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.

Cognitive decline is often associated with increasing age. However, there is growing support that modifiable lifestyle factors such as exercise and stress influence outcomes. That is, physical activity (PA) seems to be protective, while stress engenders decline. Moreover, there is evidence to suggest that these variables interact such that being active positively moderates the negative effects of stress on cognitive decline. The present study examines the effects of both average PA and stress on cognitive decline (i.e., between-person effects), the coupled association between PA and cognition and stress and cognition (i.e., within-person, or occasion specific effects), and the possible interaction between PA and stress on cognitive outcomes. Coordinated analyses of The Memory and Aging Project (MAP; N = 1,853, mean age = 79) and Longitudinal Aging Study Amsterdam (LASA; N = 4,109, mean age = 68) were conducted. A series of multilevel models (MLM) were fit to the data, evaluating differences in baseline and linear change in perceptual speed, episodic memory, and MMSE scores in both data sets. Average PA was associated with the intercept of perceptual speed and episodic memory, and decline in all 3 outcomes in MAP only. There was a significant coupled association between PA and all cognitive outcomes in MAP, and with perceptual speed in LASA. Average stress was not associated with baseline scores or rates of change in any of the cognitive outcomes in either study. However, occasion specific stress was associated with perceptual speed and episodic memory in the unexpected direction in LASA. Lastly, there was a significant positive interaction between occasion specific stress and occasion specific activity on MMSE and perceptual speed scores in LASA. That is, on occasions when participants reported more stress than usual, if they also reported more exercise than usual, they tended to score better on these outcomes. Findings support the beneficial effects of both average and occasion specific activity on cognitive abilities, however failed to demonstrate the adverse effects of stress, and only partially supported an interaction between activity and stress. Limitations and future directions are discussed. / Graduate / 2018-07-10

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.

Physical inactivity, a phenomenon on the rise in numerous countries, has gained global attention because of its negative effects on humans' physical wellness. It represents a stumbling block in the way of living a healthy lifestyle. Recent statistics of World Health Organization (WHO) ranked physical inactivity as the fourth leading risk factors for adults' mortality all over the world [1]. Also, physical inactivity is considered as one of the most prominent contributing factors in several severe diseases such as breast and colon cancer, diabetes and many heart- related diseases [1]. Therefore, improving daily physical activity levels is an urgent societal goal in order to tackle the physical inactivity problem. Achieving such challenging goal requires addressing the factors that affect adults’ physical activity. In fact, there are many factors that lead to physical inactivity such as the busy lifestyle, lack of awareness regarding required physical activity levels and other environmental factors. Physical activity advisory systems can be seen as a promising solution for the inactivity problem. In order to enhance their effectiveness, these systems must take into account most of the factors previously mentioned. In this thesis, we aim to provide a method to promote the increase of daily physical activity levels by leveraging biofeedback and context awareness features. In order to achieve this purpose, we design and develop an algorithm that provides a user with personalized physical activity advice. This advice increases the user's awareness through the use of calories expenditure. To add a context awareness component to our algorithm, we propose an extension of the Ubiquitous Biofeedback (UB) Model [2]. We believe that combining the biofeedback feature with context awareness component would make the system sensitive to the user’s status and thus increase the chances of her or him following it. This advice represents the daily-recommended amount of physical activity for maintaining healthy lifestyle according to [3, 4]and other international organizations' recommendations. In order to prove the concept of the proposed algorithm and extended UB Model, we design and develop a system called "CAB". It is a context aware biofeedback system that tracks user's physical movement and estimates the amount of calories burnt to provide the user with a personalized physical activity advice that considers user's current status, preferences and surrounding environmental context. The system utilizes a biofeedback sensor and a smart phone in order to provide the personalized advice that is delivered to the user in a form of multiple-mode feedback/notification (text, audio and haptic). In this thesis, we provide detailed information about the design requirements, the design model, the proposed system and its related hardware components and software modules. The qualitative and quantitative evaluation of the developed system CAB shows a positive impact on the experiment sample group by motivating the participants to reach or exceed the recommended number of calories to be burned daily for most of the evaluation days.

Hälsa och fysisk aktivitet är ett omdiskuterat ämne i dagens samhälle. Den tekniska utvecklingen har lett till att människor är mer stillasittande än någonsin. Under vår utbildning i idrottsvetenskap väcktes nyfikenheten kring barn och ungas rörelse och det är bakgrunden till vårt val av ämne. Syftet med studien är att jämföra elevers rastaktiviteter på två skolor med olika geografiska förutsättningar för att diskutera vad som påverkar elever till deras valda aktiviteter. De frågor vi ämnar besvara är ”Hur arbetar ledning och personal för att främja rörelse på rasterna?” och ”Vilka aktiviteter ägnar sig eleverna åt på rasterna?”I studien används genusteori och Bronfenbrenners ekologiska systemteori för att analysera studiens resultat. Empirin har samlats in via kvalitativa observationer och intervjuer på två grundskolor varav en stadsskola och en landsbygdsskola. Tre intervjuer och sex observationer gjordes på respektive skola. Analysen har gjorts utifrån studiens resultat.Resultatet visar att det finns både likheter och skillnader på elevernas rastaktivitet mellan de undersökta skolorna. Likt övriga samhället så ser vi skillnad på flickor och pojkars beteende och uppförande i olika situationer, exempelvis på fotbollsplanen. Det var tydligt på båda skolor. Vi noterade även uppenbara skillnader i rådande skolkultur och miljö på skolorna vilket resulterade i att vi såg skillnader i barnens val av aktiviteter. Stadsskolans skolgård var mindre än landsbygdsskolans och hade färre grönområden. Stadsskolan hade även en mer genomtänkt idé för aktiviteter inomhus vilket resulterade i mer sysselsättning där.Slutsatsen är att planerade rastaktiviteter är en viktig del i arbetet för att öka elevernas aktivitetsnivå under rasterna. Många elever är stillasittande då det inte finns en tillräcklig bredd i rastaktiviteterna på skolgårdarna som passar alla. Det krävs därför bra planering och struktur från ledningen för att motivera dessa elever. Vår studie visade på att landsbygdsskolan hade en större gemenskap och lekte mer på rasterna till skillnad från stadsskolan som inte lekte på samma sätt. Det tror vi bland annat berodde på att stadsskolans miljö uppmuntrade till skärmaktiviteter medan landsbygdsskolan förbjödskärmar under skoltid. En viktig process är att analysera skolans inomhus- och utomhusmiljöer för att kunna utveckla elevernas rastaktiviteter.

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.

The purpose of our research study was to examine if there was a relationship between PA and functioning in adults with DS. Our research study had 17 adults with Down syndrome participate. The functional performance of participants were measured with the Timed Up-and-Go test (TUG) and the 6-minute walk test (6MWT). After the testing session was completed, the physical activity of participants over seven days was measured. The main findings were that adults with DS had low levels of physical functioning and PA, and that physical functioning was associated with PA levels. Improving the functional profiles of adults with DS may aid these individuals in accumulating the amount of PA required for improving their health.