Higher levels of self-regulatory efficacy (SRE) appear to be helpful to those individuals with arthritis attempting to continue to be regularly physically active during an arthritis flare. Arthritis flares are presumed to represent a greater challenge to being physically active than usual arthritis symptoms but within-participant comparisons of pain intensity and SRE when considering flare status (flare vs no flare) have not been examined. While SRE has been compared between those who meet recommended levels of moderate to vigorous physical activity (MVPA) during an arthritis flare, persistence with MVPA has not been examined in arthritis. Finally, pain acceptance has been associated with differential levels of MVPA in arthritis but has not been examined in the circumstances of a flare and persistence with MVPA. Thus, 4 objectives were advanced. Primary objective one was to explore within-participant comparisons of pain intensity and SRE during a flare or usual symptoms. Primary objective two was to compare those meeting and not meeting MVPA guidelines in terms of their persistence and SRE. Secondary objective one was to explore whether persistence with MVPA in a flare could be predicted by pain acceptance and SRE, and secondary objective two was to examine psychosocial variables ability to predict MVPA volume prospectively over 4 weeks. To pursue these objectives, 53 adults with arthritis were recruited to complete an online survey with potential follow-up questions completed online four weeks later. Concerning objective one, participants reported SRE to overcome arthritis barriers (SRE-AB) and to schedule/plan MVPA (SRE-SP) in two contexts; in a flare and in the absence of a flare. Pain intensity was reported in the same flare contexts. 2 x 2 ANOVAs were conducted comparing both SRE measures and pain between those that met MVPA guidelines or not, and within-participants in a flare or usual symptoms. A MANOVA was iii conducted between MVPA groups on SRE and persistence to satisfy primary objective two. Secondary objective one was examined using a hierarchical multiple regression (HMR) with pain acceptance and SRE-SP predicting persistence. A second HMR was conducted attempting to predict MVPA at time 2 (T2) using SRE and persistence. Results of the 2 x 2 ANOVAs were that SRE (AB and SP) and pain intensity were significantly different within-groups (p < .001) such that SRE was lower and pain was higher in a flare than not in a flare. Only SRE-SP was different between MVPA groups (p < .05). The MANOVA identified only SRE-SP in a flare as significantly different between MVPA groups (p < .05). Pain acceptance did predict persistence in block 1 of the HMR (p < .01) but when SRE-SP was added, SRE-SP was the only significant predictor (p < .001). Results of the second HMR indicated that of all the psychosocial variables entered, only SRE-SP in a flare significantly predicted T2 MVPA (p < .01). Findings suggest that, as active individuals with arthritis feel less efficacious to be active and higher pain intensity during a flare, a flare does indeed represent an increased challenge to MVPA adherence. Interestingly, pain intensity did not differ between MVPA groups while SRE-SP did, supporting that greater SRE beliefs are required in challenging circumstances. Pain acceptance did initially predict persistence until SRE-SP was added to the model. SRE may have consumed the variance in the model not because of pain acceptance’s inability to predict but rather due to the high correspondence between SRE and persistence measures. Finally, SRE-SP predicted MVPA volume prospectively, further supporting the utility of high SRE when attempting to adhere to MVPA during the increased challenge posed by an arthritis flare.

This thesis explores the potential role of greenspace to promote physical activity in young adolescents in Scotland through an examination of physical activity behaviour associated with greenspace use and adolescents motivations to use greenspace, and experiences, attitudes and perceptions of greenspace. This is in light of political interest in promoting physical activity in all populations, especially in young people, as one way to help prevent obesity and promote health and well-being, and recognition that a link between greenspace provision and greenspace has been suggested by research, however, the evidence base is currently limited, particularly within Scotland. Research into greenspace links to physical activity are usually framed within an overarching socio-ecological perspective, however, additional theoretical perspectives are discussed which can add to understanding of adolescents’ use of greenspace. An argument is made for the use of Gibson’s Theory of Affordances and this is further developed to make the links between greenspace design, provision and use. The research included two studies. Study one involved the design, testing and placement of greenspace use questions into a survey of a nationally representative sample of 13 and 15 year-olds across Scotland (n=4697). This was done in collaboration with the Scotland team for the Health Behaviour in School-aged Children (HBSC) survey. The second study used a mixed methods design which employed GPS (global positioning system), accelerometry and GIS (geographical information system), referred to in this research as the GAG method, as an objective measure of physical activity location, timing and duration for a sample of n=35 13 and 15 year-olds. This is a relatively new method used in environment and physical activity research and the present study makes a contribution to understanding this method in practice. The GAG study also included semi-structured interviews with participants at the end of the period of monitoring physical activity. The two studies combined demonstrated a positive association between use of greenspace and higher quantity of and intensity of physical activity. Logistic regression on the survey data revealed that an adolescent who used greenspace more than three times per week was 42% more likely to achieve 60 minutes of moderate physical activity daily. The GAG study demonstrated that, when in greenspace, a lower proportion of time was spent being sedentary compared to when not in greenspace (48.6% vs. 81.7%). In interviews, the adolescents described a wide variety of physical activities taking place in greenspace, many incidental to being in greenspace as opposed to planned beforehand, although this was also encountered. Four types of greenspace user were identified and helped highlight how social motivations to use greenspace were paramount suggesting that the impact of greenspace on physical activity is both a result of motivation to be active, but also a benefit of going to greenspace for social reasons. This bi-directional relationship complicates endeavours to demonstrate cause and effect and suggests the requirement for more research to understand the interaction between psycho-social and environmental factors. Greenspace use appeared to be relatively high. The HBSC survey found that a large majority of young adolescents in Scotland (71%) reported using greenspace at least once per week in the summer months, and may well be one of the most frequent users groups. However, scope remains to further increase use aimed at increasing physical activity and it is argued that more flexibility exists for this possibility than within other domains for physical activity, such as school PE classes. The interviews revealed that motivations and influences on use of greenspace were found to closely reflect the a priori model (based on previous mainly public space research) with clear evidence of interplay between factors influencing intention and opportunity. Developmental attributes of the adolescent stage were indicated to be strongly influential in motivating greenspace use, however, the relative impact of the range of factors was uncertain with decisions to use greenspace complex and dynamic. Despite this complexity, improvements in the physical condition of greenspace, safety and greenspace quality are likely to be universally welcomed. From a theoretical perspective, the findings supported the existence of design, normative and individual affordances which have relevance for how greenspace and the facilities within them are designed and used and how exclusionary practices can arise. Political endorsement of the importance of greenspace to health and well-being is evident and this research supports continued protection, investment and improvement, particularly in greenspace quality. There is, however, a need to further develop policy to incorporate consideration of the role of youth and community services and park management aimed at facilitating positive use of and experiences in parks and other greenspace for all users.

This thesis is composed of an ethnography of the Women’s Running Network (WRN) – a non-elite women’s-only running group – and explores participant’s lived experiences of health and ageing (and the intersection of these) in this physical context. In-depth interviews (n = 25), inclusive of case studies (n = 3), with women between the ages of 29 and 66 allowed insight into the subjective contours of participant’s lives, and their particular biographical trajectories culminating in WRN participation. Several types of narrative analyses were applied to the emergent data, and results from these revealed insights into if, why, how, and when women engaged with health and ‘active ageing’ messages across the life course. Despite a prevalence of health knowledge, participants tended to report long periods of inactivity throughout their lives – citing the often documented barriers to physical activity such as a lack of time and caregiving responsibilities. However, a vast majority of participants also cited an utter lack of confidence with respect to physical activity, often stemming from highly influential poor early experiences. Embodying a perceived ‘non-sporting’ identity for as long as they had, they were foreclosed to the idea of physical activity despite simultaneously feeling pressure to participate. For many, it was particular life events - or ‘critical moments’ – that brought participation in physical activity to the forefront (i.e., birthdays, relationship issues, bereavement, and health scares). A consideration of these within this thesis explores the complex link that exists between health consciousness and action. In addition, alternative narratives about who could be a runner (within WRN advertising and by word of mouth) ‘hailed’ participants to reconsider their foreclosed narratives, by offering a ‘fun and non-competitive’ atmosphere for people ‘of all ages, sizes, and abilities’. Once pushed to action and within the WRN setting, participants described learning about themselves and their bodies, and thus developed the capacity to tell new stories. As such, through a narrative lens, this thesis introduces the stories that participants responded to (or not), and the stories that they used to tell, felt able to tell, and – in some cases – learned how to tell about health, about ageing, and about running/physical activity. Conclusions from this work have implications for both policy and practice, advocating for the necessity of comprehensive insight into people’s perceptions and lived experiences of (active) ageing within the context of life history, current life stage, and the everyday.

Despite the widely documented physical, psychological, and social benefits of participation in physical activity (Sallis, Prochaska, & Taylor, 2000; U.S Department of Health & Human Services, 2000), less than half of young Saudi adolescents are involved in non-school organised sport (General Presidency for Youth Welfare, 2007; Al-Hazzaa, 2004). Thus, examination of social and psychological determinants of participation in leisure time physical activity is important. This PhD examined these determinants within Saudi adolescents. A mixed methods approach was adopted to identify and test the important social and psychological determinants of participation in leisure-time physical activity. Phase one of the research was qualitative in nature. The purpose of this phase was to illustrate how an elicitation method can be used to identify salient behavioural (termed consequences), normative (termed referents), and control (termed circumstances) beliefs about physical activity as perceived by adolescents. These findings, along with theoretical propositions and evidence from previous studies, contributed to the development of a model of the social and psychological determinants of participation in leisure-time physical activity. They also contributed to the development of ways to measure important concepts in the model. Phase two was quantitative in nature and used multiple regression analysis to test the relationships among the key variables of interest. In part one of this phase, self-report questionnaires measured the respondents’ intention to participate in leisure time physical activity (dependent variable); it also measured their attitude toward physical activity behaviour, as well as subjective norms, perceived behavioural control, descriptive norms, self-efficacy, self-identity, and past behaviour (independent variables). The results revealed that attitudes, subjective norms, perceptions of behavioural control predicted physical activity intentions in a Saudi Arabian context. Moreover, descriptive norms, self-efficacy, and past behaviour contributed to the prediction of intentions, while self-identity did not. The results also pointed to some gender differences: while Saudi females considered attitude, subjective norms, perceived behavioural control and self-efficacy during intention formation, Saudi males considered attitude, subjective norms, perceived behaviour control, self-efficacy, and past behaviour only during intention formation. In terms of the salient beliefs, being active, maintaining fitness and controlling weight predicted attitudes; friends, mother, and brother predicted subjective norms; and availability of place, availability of time, and bad weather predicted perceived behavioural control. The results also pointed to some gender differences. While Saudi females considered being active, maintaining fitness, controlling weight, friends, family, father, mother, and brother, availability of place, availability of time, and bad weather, Saudi males considered being active, friends, family, father, brother, availability of place, availability of time and bad weather. In part two of this phase, five weeks after completing the main questionnaire, participants completed a follow-up questionnaire that assessed self-reported physical activity during the previous five weeks. Results revealed that intention, perceived behavioural control, subjective norms, self-efficacy, and past behaviour, but not attitude, descriptive norms, or self-identity predicted physical activity. Results also pointed out important gender differences. That is, while Saudi males appeared to consider intention, perceived behavioural control, and past behaviour when predicting exercising behaviour, this was not the case for Saudi females who considered intention, subjective norms, self-efficacy, and past behaviour only. Overall, the findings of this thesis offer partial support for the capacity of the theory of planned behaviour to predict participants’ physical activity intention and behaviour. The standard TPB variables, self-efficacy and past behaviour predicted intention, while, subjective norms, self-efficacy and past behaviour predicted behaviour. In general, findings also point out important gender differences. That is, while Saudi males appear to consider the standard TPB variables, self-efficacy, and past behaviour when predicting intention, and perceived behavioural control and past behaviour when predicting physical activity behaviour, this is not the case for Saudi females. In contrast, Saudi females consider attitude, subjective norms, and self-efficacy when predicting intention, and self-efficacy and past behaviour when predicting physical activity behaviour. Implications of these findings are that in order to alter physical activity patterns, factors influencing adolescents’ intention and behaviour to participate in physical activity must be addressed. Specially, effective interventions should target cognitive, social, environmental and psychological factors aimed at promoting physical activity among adolescents.

Psychological well-being occurs when there is an absence of mental disorders and presence of positive states. Given the increasing prevalence of mental disorders, which are thought to have their roots in childhood, improving psychological well-being in children is currently an important area of research. Physical activity has been proposed as a method by which negative states can be reduced and positive states increased, thereby increasing children’s overall psychological well-being and in turn helping to protect against a decline into clinical disorders. Research focusing on physical activity and psychological well-being has mainly used self- reported measurements to assess physical activity, a method which leads to considerable non-differential misclassification that in turn will attenuate associations between physical activity and psychological wellbeing. Few studies have employed more precise, objective measures such as accelerometry. Despite providing a more precise measure of physical activity, a number of limitations are present with the use of accelerometry, specifically concerning the data reduction processes. Various decisions made when handling accelerometer data can result in misclassification of time spent in different intensities of physical activity and can introduce selection bias. The present thesis aims to address how the decisions made during data reduction can affect estimates of physical activity prevalence and alter the observed relationships between physical activity and psychological well-being in children. The first study of this thesis assessed the misclassification of activity intensities occurring as a result of the use of various accelerometer cut-points and the resulting variation in relationships between physical activity and psychological well-being that occurs. Results showed that the use of different cut-points to determine physical activity intensity alters the magnitude of the relationship between physical activity and psychological well-being; relationships were attenuated, with some becoming non-significant. The second study addressed the issue of children’s compliance with wear time requirements over multiple time points; compliance with wear time decreased over time, whilst inclusion and exclusion rules based on minimum wear times introduced selection bias. The use of more lenient wear time criteria, to reduce selection bias, introduced misclassification of physical activity intensities. Further, longitudinal relationships between physical activity and psychological well-being differed depending upon the wear time criteria employed. The third study aimed to address whether compliance, and in turn selection bias would systematically differ between groups of a trial of a physical activity intervention, and whether this would alter the results of the intervention itself. Results showed that compliance varied across trial condition, that selection bias with groups was different for each condition and that non-compliance hindered the exploration of the mediating effect of physical activity on psychological well-being. Study four involved the validation and calibration of a new wrist worn, waterproof physical activity monitor more compatible with 24 hour wear, thus potentially overcoming the compliance problems noted in the earlier studies. Results showed good concurrent and criterion validity, with high classification accuracy for the cut-points created. The final study assessed the acceptability and compliance with 24 hour wear in children and allowed a detailed examination of the underestimation of time spent in PA intensities that occurs from capturing shorter and different periods of the day. Results showed large misclassification with 10 hour capture periods relative to complete observation, with time in activity intensities varying across different periods of the day. The results of this thesis demonstrate that substantial selection bias and misclassification of time in activity intensities can be introduced through the decisions made during the processing of raw accelerometry data. Furthermore, this error alters the relationships between physical activity and psychological well-being. The results indicate that the true relationship between physical activity and psychological well-being in children may still be unknown, with researchers reporting relationships and effects only relevant to the measurement methods and data reduction processes they have employed. A method of overcoming selection bias and reducing misclassification is through 24 hour wear, which through the design of new accelerometers is now possible. Future studies should use monitors compatible with and acceptable for complete observation. This would result in more precise estimates of time spent in physical activity intensities and less selection bias. Both of these improvements would greatly increase our understanding of the relationship between physical activity and psychological well-being in children.

Low levels of physical activity and unhealthy dietary behaviours have been associated with poor health in adolescents, leading to an increased risk of chronic disease in adulthood. These behaviours are modifiable and since adolescents spend a significant amount of time in school this provides an increasingly popular setting for physical activity and dietary interventions. A systematic review of school-based interventions aimed at changing physical activity and/or dietary behaviours in adolescents was conducted. The aim was to identify successful interventions, identify effective intervention components, behavioural theories and techniques which may have facilitated interventions success and assess reporting quality. Fifteen studies were included in the review; two dietary only, seven physical activity only and six physical activity combined dietary interventions. Diet only interventions were not successful. Interventions aimed at only physical activity behaviours were the most successful, with education combined with environmental adaptations identified as being most effective. Physical activity only interventions aimed specifically at girls were generally successful. Physical activity interventions aimed at both boys and girls tended to be more effective at improving the behaviours of boys only. Interventions aimed at both physical activity and diet showed some evidence of gender differences with boys increasing physical activity behaviours and girls improving dietary behaviours. Studies based on a theory which considered environmental influences appeared more effective. No specific behaviour change techniques were identified with studies reporting significant results. The reporting of intervention design/methodology was of moderate quality. The heterogeneity of the studies made it difficult to generalise which interventions were most effective. Education combined with environmental adaptations appeared effective at changing physical activity behaviours in both boys and girls. Further research into dietary interventions is required, especially in boys. The quality of study reporting needs to improve to facilitate the identification of the active components/techniques implemented within interventions.

Bakgrund: Forskning om att förebygga och motverka sköra tillstånd hos äldre är mer aktuellt idag än någonsin då befolkningsmängden i världen stiger och andelen äldre ökar. Frailty är den internationella benämningen på skörhet, som också används som diagnos. För att vara frail skall individen uppfylla två eller fler definierade kriterier. Dessa är ofrivillig viktminskning av cirka fem kilo eller mer under det senaste året, självupplevd utmattning, nedsatt greppstyrka, långsam gång samt låg fysisk aktivitet. Det är allmänt vedertaget att frailty ökar, att det är vanligare hos äldre med kroniska sjukdomar och vanligare bland kvinnor än bland män. Undernäring och sarkopeni kan vara en orsak till frailty. Både undernäring och sarkopeni kan motverkas och frailty bör därför kunna förebyggas och behandlas. Syfte: Syftet är att sammanställa litteratur om att behandla frailty med nutrition och fysisk aktivitet. Metod: Studiens design är en systematisk litteraturstudie med 13 kvantitativa RCT-studier.   Resultat: Resultatet indikerar att behandling med nutrition respektive fysisk aktivitet minskar frailty. Kombinerad individuellt anpassad, teambaserad behandling med personlig feedback ger bäst effekt.   Slutsats: Behandling med nutrition och fysisk aktivitet kan motverka frailty.   Nyckelord: Frailty, physical activity, nutrition

While some cognitive decline is part of the normal aging process, certain changes have been linked to physical health or lifestyle-related diseases and may be preventable. Hypertension and type 2 diabetes are two conditions that have been associated with a heightened risk of accelerated cognitive decline. In terms of protective factors, physical activity can positively impact a broad range of cognitive processes including memory, attention, and executive function and may also protect against or delay cognitive decline and dementia. The present study examined the extent to which physical activity moderates the impacts of hypertension and diabetes (and their interactions) on different cognitive functions. Data are from the Memory and Aging Project (MAP), a longitudinal study of older adults (N = 1400, mean age = 79). A series of multilevel models evaluated baseline differences and linear and quadratic change on four cognitive measures: mental status, perceptual speed, and immediate and delayed episodic memory. Higher levels of self-reported physical activity were associated with better perceptual speed at baseline, and significantly less linear decline across all four measures. Physical activity was not significantly associated with curvilinear change. Individuals with diabetes had significantly worse immediate episodic memory performance at baseline, but diabetes was largely unrelated to rate of change and initial performance on the other measures. Hypertension was associated with better initial mental status (linear and quadratic models) and delayed episodic memory (quadratic model). Contrary to expectations, most interactions between physical activity and the two health conditions were non-significant. However, physical activity appeared to moderate the relationship between comorbid diabetes and hypertension on immediate episodic memory, such that individuals with the two conditions who were more physically active experienced a reduced rate of linear and curvilinear decline compared to inactive individuals with diabetes and hypertension. The findings from this study suggest that physical activity may reduce the impact of comorbid conditions on certain cognitive functions, and that immediate episodic memory may be particularly susceptible. / Graduate

The purpose of this study was to explore the need for school nurses in the Saudi school system and to explore the current role of nurses in school health education and health promotion in Saudi Arabia. The study used a qualitative approach that was guided by implementation literature. Fifteen participants (8 nursing students; 4 nursing faculty members; 3 nurses) answered open-ended questions and participated in semi-structured interviews. From the findings, three themes emerged to identify the current role of nurses in Saudi Arabian school: “Health educator”, “Health promoter”, and “Liaison with community”. Four themes were identified based on the potential role of nurses in Saudi Arabian schools: “Leadership role”, “Care provider role”, “Educator role”, and “Liaison with community”. Five themes were identified based on facilitators and barriers to providing health and physical education in Saudi schools: “University and college level support”, “School health services”, “Governmental support”, “Lack of cultural approval”, and “Demand for nurses exceeds supply”. This study contributes to our understanding of what are the current and potential roles of nurses in Saudi Arabian schools, are nursing students currently prepared to provide health education and promotion to school staff and students, and what facilitators and barriers exist for nursing to provide health education and promotion in Saudi schools. This information can contribute to decision-making processes, formulation of necessary legislation, and government measures towards the implementation of school nursing and physical education, particularly in girls’ schools in Saudi Arabia, so as to maximize health and wellness in the Saudi community. / Graduate / 0680,0523,0714 / hebah.alqallaf@gmail.com

There has been a large growth in workplace wellness initiatives; however, use of fitness based health risk assessments (fHRAs) remains largely unexplored. I hypothesized that adding an fHRA to a physical activity counseling intervention (PAC+HRA) would greater increase physical activity levels compared to physical activity counseling alone (PAC). A 4 month, two- group quasi-experimental design was used to test this hypothesis. Over time, there was an increase in total, moderate to vigorous, and moderate physical activity ≥10-minute bouts. Self-Efficacy for Exercise increased and symptoms of depression decreased. Subgroup analysis of the PAC+HRA group found a significant improvement in overall fitness levels. Participants progressed to more advanced stages of change. In conclusion, PAC+HRA did not increase physical activity levels more than PAC. This is likely due to the characteristics of the counseling, fHRA, and outcome measurements. / October 2016