Introduction Physical inactivity is a major cause of reduced quality of life, as well as many common diseases and even premature death. Most people, globally, are scarcely or rarely physically active. Consequently, physical inactivity influences the burden of disease, and increases its societal costs. In view of this, it is necessary to ask how health care should respond when the population and the patients are either inactive or rarely physically active. Cost-effectiveness analyses of the promotion of physical activity in health care can contribute substantially to health care policy. Aims The overall aim of this thesis was to investigate the cost-effectiveness of physical activity promotion in the health care system. The specific aims were: (I) to provide a model for analyzing cost-effectiveness and equity in health for community-promoted physical activity, (II) to review current knowledge about the cost-effectiveness of health care based interventions aimed at improving physical activity, (III) to evaluate the cost effectiveness of physical activity promotion as a treatment method in primary health care, (IV) to illustrate the importance of enjoyment of exercise in interventions aimed at promoting physical activity, and (V) to describe a method of valuing the time spent on exercise. Methods Standard methods for economic evaluation were studied and adapted to create a model for the evaluation of physical activity promotion (I). Relevant databases were searched for published articles, and the articles found were analyzed using this economic evaluation model (II). A trial in primary health care was evaluated in a cost-utility analysis based on the model (III). In the same trial, the association between time spent on exercise and enjoyment of exercise was analyzed (IV). A model for valuing the time spent on exercise was developed based on existing approaches to the valuation of time, and used in two different groups of exercisers; experienced and inexperienced (V). Results An economic evaluation model was developed, as was a model to calculate an intervention’s effect on equity in health (I). In total, 26 articles were found regarding the cost-effectiveness of physical activity promotion in health care, and 20 of these described interventions, which the authors considered to be cost-effective (II). The treatment of patients in primary health care by the promotion of physical activity was shown to be cost-effective (III). For the same group of patients, time spent on exercise was associated with enjoyment of exercise (IV). A model for valuing the time spent on exercise was developed and used. Time costs were significantly higher among inexperienced exercisers (V). Conclusions There are many examples of interventions promoting physical activity that may be regarded as cost-effective. In general, it seems to be cost effective to promote physical activity among patients with increased risk, or who manifest poor health associated with physical inactivity. Unfortunately, there is still little evidence of when physical activity should be used, or what the best design of such an intervention might be. Although there is still a need for stronger evidence, the Swedish health care system should use the promotion of physical activity as a standard method among the following patients: • those who manifest increased risk (such as high blood pressure) of ill health due to a physically inactive lifestyle; • frail older people, especially those with increased risk of fall injuries; • those requiring rehabilitation after heart failure.

The use of group dynamics principles such as group goal-setting, distinctiveness and cohesion has been the basis of a burgeoning area of physical activity (PA) promotion. Recent reviews of literature suggest that these interventions are robust and increase PA in a wide variety of populations. Still, a number of questions remain unanswered in the areas of theory development, intervention implementation, and translation of research into practice. This dissertation includes a series of manuscripts that focus on research, theory, and practice of group dynamics interventions intended to promote PA. Within research, a systematic review of literature explores group dynamics-based PA interventions in terms of generalizability (through RE-AIM evaluation) and the degree to which the interventions use research techniques that are more pragmatic (reflect typical practice) or more explanatory (testing under optimal conditions). This exploration is based on an initial review of 17 interventions that employ group dynamics strategies to increase PA, fitness, and/or adherence. The results suggest that this body of literature includes a range of pragmatic and explanatory trials, but still has gaps in reporting related to external validity. Embedded within the context of a PA promotion program for minority women, the second manuscript addresses a theory-based question—to what degree do group-interaction variables (cooperation, communication, and competition) differentially predict group cohesion over time. The results suggest that friendly competition is the strongest and most consistent predictor of different dimensions of group cohesion while task and socially related communication are consistent predictors of task and socially related cohesion, respectively. Two manuscripts are included in addressing the use of group dynamics principles within practice settings. The first practice manuscript details a small pilot study in which obese, limited income women successfully (p<0.05) limited gestational weight gain to the Institute of Medicine (2009) recommendation of 11-20 pounds. This study attempted to integrate a group dynamics approach into a group visit model for pregnant women. The quantitative findings were promising, but qualitative findings indicated a number of difficulties in implementation. The purpose of the final manuscript was to determine the attributes of the program agents consider when deciding to adopt a PA and fruit and vegetable promotion program and their understanding of key strategies related to group dynamics theory. Delivery agents were able to identify key underlying principles and propose adaptations that align with those principles. / Ph. D.

Given the high prevalence of physical inactivity, effective strategies are urgently needed to increase physical activity levels among youth, especially those most at risk for inactivity including adolescent girls, older adolescents, and youth from low socioeconomic status households. A clear understanding of the factors associated with physical activity among youth is needed to design effective interventions. Physical activity is a complex behaviour that is influenced by intrapersonal, interpersonal, and environmental factors. Most recently, emphasis has been placed on the environmental correlates of youth physical activity. One consistent finding is that access to recreation facilities and opportunities to be active are positively associated with youths’ physical activity participation. Environmental interventions, which are often community-based, hold particular promise of instilling population-wide change. Yet, to date, little information is available about the effectiveness of environmental interventions to enhance youth physical activity in community settings. The manuscript presented in Chapter 3 of this thesis addresses these gaps in knowledge by providing evidence about a community-based initiative designed to increase access to recreation facilities by eliminating facility user-fees for youth. More specifically, recreation facility use among adolescents (n=1261; Mage = 14.97 ± 0.39; 46.3% girls) was objectively measured and the factors associated with the use of recreation facilities were examined. A total of 200 students accessed at least one facility. Results revealed that the likelihood of the best multilevel model examining pass use was 13 times larger than a model that included only individual-level predictors (p< 0.01). Pass users were more likely to: attend schools that were only a short distance away from facilities (OR=0.90 p< 0.01), be active (OR=1.69, p< 0.05), rate their health as fair (OR=2.32, p< 0.05), report homework as a barrier (OR=1.84, p< 0.01) and to have used facilities previously (OR=2.01, p< 0.05). Overall, results suggest that providing free access may be insufficient to enable adolescents to use recreation facilities. Furthermore, an ecological model should be used when designing interventions that aim to increase adolescents’ use of facilities. The implications of this study for research and practice will be outlined. Although further research is greatly needed to enhance our understanding of youths’ behaviours in order to develop effective interventions, the challenges associated with conducting research involving youth can deter researchers from investigating this population. In particular, several researchers have highlighted the methodological and ethical concerns of school-based research. These issues and their implications will be discussed in Chapter 4 of this thesis. Lastly, recommendations to help reduce the challenges of school-based research will be presented. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2010-09-24 22:15:55.972

Regular moderate-vigorous physical activity (MVPA) is associated with significant physiological and psychological health benefits (Department of Health, DoH, 2004). However, many children are not undertaking recommended levels of physical activity (PA) (DoH, 2009). This research examined relationships between physiological health parameters, psychological determinants and PA levels in 10-14 year old schoolchildren (N = 249) and assessed the influence of three school-based PA interventions on these constructs in the context of the Health And Physical activity Promotion in Youth (HAPPY) study. Study 1 revealed that sedentary behaviours, moderate PA (MPA), vigorous PA (VPA) and MVPA levels were higher on weekdays than weekend days (p < .001). However, schoolchildren’s PA is often difficult to measure accurately. The self-report measure utilised in study 2 underestimated total MVPA versus accelerometry for both sexes on weekdays and girls on weekend days (p < .01). However, study 3 highlighted a lack of agreement between two RT3® triaxial accelerometer cut-offs for all activity categories. The importance of VPA for promoting health was highlighted in the updated PA guidelines (DoH, 2011). Study 4 reported that cardiorespiratory fitness (CRF) was positively associated with VPA but not MPA (β = .27, p < .01) and inversely correlated with measures of body composition (% body fat; body mass index; waist circumference) (r = -.74, r = -.60, r = -.39, p < .001). Knowing the health benefits of regular MVPA and VPA, it is important to understand the determinants of PA intentions and behaviours to more effectively promote PA in less active children (studies 5 and 6). An exploratory analysis of the constructs in the Revised Theory of Planned Behaviour and the Modified Social Learning Theory for children predicted PA intentions (R2 = .38, F(5, 171) = 20.19, p < .001; R2 = .13, F(6, 147) = 3.4, p < .01, respectively) but the constructs in either model were unable to predict PA. Recognising the need to promote PA levels, study 7 investigated the effectiveness of three school-based interventions (vs. control) on outcome variables included in studies 1, and 4-6. The Health Education and Psychology Health Promotion conditions produced significant positive change scores between data collection 2 and 3 for CRF (vs. control) whereas the Youth-Led condition produced significant change scores between baseline and data collection 2 for generalised self-efficacy (vs. control). No significant change scores were reported for PA, the RTPB constructs or intentions. In conclusion, this research has emphasised the importance of employing a multidisciplinary approach to aid understanding of schoolchildren’s PA levels. Specific highlights include low weekend day PA as a possible future PA promotion target, although it is vital that accelerometry cut-points are standardised, and the relevance of VPA and body composition in predicting CRF. The psychological models identified some important determinants of PA intentions, but a prominent intention-behaviour gap and a need for more intensive interventions to promote PA levels was apparent.

Die Wirkung regelmäßiger körperlicher Aktivität auf die Gesundheit ist mittlerweile umfangreich dokumentiert. Während die Evidenz zur Wirksamkeit regelmäßiger Aktivität auf verschiedene Gesundheitsparameter eindeutig ist, sind Maßnahmen zur Förderung ei-nes körperlich aktiven Lebensstils häufig nur begrenzt wirksam. Das Ziel der vorliegenden Arbeit ist es, einen wissenschaftlichen Beitrag zur Weiterentwicklung psychologischer Interventionen zur Förderung eines körperlich aktiven Lebensstils und der psychischen Gesundheit zu leisten. Basierend auf dem Interventionsansatz der Gesundheitskommunika-tion werden die Vor- und Nachteile zielgruppenspezifischer, maßgeschneiderter und inter-personeller Ansätze zur Förderung regelmäßiger körperlicher Aktivität diskutiert und schwerpunktmäßig Persönlichkeitsmerkmale als Moderatoren von Gesundheitsbotschaften untersucht. Persönlichkeitsmerkmale wurden für die Bildung von Zielgruppen bisher kaum berücksichtigt. Die Ergebnisse der eigenen Arbeiten weisen darauf hin, dass Persönlich-keitsmerkmale die Wirkung von Gesundheitskommunikation auf die Motivation, das Ver-halten zu zeigen, moderieren. Eine Anpassung von Gesundheitskommunikation an Persön-lichkeitsmerkmale scheint daher eine Option für maßgeschneiderte Botschaften zu sein. Für die regelmäßige Durchführung körperlicher Aktivität ist neben einer ausgeprägten Motivation die Selbstregulation relevant. Exekutive Funktionen bilden die biologische Basis der Fähigkeit zur Selbstregulation und können durch körperliche Aktivität gefördert werden. Die Ergebnisse der eigenen Arbeiten zeigen an Probanden des höheren Erwachse-nenalters, dass die körperliche Fitness als Mediator zwischen der körperlichen Aktivität und der kognitiven Funktionsfähigkeit gesehen werden kann. In einer randomisierten und kontrollierten Studie konnte durch ein multimodales Gesundheitssportprogramm im Ver-gleich zu einer inaktiven Kontrollgruppe dagegen kein Effekt der Bewegungsintervention auf die kognitive Funktionsfähigkeit nachgewiesen werden. Die Ergebnisse werden kritisch diskutiert und in den Forschungsstand eingeordnet. Abschließend wird ein integratives Modell der Gesundheitsförderung durch körperli-che Aktivität am Beispiel der Gesundheitskommunikation dargestellt, das neben gängigen sozial-kognitiven Variablen Umweltfaktoren sowie exekutive Funktionen und neurokogni-tive Variablen einbezieht. Für die empirische Überprüfung dieses Modells ist die Integrati-on von Forschungsansätzen der Verhaltens-, Kommunikations- und Neurowissenschaften gefragt. Basierend auf diesem Modell werden zukünftige Forschungsfelder und praktische Ableitungen aufgezeigt.

Die Wirkung regelmäßiger körperlicher Aktivität auf die Gesundheit ist mittlerweile umfangreich dokumentiert. Während die Evidenz zur Wirksamkeit regelmäßiger Aktivität auf verschiedene Gesundheitsparameter eindeutig ist, sind Maßnahmen zur Förderung ei-nes körperlich aktiven Lebensstils häufig nur begrenzt wirksam. Das Ziel der vorliegenden Arbeit ist es, einen wissenschaftlichen Beitrag zur Weiterentwicklung psychologischer Interventionen zur Förderung eines körperlich aktiven Lebensstils und der psychischen Gesundheit zu leisten. Basierend auf dem Interventionsansatz der Gesundheitskommunika-tion werden die Vor- und Nachteile zielgruppenspezifischer, maßgeschneiderter und inter-personeller Ansätze zur Förderung regelmäßiger körperlicher Aktivität diskutiert und schwerpunktmäßig Persönlichkeitsmerkmale als Moderatoren von Gesundheitsbotschaften untersucht. Persönlichkeitsmerkmale wurden für die Bildung von Zielgruppen bisher kaum berücksichtigt. Die Ergebnisse der eigenen Arbeiten weisen darauf hin, dass Persönlich-keitsmerkmale die Wirkung von Gesundheitskommunikation auf die Motivation, das Ver-halten zu zeigen, moderieren. Eine Anpassung von Gesundheitskommunikation an Persön-lichkeitsmerkmale scheint daher eine Option für maßgeschneiderte Botschaften zu sein. Für die regelmäßige Durchführung körperlicher Aktivität ist neben einer ausgeprägten Motivation die Selbstregulation relevant. Exekutive Funktionen bilden die biologische Basis der Fähigkeit zur Selbstregulation und können durch körperliche Aktivität gefördert werden. Die Ergebnisse der eigenen Arbeiten zeigen an Probanden des höheren Erwachse-nenalters, dass die körperliche Fitness als Mediator zwischen der körperlichen Aktivität und der kognitiven Funktionsfähigkeit gesehen werden kann. In einer randomisierten und kontrollierten Studie konnte durch ein multimodales Gesundheitssportprogramm im Ver-gleich zu einer inaktiven Kontrollgruppe dagegen kein Effekt der Bewegungsintervention auf die kognitive Funktionsfähigkeit nachgewiesen werden. Die Ergebnisse werden kritisch diskutiert und in den Forschungsstand eingeordnet. Abschließend wird ein integratives Modell der Gesundheitsförderung durch körperli-che Aktivität am Beispiel der Gesundheitskommunikation dargestellt, das neben gängigen sozial-kognitiven Variablen Umweltfaktoren sowie exekutive Funktionen und neurokogni-tive Variablen einbezieht. Für die empirische Überprüfung dieses Modells ist die Integrati-on von Forschungsansätzen der Verhaltens-, Kommunikations- und Neurowissenschaften gefragt. Basierend auf diesem Modell werden zukünftige Forschungsfelder und praktische Ableitungen aufgezeigt.

Les maladies non transmissibles sont en forte hausse au Québec. La pratique régulière d’activités physiques (AP) permet d’agir en amont et de contribuer à la prévention de plusieurs de ces maladies. Cependant, une grande proportion de la population québécoise n’est pas suffisamment active pour en retirer des bienfaits pour sa santé. Plusieurs études portant sur l’efficacité des interventions de sensibilisation et de promotion de l’AP(SPAP) ont montré que les médecins omnipraticiens peuvent avoir une influence non négligeable sur le niveau de pratique d’AP de la population. Peu d’études à ce jour ont examiné la pratique de SPAP des médecins omnipraticiens du Québec auprès de leurs patients et quels sont les freins et facteurs facilitants. La présente étude vise à combler en partie cette lacune en documentant leur pratique de SPAP et en examinant dans quelle mesure les attitudes,perceptions, barrières, besoins et caractéristiques sociodémographiques influencent leur pratique. Une enquête anonyme a été retenue comme méthode pour dresser un portrait de la situation. L’échantillon de convenance est composé de 701 questionnaires recueillis lors de formations continues de la Fédération des médecins omnipraticiens du Québec. Les résultats montrent que deux répondants sur cinq (40 %) font de la SPAP auprès de la majorité de leurs patients en contexte de prévention primaire, et ce, bien que la presque totalité d’entre eux (98 %) croit que la SPAP fait partie de leur rôle fondamental. L’analyse de régression multiple a permis d’identifier les facteurs les plus souvent associés à la pratique de la SPAP chez les répondants : les médecins qui pratiquent eux-mêmes de l’AP de façon régulière, ceux qui ont plus de neuf ans d’expérience médicale, ceux qui sont moins affectés par la surcharge de travail et ceux qui ont l’impression d’être relativement efficaces dans leurs interventions de SPAP sont les plus susceptibles d’en faire auprès de leurs patients en contexte de prévention primaire. / The rate of non communicable diseases is increasing in Québec. Regular physical activity(PA) can help preventing many of these diseases. However, a great proportion of the Québec population does not meet the PA recommendations to reap the health benefits. Several researches on the effectiveness of PA awareness and promotion interventions have shown that primary care physicians can positively influence the adoption and increase of PA in the population. To date, few studies have documented the PA counselling and promotion (PACP) of Québec primary care physicians to their patients, and more specifically, what are the PACP barriers and facilitators. The aim of the current study is to address this shortcoming in documenting the Quebec general practitioners’ PACP and examining to what extent their attitudes, perceptions, barriers, needs and sociodemographic characteristics influence their behavior. We used an anonymous questionnaire survey to draw a picture of the current situation. The convenience sample consisted of 701 completed questionnaires collected during continuing medical education sessions of the Fédération des médecins omnipraticiens du Québec. Results showed that two respondents out of five (40%) reported PACP to their patients in the context of primary care, while almost the majority (98%) of them considers that it is an integral part of their professional role. A multiple logistic regression analysis allowed the identification of the factors predominantly associated with physicians’ PACP. Physicians who are personally physically active on a regular basis, who have more than nine years of medical experience, who are less affected by work overload, and who feel to be effective in the PACP interventions are more likely to promote PA to their patients.

The main issues, which arise in that research project, are connected with health dimensions. There are emphasised points, which contribute to the employees’ health and well-being, solutions, which organisations implement to prevent workers from diseases and illnesses, to track their current condition of body and mind and generally to improve their overall health situation. From the very beginning the main stress was supposed to lie on physical activity promotion being an integral part of health promotion at the workplace but the obtained information from the conducted interviews verified that idea. The research also touches other variables contributing to the employees’ health and cons tituting the idea of health promotion at the workplace, namely health profiles and Corporate Social Responsibility. It is argued who may benefit from workplace physical activities and to which extent such programs may succeed. Interviews showed double points of views according to the necessity to encourage employees to train within the organization. Basis for the discussion of the topic were interviews gained from the interaction with the staff of the organization Xylem located in Sweden in Emmaboda, a world leader in water solutions. The chosen methodology based on the case study appeared to be the most relevant to explore health issues thanks to the clear empirical example. The company was distinguished because of the sport and rehabilitation centre, which it had in its possession and which seemed to make Xylem be different from the competitors and gave advantages for the employees in the form of additional benefits causing going in for sport at the company’s expense. The results of the research indicate that health promotion at the workplace may be viewed as a part of Corporate Social Responsibility. The evidences for IV that perspective are presented with a proper motivation mostly in the conclusion part. The research intended to show to the readers to what extent health promotion at the workplace incorporating physical activities, health profiles and CSR is important, how it is regarded and how much attention, time and efforts is and should be devoted to deal with that dimension in a proper way.

Les maladies non transmissibles sont en forte hausse au Québec. La pratique régulière d’activités physiques (AP) permet d’agir en amont et de contribuer à la prévention de plusieurs de ces maladies. Cependant, une grande proportion de la population québécoise n’est pas suffisamment active pour en retirer des bienfaits pour sa santé. Plusieurs études portant sur l’efficacité des interventions de sensibilisation et de promotion de l’AP(SPAP) ont montré que les médecins omnipraticiens peuvent avoir une influence non négligeable sur le niveau de pratique d’AP de la population. Peu d’études à ce jour ont examiné la pratique de SPAP des médecins omnipraticiens du Québec auprès de leurs patients et quels sont les freins et facteurs facilitants. La présente étude vise à combler en partie cette lacune en documentant leur pratique de SPAP et en examinant dans quelle mesure les attitudes,perceptions, barrières, besoins et caractéristiques sociodémographiques influencent leur pratique. Une enquête anonyme a été retenue comme méthode pour dresser un portrait de la situation. L’échantillon de convenance est composé de 701 questionnaires recueillis lors de formations continues de la Fédération des médecins omnipraticiens du Québec. Les résultats montrent que deux répondants sur cinq (40 %) font de la SPAP auprès de la majorité de leurs patients en contexte de prévention primaire, et ce, bien que la presque totalité d’entre eux (98 %) croit que la SPAP fait partie de leur rôle fondamental. L’analyse de régression multiple a permis d’identifier les facteurs les plus souvent associés à la pratique de la SPAP chez les répondants : les médecins qui pratiquent eux-mêmes de l’AP de façon régulière, ceux qui ont plus de neuf ans d’expérience médicale, ceux qui sont moins affectés par la surcharge de travail et ceux qui ont l’impression d’être relativement efficaces dans leurs interventions de SPAP sont les plus susceptibles d’en faire auprès de leurs patients en contexte de prévention primaire. / The rate of non communicable diseases is increasing in Québec. Regular physical activity(PA) can help preventing many of these diseases. However, a great proportion of the Québec population does not meet the PA recommendations to reap the health benefits. Several researches on the effectiveness of PA awareness and promotion interventions have shown that primary care physicians can positively influence the adoption and increase of PA in the population. To date, few studies have documented the PA counselling and promotion (PACP) of Québec primary care physicians to their patients, and more specifically, what are the PACP barriers and facilitators. The aim of the current study is to address this shortcoming in documenting the Quebec general practitioners’ PACP and examining to what extent their attitudes, perceptions, barriers, needs and sociodemographic characteristics influence their behavior. We used an anonymous questionnaire survey to draw a picture of the current situation. The convenience sample consisted of 701 completed questionnaires collected during continuing medical education sessions of the Fédération des médecins omnipraticiens du Québec. Results showed that two respondents out of five (40%) reported PACP to their patients in the context of primary care, while almost the majority (98%) of them considers that it is an integral part of their professional role. A multiple logistic regression analysis allowed the identification of the factors predominantly associated with physicians’ PACP. Physicians who are personally physically active on a regular basis, who have more than nine years of medical experience, who are less affected by work overload, and who feel to be effective in the PACP interventions are more likely to promote PA to their patients.

Les habiletés motrices des jeunes sont en déclin depuis plusieurs années au Canada. Plusieurs interventions ou programmes ont ainsi été développés, et ce, en vue d’améliorer la pratique d’activités physiques (AP) à long terme chez les enfants. Quelques études ont réalisé une évaluation des effets de ces programmes mais peu d'entre elles ont procédé à une évaluation de leur processus d'implantation. Or, l'évaluation de processus est importante pour comprendre les freins ou facteurs facilitants qui peuvent moduler les résultats. Cet aspect est d'autant plus important quand une intervention est déployée dans plusieurs milieux à la fois. Notre étude vise à évaluer le programme Bleu Blanc Bouge en Action (BBBEA) de la Fondation des Canadiens pour l’Enfance afin de rendre compte des facteurs qui ont pu faciliter ou nuire à son implantation. Trois composantes du processus d'implantation ont été évaluées : le « Reach », la « dose delivered » et la « dose received ». Les données ont été collectées au moyen d'une grille d’observation créée à partir de la grille SOFIT (McKenzie, Sallis et coll. 1991) ainsi qu'au moyen d'un questionnaire auprès des parents des jeunes (n=238) des six écoles participantes. Quatre des six séances de BBBEA ont fait l'objet d'observations auprès d'un échantillon de deux des six milieux ciblés par le programme. Les observations ont porté à la fois sur les interventions des animateurs et sur les activités d'un sous-échantillon de jeunes (Montréal-Nord : n = 35 et Verdun : n = 38). Nos résultats indiquent que la clientèle ciblée par BBBEA (des jeunes ne sachant pas patiner) compose près de 75 % des participants du programme. La part relative du temps d’engagement moteur est significativement plus élevée (50,5 % contre 41,0 %) dans le milieu comportant davantage de jeunes sachant patiner, ce qui suggère un effet d’entraînement du groupe sur les apprenants. Un constat positif du programme est que le temps d’engagement moteur dans les deux milieux étudiés est semblable ou supérieur à celui de programmes de promotion de l’activité physique comparables à BBBEA. Lors de jeux et d’activités libres, l’engagement moteur des jeunes est significativement plus faible dans le milieu où l’effet d’entraînement du groupe est moins manifeste. Ceci suggère que des activités plus structurées (éducatifs lors de la pratique d'une habileté motrice) seraient favorables à l’engagement moteur des jeunes lorsque ceux-ci semblent peu engagés ou autodidactes. / Canadian youth’s motor skills have been declining over the last few years. Many interventions or programs have been developed to enhance children’s long term physical activity practice. Some studies evaluated the effects of those interventions, but only a small number carried on a process evaluation of the implementation. A process evaluation is important to get a better understanding of barriers and facilitators of the intervention. These components of evaluation are some of the most important criteria to explain the divergent results of an intervention deployed in various environments. Our research was an evaluation of the Bleu Blanc Bouge en Action (BBBEA) program of the Montreal Canadiens Children’s Foundation aiming to reflect elements impairing or enabling its implementation. Three components of the implementation process have been evaluated: the Reach, the dose delivered and the dose received. Data was collected with an observational form adapted from the System for observing fitness instruction time (SOFIT) (McKenzie, Sallis et al. 1991) and with questionnaire distributed to the parents of the youth of the six targeted participant schools. A sub-sample of 35 children from Montréal Nord and 38 from Verdun were observed during 4 of the 6 skating lessons. Results show that targeted participants (children that do not know how to skate) compose almost 75 % of the program’s attendees. Physical engagement proportion was significantly higher (50.5 % vs 41.0 %) in the environment composed of a higher number of children knowing how to skate, suggesting a ripple effect on the learners. As a positive outcome, MVPA (moderate to vigorous physical activity) proportion in both neighborhoods was equal or higher than other programs comparable to BBBEA. During “game” or “free play” contexts, children’s physical activity levels were significantly lower in the context where the ripple effect was the weakest. This suggests that structured activities (drills during motor skills practice) favor youth’s physical engagement when they are disengaged or less autodidact.