This doctoral dissertation explores the complex food/nutrition, leisure physical activity (LPA) and mental health (MH) needs in Arab immigrants/refugees (AIR) in Ontario, Canada. The main goal is to improve the MH and well-being of AIR. The CAN-HEAL (Canadian Arab Nutrition, Health Education and Active Living) project used a collaborative community-based participatory research and integrated knowledge translation approach, and triangulated data from three different methods (qualitative interviews, Photovoice, and a questionnaire survey) to enhance study rigour. A primary finding of this research is that food/nutrition, LPA, and MH needs in AIR are multi-layered and vary considerably according to intersectional experiences, cross-cultural pressures, living conditions and racism. The research found an alarming prevalence of poor mental well-being (55%), food insecurity (65%) and low LPA levels (87%) in AIR participants (n=60). Among first-generation immigrant participants, 87% reported negative changes in MH since immigration. These negative changes are not straightforward; they are complex and dynamic, and mainly related to structural barriers, poor living conditions, and system failures to accommodate the distinct cultural needs of the AIR community. Intersections among different socio-demographic factors (e.g., gender, length of residency, income, parenthood, religion, immigration status), amplified the negative changes in MH, and played a considerable role in how nutrition, food security and LPA impacted AIR’s MH, exacerbating inequities within the AIR community. This research shows that the relationships among food/nutrition, LPA and MH among AIR are multi-faceted, and that there are various psycho-socio-cultural pathways and processes through which diet quality, cultural foods and LPA can contribute to shaping AIR’s MH. As part of this research, an upstream-downstream-based socio-political and community-level action plan was co-developed to thoroughly address the complex needs among AIR and to work towards health equity for this marginalized population. Collaboration between health and non-health sectors is required to effectively implement this action plan. / Thesis / Doctor of Philosophy (PhD) / This research explored the food, leisure time physical activity, and mental health (MH) experiences among Arab immigrants/refugees (AIR) in Ontario, Canada. The goal is to investigate pathways to promote the MH and well-being of the AIR community. The CAN-HEAL (Canadian Arab Nutrition, Health Education and Active Living) project was done in collaboration with the AIR community and used three different tools (interviews, photography, and a survey) to gain a better understanding of the community’s needs. In the survey of 60 AIR participants, we found high rates of poor mental well-being (55%), physical inactivity (87%), and poor reliable access to healthy and affordable food that meets one’s cultural preferences (65%). Eighty-seven percent of first-generation immigrant participants reported unfavorable changes in MH after immigration because of unfair opportunities, and poor living conditions and unjust systems. Interactions between different individual characteristics (e.g., gender, income, religion, immigration status) increased the unfavourable changes in MH, played a big role in how food and physical activity affected AIR’s MH, and led to unfair gaps in health and opportunities within the AIR community. The relationship between food, physical activity and MH among AIR is complex. For example, food quality, traditional foods and favourite physical activities play a large role in the feelings and well-being of AIR. As part of this project, a thoughtful plan has been produced with members of the AIR community in Ontario to allow their voices to be heard, to advocate for fair opportunities and treatment, and to promote their health and well-being.

Aims: The aims of this study are three-fold: to review the worldwide literature on monitoring the health, physical activity and fitness of young people; to determine the purpose and prevalence of the monitoring of young people's health, physical activity and fitness within secondary PE school curricula in England and to explore the factors affecting teachers' views of and approaches to such monitoring; and to propose recommendations for monitoring health, physical activity and fitness within secondary school PE curricula in England which may have relevance and applicability to the Taiwanese context. Methods: The research design involved the integration of quantitative and qualitative methods, including a national survey of selected state secondary schools and interviewing a sample of Head of PE department (HoPE). Descriptive statistics and Chi-Square analysis were employed to analysis quantitative data of the prevalence of monitoring pupils' health, physical activity or fitness within school curriculum, and to exam the homogeneity of HoPEs' attitudes and views (agree v.s disagree) towards specific statements with different gender, and teaching experience. The significant level of Chi-square is .05. Coding and thematic analysis were employed to analysis qualitative data. Results: 118 schools (38.4%) returned the questionnaires and 12 teachers were interviewed. The proportion of schools which monitored pupils' health, physical activity and fitness was 39%, 61.9%, and 89.0% respectively. The interview data revealed issues including purpose and value of monitoring; responsibility and accountability; pupils' responses; teachers' conceptual confusion, and resource limitations. Recommendations: Nine recommendations were proposed including: (1) physical educators should broaden their monitoring approach beyond fitness; (2) formal guidance on monitoring within the PE school curriculum should be produced; (3) teachers should be offered continuing professional development on this topic; (4) PE teachers should be encourage to employ simply, manageable monitoring methods; (5) health benefits of physical activity and physical activity promotion should be weighted through monitoring processes; (6) PE teachers should realise that the processes of monitoring health, physical activity and fitness are appropriate contexts for learning; (7) it is unnecessary to make comparisons between students or against standardized norms; (8) teachers should aim to personalise monitoring procedures and ensure that pupils' experience of monitoring is positive; (9) PE teachers should encourage and teach children self-monitor skills to develop their independence and self- management skills. An example formal guidance for key stage 3 on monitoring health, physical activity and fitness within the PE curriculum has been proposed to help PE teachers broaden their approaches on monitoring and present them a range of implementation example.

Cardiovascular disease (CVD) and type two diabetes mellitus (T2D) are among the leading causes of death worldwide. Insulin resistance (IR) and hyperglycaemia are risk factors for CVD and T2D and are known to be prevalent in youth. Physical activity (PA) is known to improve IR and glucose tolerance in youth, but current levels of PA are low meaning alternative PA recommendations are needed. The purpose of this thesis is to investigate the effect of low volume high-intensity interval exercise (HIIE) on insulin and glucose health outcomes in male children and adolescents. Additionally, the thesis will explore the potential for HIIE to improve glycaemic control in paediatric patients with type one diabetes mellitus (T1D). Chapter 4 examines the relationship between estimates of insulin sensitivity (IS) based on oral glucose tolerance test (OGTT) and fasted assessment methods, in addition to the day-to-day reliability of these measures in children and adolescents. Results from this chapter advocated the Cederholm index to measure IS in this sample due to the low day to day reliability (coefficient of variation (%CV) of 6.4%). Chapter 5 demonstrates comparable results, reporting moderate improvements to IS and glucose tolerance measured via an OGTT 10 minutes after a single bout of HIIE and work-matched moderate-intensity exercise (MIE) in adolescent boys (13-15 y old). The findings from Chapter 5 are extended in Chapter 6, where changes to OGTT derived IS and glucose tolerance were measured up to 24 h post exercise and fasting measures of IS up to 48 h after exercise. Improvements to IS and glucose tolerance after the OGTT persisted for up to 24 h after HIIE and MIE, but no changes to fasting outcomes were observed over the 48 h period. In contrast to Chapter 5, Chapter 7 reports that a single bout of HIIE but not work-matched MIE resulted in only a small improvement in IS in 8-10 year old boys. Chapter 8 assesses the efficacy of 6 sessions of HIIE performed over 2 weeks to alter fasting and postprandial (mixed-meal tolerance test) insulin and glucose outcomes in adolescent boys. In contrast to acute exercise (Chapters 5 and 6), HIIE training over 2 weeks did not improve insulin and glucose outcomes in this population. Finally, Chapter 9 presents a case study on three adolescents with T1D to examine the effect of acute HIIE and MIE on glycaemic control. This study indicates that both MIE and HIIE have the potential to improve short-term (24 h) glycaemic control within this clinical population. Taken collectively, the studies from this thesis demonstrate that HIIE offers an effectual and feasible alternative to MIE to improve insulin and glucose health outcomes in healthy children and adolescents, and short-term glycaemic control in adolescents with T1D.

The term sedentary refers to a distinct class of activities which involve sitting or reclining and which do not cause an increase in energy expenditure above resting levels. Observational studies have reported positive associations between both sedentary time and the number of hours spent sitting per day, with risk for a number of health outcomes that are independent of moderate to vigorous physical activity (MVPA). The total time spent sitting can be amassed in different patterns (long and short bouts) and different types (watching TV, driving, working at a computer) that may have differential associations with health outcomes as well as different confounders that have yet to be properly explored. Further, limitations in current measures used to quantify sedentary behaviour and the possibility of residual confounding, mean that it is unclear whether the posture of sitting itself represents a risk to health or whether sitting is actually a proxy for low energy expenditure. This thesis aimed to examine; the associations between five separate sitting types with health risk, the prevalence of sitting behaviour in England, and the biological mechanisms which might underpin the observed negative health consequences of sitting. Using data from the Whitehall II cohort study the first four studies of this thesis examined prospective associations between sitting at work, TV viewing, non-TV leisure time sitting, total leisure time sitting (TV and non-TV leisure sitting combined) and total sitting from work and leisure, with four health outcomes; mortality, cardiovascular disease, type II diabetes and obesity. No association between any of the sitting indicators with risk for mortality or incident cardiovascular disease was found. TV viewing and total sitting were associated with an increase in risk for type II diabetes following adjustment for sociodemographic covariates and MVPA, but were attenuated following further adjustment for body mass index. None of the five sitting indicators were associated with incident obesity but being obese prior to the measurement of sitting was associated with the number of reported hours of daily TV viewing. The final study of this thesis examined the acute effect of sustained versus interrupted sitting on glucose and insulin metabolism. Interrupting sitting with repeated short bouts of light intensity walking significantly improved insulin sensitivity while repeated short bouts of standing did not. Sitting is a prevalent behaviour in English adults and varies by socio-demographic characteristics. Previously reported associations between sitting time and health risk may be confounded by light intensity physical activity and obesity. The absence of an effect of repeated standing bouts (a change in posture without a change in energy expenditure) suggests that promoting reductions in sitting without also promoting increases in movement are not likely to lead to improvements in metabolic health. New measures of sedentary behaviour are required that can be used in population studies, and can discriminate between the posture of sitting, standing and very low levels of physical activity of a light intensity. This would permit further studies that are needed to clarify the precise nature of the association between sitting and health.

The overall aim was to follow the development of nutritional status and its significance for general health status using an epiemiologic method in a representative population‐based selection of older individuals in two cohorts. The main focus was to prospectively examine the significance of demographic, social and medical factors and to establish a basis to investigate the possibilities of preventive measures. Methods: Five hundred and eighty‐three individuals (278 women and 305 men), 75 and 80 years old, when included, living in a municipality in Östergötland in Sweden, participated in this study. Data collection took place 2001‐2006 with one examination yearly. The examination included a single question regarding self‐perceived health demographical questions, different questionnaires in the areas of nutritional status, symptoms of depression, cognitive function, health‐related quality of life and well being and objective assessments such as anthropometrical, physical and biochemical measurements. Results: Fifty percent of the women (I) and 58% of the men (II) perceived themselves as healthy. Important factors for women’s health (I) at baseline were no or few symptoms of depression, better physical mobility and better physical health. Among men who perceived themselves as healthy (II) at baseline, important factors were better physical health, maintaining a social network and the ability to walk outdoors. After one year 69% of the women and 75% of the men still perceived themselves as healthy. Among those women (I) who perceived themselves as healthy after one year, better physical mobility and better physical health were still important, with the addition of less or no pain. Important predictors for preserving health among men (II) were no symptoms of depression and the ability to walk up and down stairs. The prevalence of risk for malnutrition (III) was 14.5% (n=84), among women 18.8% and men 10.6%. Risk factors for malnutrition at baseline were a lower TSF, lower handgrip strength and worse physical health according to the PGC MAI. The incidence was 7.6%‐16.2%, and was distributed equally among women and men over time. Predictors for developing malnutrition were lower self‐perceived health, increased number of symptoms of depression.  Especially men with symptoms of depression ran a higher risk. Reported energy intake (IV) was low in relation to the estimated requirement, on average 74% among women and 67% among men. Intake of vitamins A, D, E and folate was below the recommended intake and the same pattern was found over time. A smaller weight loss was found among women and men from baseline to Follow‐up 2. Conclusions: The experience of a good physical health was the only common factor for a good self‐perceived health among women and men. The highest risk for developing malnutrition was a combination of impaired self‐perceived health and increased number of symptoms of depression. Clinical implications: A combination of nutritional status, self‐perceived health and symptoms of depression can be a base for clinical judgement and can be used by different professionals in ealth and medical care and in home care service.

African Americans have more disease, disability, and early death than whites. The leading causes of death for African American women are heart disease, cancer, stroke, diabetes, and kidney disease. Several reasons for these differences, including racism, poverty, cultural differences, lack of knowledge about the importance of screening or testing to prevent health problems, inability to get to the doctor, or lack of trust in the medical system. Healthy eating habits are less evident among lower class neighborhoods because of the lack of availability and education about healthy foods. Although African Americans have a healthy acceptance of a wider range of body sizes, their tolerance may lead to more obesity and serious nutrition-related health problems. This study analyzed the risk of nutrition related deficits in African American women living in low income housing. The majority of respondents had been diagnosed with nutrition related medical conditions. Significant relationships were found between medical conditions and income. The behavioral changes within low-income families might be most difficult because of many barriers, but by further educating this population, they can learn to live with these disadvantages and create healthier diets for themselves and family.

In diploma thesis is an analysis of the literature to characterize health and healthy lifestyle. The aim of this thesis is to gain an overview of knowledge about health and physical activity, the level of knowledge about health issues of selected group of students at secondary technical schools. The theoretical part focuses on the definition of the term healthy lifestyle. For quantitative research is selected the knowledge test. The practical part presents results from 120 students of the knowledge test relating to issues of health physical activity and also the questionnaire of healthy lifestyle. The research found that the inform and knowledge in the areas of students of Secondary technical colleges (Machinery and Electrical) is average and it is not significantly different from the knowledge level of Secondary grammar school students. The diploma thesis can help to increase the knowledge level of students in the areas of health, an increase in motivation in applying and following a healthy lifestyle in your life.

Regular physical activity reduces the risk of many chronic diseases. Consequently, the promotion of it and particular types (e.g. walking and cycling for travel), have become a priority for governments seeking to improve health and constrain rising demand on health services. Despite this many uncertainties persist. The aim of this thesis is to address two particular areas of uncertainty: a) the association of walking and cycling for travel with indices of health and well-being; b) and the extent to which increases in physical activity will reduce need for health and social care. The first part of my thesis consists of three studies that describe the health benefits associated with walking and cycling to work among working age adults. The first is a longitudinal study of the associations between maintenance of active commuting with sickness absence and well-being using the Commuting and Health in Cambridge dataset. The second, using the same dataset, describes the longitudinal associations between maintenance of active commuting and self-reported body mass index. Building on this, the third study using a large cohort study (the Fenland Study) with detailed characterisation of diet and physical activity (including objective measurement) describes the baseline associations between active commuting and objective measures of adiposity. The second part of my thesis describes the development of a combined microsimulation multi-state life table model that is used to characterise the effects of a population ‘shift’ in physical activity on the burden of six major diseases at the population-level. Specifically, it seeks to better describe the effect of increases in physical activity on healthcare need considering not just the effect of physical activity on disease incidence but also the effect on healthcare need arising from consequent survival to an older age (at which disease incidence is higher), and contrasts this with a method that does not make allowance for increased survival. The findings of this thesis provide evidence of the importance of walking or cycling to work in maintaining or improving the health and well-being of working age adults. It suggests that increases in physical activity, even after allowance for increased survival, are likely to reduce need for healthcare, although the reductions in need are less than might be assumed when allowance is not made for increased survival. Taken together this work provides a stronger empirical basis to inform public health practice. A stronger ‘health case’ for active travel can be made. The benefits of which should be communicated to individuals choosing how to travel as well as policy makers and others who can influence the determinants of active travel. It also provides a more realistic and nuanced understanding of how increases in physical activity may affect future healthcare need.

Made available in DSpace on 2015-09-25T12:20:26Z (GMT). No. of bitstreams: 1 PDF - Patricia Leite de Oliveira Belem.pdf: 1378840 bytes, checksum: 7e55abca639a29f7566d9d067a50b9ba (MD5) Previous issue date: 2011-11-18 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Objective: To assess the self-perception of health status of elderly registered in the Family Health Strategy of Campina Grande-PB and associated factors. Material and method Crosssectional household with primary data collection, carried out with elderly (60 years or more) of both sexes. The variables studied were: self-perception of health, demographic and socioeconomic factors, number of chronic diseases such and degree of dependence in Basic Activities of Daily Living (BADL). We evaluated 420 elderly (68.1% women) whose average age was 71.57 years. Of the total 48.6% were aged between 60 and 69 years, 58.2% were nonwhite, 56.7% were married, 94% lived together, 43.8% had 1-4 years of study and 46 , 9% belonged to class C. Higher proportion of elderly (45.8%) reported two or three chronic diseases was 65.9% and 51.4% had independent self-perceived health regularly. The variables sex, number of chronic diseases and BADL were associated with self-perception in the bivariate analysis and multivariate analysis, only number of chronic diseases and BADL. Results: The elderly with one or two or more chronic diseases were less likely to perceive health as poor than those who reported none. The chance of the elderly with moderate dependence and total dependence / severe presenting poor perception of health was 6.52 and 6.41 times higher, respectively, compared to independents. Conclusions: Self-perceived health status of the aged is associated with a number of chronic diseases and BADL. The results of this study suggest the need for prevention and diagnosis of chronic diseases, promotion and maintenance of functional capacity, as well as prevention or treatment of disabilities. / Objetivo. Avaliar a autopercepção do estado de saúde e fatores associados de idosos cadastrados na Estratégia Saúde da Família de Campina Grande-PB. Metodologia. Estudo transversal, de base domiciliar com coleta de dados primários, realizado com idosos (60 anos ou mais) de ambos os sexos. As variáveis estudadas foram: autopercepção da saúde, aspectos demográficos e socioeconômicos, número de doenças crônicas referidas e grau de dependência nas Atividades Básicas de Vida Diária. Resultados. Foram avaliados 420 idosos (68,1% mulheres), cuja média etária foi 71,57 anos. Do total de idosos 48,6% tinham idade entre 60 a 69 anos; 58,2% eram não brancos; 56,7% eram casados; 94% moravam acompanhados; 43,8% tinham de 1 a 4 anos de estudo e 46,9% pertencia à classe econômica C. Maior proporção dos idosos (45,8%) referiu duas ou três doenças crônicas, 65,9% era independente e 51,4% apresentou autopercepção de saúde regular. As variáveis sexo, número de doenças crônicas e grau de dependência nas atividades básicas de vida diária estiveram associadas à autopercepção na análise bivariada, e na multivariada, apenas as duas últimas. Os idosos com uma e duas ou mais doenças crônicas apresentaram menor chance de perceber a saúde como má em relação aos que referiram nenhuma. A chance dos idosos com dependência moderada e dependência total/severa apresentarem má percepção de saúde foi 6,52 e 6,41 vezes maior, respectivamente, em relação aos independentes. Conclusões. A autopercepção do estado de saúde dos idosos estudados está associada ao número de doenças crônicas e ao grau de dependência nas atividades básicas de vida diária. Os resultados deste estudo sugerem a necessidade de ações de prevenção e diagnóstico de doenças crônicas, de promoção e manutenção da capacidade funcional, assim como de prevenção ou tratamento de incapacidades.

This thesis investigates the acceptability and efficacy of Functional Imagery Training (FIT), a motivational intervention for weight-management. FIT is based on Elaborated Intrusion Theory, delivered in the style of Motivational interviewing (MI), and designed to promote sustained behaviour change and address cravings. It trains the habitual use of affective, goal-directed mental imagery of personal incentives, using imagery to plan behaviours, anticipate obstacles, and mentally try out solutions from previous successes. Participants are taught to update their imagery from their experience, and to generalise their imagery skills to new goals. In study 1, focus groups explored problems and wishes in regards to weight-management, including reactions to Functional Imagery Training (FIT) as a possible intervention. The issue of waning motivation and the desire for motivational app support was expressed in all groups. Participants were positive about FIT. Study 2 was an uncontrolled pilot trial of FIT. Eleven out of 17 participants (65%) lost 5% body weight or more by three months. Participants continued to lose weight during an unsupported 12-month period and experienced mean weight loss of 6kg (SD= 5.7; d=1.06) and mean waistline reduction of 11.5 cm (SD= 7.4; d=1.56) at 15 months. Study 3 compared the impact of FIT with MI on motivation and self-efficacy, over the first month of a randomised controlled trial (RCT) for weight-loss. Structured elicitation and training in goal-related imagery, i.e., FIT, increased motivation and self-efficacy for weight-loss relative to MI. Study 4 was the RCT for weight-loss, comparing FIT and MI over an intervention-supported six-month period, followed by six months unsupported. The FIT group achieved clinically meaningful weight-loss at 6 months (M kg-loss=4.11) and continued weight-loss at 12 months (M kg-loss=6.44); the MI group stabilised by 12 months (M kg-loss=.67), after minimal weight loss at 6 months (M kg-loss=.74). Study 5 qualitatively explored experiences of MI and FIT RCT participants, upon completing the 6-month intervention phase. MI participants wished for continued therapist- support and feared relapse. FIT participants described a mind-set-change and were confident they could maintain changes and overcome challenges using imagery techniques. Given the demonstrated benefit of motivational imagery in weight-control, FIT should be considered and further tested as an intervention for health behaviour change.