Background: The prevalence of childhood overweight and obesity is increasing worldwide. One main determinant of overweight and obesity is inactivity. Little is known about the factors that influence physical activity and sedentary behaviour among young children. Seasonal variation was examined as a correlate of physical activity in both a literature review and in a sample of pre-school children in Edmonton, Alberta. Neighbourhood socioeconomic status (SES) was examined as a correlate of screen time use in the same sample of children. Methods: For study 1, databases were searched for studies on seasonal variation in physical activity levels. Studies 2 and 3 involved a sample of 4- and 5-year-old children, who were attending a health center in and around Edmonton, Alberta for preschool immunization between November, 2005 and August, 2007. Parents provided proxy reports of their children’s screen time viewing and physical activity. Height and weight were measured by a trained health assistant and body mass index (BMI) was calculated. Children’s postal codes were retrieved from health records to calculate neighbourhood SES through census data. The month the proxy report was completed was used to determine seasonality. Several regression models were constructed to examine relationships between variables in studies 2 and 3. Results: The review of literature revealed that 83% (29/35) of the studies found seasonal variation in physical activity among children and/or adolescents. For study 2, total physical activity as well as active play, weekday and weekend minutes were highest in the summer and lowest in the winter. Finally, neighbourhood SES was a predictor of screen time and TV/video use for girls but not for boys in study 3. Conclusion: Some consideration should be given to increasing physical activity opportunities in the winter for children, especially in areas of the world that experience extreme winter conditions. As well some consideration should be given to providing alternative activity opportunities for young girls who live in lower SES neighbourhoods.

Introduction Globally stroke remains the leading cause of adult disability. An aging population and a reduction in stroke case fatality has led to an increasing number of people living with stroke i.e. stroke survivors. The ability to perform important day-to-day activities, such as walking and housework, is frequently impaired in stroke survivors. Therefore, it has become essential to address the long-term needs of stroke survivors, prompting focussed research on life after stroke. A reduction in physical fitness after stroke may contribute to stroke related disability. It is possible to improve physical fitness by regular, structured physical activity. Improving physical fitness after stroke and increasing physical activity are aspects of life after stroke that are increasingly being researched. Although the evidence base for the benefits of physical fitness training is growing, research has indicated that benefits gained are not always maintained at follow-up. To facilitate the uptake and maintenance of physical activity after stroke, it is essential to understand why many stroke survivors do not undertake regular physical activity. Understanding this difficult concept will enable the tailoring of behaviour change interventions to promote and maintain physical activity after stroke. However, there has been limited work in developing theory driven behaviour change interventions to increase physical activity in stroke survivors. Therefore, the aim of this thesis was to develop and test a behaviour change intervention to increase physical activity after stroke. Methods In order to address the above aim, six interlinking studies were conducted within the development and feasibility stages of the MRC framework for the development of complex interventions. A systematic review (study one) examined barriers and facilitators to physical activity perceived by stroke survivors. This study showed a lack of literature in this area, and that the already published studies had limited generalisability to the UK stroke population. Therefore, it was deemed appropriate to conduct a qualitative study (study two) to examine the perceived barriers and facilitators to physical activity in the local stroke population. Both studies one and two highlighted the influence of self-efficacy towards increasing physical activity. As part of earlier work conducted prior to this PhD, there was previously unanalysed data on perceived barriers and facilitators to physical activity after stroke. These quantitative data encompassed specific questions exploring self-efficacy and intention to physical activity post stroke. In light of the evidence it was deemed necessary to analyse these data (study three). It was envisaged that the behaviour change intervention would incorporate a feedback device, so participants could clearly see how much daily physical activity they were undertaking. An opportunity arose to collaborate with a team at Newcastle University who had developed an accelerometer that incorporated an immediate feedback screen. Therefore, a device validation study was conducted as study four. Results from studies one to four were combined, with the use of the Theoretical Domains Framework, and the behaviour change intervention was developed. Two uncontrolled pilot studies (studies five and six) were conducted to determine the feasibility and acceptability of the behaviour change intervention to the stroke population. Results The systematic review included six articles, providing data on 174 stroke survivors. Commonly reported barriers were environmental factors, health concerns and stroke impairments. Commonly reported facilitators were social support and the need to be able to perform daily tasks. Qualitative interviews were conducted with 13 stroke survivors, at which point data saturation was reached. The most commonly reported TDF domains were ‘beliefs about capabilities’, ‘environmental context and resources’ and ‘social influence’. The quantitative study provided data from 50 stroke survivors. Intention and self-efficacy were high, with self-efficacy graded as either 4 or 5 (highly confident) on a five-point scale by [34 (68%)] participants, whilst 42 (84%) participants “strongly agreed” or “agreed” that they intended to increase their walking after their stroke. Ten participants were recruited to validate the new accelerometer. Mean time since stroke was 29 days (SD =27.9 days). The 10 participants walked a mean distance of 245 meters (SD=129m) and their mean walking speed was 0.79ms-1 (SD=0.34ms-1). The Culture Lab were unable to develop the accelerometer in the necessary time frame and therefore no accelerometer was available for trialling the behaviour change intervention. Therefore, pedometers were used to record step count during the behaviour change intervention. A total of four participants took part in the 12 week behaviour change intervention, over two study periods. All participants managed to increase their step counts during this time. The studies had problems both with recruitment and retention of participants. These issues have been discussed. Conclusions This work has enhanced the understanding of the barriers and facilitators perceived by stroke survivors to increase physical activity. This work has allowed the development of a theoretically driven, complex behaviour change intervention that was successfully trialled with a small group of stroke survivors. Areas of further research have been discussed.

The benefits of physical activity for cancer survivors are numerous and well-substantiated. However, it is unclear how to accommodate specific cancer treatments, such as a stoma as part of treatment for rectal cancer, in order to be physically active. To bridge this gap, this study undertook an interpretive phenomenological analysis to explore the experience of 15 rectal cancer survivors' engagement in physical activity with a stoma. Overall, three themes were found: 1) understanding the drive and the motivation to be physically active, 2) despite being motivated to be physically active with a stoma it can be challenging, and 3) how to be physically active with a stoma: lessons learned. The findings suggest rectal cancer survivors with a stoma require motivational support and enhanced competence and self-efficacy in order to engage in greater physical activity. Incorporating these skills into current information and supportive services targeting rectal cancer survivors with a stoma may help promote physical activity in this population.

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, education-based PA curriculum is not included in the rehabilitation program for individuals with a brain injury, indicating a gap in services provided. Consequently, the purpose of this study was to create and deliver a physical activity centered education (PACE) program that supplemented the existing rehabilitation program for brain injury. PACE consists of an 8-week (16 session) program aimed to (1) increase self-efficacy for being physically active of PACE program participants, (2) increase PA stage of change in PACE program participants or the maintenance of adequate level of PA, and (3) improve the rehabilitation outcomes (i.e., abilities, participation, adjustment) of PACE program participants. Based on previous research, it is hypothesized that participation in PACE will result in (1A) increased self-efficacy for PA, (1B) greater self-efficacy for PA than the standard of care group, (2A) increased readiness to be physically active, (2B) greater readiness to change their PA behavior than the standard of care group, (3A) improved rehabilitation outcomes, and (3B) greater rehabilitation outcomes than the standard of care group. the PACE program resulted in: (1) an average increase of 19.36% in participants’ PA self-efficacy (effect size [ES] = 0.37), (2) 15 of the 22 PACE participants (68.18%) reported readiness to engage in regular PA , and (3) an increase in rehabilitation outcomes (i.e., abilities, adjustment, and participation)In conclusion, the PACE program can improve PA self-efficacy, readiness for regular PA behavior, and improved short-term rehabilitation outcomes.

Philosophiae Doctor - PhD / Over the past decades there has been a global increase in the prevalence of overweight and obesity. The increase in the prevalence of overweight and obesity leads to surging of associated co-morbidities of overweight and obesity in low/medium income countries which eventually overburdens the vulnerable health systems threatens by malnutrition and communicable diseases in low/medium income countries. The designed interventions to curb overweight/obesity in high income countries might be inappropriate to apply in low income countries, such as Nigeria, due to the different cultural norms and values regarding types of food, and physical activity. The overall aim of this study is to design an intervention that will be culturally appropriate for overweight and obesity management among Nigerians. The convergent parallel mixed method design specifically was used in this study. This involves simultaneous timing of carrying out both quantitative and qualitative strands of mixed methods during the same phase of the research process, prioritizes the methods equally, and keeps the strands autonomous during analysis and then mixes the results during overall implementation/execution. The population for the quantitative part was Nigerians residing within sixteen enumeration areas of Alimosho Local Government area of Lagos State, Nigeria. Overweight and obese Nigerians as well as traditional healers and healthcare professionals were purposely selected for the qualitative phase. Delphi study was the last phase of study which involved recruitment of healthcare professionals in the management of overweight and obesity. A sample size of 2250 was projected and approached for this while 1571 consented and participated in the study. This gave a response rate of 69.82%. About 51.2% of the sample population was male and 48.8% female. The mean age of the total sample was 35.36(SD =11.66). Using BMI, the prevalence of overweight/obesity was 42.3% using BF%, the prevalence of body fatness was 39.2% of which 62.5% were females. Data analysis shows strong positive correlation between other measures of body fatness (.694 to .872) except WHR with low but positive relationships between BF% (184), BMI (.280), WC (.495), and negative relationships with HC (-.077) and BAI (-.076). Gender, marital status and age are predictors of overweight and obesity among Nigerians. Type of diet, meal timing, reduced physical activity and genetic factor were perceived as the causes of overweight and obesity. Diet therapy, an increase in physical activity and the use of herbs were various ways perceived to assist in reducing excess body weight. Among the challenges faced by overweight and obese Nigerians were lack of time for exercise because of the nature of their jobs, lack of recreational facilities, lack of motivations and support from family members to reduce weight, lack of money and poor/lack of knowledge to reduce weight. Experts unanimously agreed that the content of a culturally appropriate intervention should be individualised and to include physical activity/exercise, diet therapy, education and self-monitoring. There was a unanimous decision that the intervention should be done for a duration of 12 weeks at health facility and should be held for between 1-2 times per week if holding at community (excluding community/ public health facility) for 12 weeks in total. In addition, experts agreed that the use of media such as television, radio, weekly newspapers and magazines should be used for preventive campaigns.

Physical Activity, Healthcare Use, and Medication Use in Diabetes Patients by Julie Kwon Evans MS, The Chicago School of Professional Psychology, 2013 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Psychology Walden University November 2019

Clinically significant motor impairment affects 50-100% of those with Autism Spectrum Disorder (ASD). Although not included in the diagnostic criteria, research suggests that motor impairments appear during infancy, precipitate the onset and progression of classical autistic symptomology, and are associated with the severity of autist deficits. Presently, few studies directly address motor impairment in ASD. In those that do, physical education, exercise, and exergaming interventions have been found to enhance motor skill proficiency. Little is known about the effect of unstructured physical activity on motor skills in children with autism. Thus, this pilot study sought to examine the impact of unstructured, one-on-one, physically active play on motor skill proficiency as defined by the Test of Gross Motor Development-2 (TGMD-2) in autistic children between ages 3 and 10. Twenty, one-on-one, 60-minute play-based physical activity sessions were administered over a 10-week period (2x/week). The physical activity environment was arranged according to the North Carolina Treatment and Education of Autistic and Related Communications Handicapped Children (TEACCH) guidelines. Session structure precluded skill teaching and sought to elicit gross and fine motor activity within physical activity opportunity stations, but without regard to type or intensity of activity. A comparison of pre-and post-intervention TGMD-2 scores captured motor skill outcomes. Findings suggest that unstructured physically active play is not sufficient to improve global motor skill competency in young children with autism. However, active play fostered significant improvements in two in running skill scores. The TGMD-2 is designed to assess those skills that would foster participation in physical education and recreational settings. Improved running may advance play-abilities and support other forms of activity. Future research should consider using assessments more sensitive to acute changes in motor skill efficacy, measurement of time spent in physically active play, and qualitative analysis of parent-perceived outcome and improvement.

Indiana University-Purdue University Indianapolis (IUPUI) / The ability of virtual reality (VR) active games to elicit moderate-to-vigorous physical activity (MVPA) has yet to be fully understood. Also, whether VR combined with physical activity could have a greater pain reducing effect compared to non-active VR distraction remains unknown. The purpose of this study was to evaluate the effects of commercial VR active games on physical activity intensity levels, enjoyment, and pain sensitivity in young health adults. Thirty-six (18 males, 18 females) participants completed four study sessions, with each devoted to playing one VR game for fifteen minutes. The games included Beat Saber, Holopoint, Hot Squat, and Relax Walk VR. Levels of physical activity reached during VR gameplay were measured with percentage of heart rate reserve (%HRR), ratings of perceived exertion (RPE), and accelerometry. Enjoyment was measured with a visual analog scale and the Physical Activity Enjoyment Scale following each gaming session. Pressure pain thresholds (PPT’s) of the dominant forearm and ipsilateral thigh were conducted before and after VR gameplay. The primary outcome measures were analyzed with mixed model ANOVAs. The %HRR and RPE results showed that only Hot Squat consistently elicited moderate intensity activity. Accelerometry data showed that Hot Squat and Holopoint elicited higher whole body and lower body intensity levels than Beat Saber and Relax Walk VR. For enjoyment, Beat Saber and Holopoint were rated higher than Hot Squat and Relax Walk VR. Results for pressure pain thresholds (PPT’s) showed 1) an overall acute hypoalgesic effect on the forearm and thigh following all VR games, and 2) an enhanced hypoalgesic effect (combining MVPA and VR distraction) on the thigh following Hot Squat. Overall, results from this study suggest that active VR games can elicit varying degrees of physical activity intensity levels in young healthy adults, with Hot Squat eliciting moderate intensity activity. Thus, active VR games could be an alternative and enjoyable mode of obtaining physical activity. This study also showed that active VR games can elicit an acute hypoalgesic effect, with the effect potentially exacerbated with greater movement during gameplay.

A selection of common children’s games were measured in a laboratory-based study to be enjoyable and to elicit sufficient physical activity energy expenditure (PAEE) in 3rd grade children to combat the purported chronic energy surplus of childhood obesity (~100 kcal.day-1). PAEE during the games was similar for boys and girls, yet overweight children expended greater PAEE relative to body weight than healthy weight children. During a subsequent simulated recess program, the enjoyment declined over the 10-session program with no significant decline in PAEE. Using the enjoyable games of known energy cost in a structured recess program for 9 weeks successfully increased total daily PA compared to the control school who reported substantially greater amount of free-play time. The greater amount of acquired PA in the intervention school children did not affect the amount of time spent in sedentary pursuits but it did result in a smaller increase in body weight after 9 weeks. More research is needed to expand on this initial list of games that reduce the excessive weight gain in children when incorporated into a structured recess intervention.

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. Fortyour parents and guardians of elementary aged children participated in focus groups to discuss current physical activity levels and factors impacting and limiting local children’s physical activity levels. The most frequently reported barriers were environmental issues such as fear of children’s 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.