The four studies of this thesis provide an overview of the epidemiology of physical activity in Canada. In the first study two methods of coding activities used in estimating leisure-time physical activity energy expenditure (LTPAEE), from a questionnaire including 21 specific activities, and up to three “other” activities were compared. The authors assessed whether the assignment of activity intensity for “other” activities has an effect on LTPAEE and the classification of respondents as physically active versus inactive. The results indicate that the population classification of activity level is not affected by the intensity code; however, individual level LTPAEE is under-estimated from light and vigorous activities and over-estimated from moderate activities using the current method. In study two the proportion of Canadians meeting Canada’s physical activity guidelines for moderate and vigorous activities was estimated. The prevalence of adults reporting no activity has not changed since 1994/95 and the prevalence of meeting the guidelines has increased by about 11%. Men, younger adults, those with higher income and lower body mass index (BMI) meet the guidelines more often than their peers. The epidemiology of walking among Canadians between 1994 and 2007 was assessed in the third study. Walking was the most popular activity, regardless of age, sex, BMI or income group; however, only 30% of walkers walked regularly. Women, older adults, those with lower BMI and lower household income walk regularly more often than their counterparts. Women, older adults and lower income Canadians tended to derive 100% of their total LTPAEE from walking. An evaluation of whether meeting the guidelines for physical activity was associated with lower odds of chronic conditions and reporting fair/poor health was undertaken in study four. After adjustment for covariates, the odds of type 2 diabetes, obesity and reporting fair/poor health were significantly higher among those not meeting the guidelines for both sexes and for high blood pressure among women. Together these findings provide an understanding of the limitations of estimating LTPAEE, provide estimates of the proportion of Canadians meeting the guidelines for physical activity and provide insight into the relationship between meeting the guidelines and chronic conditions. / Thesis (Ph.D, Kinesiology & Health Studies) -- Queen's University, 2009-06-18 16:18:44.998

Cooperative Extension (CE) is a nationwide system that addresses leading concerns for United States residents from agricultural production to healthy youth development. As 80% of Americans are not meeting the Physical Activity Guidelines (PAG), promoting physical activity is a recent addition to CE priority areas. To build capacity of CE to offer physical activity, training on physical activity within the system is needed. Since yoga is a public health intervention growing in popularity due to its link to flourishing and mental well-being, this is a holistic practice that may target physical and mental health in the United States. Due to the variety of yoga practices one could engage with it is important to clarify the link between physical activity and yoga. This dissertation included four studies to promote physical activity and yoga within CE. Study one established the efficacy of a virtual micro-credentialing program for CE professionals (N = 64) that increased their knowledge about physical activity programming and increased their own physical activity levels. The second study was an iterative and pragmatic investigation of wellness initiatives for CE professionals to increase flourishing and physical activity within themselves. The third study explored the degree to which temperature and tempo of yoga classes impacted measured heart rate and rate of perceived exertion. Preliminary evidence suggests that ~30% of the yoga class contributed to moderate-vigorous physical activity, regardless of the temperature and speed. The fourth study was a systematic appraisal of urban and rural yoga studio offerings. The results included that most studios offer 60-minute classes, focused on asana (movement) rather than the other limbs (components) of yoga. This work also resulted in a studio audit form for CE professionals to assess yoga studios for appropriateness to recommend to their participants. Future work includes scaling out the micro-credentialing program and determining the degree to which knowledge of physical activity leads to physical activity program adoption (study 1); ensuring CE professionals have access to wellness initiatives to avoid burn out (study 2); ongoing investigation of the physiological benefits of yoga (study 3); and testing the utility of the studio audit form (study 4). / Doctor of Philosophy / Physical activity is an important part of living a healthy life and can look different for everyone. The Physical Activity Guidelines for Americans recommend for people to get 2 days of full body strength training along with 150 minutes of moderate intensity aerobic activity each week. Aerobic activity is activity that gets your heart rate up. In the first manuscript of this dissertation, Cooperative Extension professionals were trained in how to promote physical activity and physical activity programming. Cooperative Extension is a nationwide program that helps get research knowledge from the universities to the public. The second manuscript looks at how Cooperative Extension professionals were able to incorporate more mindfulness, yoga, and self-care for themselves through employee wellness programs, and which programs worked best in a practical way. The third manuscript looks at if the physical practice of yoga can increase heart rate to moderate to vigorous intensity zones in order to determine if a typical community-based yoga flow could contribute to meeting the aerobic components of the Physical Activity Guidelines. Based on this study, yoga can help participants get into the moderate intensity aerobic activity zone. The fourth manuscript explores the research and development of a yoga studio audit tool. This tool helps assess yoga studios so that public health professionals can recommend the studio that is the right fit for their clients.

Engaging in regular physical activity is important for maintaining and improving health. Unfortunately, most college students fail to meet the recommendations for both aerobic and muscle-strengthening physical activity guidelines (PAGs). Psychosocial factors described within the social cognitive theory are related to the acquisition and retention of physical activity behaviors. The purpose of this study was to examine the relations of gender, self-efficacy, outcome expectancies, and social support with college students meeting aerobic, muscle-strengthening and both PAGs. Participants (N = 396) completed online questionnaires assessing their physical activity behaviors, exercise self-efficacy, outcome expectancies, and social support. Self-reported physical activity was classified as meeting / not meeting PAGs. Using gender, exercise self-efficacy, outcome expectancies, and social support as predictors, separate logistic regressions were used to examine their relations with the three PAG classifications. Analyses revealed that being male and level of social support increased the odds of meeting muscle-strengthening PAGs, but students’ level of self-efficacy and outcome expectations increased the odds of meeting all three PAG classifications. These findings indicate that interventions designed to increase self-efficacy and outcome expectancy may be beneficial for increasing college students’ physical activity for meeting the PAGs. Promotion of muscle-strengthening activities targeted at young women is also warranted.

Problem: Mostly attributed to lack of time, only about 15% of Canadian adults are currently reaching the Canadian Physical Activity Guidelines (CPAG). Recently, studies have suggested that any bout of aerobic exercise reaching moderate to vigorous intensity has the potential to improve health. Methods: Sixty adults (20 young non-overweight adults, 20 overweight adults, 20 older adults) already doing some resistance training (RT) were recruited. Participants performed eight RT exercises during three visits. The objective was to identify the proportion of time spent at moderate to vigorous intensity during RT sessions. Results: Overall, the participants were at moderate to vigorous intensity during 82% of the time. However, the older adult group compared to the young adult group spent lower proportion of time at moderate to vigorous intensity during RT sessions. Conclusion: Most Canadian adults can reach HR equivalent to those achieved during moderate to vigorous aerobic activity by doing RT.

In 2011, the United Kingdom (U.K.) physical activity (PA) guidelines were updated. The adult moderate-to-vigorous intensity PA (MVPA) recommendation changed to reflect that different frequency and intensity permutations lead to equivalent health benefits. New recommendations were added for muscle strengthening activities (MSA) and the reduction of sedentary time (ST). Those over 65 years were also recommended to undertake balance and co-ordination activities (BCA). Despite these new additions, Scottish PA policy still concentrated on MVPA, with considerable resources allocated to sport and some exercise activities. Since 2012, the Scottish Health Survey (SHeS) has collected data relating to these new recommendations annually, but few analyses have been undertaken. This thesis contains the most comprehensive analyses of the 2012-15 SHeS PA and ST data to date, and a review into whether the method produces valid and reliable estimates. The aim of this thesis was to inform Scottish PA and sedentary behaviour policy by producing research to support the incorporation of these new recommendations and the promotion of non-sport-related MVPA policies. It also aimed to inform any future developments to PA and ST surveillance in Scotland. The first three studies of this thesis are cross-sectional analyses of the updated recommendations for adults in Scotland. They present prevalence and participation data in specific domains, activities, and behaviours by age and sex. The main findings were that (1) sport was a minority contributor to the total MVPA of adults in Scotland, regardless of sex, age, or activity status (never more than 20%), (2) compliance with the MSA recommendation was approximately half that of the MVPA recommendation (31% of men and 24% of women), and compliance with the BCA recommendation amongst those over 65 years was very low (19% of older men and 12% of older women), and (3) middle-aged adults in work reported a comparable amount of weekday ST to adults over 75 years (7-8 hours per day). The fourth study was a review of the available evidence into whether the PA and ST estimates produced by the 2012-15 SHeS were valid and reliable. The SHeS was found to be fit for purpose, but recommendations were made regarding the analysis and interpretation of the data to minimise areas of concern. These were (1) analyse MVPA data with and without the domain of occupational MVPA, (2) make it clear that only sport and exercise activities can contribute to achieving the MSA and BCA recommendations under the SHeS method, and (3) focus on the comparisons between groups in relation to ST, rather than on the absolute values. The fifth study used the findings from the previous four to inform the design of a prospective cohort study that will investigate the joint effects of MVPA and total ST on all-cause mortality, cardiovascular disease, cancer, and diabetes. This thesis contains the results of the preliminary analyses. This study is designed to inform policy by providing novel information on how the combination of these behaviours affects health outcomes in a representative sample of Scottish adults. There is clear evidence that this work has already informed policy and surveillance. The work on the relative contribution of the domains of MVPA is regularly cited in evidence briefings for the Scottish Government and the Scottish Parliament. This has increased the awareness amongst key policy-makers that sport is not a major contributor to the total MVPA of adults in Scotland. The work on MSA, BCA, and ST was a catalyst for a proposal to include indicators relating to these recommendations on the national PA monitoring framework. The work on MSA and BCA has also been a key reference text in preparation for the next update to the U.K. PA guidelines, stressing the need to consider surveillance at an early stage. In summary, the novel analyses of SHeS data undertaken for this thesis have demonstrably informed PA and sedentary behaviour policy and surveillance in Scotland.

Background: Hispanics are the largest minority group in the U.S. and by the year 2060 the number of Hispanics is projected to double. They are disproportionately affected by obesity and chronic diseases which translate into decreased quality of life, loss of work opportunities and perceptions of injustice for the Hispanic population. The Dietary Guidelines (DG) provide information to help Americans make healthy food and physical activity choices and if followed can be a means of reducing the health disparity gap. However, culturally relevant recommendations specific to Hispanics’ health and nutritional habits are often lacking. The purpose of this study was to examine Hispanics’ knowledge, perceptions, benefits and barriers to the recommendations in the DG for Americans, Choose MyPlate, and the Department of Health and Human Services physical activity guidelines. Methods: A qualitative research design was used. Focus groups were conducted in Spanish and audiotapes were transcribed and then, translated into English. Thematic analysis was used to identify different key concepts subgrouping these topics according to common emergent themes. Results: A total of 24 participants took part in the study. Participants viewed healthy eating in terms of portion sizes. They viewed the DG as helpful but felt they needed more information to follow the guidelines. Several barriers were identified in following the MyPlate: lack of availability of healthy, fresh, inexpensive grocery options in Hispanic neighborhoods. Participants described the benefits of physical activity as related to improved mental health and quality of life such as looking and feeling better. Conclusion and Implications: Promoting nutrition education that is culturally and linguistically appropriate for Hispanics might help facilitate the adoption of the DG and MyPlate recommendations. Also, improving the design of existing low-income neighborhoods is still a challenge to improve participation in physical activity among Hispanics’.

Fatigue is a prevalent and debilitating symptom that affects up to 97% of individuals with multiple sclerosis (MS). It can negatively influence the socioeconomic status, activities of daily living and quality of life for the affected individuals. Fatigue is multidimensional and abstract, thereby making it complex to understand, target and treat. Over the past 20 years, physical activity has become more recognized as a management method that could help with the alleviation of fatigue. One of the reasons could be due to the anti-inflammatory effects of exercise. However, due to the multi-factorial nature of fatigue and the heterogeneity of the training intervention protocols, the potential mechanisms that underlie the relationship between fatigue and exercise are still not fully understood. In 2013, Latimer-Cheung and colleagues developed an evidence based physical activity guideline (PAGs) for people with MS. Since then, studies have shown consistent beneficial effects of exercise on reducing fatigue in people with MS by adhering to the PAGs. To date, however, there are no published studies that examined the potential mechanism that underlie the beneficial effect of the PAGs on reducing fatigue. The primary purpose of this thesis was to evaluate the effects of adhering to the PAGs on fatigue in people with MS and to assess whether any exercise-induced changes in fatigue were associated with changes in inflammatory cytokines. The secondary purpose of this thesis was to evaluate the effects of exercise on depression, strength, aerobic fitness, muscular endurance and quality of life. This study had a wait-list control design. Participants with relapse remitting multiple sclerosis (RRMS) were recruited and randomized to begin with either a 12-week supervised exercise training program (G1) or a wait-list control period (G2). The training program involved at least 30 minutes aerobic training and resistance training for major muscle groups twice per week. The G2 group maintained their regular lifestyle. After 12 weeks, G1 reverted back to their usual lifestyle and G2 began their 12-week supervised exercise training. Following training, we found a reduction in fatigue and depression with increased strength and quality of life. No changes were observed in pro-inflammatory cytokines, aerobic fitness or muscular endurance. This is the first study that examined the underlying potential mechanism for the beneficial effects of exercise by adhering to the PAGs. Following the PAGs for 12 weeks results in significant improvements in fatigue, depression, strength and quality of life. However, our results do not support the role of inflammatory cytokines in mediating these improvements. / Thesis / Master of Science in Kinesiology

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