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Background: Despite improving survival rates, people with advanced cancer experience high symptom burden, functional challenges, and negative impacts upon their quality of life. Moreover, these individuals frequently report unfulfilled needs related to supportive care, including rehabilitation support. Leisure-time physical activity (LPA), including exercise, has been found to be beneficial for people following diagnosis of cancer. However, little is known about LPA for individuals living with advanced cancer, particularly from a rehabilitation perspective. Purpose and objectives: The overall purpose of my dissertation research is to explore LPA in people with advanced cancer, through the perspectives of adults diagnosed with stage 4 cancer as well as those of oncology physiotherapists. Specific objectives are: (1) to map the research and understand key concepts from the literature about LPA in individuals with advanced cancer; (2) to explore the perspectives and experiences of LPA in adults diagnosed with stage 4 cancer; and (3) to describe the clinical practices, knowledge, skills, and perspectives of oncology physiotherapists related to LPA in the advanced cancer population. Methods: To meet these objectives, I conducted three research studies: (1) a scoping review of 92 articles exploring LPA in people with advanced cancer; (2) a qualitative interpretive-description study, involving individual, semi-structured interviews with 20 Canadian adults diagnosed with stage 4 cancer; and (3) a mixed-methods study, consisting of an online survey with 62 Canadian oncology physiotherapists, followed by qualitative, individual interviews with 13 physiotherapists. Results: The scoping review demonstrated a recent surge in research on the topic of LPA in advanced cancer, with many studies adopting quantitative methods and investigating aerobic and resistance exercise interventions. These studies have contributed to important research developments highlighting the safety, feasibility, and benefits of such interventions for people with advanced cancer. This scoping review also identified several gaps in the literature, particularly highlighted by the few qualitative studies exploring patient perspectives and experiences with different types of LPA. The second study helped address some of the research gaps noted in the scoping review. In this qualitative interpretive-description study, individuals with stage 4 cancer revealed the diverse and fluid nature of their experiences with LPA, necessitating intentional planning and modifications of activities. Moreover, important health benefits and psychosocial meanings of activity participation were identified. In addition, common supportive care needs related to LPA were recognized through this work. In particular, the participants desired professional LPA support that is integrated, interprofessional, accessible, and tailored to their individual abilities and preferences. To complement the patient perspectives and experiences, the third study offered insight on the perspectives of rehabilitation professionals. This mixed-methods study with oncology physiotherapists demonstrated positive views about the safety, importance, and benefits of activity in people with advanced cancer. Key considerations with this population included addressing cancer-related issues (e.g., bone metastases), identifying individually meaningful goals, and tailoring activity recommendations. The physiotherapists also highlighted their overall roles in optimizing functional capacity and alleviating symptom burden in people with advanced cancer. The lack of awareness about the role of physiotherapy and the limited access to rehabilitation services in oncology were identified as important challenges. Conclusions: The overall findings from this dissertation research highlight the scope of literature on LPA in advanced cancer and offer patient and professional perspectives related to this topic. As such, these findings may help inform the design and integration of supportive care resources targeted to this population. Strategies to promote LPA in this population require consideration of the complexities associated with advanced cancer and the important meanings of LPA for people living with this challenging diagnosis. Physiotherapists can be well-suited to promote safe, meaningful LPA in the advanced cancer population, as well as to optimize functional activity and symptom management. Practically, these findings support a patient-centered approach to encourage appropriate LPA in the care of people with advanced cancer. Key elements include: (1) comprehensive, regular patient assessment; (2) open communication with patients and families; (3) interprofessional collaboration between oncology care providers and specialized rehabilitation professionals; (4) integrated, routine delivery of LPA information and individualized activity recommendations; and (5) access to tailored LPA resources and programs within cancer care and community-based settings. Additional research is warranted to examine different types of LPA and explore other rehabilitation needs, particularly in understudied subgroups of advanced cancer (e.g., non-breast cancer). Moreover, further efforts are needed to develop, evaluate, and implement clinical strategies targeting LPA within integrated care models for advanced cancer. Simultaneously, educational initiatives are necessary to enhance relevant knowledge in physiotherapists and oncology care providers. These can support the personalization of LPA resources, facilitate interprofessional collaboration, and improve the quality and integration of rehabilitation services in cancer care. Therefore, the findings of my dissertation research provide comprehensive and applicable knowledge about diverse patient and professional perspectives related to LPA in the advanced cancer population. This work can support future efforts aimed at facilitating LPA participation and enhancing supportive care experiences in individuals living with advanced cancer.

Yes / This paper explores why teachers adopt physically active learning (PAL). Data were collected through ‘go-alongs’ supplemented by individual interviews with 13 teachers in seven Norwegian lower secondary schools. Data were then analysed thematically. Results indicated that as well as to enhance their teaching and pupils' learning, teachers adopt PAL to adhere to school policy (The Conforming Teacher), to be an innovative educator (The Innovating Teacher), and, because it matches past positive personal experiences (The Connecting Teacher). The findings can be used to shape PAL teacher training programs to increase the likelihood of adoption.

Yes / The school environment is an ideal setting for promoting physical activity (PA). Wearable activity trackers (wearables) have previously been implemented, in research, as intervention tools within the school-environment. However, the large-scale use and acceptance of wearables, in schools, is unknown. This study distributed a cross-sectional survey to school staff to investigate the prevalence of child and adolescent wearable use in schools, including when and how they are used, and school staff's willingness to use them in the future (as implemented by school staff). This survey consisted of between 13 and 22 items, including closed-ended and open-ended questions. Closed-ended responses were displayed descriptively (wearable prevalence and characteristics), and open-ended qualitative responses were categorised using descriptive content analysis (how wearables are used). 1087 school staff provided valid responses. Of those, 896 (82.4%) had never used a wearable as a teaching or support tool for their students, and 120 (11%) currently used- and 71 (6.5%) had previously used- a wearable as a teaching or support tool for their students. When wearables were used, school staff implemented their use regularly and during physical education lessons or throughout the entire school day. Wearables were used to monitor or increase student's PA levels, or for student and staff educational purposes (e.g., academic learning, movement breaks). Most school staff were willing to use a wearable as a teaching or support tool to promote student's PA, and/or learning about PA, in the future. This study is the first study to explore the widescale use and acceptance of children and adolescents using wearables in the school-setting. Findings may inform the development of future school-based interventions and public health initiatives for physical activity promotion, using wearables. / This study is funded as part of a PhD studentship by the Born in Bradford study. The Born in Bradford study receives core infrastructure funding from the Wellcome Trust (WT101597MA) and the National Institute for Health Research (NIHR), under its NIHR ARC Yorkshire and Humber (NIHR200166) and Clinical Research Network (CRN) research delivery support. For this piece of work, funding from the Sport England’s Local Delivery Pilot awarded Born in Bradford funding for this PhD studentship. S.A.C is supported by the NIHR Leicester Biomedical Research Centre—Lifestyle theme.

Master of Public Health / Department of Kinesiology / Brandon Irwin / Purpose: Face-to-face group dynamics-based (GDB) programs have been shown to be effective in promoting group cohesion and physical activity (PA). Recent evidence suggests that GDB principles can be successfully translated to web-based applications to impact group cohesion. The social nature of such applications allows for interactions to occur between friends and strangers alike, potentially moderating the effects of such GDB applications. Optimal group composition within GDB web applications has yet to be determined. The present study examines the moderating effects of group composition in a GDB application on group cohesion and PA. Methods: Participants (n = 166) were randomized into same-sex pairs and then randomly assigned to an experimental condition: stranger (no app), stranger (using app), friend (using app) or individual control. Participants in all conditions performed two sets of planking exercises. In between sets, those in partnered conditions interacted with their partner using a GDB social media app, where they participated in a series of team-building activities. The main dependent variables were group cohesion and physical activity, calculated as the total persistence during Block 2, controlling for Block 1 persistence. Results: Results indicate that the group integration dimensions of cohesion were higher in groups that used the application than those that did not (GI-T: p= .001; GI-S: p= .004). Friends that used the app reported greater cohesion across all dimensions than strangers that did the same (ATG-T: p= .006; ATG-S: p= .003; GI-T: p= .001; GI-S: p< .001). There was also a significant difference in PA (p=.004) between the two app-using conditions. However, there was no significant difference in PA between app using conditions and strangers that did not use the app (p= .495). Conclusions: Group cohesion can be enhanced through the use of an online GDB application. Using an online GDB application with a friend is associated with higher levels of cohesion. Further research is necessary to identify effective online GDB applications for impacting physical activity and cohesion in field settings.

Research has highlighted that adolescent girls are insufficiently active which has serious implications for their current and future health. Walking is recognised as an effective way of implementing regular, health enhancing physical activity (PA) into the daily routine of the general population and in an adolescent population walking is a convenient alternative to active play and sports participation. However it is currently difficult to promote walking and walking initiatives with adolescent girls due to lack of well-established evidence regarding both the quantity and quality of walking that might be advocated to promote PA and health. Therefore the aim of this thesis was to provide step based guidelines with regard to both the quantity and quality of walking required for health and thus inform walking interventions in adolescent girls. In order to achieve this aim four studies were undertaken. Study one explored the most appropriate way to assess walking activity, specifically whether walking on a treadmill accurately replicates walking overground in adolescent girls. Treadmill walking was found to overestimate the metabolic cost of walking in this population. This indicated that studies with the aim of exploring or promoting moderate intensity walking should focus on overground walking. Study 2 explored the quality of walking (steps·min-¹) required to achieve moderate intensity physical activity (MPA) overground. The influence of different anthropometric measures on step rate (steps·min-¹) equating to MVPA were also compared. Results suggest that a generic step rate of 120 steps·min-¹ and 7200 steps in 60 minutes may be advocated to achieve MPA in adolescent girls. However inter-individual variation in step rate associated intensity was observed and it was suggested that a step rate range based on the girl’s body mass may be beneficial for use with adolescent girls. Study 3 considered the most appropriate step measurement instrument to assess free-living walking. Five commercially available instruments (activPAL™ and pedometers; Omron HJ-720-ITC, Omron HJ-304-E, New Lifestyles NL-1000, Yamax CW-701) were compared to direct observation hand-tally step counts, during continuous (study 3a) and incidental (study 3b) walking overground. The New lifestyles NL-1000 was most consistently accurate in quantifying steps and ‘activity time’ during continuous walking, but not during incidental walking. However due to the ease of use and additional youth friendly design features, the New Lifestyles NL- 1000 was utilised in study 4. Study 4 explored the quantity of walking (steps·day-¹) required for health in adolescent girls. The results indicated that in terms of walking activity, ‘healthy’ adolescent girls do not walk significantly more in term of steps∙day⁻¹ or time spent in activity than girls classified as at ‘health risk’. Therefore specific thresholds for quantity and quality of walking required for health could not be defined for this population. Overall findings of this thesis highlight, that walking should be assessed overground with an appropriate measurement instrument. A step rate of 120 steps·min-¹ and 7200 steps in 60 minutes may be advocated to achieve MPA in adolescent girls. However further research is required to explore the relationship between walking and health in this population before we can promote an appropriate threshold of walking that is conducive to good health in adolescent girls.

published_or_final_version / History / Master / Master of Philosophy

The lag phase, the specific growth rate, the minimum a [subscript w] required for growth and the temperature characteristic of Fsendomonas fluorescens, Brochothrix thermosphacta, Salmonella typhlmurium, Streptococcus faecalis and, Staphylococcus aureus have been studied in liquid model media under controlled temperature and a [subscript w] conditions. The results show that the lag phase increases and the specific growth rates decreases when the temperature is lowered or the a [subscript w] is reduced. The minimum a [subscript w] required for growth increases when the incubation temperature is lowered. At refrigeration temperature the minimum a [subscript w] for growth of mesophiles is higher than that of psychrotrophs. The temperature characteristic (representing the activation energy for growth) of psychrotrophs is lower than that of mesophiles, and therefore mesophiles are more sensitive to temperature changes. All of these growth parameters depend on the a [subscript w] controlling solute. The solute effect can be traced to the ability of the solute to penetrate into the cell and can be explained by the osmoregulatory mechanism. In general, it was found that the effect of the solute on these parameters had the order glycerol<NaCl<sucrose. A comparison of three models for the effect of temperature on growth rate (linear, square-root, and Arrhenius) showed that the linear model had both the advantage of simplicity and accuracy. In general, the Arrhenius model showed the poorest fit to experimental data. A predictive method was developed to assess the microbial stability of liquid model systems exposed to fluctuating temperatures. The strategy was to predict lag time and growth rate by different regression equations, and to estimate microbial growth using an integral function of the accumulated time. A lag time predictive model was developed using a linear relationship between lag time and reciprocal growth rate. A linear equation was used to predict growth rate as a function of temperature. The model was used to predict the growth of B. thermosphacta in liquid model media with low a [subscript w] and exposed to fluctuating temperatures. The predictions were acceptable at a 95% confidence level. This method will be used in future studies to predict the microbial stability of refrigerated foods exposed to temperature abuse. / Graduation date: 1989

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