Background: Physical inactivity has been identified as the fourth leading risk factor for global mortality. Despite public health guidelines advising children and adolescents to spend a minimum of 60 minutes per day of at least moderate intensity physical activity, a large proportion of children and adolescents fail to meet these guidelines. Interventions promoting physical activity show varying degrees of success, and more detailed evaluations of such interventions are essential. The aim of this research was to conduct an in-depth evaluation of a community-based physical activity program aimed at children and adolescents, specifically the Tribe Project. Methods: The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) was used to evaluate the individual and organisational-level impact of the Tribe Project. A single mixed method case study was used based on five sources of evidence: interviews, questionnaires, documentation, archival records and direct observations. Participants included the Tribe managers and coaches implementing the program and the Tribe parents and children/adolescents who attended. Results: The Tribe Project reached approximately 2.5% of the eligible population living within Bath and North East Somerset. The program successfully met some of its objectives although feedback procedures were poor and the program aims were unclear. The community-level adoption of the program was high, however, the implementation and adherence to the program principles at the setting-level varied. The program was successfully institutionalised within the University of Bath yet pathways after the program into the community varied, and were mostly competitive only. Nonetheless, a combination of social, psychological and physical benefits was reported following participation. Conclusion: To assess accurately the potential impact of physical activity interventions a combined assessment of individual and organisational-level factors is necessary. This will help inform policy on effective strategies to promote physical activity in the community, and develop interventions that are more effective as a result.

College is an important time for young adults, but most college students fail to meet the daily recommendations for physical activity. Social support is associated with positive health practices, but limited research is available on the role of perceived support from specific relationships, (e.g., peers and parents). The purpose of this study was to evaluate the effect of perceived support from parental and peer relationships on health-related beliefs and behaviors. Participants (N = 333) completed the Quality of Relationships Inventory, Multidimensional Scale of Perceived Social Support, Satisfaction With Life scale, and a short version of the Physical Self-Description Questionnaire. While highly active students did not necessarily have more socially support relationships, females self-reported more conflict with both parents and more depth and support with a special person in their life than males, and parental and peer relationships appeared to be a greater influence on females' perceptions of satisfaction and self-worth.

Large-scale assessments of children and youth physical activity (PA) behaviors are regularly conducted in school settings. In addition to assessing actual fitness, the FITNESSGRAM® assesses self-reported PA behaviors for aerobic, strengthening, and flexibility activity within the past 7 days. The purpose of this study was to examine the reliability and validity of the three PA items. Participants included 1010 students in grades three through twelve and were either tested under a teacher – teacher condition, an expert - expert condition, a teacher – expert condition, or a trained teacher – expert condition. Comparisons of the responses to the PA items indicated adequate reliability for teachers, but the reliability improved with training. Likewise, the validities for teachers are moderate to fair; however, they improved when teachers received additional training.

Body weight perceptions remain an important area of study. Beauty ideals have changed significantly with more emphasis on thinness. According to sociocultural perspectives, the pressure to be thin results in negative psychological consequences in most Western societies. Evidence, however, suggests that certain cultural and ethnic groups retain a traditional preference for plumpness. This thesis aimed to understand cultural perceptions of body weight and its influence on body dissatisfaction, self-esteem, body appreciation and physical activity in Jamaica. The research employed a mixed methodology approach. Qualitative inquiry using thematic analysis unearthed various beliefs about body weight and its health consequences. Specifically, it identified varying body ideals for women in Jamaica. These are the 'fluffy' body ideal and the slim ideal. The term 'fluffy' referred to women with larger bodies who were perceived to be confident and attractive. The novel Fluffy Rating Questionnaire (FRQ) was developed and was subjected to both exploratory factor analysis (parallel analysis) in study 2 and later confirmatory factor analysis in study 3. It was determined that the FRQ was best suited to examine impressions of fluffy women's personality which was a significant contribution to knowledge on fluffiness in Jamaica. Data were analyzed using Pearson's correlation, regression analysis, and analysis of variance. There were no relationships between impressions of fluffy women's personality, self-esteem, body appreciation or body dissatisfaction. However, the results support existing knowledge on the relationship between body mass index and body dissatisfaction, self-esteem and body appreciation. Impressions of fluffy were simulated and results suggest impressions of fluffy were related to lower recall of physical activity compared to impressions of obesity and the control. Overall, the findings indicate that there are influences of Western body ideals in Jamaica; however, there is still a traditional preference for plumpness which is conveyed through local expressions such as 'Fluffy'.

Background: Chronic obstructive pulmonary disease (COPD) is an important common chronic lung condition that is a leading cause of morbidity and mortality worldwide, resulting in a substantial and increasing economic and social burden to health care systems. Physical activity (PA) is the strongest predictor of mortality in this population, playing an important role determining the quality of life in COPD, with better outcomes being reported by those who have higher levels of PA. Therefore, improving PA levels has been considered a key component in the management of patients with COPD. Likewise, it is important to understand the mechanisms that lead to inactivity, as it is to develop accurate methods of measuring PA in this population. Aims of the thesis: 1) To identify and to summarize the interventions able to increase PA levels in patients with COPD; 2) To understand the longitudinal interaction between muscle mass and function and PA levels in COPD; 3) To study the acceptability and the suitability of a new activity monitor (TracMor D - Philips, the Netherlands) for home coaching in daily routine of patients with COPD; and 4) To investigate whether a PA enhancing programme with set targets and feedback would constitute a successful intervention to increase PA levels in patients with COPD attending pulmonary rehabilitation (PR). Methods: To achieve the first aim of the thesis I performed a systematic review summarizing interventional studies that assessed PA as an outcome in patients with COPD. For the second aim, I analysed some multicentric longitudinal data (one year follow-up) on PA and muscle mass/function in COPD. The third aim was achieved with a pilot study I conducted in Edinburgh, where patients with COPD wore three TracMor D in different body places simultaneously with the criterion method (Actigraph GT3x activity monitor) for a week. To accomplish the fourth and main aim of my PhD, I conducted a randomised controlled trial (RCT) where patients with COPD undergoing PR were randomised to either receive PR only or PR plus a PA coaching programme using the TracMor D activity monitor for 12 weeks. Main Results: Study 1: Sixty studies were considered for data extraction in the systematic review. Seven types of intervention with the potential to increase PA levels in patients with COPD were identified. PR programmes with more than 12 weeks of duration and PA coaching programmes with feedback of an activity monitor are promising interventions to increase activity levels in patients with COPD. Overall, the quality of evidence across interventional studies was graded as very low. Study 2: The longitudinal study showed that there were weak correlations between PA levels and muscle strength at baseline (0.19 ≤ r ≤ 0.33 p < 0.001 for all). No correlations were found between changes in PA and muscle strength (-509 [-1295-362] vs -0.4 [-3.5-2.6] - 12 months minus baseline - respectively) and future muscle mass (p > 0.05). Baseline PA levels are related to future muscle strength (0.30 ≤ r ≤ 0.41, p < .0001) but not with muscle mass. Study 3: This study showed that TracMor D had strong correlations with Actigraph GT3x in terms of Kcal consumption in all three positions (necklace, pocket and hip) (0.84 ≥ r < 0.86, p < 0.001 for all). TracMor D was considered comfortable and easy to use at home, receiving a mean usability score of 98 out of 100 maximum points. Study 4: My RCT showed that the proposed PA intervention was effective in changing steps/day (1251 ± 2408 vs control -410 ± 1118, p=0.01), time spent in light activities (21 ± 60 vs -37 ± 55, p=0.004), exercise capacity (99 ± 139 vs 3 ± 83 meters; 85 ± 114 vs 2 ± 62 seconds, p < 0.03 for both) and muscle strength (15 ± 20 vs -5 ± 18, p=0.01) among others when compared to the control group. Conclusions: Strategies focussing specifically on increasing PA and longer PR programmes may have greater impacts on PA levels in COPD. Well-designed clinical trials with objective assessment of PA in patients with COPD are needed. PA levels are not related to one-year changes in muscle mass and muscle strength in patients with COPD. However, higher PA levels at baseline are related to having higher muscle strength at one-year. TracMor D strongly correlated with the criterion method and was highly accepted by patients with COPD in their daily routine, being considered comfortable and easy to use at home. The combination of PR with a physical activity enhancing programme using a PA monitor to set targets and give feedback on activity levels significantly improves PA, exercise capacity, muscle strength, quality of life, and anxiety and depression levels in patients with COPD.

abstract: College students are a niche of young adults, characterized by abnormal sleeping habits and inactive lifestyles. Many students entering college are as young as 18 years old and graduate by 22 years old, a window of time in which their bones are still accruing mineral. The purpose of this cross-sectional study was to determine whether sleep patterns and physical activity observed in college students (N= 52) 18-25 years old at Arizona State University influenced bone biomarkers, osteocalcin (OC) and N-terminal telopeptide of type 1 collagen (NTX-1) concentrations. Students completed various dietary and health history questionnaires including the International Physical Activity Questionnaire short form. Students wore an actigraphy watch for 7 consecutive nights to record sleep events including total sleep time, sleep onset latency and wake after sleep onset. Total sleep time had a significant, negative correlation with OC (r = -0.298, p-value =0.036) while sleep onset latency had a significant, positive correlation with NTX-1 serum concentration (r = 0.293, p-value = 0.037). Despite correlational findings, only sleep percent was found to be significant (beta coefficient = 0.271 p-value = 0.788) among all the sleep components assessed, after adjusting for gender, race, BMI and calcium intake in multivariate regression models. Physical activity alone was not associated with either bone biomarker. Physical activity*sleep onset latency interactions were significantly correlated with osteocalcin (r = 0.308, p-value =0.006) and NTX-1 (r = 0.286, p-value = 0.042) serum concentrations. Sleep percent*physical activity interactions were significantly correlated with osteocalcin (r = 0.280, p-value = 0.049) but not with NTX-1 serum concentrations. Interaction effects were no longer significant after adjusting for covariates in the regression models. While sleep percent was a significant component in the regression model for NTX-1, it was not clinically significant. Overall, sleep patterns and physical activity did not explain OC and NTX-1 serum concentrations in college students 18-25 years old. Future studies may need to consider objective physical activity devices including accelerometers to measure activity levels. At this time, college students should review sleep and physical activity recommendations to ensure optimal healthy habits are practiced. / Dissertation/Thesis / Masters Thesis Nutrition 2019

Short sleep duration in childhood has been associated with an increased risk of overweight and obesity. Research suggests that physical activity might mediate this association; however, studies examining associations between physical activity and sleep in young children have reported equivocal findings. A possible explanation for these inconsistencies is that past studies have looked at total physical activity counts rather than examining physical activity regularity. We aim to explore the relationship of regular physical activity, sedentary behavior, and sleep in preschoolers and kindergartners. 131 children (ages 4-6) were included in this study. Each child wore a waist-worn accelerometer for three days and three nights. Waist-worn accelerometers reliably measure sleep and physical activity in children. Associations of regular physical activity, sedentary behavior, and sufficient sleep were determined using logistic regression models. There was no association between the number of days that children engaged in physical activity (≥ 60 minutes) and sufficient sleep. Further, there was no association between the number of days that children engaged in ≥ 20 minutes of vigorous activity and sufficient sleep. Children who engaged in minimal sedentary activity had greater odds of obtaining sufficient sleep as compared to children who engaged in more sedentary activity.

Background: It is well established throughout the literature that regularly engaging in physical activity throughout pregnancy is associated with optimized health outcomes for both the mother and the fetus. The mediators and mechanistic pathways through which these observed exercise-induced outcomes are achieved are largely unknown. This thesis attempts to address this gap in knowledge. Methods: The objective of the first study was to develop an exercise protocol based on the recommendations from the ‘2019 Canadian guideline for physical activity throughout pregnancy’ and to subsequently evaluate the myokine response post-exercise. Pregnant (n=13) and non-pregnant (n=17) women performed a moderate-intensity bout of treadmill walking following which pre- and post-exercise serum for a panel of ten well-characterized myokines was analyzed. The objective of the second study was to evaluate whether acute and/or chronic exercise elicited changes in metrics of placental growth and development – thereby proposing possible mechanisms through which physical activity may be conferring health benefits to the fetus. Serum (pre- and post-exercise) collected from the first study was used to treat placental cell lines to assess the effect of acute exercise on cellular proliferation as well as nutrient transporter (GLUT1, SNAT1, FATP4) expression and localization. Term placental tissue collected from active (n=10) and non-active (n=10) participants in the PLACENTA study were used to evaluate the role of chronic exercise on changes in nutrient transporter (GLUT1, SNAT1, FATP4) expression and localization. Results: Pregnant women from the first study exhibited higher levels of four myokines post- versus pre-exercise: FGF21, EPO, BDNF and IL-15. As for the second study, BeWo cell lines treated with serum collected from pregnant women yielded higher GLUT1 expression compared to non-pregnant serum, independently of exercise. Lastly, FATP4 expression was found to be higher in term placentas of active compared to non-active pregnant women. Conclusion: This thesis identified four myokines that are elevated in the serum of pregnant women following a bout of acute exercise. The role of these myokines in pregnancy remains to be elucidated. Further, chronic and acute exercise are shown to alter expression of key placental macronutrient transporters.

Childhood obesity is a worldwide epidemic. In the United States, approximately 17% of adolescents are obese; and 13% of the general population is overweight. Obese adolescents are at threefold risk for developing chronic health conditions in adulthood, including type II diabetes, hypertension, and heart disease. The purpose of this project was to evaluate the results of a quality improvement program to reduce adolescent obesity as measured by BMI 5% over 18 months in a rural health primary care clinic. The health belief model and theory of planned behavior guided the project as adolescents need to first understand the risks associated with obesity and the benefits derived from a healthier lifestyle Then, they can be prepared to engage in regular exercise and good eating behaviors. A convenience sample of 100 adolescents was randomly assigned to an intervention group with structured physical activity regimen and dietary education classes and a standard care group with normal counseling. Two separate one-sided t tests with 90% confidence intervals were used to analyze the data. Also, run charts were constructed to assess the effectiveness of the program. The result of the t test revealed the weight for the intervention group at 18 months (M = 42.85, SD = 0.79) was significantly lower than it was for those in the non-intervention group (M = 45.06, SD = 0.59), t(36) = -9.79, p < 0.01. Furthermore, the run charts demonstrate the average BMI for those in the interventional group steadily decreased over 18 months while the non-intervention group steadily increased. Positive social change was achieved at the organization level as adolescent obesity was reduced with the evidence-based interventions. This project serves as a potential model for replication in other rural health primary care clinics.

There are few data available regarding the relationship between physical activity and veteran status in those with combined chronic obstructive pulmonary disease (COPD) and obesity. COPD is a common illness and a leading cause of death in the United States. Veterans represent a distinct subpopulation in the United States and are more likely to have COPD, which is a disease with a high rate of comorbidities such as obesity. Physical activity can improve outcomes for those with COPD and obesity. However, recommendations for physical activity for those with COPD and obesity are vague. This study, based on the self-determination theory, sought to explore the relationship between average weekly physical activity and veteran status while controlling for age, sex, race, ethnicity, smoking status, body mass index (BMI), education level, and annual household income in those with comorbid COPD and obesity. Also, the relationship between not meeting, meeting, and exceeding physical activity recommendations and veteran status, while accounting for variation in for age, sex, race, ethnicity, smoking status, BMI, education level, and annual household income, was explored. A case-control study was done to answer the research questions using multiple regression and ordinal regression analyses, respectively, using data from 1,430 participants from the 2015 BRFSS. Veteran status was not significantly associated with physical activity nor was it significantly associated with falling below, at, or above recommended physical activity amounts. However, it was found that increased BMI was associated with decreased physical activity. The results from this study can be used to inform policies, refine recommendations, and guide interventions for those with COPD and obesity.