Background: The high prevalence of children and adolescents not meeting the recommended 60 minutes of physical activity (PA) per day and the associated negative health consequences make it critical to increase PA. Ecological models suggest that the school environment may influence student health behaviour. However, few studies have examined the school environment in relation to student PA. Purpose: To examine between-school variability in students’ time spent in PA, and identify factors of the school built environment that account for the between-school variability in students’ time spent in PA overall as well as by gender and school location, while also considering school physical education (PE) and PA programming and controlling for student-level characteristics and potential environment-level confounders. Methods: This thesis consisted of a secondary data analysis of the School Health Action, Planning and Evaluation System (SHAPES) Ontario project, which included self-report data from administrators and 25,416 students in 76 secondary schools across Ontario. The student- and school-level survey data were supplemented with GIS-derived measures of the built environment within 1-km buffers of the 76 schools. Multilevel modeling was used to examine between-school variability in students’ time spent in PA, as well as environment-level factors associated with PA. Results: There was significant between-school variability in students’ time spent in PA overall as well as by gender and school location, respectively. Schools having another room for PA and schools offering daily PE were positively associated with students’ PA. Schools located in areas with higher land-use mix diversity and walkability were negatively associated with students’ PA. Results of the gender-specific multilevel analyses indicated schools should consider providing another room for PA, especially for offering flexibility activities directed at female students. Schools should also consider offering daily PE to male students in senior grades. Students attending schools in urban and suburban areas that provided another room for PA or were located within close proximity to a shopping mall or fast food outlet spent more time in PA. Conclusions: These findings support the ecological notion that the school environment can influence student PA behaviour. A better understanding of the relationship between the school environment and PA will assist in the development of effective school-based policies, programs and interventions to increase PA.

Physical activity and healthy eating are key components of healthy living, and they reduce the risk of developing chronic diseases. Current research indicates that Canadian early years children are not active enough for healthy growth and development. Additionally their diets are high in processed foods and lack fresh and locally grown foods. Parents play a key role in establishing healthy behaviours; however caregivers also have a strong influence, as many early years children spend a large portion on their day in care centres. To date, very little is known about the factors influencing rural caregivers in the provision of healthy opportunities for early years children in their care. Purpose: The purpose of this study was to use an ecological framework to identify facilitators and barriers that rural caregivers face when providing physical activity and healthy eating opportunities in care centres. Methods: Caregivers (N = 8) in rural settings participated in one on one semi-structured interviews. Perceived facilitators and barriers reported by caregivers were categorized using the ecological model as (intrapersonal, interpersonal, institutional, community, and policy). Results: Caregivers identified facilitators and barriers. (i.e., personal health and wellness, caregiver perceptions of lack of parental knowledge, parental support and access to facilities and local foods in the community), that influenced their ability to provide physical activity and healthy eating opportunities for children in their care. Similar barriers and facilitators were clustered together to create themes within each ecological category. A total of 12 key themes emerged from the data. Conclusion: Rural caregivers identified a number of factors that facilitated and inhibited their ability to provide opportunities for engaging in health promoting behaviours. Interestingly caregivers did not identify any intrapersonal barriers. Factors in the interpersonal category were the most commonly reported. Thus behaviours of others were the often indicated as a key factor influencing caregivers in the provision of healthy opportunities. In the institutional and community categories caregivers identified a number of facilitators that supported them in the provision of healthy opportunities. Additionally, some caregivers discussed practices they used to overcome barriers and this in turn, facilitated the promotion of physical activity and healthy eating within the care centres. Research in rural areas is limited and the majority of studies focus the barriers to living in rural areas. This study contributes to the literature because it identified, not only challenges, but also benefits to living in rural areas. Furthermore, the use of an ecological framework allowed barriers and facilitators to be classified into distinct categories. This is important, as classification of specific factors can aid in designing initiatives that target facilitators and alleviate barriers. Such initiatives can then support early years caregivers in the provision of healthy opportunities for children. In turn, this will aid Canadian early years children in establishing lifelong physical activity eating and healthy eating patterns.

FACILITATORS AND BARRIERS OF PHYSICAL ACTIVITY IN OLDER PERSONS WHO HAVE EXPERIENCED A FALL Edwin Yoshiyuki Hanada, Master's of Science Degree, Institute of Medical Science, University of Toronto, 2008 ABSTRACT A systematic review and four focus groups were conducted to determine the facilitators and barriers of physical activity in older adults who have experienced a fall. Results from the systematic review demonstrated facilitators and barriers of purposeful and non-purposeful physical activity for older adults, but not specifically fallers. Facilitators identified in the systematic review and elaborated upon in the focus groups involving older fallers included: deriving benefits from physical activity in the physical, psychological, or functional realms; and social support providing encouragement for participation in physical activity, or acting as a distraction from negative physical symptoms during participation in group physical activity. Conversely, barriers to purposeful and non-purposeful physical activity included: symptoms of chronic illnesses, such as cardiac chest pain, arthritic pain, poor balance or poor eyesight; a fear of falling; and adverse physical environmental conditions, such as cold or warm, humid weather. The focus groups identified disinclination to activity as an important barrier to purposeful physical activity. When placed in a theoretical context such as Bandura’s Social Cognitive Theory and Marcus and Owen’s Readiness for Change model, the results of this study can help inform the design of physical activity interventions to prevent falls in older adults with a history of falls.

A child’s level of physical activity is an important component of that child’s health. Our understanding of physical activity patterns in children is limited in rural settings, and virtually absent for climates with snow cover. Opportunities for physical activity intervention need to be identified. PURPOSE: Investigation of the relationships between pedometer-measured physical activity, body composition and aerobic performance in rural children in the winter and examination of within-day variation in stepping behavior using interval pedometry. METHODS: Aerobic performance (20 m shuttle run) with “talk test” validation and body composition (BMI, BF) were measured during mid-winter during the school year in 8 to 10 year old children. Pedometer step counts were recorded at 6 intervals throughout the day for 7 days. RESULTS: Fifty-six subjects (22 males and 34 females, mean age 9.09 (0.49), had the following measurements; BMI 17.9 (3.3), BF% 24.3 (9.5) (tricep/calf), 10,465 (±2506) steps/day, VO2 45.12 ml/kg/min (±2.87), shuttle run stage 3.0 (±1.34). Weekday steps/day (11,422 ±2573) were greater than weekend (8,112, ±3499) steps/day for both boys and girls (p<0.01). Town children recorded 1800 more steps/day than out of town children (p<0.01). All measures of body composition were found to be significantly related to aerobic power (p<0.01). Weekday steps were related to aerobic performance. The fittest (upper 1/3) children were leaner and had more afternoon school steps, and higher afternoon school step rates. CONCLUSION: Daily step counts were 2000-4000 steps lower than other studies and may be an impact of winter in Manitoba or the rural setting. This was consistent with overall low aerobic performance and higher adiposity of the children. Interval pedometry was capable of identifying differences in activity patterns between most and least fit children in rural Manitoba providing for targeted intervention strategies. / October 2006

Cardiovascular disease is currently the leading cause of death in Canada and other developed countries. Physical activity based cardiac rehabilitation programs have been shown to reduce the likelihood of subsequent cardiac events and even reverse the disease process. However, factors influencing physical activity in cardiac patients are still not clearly understood. The overall objective of this dissertation was therefore to better understand motivation and physical activity in a cardiac rehabilitation context. Specifically, theory-based motivational variables were studied as correlates of physical activity. To accomplish this objective, a two-purpose research approach was taken. First, two articles (Article-1 and Article-2) aimed to test and integrate concepts from two strong motivational theories: Self-Efficacy Theory (SET) and Self-Determination Theory (SDT) into one comprehensive model using the novel and rigorous approach of Noar and Zimmerman (2005). The second purpose of this dissertation was to extend the findings from the first purpose by investigating physical activity and motivational patterns over a 24-month period in cardiac patients (Article 3). With regards to the first purpose, Article-1 revealed that the integration of SDT and SET was feasible as the integrated model had good model fit, explained more variance in self-determined motivation, confidence, and physical activity and supported similar number of hypothesised links in a cross-sectional cardiac sample as well two other samples: primary care adults and university students. Due to the cross-sectional nature of Article-1, Article-2 tested the integrated SDT-SET model from cardiac patients with longitudinal data of patients following a cardiac rehabilitation program. Although no motivational variables predicted residual change in physical activity at 4-months, this longitudinal model was found to have good model fit. Across both articles, the integration of SDT and SET was found to be possible. However, more research is needed to further test the integration of these theories. As for the second purpose of this dissertation, Article-3 investigated physical activity and motivational patterns of cardiac rehabilitation participants over the course of 24 months. Distinct patterns were found for physical activity, self-determined motivation, barrier self-efficacy and outcome expectations. In addition, individuals in the higher patterns of the motivational/expectancy variables had greater probability of being in the maintenance physical activity pattern compared to individuals in the other motivational/expectancy patterns. Therefore, this article extended findings from the first purpose by linking SDT and SET variables to long-term physical activity behaviour. SDT and SET should continue to be investigated together in order to increase our understanding of the mechanisms leading to greater motivation and subsequent increases in physical activity levels. Having a theoretically supported pathway to build motivation is ideal to inform future interventions and cardiac rehabilitation programs.

This thesis, comprising two studies, investigated whether negative expectations and self-perceptions relating to the aging process are associated with less physical activity (Study 1), and whether less active adults are likely to report age as a cause for physical activity failure than more active adults (Study 2). Using Sarkisian et al.’s (2002) Expectations Regarding Aging (ERA-38) survey, Study 1 first developed reliable and valid sub-factors for constructs relating to general aging expectations (GAE) and aging self-perceptions (ASP) by conducting exploratory factor analyses on 167 adults (M age = 59.5). Results revealed three acceptable GAE sub-factors relating to satisfaction/contentment, physical function and cognitive function, and three ASP sub-factors pertaining to functional, social, and sexual health. Subsequent MANOVA analyses showed that active adults reported higher GAE for satisfaction/contentment and cognitive function than less active adults. Regression analyses revealed that physical activity levels positively predicted satisfaction/contentment and physical function expectations among 45-54 yr olds. In Study 2, 177 adults (M age = 60.1) completed our Causal Dimension Scale for Aging (CDSA) and a survey asking whether age was a likely cause of failure in various physical activity contexts. Responses on the CDSA were used to validate ‘General Attributions towards Age’ (GATA), a measure which captured how adults view the aging effects. Subsequent analyses of variance determined that GATA interacted with physical activity status (active, less active) to influence the reported likelihood of age as a cause for failure. Less active adults with stable/uncontrollable GATA reported greater likelihood of age as a cause for failure than all other groups in gym, recreational/community program, and unstructured/spontaneous activity settings. Separate age group analyses indicated that these trends were pronounced in an unstructured/spontaneous activity setting for 45-54 yr olds, and in a generally recently inactive scenario for 55-64 yrs.

This investigation, comprising two studies, examined the number of barriers to physical activity (Study 1) and barrier strength (Study 2) reported by middle-aged and older adults using a social ecological framework (McLeroy et al., 1988). Researchers were interested in assessing age group (45-54; 55-64; 65-74 yrs) by physical activity group (active, less active) effects for barrier responses using analyses of variance. In Study 1, 180 participants completed a physical activity level survey (Godin & Shephard, 1985) and answered open-ended questions about barriers. Results indicated that 45-54 yr-olds reported more barriers overall, and more intrapersonal barriers than older groups. Less active 45-54 yr-olds reported more organizational-interpersonal barriers than the other groups. Descriptive analyses of coded themes demonstrated that common intrapersonal barrier sub-themes cited by younger adults related to family commitments, while sub-themes reported by middle-aged and older adults related to having a health problem or an injury. In the organizational-interpersonal category, the most common barrier sub-theme related to the workplace. In Study 2, 116 participants completed a survey assessing weekly physical activity and barrier strength for items pertaining to ecological categories and barrier sub-factors. Results showed that less active adults reported each of intrapersonal, interpersonal, and physical environment barriers more strongly than active adults, irrespective of age; the intrapersonal category was relatively the most constraining for our participants. In terms of barrier sub-factors, results showed that significantly higher barrier strength scores are most often associated with physical activity level (i.e., less active), and only occasionally associated with age group. The overall investigation can provide valuable information for improving physical activity interventions for middle-aged and older adults.

The health and fitness status of Canadian children has been declining over the past several decades. Children’s health and fitness impacts future health status as many health and fitness indicators track from youth into adulthood and are associated with serious illnesses such as cardiovascular disease (CVD). One potential determining factor of health and fitness may be the level of proficiency exhibited in performing fundamental movement skills (FMS). Failure to master FMS in childhood may decrease the physical activity options available in adulthood because FMS provide a foundation for all forms of physical activity pursuits necessary for health and fitness benefits. Todate, the relationship between health, fitness and proficiency of FMS has not been examined in Canadian children. Therefore, the purpose of the present investigation was to examine the current state of movement skill proficiency in relation to health and fitness in Canadian elementary-aged children. Boys (n = 71) and girls (n = 91 girls) ages 8 to 11 years were recruited from schools participating in the evaluation component of the Action Schools! BC program. Measures of fundamental movement skill proficiency (i.e., running, horizontal jumping, vertical jumping, jumping from a height, hopping, and skipping) and indicators of health and fitness (i.e., blood pressure, arterial compliance, weight status, musculoskeletal and cardiovascular fitness) were assessed. Results indicated low levels of FMS proficiency for both boys and girls. Analysis also revealed significant relationships between EMS and indicators of health and fitness. Correlation analyses found running and hopping to be significantly (p < .01) related to musculoskeletal and cardiorespiratory fitness tests. Significant (p < .01) relationships between vertical jumping and weight status, musculoskeletal and cardiorespiratory fitness were also found by the correlation analyses. Regression analyses were performed to determine the independent relationship between health and fitness indicators. Vertical jump was significantly (p < .01) related to blood pressure (BP) independent of confounding health and fitness variables. Finding significant relationships between FMS proficiencies and health and fitness indicators coupled with the low proficiencies demonstrated by our sample of children suggest the need for a greater emphasis on the development of FMS.

Social ecological models of physical activity (PA) promotion embrace a wide range of factors and disciplines that may contribute to active living. Parks, trails, and recreation facilities have been acknowledged as important components of the built environment for promoting PA and overall health, but little research has investigated these community resources in detail. Therefore, the purpose of this study was to examine the association between the presence and characteristics of parks and recreation amenities and PA levels of community members. The study involved four integrated components: i) a written questionnaire with 585 adult residents from four Waterloo planning districts that addressed a variety of personal, psychosocial, and environmental correlates of PA, ii) a detailed seven-day log booklet of recreational, transportation, household and job-related PA episodes, iii) objective assessment of PA via accelerometers, and iv) observation and rating of parks for their features that may be related to PA. Ratings of psychosocial characteristics (e.g., self-efficacy, social support) and perceptions of neighbourhood walkability attributes (e.g., land use diversity, street connectivity) were significantly different between those who engaged in some PA versus those who engaged in no PA, but neighbourhood perceptions did not moderate the relationship between psychosocial variables and PA, nor did psychosocial variables mediate the relationship between neighbourhood perceptions and PA. Parks and trails were used in approximately 8% and 3% of total PA episodes, respectively, with an average duration per episode of 49 minutes and 38 minutes, respectively. Parks with more facilities for PA and supporting amenities were more likely to be used for PA than parks with fewer facilities and amenities, and trails were the park feature most strongly related to park-based PA. The number of municipal parks within 1 km from participants’ homes the and total parkland area within 1 km were associated with higher odds of neighbourhood PA and neighbourhood park PA, while distance to the closest park from home was not related to either outcome. Although subject to several limitations, these results provide guidance for municipal and park planners in designing communities and the resources within them to promote increased levels of PA and active living. Suggestions for future research include studying environmental correlates of PA among youth and older adults, direct observation of PA in parks, and development of a comprehensive surveillance system to track both changes in the built environment and associated changes in residents’ PA participation.

Introduction: The benefits of regular exercise on skeletal health have been well-documented in terms of stimulation of bone accrual and bone maintenance. Medium-impact sports activities such as running have been demonstrated to exert site-specific enhancement of bone mass in the lower appendicular skeleton. However, elite female runners engaged in high intensity training and sports activity may also be at risk of amenorrhea and low bone mineral density (BMD) resulting from inadequate caloric intake. Purpose: To investigate the effect of intensive exercise and maintenance of adequate caloric intake on BMD in a group of elite female runners. Methods: This study represents a secondary assessment of existing data that were obtained between 1994 and 2009. Using dual-energy X-ray absorptiometry, a group of elite runners (n=11) in this study was screened in the Laboratory for Elite Athlete Performance at Georgia State University. This was a longitudinal study in which three sequential measurements of BMD, as well as fat and lean tissue body composition of each athlete took place. The average interval between measurements was 1.1 years and 2.6 years respectively. Regional BMD measurements for head, arms, legs, trunk, ribs, pelvis, and spine were assessed, as well as the value for total body BMD. The study participants also received dietary counseling emphasizing daily caloric balance and adequate calcium intake. Results: The average age of the runners increased from 24.59 (±4.41) to 28.14 (±5.94) years over the study. This was accompanied by an increase in body mass (54.98±3.54 to 56.11±4.07 kg), while height remained constant. The average body mass index (BMI) of the subjects increased from 19.34 to 19.71 kg/m2, largely due to an increase in total per cent body fat (13.97±2.96% to 16.01±4.28%). Average regional and total BMD values increased over the study period and increases were between 2 and 4%. A majority of subjects (n=7) had a BMI>19 kg/m2, while a sub-group of runners (n=4) had a BMI˂19 kg/m2. Mean trunk, pelvis and spine BMD parameters for the two BMI groups were significantly different (p˂0.05), with reduced BMD values in the lower BMI sub-group. The average T-scores associated with arm BMD were considerably lower than T-scores associated with leg BMD values in the runners. The average T-scores for leg BMD values were almost two standard deviations higher than leg BMD values for a reference population at peak bone mass. Two subjects were osteopenic, resulting in an 18% prevalence rate of osteopenia in the group of runners. Conclusions: The majority of elite runners in this study exhibited a positive trend in BMD parameters. This was reflected as increased total as well as regional BMD values. Increased body mass in addition to the activity of running positively contributed to bone mass via a weight-bearing effect. Increased adipose tissue may also have been a source of endocrine hormones such as estrogen and leptin, which exert a positive effect on bone accrual.