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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.

Regular physical activity is significant for overall health and can reduce the risk of chronic disease and health related conditions. Individuals with central nervous system CNS lesions experience impairments that limit their participation in physical activity and reduce quality of life; therefore it is even more important to understand the relationship between the barriers and affordances to engaging in physical activity for this cohort. The current study has uniquely identified a population (n= 11) based on the common experience of spasticity in the lower limb resulting from an CNS lesion across multiple diagnostic categories and used the International Classification of Functioning, Disability and Health model (ICF) (WHO, 2001) to characterize the impairments in body structure and functions, activities and contextual factors to better understand their influence on physical activity levels in this cohort. The findings showed that each individual experienced physical impairments for multiple body functions and structures comprising reduced ankle range of motion (M= 9.98 PlantarFlexion), spasticity as measured by the Ankle Plantar Flexor Tone Scale (middle ankle range resistance M= 1.56, stretch reflex M= 1.64) as well as some reports of pain on a Visual Analog Scale (Usual, M =1.10, and Worst pain, M= 1.64). On average the cohort presented with mild to moderate impairments in their mobility as measured by Timed Up and Go (M= 28.28 seconds), walking velocity (M= 74.94cm/sec Gaitrite mat) and falls (M= .91). Findings from both the Physical Survey for Individuals with Physical Disabilities (PASIPD) and semi-structured interviews suggest that participation in physical activity was low across life roles including areas of work and employment, recreation and leisure, domestic life and selfcare. The physical component summary (PCS) scores of the Short-Form 36 Version 2 Quality of life Survey were lower than average norms (M=38.12, SD=7.53), while the mental components summary (MCS) scores were on par with average ranges (M=50.61, SD=10.02); however the overall MCS score was slightly higher than the trend reflected in the mental health sub-scores which ranged from between slightly below average to average. Clearly aligning with the ICF model, the volume and intensity of physical activity was hampered by physical impairments, fear of falling, cost of activities, poor weather, a lack of transportation, and cut backs to services as reported in the semi-structured interviews. However, the quantitative relationships between the domains of the ICF were less obvious. Through qualitative interviews the participants’ positive outlook toward participating in life roles was strongly expressed. Despite barriers, individuals were finding ways to be somewhat active and were motivated to do more and overcome their functional limitations. / Graduate

Work may be a potential source of physical activity for adults with ID, and therefore may be beneficial to their health. Using a cross-sectional descriptive research design this study examined the contribution of work to the overall physical activity levels of adults with intellectual disabilities. GT3X Actigraph accelerometers were used to measure the physical activity intensity levels of six employed adults with intellectual disabilities over eight consecutive days. Intensity levels were categorized into sedentary, light, or moderate-to-vigorous physical activity (MVPA). The overall physical activity levels were determined to establish whether participants met the Canadian physical activity guidelines for adults. In addition physical activity levels during work were compared to physical activity during non-work. Five out of the six participants met the Canadian physical activity guidelines of 150 minutes of MVPA per week. There were no significant differences between the amount of sedentary, light or MVPA during participant’s work and non-work. There were, however, medium and large effect sizes for physical activity levels during work versus non-work, showing that work had a substantial impact on physical activity behaviours. / Graduate / 0566

An examination of data from 21 older members of the University community aged 59 and older, including those who do and those who do not use the campus gyms, and six athletic programming staff from the two facilities to attempt to understand how older adults choose to negotiate their physical activity as they age. The study demonstrates that those respondents most comfortable in the gym spaces in the university setting are those who have occupied those spaces over many years, or those who have been habituated to gym culture through their activities outside the university setting. Using the ’mask of ageing theory’ in combination with Bourdieu’s concepts of habitus, capital and field, this study is an attempt to understand the individual and cultural practices that older adults engage in to manage their physical activities at the University, their other activities outside, as well as the performative aspects of their engagement.

An examination of data from 21 older members of the University community aged 59 and older, including those who do and those who do not use the campus gyms, and six athletic programming staff from the two facilities to attempt to understand how older adults choose to negotiate their physical activity as they age. The study demonstrates that those respondents most comfortable in the gym spaces in the university setting are those who have occupied those spaces over many years, or those who have been habituated to gym culture through their activities outside the university setting. Using the ’mask of ageing theory’ in combination with Bourdieu’s concepts of habitus, capital and field, this study is an attempt to understand the individual and cultural practices that older adults engage in to manage their physical activities at the University, their other activities outside, as well as the performative aspects of their engagement.

Background: The prevalence of childhood overweight and obesity is increasing worldwide. One main determinant of overweight and obesity is inactivity. Little is known about the factors that influence physical activity and sedentary behaviour among young children. Seasonal variation was examined as a correlate of physical activity in both a literature review and in a sample of pre-school children in Edmonton, Alberta. Neighbourhood socioeconomic status (SES) was examined as a correlate of screen time use in the same sample of children. Methods: For study 1, databases were searched for studies on seasonal variation in physical activity levels. Studies 2 and 3 involved a sample of 4- and 5-year-old children, who were attending a health center in and around Edmonton, Alberta for preschool immunization between November, 2005 and August, 2007. Parents provided proxy reports of their children’s screen time viewing and physical activity. Height and weight were measured by a trained health assistant and body mass index (BMI) was calculated. Children’s postal codes were retrieved from health records to calculate neighbourhood SES through census data. The month the proxy report was completed was used to determine seasonality. Several regression models were constructed to examine relationships between variables in studies 2 and 3. Results: The review of literature revealed that 83% (29/35) of the studies found seasonal variation in physical activity among children and/or adolescents. For study 2, total physical activity as well as active play, weekday and weekend minutes were highest in the summer and lowest in the winter. Finally, neighbourhood SES was a predictor of screen time and TV/video use for girls but not for boys in study 3. Conclusion: Some consideration should be given to increasing physical activity opportunities in the winter for children, especially in areas of the world that experience extreme winter conditions. As well some consideration should be given to providing alternative activity opportunities for young girls who live in lower SES neighbourhoods.

Objectives: This study specifically focused on health promotion and physical activity in midlife women. Health promotion in midlife women was examined to determine if exercise could improve the menopausal symptoms and health status in midlife women and if a multi-modal intervention might improve the level of activity in midlife women. The objectives of the study included 1) To identify the relationship between physical activity, menopausal symptoms and health status in midlife women, and 2) To determine the effect of a multi-modal intervention on increasing levels of exercise in midlife women. Methods: The study was conducted in two phases. The first phase included a secondary data analysis of 886 women who took part in the Queensland Midlife Women Health Survey (QMWHS) aged 45-60 years, who were randomly selected from South-East Queensland. In the second phase a randomised, controlled study was conducted on a subset of women who participated in the QMWHS. Women who were allocated to the intervention group (n=47) received an intervention, which combined a multi-modal program of physical activity with health education. Women in the control group continued their normal physical activities (n=66). Results: Findings of this study indicated that increasing exercise was associated with lower psychological and somatic symptoms in midlife women. The study found that exercise was associated with decreasing menopausal symptoms. In the area of health status, significant differences were found between exercise and mental health, vitality, general health and physical function. This study revealed that a multi modal intervention could increase the level of activity in midlife women. There were significant differences in monthly exercise and vigorous activity between the intervention and control groups 3 months after the intervention. Women stated that they felt physical and mentally better and the program motivated them into being more active. They mentioned that the program was easy to understand and follow and the concept of the program was well organized and useful for them. Conclusion: This study showed that exercise might provide a wider health effect on midlife women's health by decreasing menopausal symptoms and improving health status. Exercise counselling is an essential component of healthcare, especially among middle-aged women who are experiencing physical, emotional, and social changes. Health professionals and nurses are in a good position to assist midlife women through providing information about the health effect of exercise. Physical activity should be encouraged for the prevention and reduction of risks for chronic disease and the improvement of health in midlife women. The multi-modal program was effective in increasing levels of activity in midlife women. This is an important finding as exercise is difficult health behaviour to change. Study implications suggest that this type of intervention may provide an effective, clinically manageable therapy for women who choose a self-directed approach to increase their level of activity. This program may offer implications for designing and implementing exercise interventions in further studies.

Introduction Globally stroke remains the leading cause of adult disability. An aging population and a reduction in stroke case fatality has led to an increasing number of people living with stroke i.e. stroke survivors. The ability to perform important day-to-day activities, such as walking and housework, is frequently impaired in stroke survivors. Therefore, it has become essential to address the long-term needs of stroke survivors, prompting focussed research on life after stroke. A reduction in physical fitness after stroke may contribute to stroke related disability. It is possible to improve physical fitness by regular, structured physical activity. Improving physical fitness after stroke and increasing physical activity are aspects of life after stroke that are increasingly being researched. Although the evidence base for the benefits of physical fitness training is growing, research has indicated that benefits gained are not always maintained at follow-up. To facilitate the uptake and maintenance of physical activity after stroke, it is essential to understand why many stroke survivors do not undertake regular physical activity. Understanding this difficult concept will enable the tailoring of behaviour change interventions to promote and maintain physical activity after stroke. However, there has been limited work in developing theory driven behaviour change interventions to increase physical activity in stroke survivors. Therefore, the aim of this thesis was to develop and test a behaviour change intervention to increase physical activity after stroke. Methods In order to address the above aim, six interlinking studies were conducted within the development and feasibility stages of the MRC framework for the development of complex interventions. A systematic review (study one) examined barriers and facilitators to physical activity perceived by stroke survivors. This study showed a lack of literature in this area, and that the already published studies had limited generalisability to the UK stroke population. Therefore, it was deemed appropriate to conduct a qualitative study (study two) to examine the perceived barriers and facilitators to physical activity in the local stroke population. Both studies one and two highlighted the influence of self-efficacy towards increasing physical activity. As part of earlier work conducted prior to this PhD, there was previously unanalysed data on perceived barriers and facilitators to physical activity after stroke. These quantitative data encompassed specific questions exploring self-efficacy and intention to physical activity post stroke. In light of the evidence it was deemed necessary to analyse these data (study three). It was envisaged that the behaviour change intervention would incorporate a feedback device, so participants could clearly see how much daily physical activity they were undertaking. An opportunity arose to collaborate with a team at Newcastle University who had developed an accelerometer that incorporated an immediate feedback screen. Therefore, a device validation study was conducted as study four. Results from studies one to four were combined, with the use of the Theoretical Domains Framework, and the behaviour change intervention was developed. Two uncontrolled pilot studies (studies five and six) were conducted to determine the feasibility and acceptability of the behaviour change intervention to the stroke population. Results The systematic review included six articles, providing data on 174 stroke survivors. Commonly reported barriers were environmental factors, health concerns and stroke impairments. Commonly reported facilitators were social support and the need to be able to perform daily tasks. Qualitative interviews were conducted with 13 stroke survivors, at which point data saturation was reached. The most commonly reported TDF domains were ‘beliefs about capabilities’, ‘environmental context and resources’ and ‘social influence’. The quantitative study provided data from 50 stroke survivors. Intention and self-efficacy were high, with self-efficacy graded as either 4 or 5 (highly confident) on a five-point scale by [34 (68%)] participants, whilst 42 (84%) participants “strongly agreed” or “agreed” that they intended to increase their walking after their stroke. Ten participants were recruited to validate the new accelerometer. Mean time since stroke was 29 days (SD =27.9 days). The 10 participants walked a mean distance of 245 meters (SD=129m) and their mean walking speed was 0.79ms-1 (SD=0.34ms-1). The Culture Lab were unable to develop the accelerometer in the necessary time frame and therefore no accelerometer was available for trialling the behaviour change intervention. Therefore, pedometers were used to record step count during the behaviour change intervention. A total of four participants took part in the 12 week behaviour change intervention, over two study periods. All participants managed to increase their step counts during this time. The studies had problems both with recruitment and retention of participants. These issues have been discussed. Conclusions This work has enhanced the understanding of the barriers and facilitators perceived by stroke survivors to increase physical activity. This work has allowed the development of a theoretically driven, complex behaviour change intervention that was successfully trialled with a small group of stroke survivors. Areas of further research have been discussed.

Doctor of Philosophy / Department of Kinesiology / David Dzewaltowski / Emily Mailey / Despite health benefits of physical activity (PA) in youth, worldwide estimates indicate that only 10% of children meet recommended PA guidelines of 60 minutes of moderate-to-vigorous physical activity (MVPA) per day.¹,² The places where children go to live, learn, and play influence the amount of PA children accrue,³,⁴ therefore, purpose of this dissertation was to examine social contexts of youth settings and describe contextual influences on youth PA. Chapters one and two address the methods of direct observation (DO) used to characterize contextual influences on youth PA. Chapter 1 serves as a review of the methods of current DO systems, and Chapter 2 describes the implications of using different methods to characterize contexts and PA in youth settings. Using youth sport (YS) as an example, we examined the distinct types of data that resulted from two DO systems, and discussed implications for describing influences of children’s PA. Little is known about the distribution of PA among children within setting time, such as whether social contexts promote inequalities in PA where some children are very active and others are inactive. Therefore, the purpose of the study in Chapter 3 was to describe the distribution of PA during time segmented YS practices and identify whether inequalities in PA exist. We hypothesized that inequality would vary between time segments of different contexts, specifically, that segments that fostered inclusion (i.e., optimal demand) would have lower inequality than segments that fostered exclusion (i.e., disadvantaged demand). We found that inequality in PA was varied between segment types and that social contexts of task (i.e., purpose of the segment time) and demand influenced inequality in PA. To create improvements in child population PA, we propose researchers and practitioners should focus not only on the mean PA of setting time, but also on the distribution of PA within setting time. Chapter 4 focuses on the social structure of relationships within a school district that may influence implementation of wellness policies within school systems. The study described a method and investigated the social structure between school district wellness committees and their associated elementary schools. Results of the study showed variability in the pattern of social structure between and within school districts, with some districts having a social structure with representation of schools on the district wellness committee, and other districts with no representation. As social structure characteristics influence the implementation of policies and practices within social systems, these characteristics should be investigated by researchers, and should be used to enhance implementation, rather than be disregarded. In conclusion, this dissertation provided recommendations for describing the social contexts of youth settings, provided preliminary evidence that social contexts influence the amount and distribution of PA within youth settings, and that social contexts are highly variable within and between settings. Further research is needed to find the combination of social contexts most conducive to youth PA, and future researchers should consider social contexts when designing and implementing interventions for improving youth PA within settings.