity, and were planning to add more physical activity to their lives. Recommendations include an examination of physical activity programming and an increase in programs that serve participants with varied needs. Developing more student-centered programs that teach or include fitness education can decrease the number of students lacking physical fitness and increase the population of those who carry fitness activities and better health with them into the future.

Background An increase in the burden of disease due to low physical activity has been reported in many countries, including Pakistan. Physical activities are not given priority and are not seen as beneficial for young adolescents' health. The study investigated the physical activity levels of young adolescents in Karachi, Pakistan. The COM-B model provided the framework for examining the challenges, opportunities, and motivating factors related to physical activity. Study Design A sequential explanatory mixed methods design was employed. Quantitative data were collected and analysed from adolescents attending a private school in Karachi that functions under the Aga Khan Education Services Network. The quantitative data were used to profile the physical activity of the 6th to 8th grade students. Six hundred and seventy-one adolescents from the ages of 10 to 14 years participated in the survey and a total of eight focus groups were conducted with students, physical education teachers, and parents’ groups. A total of 79 participants participated in FGDs. The BMI of each participant was calculated to profile the sample. The qualitative data were gathered through focus group discussions to explore the factors that influence physical activity behaviors. Utilizing Elo & Kyngas's (2008) method of analysis, the qualitative data that could not be aligned with the existing domains of the model used in the study were analyzed through an inductive approach. Findings Height, weight, and BMI were measured with a sample of 604 students. The average BMI of young adolescents aged 10-14 years was 18.5 ±4.1 for both the sexes; boys had Mean ± SD, BMI of 18.2 ±4.2, whereas, girls had Mean±SD, BMI of 18.6. ±3.9. The mean height and standard deviation of adolescents were 147.7cm ± 8.8 and the mean weight and the standard deviation was 40.7 kg ± 11.4. Age and BMI category were not associated with physical activity. On a scale of 1 (low physical activity) to 5 (high physical activity), the students reported a mean physical activity score of 3.09 (SD 0.70). Girls had lower physical activity scores than boys in each grade: Grade 6 (p = 01); Grade 7 (p = .01) and Grade 8 (p <.001). The mean levels of physical activity did not change across the 3 grades for all the students (males and females), while for girls, the levels of physical activity dropped across the grades, from Grade 6 to Grade 8 (p = .001) and from Grade 7 to Grade 8 (p <.001). The qualitative findings revealed that there are many impeding and enabling factors influencing adolescents’ PA related to capability, opportunity, and motivation. Further, factors that were rooted in religious as well as cultural norms were evident in the data. Conclusion The adolescent students were engaged in moderate levels of physical activities. Physical activity declined for girls as they reached higher grades. Hence, the study revealed that understanding these factors is necessary to promote PA among young adolescent students in a local context. In addition, the BMI of students’ increases with age, however, no association is found between BMI and physical activity.

Implémentation et évaluation d'un programme de promotion de la santé au sein de clubs sportifs : « Promouvoir l'Activité Physique des Adolescents » La pratique sportive est considérée comme bénéfique pour la santé (OMS, 1995). Malgré ce constat, tous les jeunes ne bénéficient pas d'expérience sportive positive. Pour encourager ce type d'expérience, ce travail doctoral est composé de trois parties : (1) une analyse de la contribution du club sportif à la promotion de la santé, (2) l'évaluation des effets et (3) du processus d'implémentation d'une intervention basée sur la théorie de l'autodétermination et la théorie des buts d'accomplissement visant une expérience sportive positive et durable : le programme « Promouvoir l'Activité Physique des Adolescents ». Pour apprécier la contribution du club sportif à la promotion de la santé, 2 études ont été réalisées. La première analyse les représentations de 125 éducateurs des missions et actions de promotion de la santé des clubs sportifs, concluant que le club pourrait être plus actif en termes de politique et de pratiques. La seconde, évaluant la contribution de la pratique sportive pour atteindre les recommandations en termes d'activité physique (AP ; OMS, 2010) auprès de 331 jeunes footballeurs, observe que la pratique sportive semble favoriser la pratique d'AP. L'évaluation des effets de l'intervention a été réalisée à l'aide d'une étude contrôlée randomisée auprès de 617 joueurs (339 du groupe expérimental et 278 du groupe expérimental). Les résultats montrent qu'en comparaison au groupe contrôle, les joueurs entraînés par un éducateur formé ont une évolution plus positive de la perception du climat motivationnel, de la satisfaction du besoin de compétence, de leur motivation autodéterminée, de l'estime de soi, et de moindres intentions et un taux d'abandon plus faible. En contrôlant le niveau au 1er temps de mesure, la formation a un effet sur l'expérience sportive médiatisée complètement par le climat motivationnel qui est partiellement médiatisé par la satisfaction de besoins et la motivation. L'évaluation du processus montre que la formation de formateurs pour délivrer notre intervention est efficace, que l'intervention un taux correct d'implémentation. Le taux d'implémentation individuel est modéré
Implementation and evaluation of a health promotion program in sport clubs: "Promoting Adolescent Physical Activity" The benefits of sport participation have been demonstrated (OMS, 1995). Despite this statement, not all participants have a positive sport experience. To foster this type of experience, this doctoral thesis is composed of three aims : (1) an analysis of sport clubs contribution to health promotion (HP), (2) the evaluation of the effects and (3) process of an intervention based on self-determination and achievement goal theories to foster positive and long term sport involvement: the “Promoting Adolescent Physical Activity” intervention. Two studies have been realised to better understand the role sport clubs can play to HP. The first analyse the representation of sport clubs HP actions and mission of 125 grassroots coaches, underlining that sport clubs could be more active concerning HP policies and practices. The second question the contribution of sport participation to help 331 youth football players to reach WHO's physical activity (PA) recommendations (2010), showing that sport participation might favour participants' PA. The effects of the intervention have been evaluated trough a cluster-randomised trial including 617 players (339 in the experimental group and 278 in the control group). Results have shown that in comparison to the control group, players in the experimental condition have a more positive evolution of their motivational climate, the satisfaction of their competence need, a self-determination index (SDI) and self-esteem, as well as a decrease of their dropout intentions and behaviours. Controlling for Time 1, the intervention has an effect on sport experience fully mediated by the climate, which is partially mediated by basic needs satisfaction and a SDI. The process evaluation has shown that coach expert training to deliver our intervention was effective, that the intervention has no effect at the organisational level, but a correct implementation score. The individual implementation score is moderate