Objective data from national surveillance programmes show that, on average, individuals accumulate high amounts of sedentary time per day and only a small minority of adults achieve physical activity guidelines. One potential explanation for the failure of interventions to increase population levels of physical activity or decrease sedentary time is that research to date has been unable to identify the specific behavioural levers in specific contexts needed to change behaviour. Novel technology is emerging with the potential to elucidate these specific behavioural contexts and thus identify these specific behavioural levers. Therefore the aims of this four study thesis were to identify novel technologies capable of measuring the behavioural context, to evaluate and validate the most promising technology and to then pilot this technology to assess the behavioural context of older adults, shown by surveillance programmes to be the least physically active and most sedentary age group. Study one Purpose: To identify, via a systematic review, technologies which have been used or could be used to measure the location of physical activity or sedentary behaviour. Methods: Four electronic databases were searched using key terms built around behaviour, technology and location. To be eligible for inclusion papers were required to be published in English and describe a wearable or portable technology or device capable of measuring location. Searches were performed from the inception of the database up to 04/02/2015. Searches were also performed using three internet search engines. Specialised software was used to download search results and thus mitigate the potential pitfalls of changing search algorithms. Results: 188 research papers met the inclusion criteria. Global positioning systems were the most widely used location technology in the published research, followed by wearable cameras and Radio-frequency identification. Internet search engines identified 81 global positioning systems, 35 real-time locating systems and 21 wearable cameras. Conclusion: The addition of location information to existing measures of physical activity and sedentary behaviour will provide important behavioural information. Study Two Purpose: This study investigated the Actigraph proximity feature across three experiments. The aim of Experiment One was to assess the basic characteristics of the Actigraph RSSI signal across a range of straight line distances. Experiment Two aimed to assess the level of receiver device signal detection in a single room under unobstructed conditions, when various obstructions are introduced and the impacts these obstructions have on the intra and inter unit variability of the RSSI signal. Finally, Experiment Three aimed to assess signal contamination across multiple rooms (i.e. one beacon being detected in multiple rooms). Methods: Across all experiments, the receiver(s) collected data at 10 second epochs, the highest resolution possible. In Experiment One two devices, one receiver and one beacon, were placed opposite each other at 10cm increments for one minute at each distance. The RSSI-distance relationship was then visually assessed for linearity. In Experiment Two, a test room was demarcated into 0.5 x 0.5 m grids with receivers simultaneously placed in each demarcated grid. This process was then repeated under wood, metal and human obstruction conditions. Descriptive tallies were used to assess the signal detection achieved for each receiver from each beacon in each grid. Mean RSSI signal was calculated for each condition alongside intra and inter-unit standard deviation, coefficient of variation and standard error of the measurement. In Experiment Three, a test apartment was used with three beacons placed across two rooms. The researcher then completed simulated conditions for 10 minutes each across the two rooms. The percentage of epochs where a signal was detected from each of the three beacons across each test condition was then calculated. Results: In Experiment One, the relationship between RSSI and distance was found to be non-linear. In Experiment Two, high signal detection was achieved in all conditions; however, there was a large degree of intra and inter-unit variability in RSSI. In Experiment Three, there was a large degree of multi-room signal contamination. Conclusion: The Actigraph proximity feature can provide a binary indicator of room level location. Study Three Purpose: To use novel technology in three small feasibility trials to ascertain where the greatest utility can be demonstrated. Methods: Feasibility Trial One assessed the concurrent validity of electrical energy monitoring and wearable cameras as measures of television viewing. Feasibility Trial Two utilised indoor location monitoring to assess where older adult care home residents accumulate their sedentary time. Lastly, Feasibility Trial Three investigated the use of proximity sensors to quantify exposure to a height adjustable desk Results: Feasibility Trial One found that on average the television is switched on for 202 minutes per day but is visible in just 90 minutes of wearable camera images with a further 52 minutes where the participant is in their living room but the television is not visible in the image. Feasibility Trial Two found that residents were highly sedentary (sitting for an average of 720 minutes per day) and spent the majority of their time in their own rooms with more time spent in communal areas in the morning than in the afternoon. Feasibility Trial Three found a discrepancy between self-reported work hours and objectively measured office dwell time. Conclusion: The feasibility trials outlined in this study show the utility of objectively measuring context to provide more detailed and refined data. Study Four Purpose: To objectively measure the context of sedentary behaviour in the most sedentary age group, older adults. Methods: 26 residents and 13 staff were recruited from two care homes. Each participant wore an Actigraph GT9X on their non-dominant wrist and a LumoBack posture sensor on their lower back for one week. The Actigraph recorded proximity every 10 seconds and acceleration at 100 Hz. LumoBack data were provided as summaries per 5 minutes. Beacon Actigraphs were placed around each care home in the resident s rooms, communal areas and corridors. Proximity and posture data were combined in 5 minute epochs with descriptive analysis of average time spent sitting in each area produced. Acceleration data were summarised into 10 second epochs and combined with proximity data to show the average count per epoch in each area of the care home. Mann-Whitney tests were performed to test for differences between care homes. Results: No significant differences were found between Care Home One and Care Home Two in the amount of time spent sitting in communal areas of the care home (301 minutes per day and 39 minutes per day respectively, U=23, p=0.057) or in the amount of time residents spent sitting in their own room (215 minutes per day and 337 minutes per day in Care Home One and Two respectively, U=32, p=0.238). In both care homes, accelerometer measured average movement increases with the number of residents in the communal area. Conclusion: The Actigraph proximity system was able to quantify the context of sedentary behaviour in older adults. This enabled the identification of levers for behaviour change which can be used to reduce sedentary time in this group. Overall conclusion: There are a large number of technologies available with the potential to measure the context of physical activity or sedentary time. The Actigraph proximity feature is one such technology. This technology is able to provide a binary measure of proximity via the detection or non-detection of Bluetooth signal: however, the variability of the signal prohibits distance estimation. / The Actigraph proximity feature, in combination with a posture sensor, is able to elucidate the context of physical activity and sedentary time.

abstract: Sedentary behavior has recently been recognized as a widespread, independent risk factor for increased morbidity and mortality from chronic conditions including diabetes, cardiovascular disease, and cancer. Midlife women (age 40-64) are known to have high levels of sedentary behavior and corresponding cardiovascular disease risk. Currently, little is known about mechanisms involved in reducing and maintaining reductions to sedentary behavior in midlife women. Theory-based nursing interventions are needed which reflect process, personal meaning, person-environment interaction, and incorporate a strength-based perspective. Wellness Motivation Theory guided the research, conceptualizing behavioral change processes within culturally and environmentally relevant contexts, while recognizing bidirectional influences of personal and environmental factors on behavioral patterns. The Wellness Motivation Theory addresses social support and norms, community and material resources that influence behavioral choices, individual motivation and goals, and the behavioral change processes of self-knowledge, motivational appraisal, and self-regulation. A qualitative descriptive approach was used to explore social contextual resources and behavior change processes leading to action as decreasing sedentary time in midlife women. The maximum variation sample included 31 midlife women, employees of Arizona State University. Participants attended a one-hour focus group to discuss their experiences with sedentary behavior, and their efforts to sit less and move more. Midlife women characterized social support as: Raising Me Up, Timing Time and Walking and Talking. Support from contextual resources reflected themes of Seeking Place, Stepping Up, and Walking the Talk. Women experienced self-knowledge as Envisioning the Future, Taking Inventory, and Considering Possibles. Motivational appraisal was characterized as Reevaluating Priorities, Wayfinding, and Going All In. Self-regulation was reflected as Recounting Benefits, Keeping On Track, and Creating New Ways. A deeper understanding of motivational processes central to reducing sedentary behavior in midlife women fosters identification of leverage points for future theory-based intervention research which provides primary prevention opportunities to lower cardiovascular disease risk, and promote successful aging. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2018

Made available in DSpace on 2014-06-11T19:29:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-24Bitstream added on 2014-06-13T18:39:14Z : No. of bitstreams: 1 nicola_m_me_botfm.pdf: 407001 bytes, checksum: d2df4d7f944f99c1f3db242c773a0c60 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A prevalência crescente de hipertensão arterial é perpetuada por fatores comportamentais tais como dieta inadequada e inatividade física. Determinar os fatores associados à hipertensão arterial em adultos clinicamente triados para programa de mudança de estilo de vida. Foram estudados 1041 indivíduos, de ambos os sexos, com idade entre 26 a 88 anos, voluntários de programa de mudança de estilo de vida. A avaliação da pressão arterial foi realizada obedecendo a VI Diretriz Brasileira de Hipertensão Arterial. Colesterol total e frações, triglicerídios, glicemia, uréia, creatinina, ácido úrico e albumina foram analisados pelo método de Química Seca e proteína C reativa por imunoquimioluminescência. A avaliação antropométrica foi composta pelas medidas de circunferência abdominal, massa e estatura, com posterior cálculo do índice de massa corporal, e o percentual de gordura foi obtido por bioimpedância. A ingestão dietética foi realizada pelo recordatório de 24 horas, com posterior cálculo das porções da pirâmide e Índice de Alimentação Saudável adaptado. A avaliação cardiorrespiratória em esteira ergométrica foi feita pelo teste de Balke modificado. Análises estatísticas foram realizadas utilizando o programa SAS versão 9.2 e descritos em média e desvio padrão. Foi realizado o teste de Wilcoxon com normalidade da amostra sendo avaliada pelo teste de Shapiro-Wilk, e regressão linear com intervalo de confiança de 95%. Os resultados foram discutidos com base no nível de significância de p<0,05. O total de hipertensos atingiu 37,7% sendo 20,8% em uso de hipotensores medicamentosos. Não houve influência significativa da renda e da ingestão dietética sobre a prevalência de hipertensão. Por outro lado houve associação da obesidade e da adiposidade (corporal e abdominal) assim como da hiperglicemia e hipercolesterolemia. Na ausência... / The growing prevalence of hypertension is mainly due to happens by behavioral factors, such as inappropriate diet and physical inactivity. These study aims to determine the associated factors of hypertension in clinically screened adults a lifestyle modification program. One thousand and forty one volunteers were studied, both male and female, between 26 and 88 years old. The blood pressure was measured following VI Hypertension Brazilian Guideline. Plasma total cholesterol, triglycerides, glucose, urea, creatinine, uric acid and albumin were analyzed by the dry chemistry method and C-reactive protein by immunechemmiluminescence. The anthropometric evaluation consisted of weight and height measurements, with subsequent body mass index calculation. Fat percentage was obtained by electrical bioimpedance. Dietary intake was evaluated by a 24-hour food recall, with posterior pyramid servings and the adapted health eating index calculation. The cardiorespiratory fitness evaluation on treadmill was done by the modified Balke test. Statistic analyses were done using the 9.2 version SAS program and described in mean and standard deviation. The Wilcoxon test was done with normality sample being evaluated by the Shapiro-Silk test and linear regression with 95% confidence intervals. The results were discussed based on the significance level of p<0.05. The total number of hypertensive individuals was 37.7%, 20% of them taking anti-hypertensive medicine. There wasn’t significant influence of income and dietary intake concerning hypertension prevalence. On the other hand, there was an association of obesity and adiposity (corporal and abdominal) as well as of hyperglycemia and hypercholesterolemia. In the absence of medicine the hypertensive individuals showed similar age and body mass index values, higher of abdominal circumference (female) and glucose and lower of VO2max (female)... (Complete abstract click electronic access below)

abstract: The health benefits of physical activity are widely accepted. Emerging research also indicates that sedentary behaviors can carry negative health consequences regardless of physical activity level. This dissertation explored four projects that examined measurement properties of physical activity and sedentary behavior monitors. Project one identified the oxygen costs of four other care activities in seventeen adults. Pushing a wheelchair and pushing a stroller were identified as moderate-intensity activities. Minutes spent engaged in these activities contribute towards meeting the 2008 Physical Activity Guidelines. Project two identified the oxygen costs of common cleaning activities in sixteen adults. Mopping a floor was identified as moderate-intensity physical activity, while cleaning a kitchen and cleaning a bathtub were identified as light-intensity physical activity. Minutes spent engaged in mopping a floor contributes towards meeting the 2008 Physical Activity Guidelines. Project three evaluated the differences in number of minutes spent in activity levels when utilizing different epoch lengths in accelerometry. A shorter epoch length (1-second, 5-seconds) accumulated significantly more minutes of sedentary behaviors than a longer epoch length (60-seconds). The longer epoch length also identified significantly more time engaged in light-intensity activities than the shorter epoch lengths. Future research needs to account for epoch length selection when conducting physical activity and sedentary behavior assessment. Project four investigated the accuracy of four activity monitors in assessing activities that were either sedentary behaviors or light-intensity physical activities. The ActiGraph GT3X+ assessed the activities least accurately, while the SenseWear Armband and ActivPAL assessed activities equally accurately. The monitor used to assess physical activity and sedentary behaviors may influence the accuracy of the measurement of a construct. / Dissertation/Thesis / Ph.D. Kinesiology 2012

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / A validaÃÃo dos diagnÃsticos de enfermagem à uma fase essencial no desenvolvimento do conhecimento para a prÃtica assistencial e para a promoÃÃo da saÃde da populaÃÃo assistida. Sabe-se que diagnÃsticos de enfermagem como Estilo de Vida SedentÃrio representam problemas atuais de grupos especÃficos como o de adolescentes. Faz-se necessÃrio aprimorar estes diagnÃsticos para facilitar sua utilizaÃÃo na prÃtica por enfermeiros. Portanto, para ampliar a confiabilidade desses diagnÃsticos, à preciso submetÃ-los a um processo de validaÃÃo, refinando o conjunto de indicadores clÃnicos e tornando confiÃvel sua utilizaÃÃo, tanto na prÃtica como no ensino. Assim, este estudo objetivou identificar a acurÃcia das caracterÃsticas definidoras. Estudo transversal desenvolvido com 564 adolescentes, de 14 a 19 anos, alunos de seis escolas pÃblicas de Fortaleza, CearÃ. A coleta de dados ocorreu no terceiro trimestre de 2012. Os dados foram coletados mediante aplicaÃÃo de questionÃrio e avaliaÃÃo fÃsica para identificaÃÃo das caracterÃsticas definidoras presentes em adolescentes com base em definiÃÃes conceituais e operacionais. Posteriormente, foram enviadas histÃrias clÃnicas para oito enfermeiros inferirem a presenÃa do diagnÃstico Estilo de vida sedentÃrio. Estas inferÃncias possibilitaram o cÃlculo de valores de sensibilidade, especificidade e valor preditivo. A anÃlise estatÃstica foi efetuada pelo pacote estatÃstico IBM SPSS versÃo 20 e software R. O estudo foi aprovado por Comità de Ãtica em Pesquisa com parecer nÂ70539/12. A amostra era em sua maioria do sexo feminino, pertencente ao 1 ano do ensino mÃdio e com uma mÃdia de 16 anos de idade. O diagnÃstico Estilo de Vida SedentÃrio esteve presente em 48,6% dos participantes do grupo. Adolescentes do sexo feminino apresentaram 2,1 vezes mais chance de desenvolver o diagnÃstico. Entre as caracterÃsticas definidoras mais frequentes, destacam-se: Verbaliza preferÃncia por atividades com pouco exercÃcio fÃsico (59,9%), Capacidade respiratÃria diminuÃda (55,3%) e Escolhe uma rotina diÃria sem exercÃcios fÃsicos (49,1%). Vale destacar que ForÃa muscular diminuÃda nÃo foi evidenciada no grupo estudado. Destas, Escolhe uma rotina diÃria sem exercÃcios fÃsicos mostrou-se como a principal caracterÃstica para predizer o diagnÃstico (Se = 98,18; Es = 97,24). Entre os fatores relacionados mais prevalentes na amostra, destacam-se: Relato de dor (65,2%) e Falta de recursos (tempo, dinheiro, lugar, seguranÃa e equipamento) (61,3%). Os fatores relacionados Mobilidade prejudicada e IntolerÃncia à atividade nÃo foram encontrados nos adolescentes do estudo. Por fim, pode-se concluir que este estudo possibilitou determinar as caracterÃsticas definidoras mais especÃficas e fatores relacionados mais prevalentes na populaÃÃo de adolescentes e apresentar Escolhe uma rotina diÃria sem exercÃcios fÃsicos como a caracterÃstica legÃtima para Estilo de vida sedentÃrio. Diante da prevalÃncia do Estilo de vida sedentÃrio em praticamente metade da populaÃÃo estudada, à essencial que os enfermeiros continuem a investigar e discutir este diagnÃstico, a fim de promover intervenÃÃes mais efetivas desta resposta humana, bem como a promoÃÃo da validaÃÃo dos diagnÃsticos, enquanto instrumentos de tecnologia do cuidado. / The validation of nursing diagnoses is an essential phase in the development of knowledge to nursing practice and health promotion of the population served. It is known that nursing diagnoses as Sedentary Lifestyle represent current problems of specific groups such as teenagers. It is necessary to improve these diagnostics to facilitate their use in practice by nurses. Therefore, to extend the reliability of these diagnoses, we must subject them to a validation process, refining the set of clinical indicators and reliable making their use, both in practice and in teaching. Thus, this study aimed to identify the accuracy of the defining characteristics and prevalence of nursing diagnosis Sedentary lifestyle among adolescents in public school. Crosssectional study carried out with 564 adolescents, aged 14 to 19 years, students from seven public schools in Fortaleza, CearÃ. Data collection occurred in the third quarter and 2012. Data were collected through a questionnaire of physical examination to identify the defining characteristics present in adolescents based on conceptual and operational definitions. Subsequently, clinical histories were sent to eight nurses infer the presence of diagnostic Sedentary lifestyle. These inferences allowed the calculation of sensitivity, specificity and predictive value. Statistical analysis was performed by the statistical package SPSS  20 version. The study was approved by the ethics committee opinion research No. 70539/12. The population is mostly female, students of 1st year of high school and with an average age of 16. The results show a high prevalence of adolescents with a diagnosis Sedentary Lifestyle (48.6%), in which being female represents a 2.1 times greater chance of presenting a sedentary lifestyle. Among the most common defining characteristics stand out: "verbalizes preference for activities with little exercise" (59.9%), "decreased respiratory capacity" (55.3%) and "Choose a daily routine without exercising" ( 49.1%). It is noteworthy that decreased muscle strength was not observed in the study group. Of these, "Choose a daily routine without exercising" showed up as the main feature for predicting the diagnosis, high value under the ROC curve (0.9771) and elevated high-sensitivity value (98.18) and specificity (97 ,24) for the Sedentary Lifestyle. Among the factors related most prevalent, include: "Reporting of pain" (65.2%) and "Lack of resources (money, time, place, and safety equipment)" (61.3%). Factors related "mobility impaired" and "activity intolerance" were not found among adolescents studied. Finally, we can conclude that this study allowed us to determine the defining characteristics and related factors more specific to the adolescent population. But it is essential that nurses continue to investigate and discuss this diagnosis in order to promote more effective interventions that human response as well as the promotion of validation of diagnoses, as instruments of care technology.

The recognition of good clinical indicators and characteristics of accuracy for certain nursing diagnosis allows nurses to identify more accurately the diagnosis and effectively promotes the practical application of the process of nursing work. Given the importance of identifying accurate clinical indicators, this study will be developed in order to analyze the defining characteristics (DC) and related factors (RF) of the nursing diagnosis "Sedentary Lifestyle" (SL) reviewed by Guedes (2011 ) in individuals with hypertension. It was a cross-sectional study conducted with 285 individuals with hypertension, aged between 19 and 59 years, followed at a center for outpatient care, in Fortaleza, CearÃ. Data collection was performed using a form based on empirical references of DC and RF in reviewing proposed by Guedes (2011), by interview and physical examination. The data obtained were analyzed by the researcher to determine the presence or absence of DC and RF and later were referred to specialist nurses who performed the diagnostic inference. It was used EXCEL, SPSS and R software for organizing and analyzing statistical data. The level of significance was 5%. The population was predominantly female, coming from the capital, living with a partner and holder of Diabetes mellitus. Half of the sample had up to 53 years, education time up to 10 years, per capita income up to R$ 500.00 and have a diagnosis of hypertension for over 10 years. The DC more frequent among patients with hypertension were "reduced flexibility of the articulations" (93.7%), "excess weight" (85.3%), "it does not carry out physical activities in the leisure time" (83.9 %) and "it verbalizes preference for activities with little physical exercise" (83.9%). Of total DC evaluated, only five were statistically significant. The RF more frequent were "lack of resources (money, time, place, security and equipment) for the physical exercise" (87.45%), "defective knowledge on the benefits that the physical activity brings to the health and / or on the consequences of the sedentary life style" (78.6%) and "lack of social support for the practice of physical exercise" (76.8%). A total of 11 RF evaluated, seven had a significant association with the diagnosis SL. The prevalence of the diagnosis in question was 55.8%. The DC "chooses routines without physical exercises" was the main characteristic for this diagnosis, with a sensitivity of 100% and a high specificity value (84.13%). Three defining characteristics were not statistically significant from the analysis of likelihood ratios and diagnostic odds ratio: "excess weight", "reduced flexibility of the articulations" and "reduced muscular strength." The RF "lack of motivation for practicing physical exercise" and "lack of interest in exercising" had the highest prevalence ratios (PR = 5.358). It was found in this study that most of these new elements identified in the review of Guedes (2011) are relevant to the accurate identification of diagnosis SL in people with hypertension. Thus, it is expected that this information can contribute to efficient and systematic nursing practice, with an emphasis on health promotion for people with hypertension. / O reconhecimento de bons indicadores clÃnicos e de suas caracterÃsticas de acurÃcia, para determinado diagnÃstico de enfermagem, permite que o enfermeiro identifique com maior precisÃo o diagnÃstico e favorece efetivamente a aplicaÃÃo prÃtica do processo de trabalho de enfermagem. Diante da importÃncia de se identificar indicadores clÃnicos acurados, este estudo foi desenvolvido com o objetivo de analisar as caracterÃsticas definidoras (CD) e os fatores relacionados (FR) do diagnÃstico de enfermagem âEstilo de vida sedentÃrioâ (EVS) revisado por Guedes (2011) em indivÃduos com hipertensÃo arterial (HA). Estudo do tipo transversal, realizado com 285 indivÃduos com hipertensÃo arterial, com idade entre 19 e 59 anos, acompanhados em um centro de atendimento ambulatorial, em Fortaleza, CearÃ. A coleta de dados foi realizada utilizando um formulÃrio baseado nas referÃncias empÃricas das CD e os FR propostos na revisÃo de Guedes (2011), por meio de entrevista e exame fÃsico. As informaÃÃes obtidas foram analisadas pela pesquisadora para determinar a presenÃa ou ausÃncia das CD e dos FR e, posteriormente, foram encaminhadas aos enfermeiros especialistas que executaram a inferÃncia diagnÃstica. Foram utilizados os softwares EXCEL, SPSS e R para organizaÃÃo e anÃlise estatÃstica dos dados. O nÃvel de significÃncia adotado no estudo foi 5%. A maioria da amostra era do sexo feminino, procedente da capital, morando com companheiro e com diagnÃstico de Diabetes mellitus. Metade da amostra tinha atà 53 anos, tempo de escolaridade de atà 10 anos, renda per capita de atà R$ 500,00 e diagnÃstico de hipertensÃo arterial hà mais de 10 anos. As CD mais frequentes entre os pacientes com de HA foram âflexibilidade das articulaÃÃes diminuÃdaâ (93,7%), âexcesso de pesoâ (85,3%), ânÃo realiza atividades fÃsicas no tempo de lazerâ (83,9%) e âverbaliza preferÃncia por atividades com pouco exercÃcio fÃsicoâ (83,9%). Do total de CD avaliadas, somente cinco apresentaram significÃncia estatÃstica. Os FR mais frequentes foram âfalta de recursos (tempo, dinheiro, lugar, seguranÃa, equipamento) para a prÃtica de exercÃcio fÃsicoâ (87,45%), âconhecimento deficiente sobre os benefÃcios que a atividade fÃsica traz à saÃde e/ou sobre as consequÃncias do sedentarismoâ (78,6%) e âfalta de apoio social para a prÃtica de exercÃcio fÃsicoâ (76,8%). De um total de 11 FR avaliados, sete apresentaram associaÃÃo significante com o diagnÃstico EVS. A prevalÃncia do diagnÃstico em questÃo foi 55,8%. A CD âescolhe rotina diÃria sem exercÃcio fÃsicoâ foi a principal caracterÃstica para este diagnÃstico, apresentando uma sensibilidade de 100% e um elevado valor de especificidade (84,13%). TrÃs caracterÃsticas definidoras nÃo apresentaram significÃncia estatÃstica a partir da anÃlise das razÃes de verossimilhanÃa e odds ratio diagnÃstica: âExcesso de pesoâ, âFlexibilidade das articulaÃÃes diminuÃdaâ e âForÃa muscular diminuÃdaâ. Os FRs âfalta de motivaÃÃo para a prÃtica de exercÃcio fÃsicoâ e âfalta de interesse em se exercitarâ apresentaram as maiores razÃes de prevalÃncia (RP = 5,358). Constatou-se neste estudo que a maior parte desses novos elementos encontrados na revisÃo de Guedes (2011) à relevante para a identificaÃÃo acurada do diagnÃstico EVS. Dessa forma, espera-se que estas informaÃÃes possam contribuir para uma prÃtica de enfermagem eficiente e sistematizada, com Ãnfase na promoÃÃo da saÃde de pessoas com hipertensÃo arterial.

Workplace interventions to reduce discomfort and sedentary time have been studied in a variety of settings. Adjustable workstations are one type of ergonomic intervention that is used to potentially reduce occupational sitting time, negative health impacts, and to increase productivity. This investigation compared two types of ergonomic interventions, as well as contrasting behavioral interventions among workers with and without adjustable workstations. Seventy-two sedentary office workers were selected to participate in a longitudinal study to evaluate interventions for a reduction in occupational sitting time, to understand the effect on productivity and to evaluate musculoskeletal pain and behaviors. Workers were randomly placed into four different intervention groups and observed over 14 weeks. Group assignments were: control group, employees trained on behavioral interventions, employees given adjustable workstations and the final group had both ergonomic and behavioral interventions. During the study, there was a decrease in discomfort scores and fatigue for the adjustable workstation users. Standing time was increased in groups that had the adjustable workstations and frequency of workstation use remained constant throughout the 14 weeks. There was sufficient evidence to suggest that adjustable workstations will decrease sitting time and decease all over body discomfort in occupations that typically involve long hours of sitting. More research is needed to determine the health benefits of less occupational sitting.

Physical inactivity and sedentary behaviour have been independently associated with a wide range of negative health indicators including obesity, poor cardio-metabolic health, and poor psychosocial health. The overarching objective of this research was to gain a better understanding as to why children are sedentary, and where we need to focus public health messages and interventions to reduce sedentary behaviour. Specifically, I aimed to provide insight on current awareness of sedentary behaviour guidelines; determine important correlates of total sedentary time (SED), and screen time (ST) in Canadian children; and understand correlates of SED and ST in a global context. The primary dataset used for this project was the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). Background work was completed to review current literature on knowledge and awareness of Canadian physical activity and sedentary behaviour guidelines (in all age groups), and to understand the representativeness of the ISCOLE dataset. In addition to the two background papers, this dissertation includes three manuscripts, all prepared for submission in scientific, peer-reviewed journals: 1. Manuscript 1: Canadian physical activity and screen time guidelines: do children know? 2. Manuscript 2: Correlates of objectively measured sedentary time and self-reported screen time in Canadian children 3. Manuscript 3: Correlates of total sedentary time and screen time in 9-11 year-old children around the world: The International Study of Childhood Obesity, Lifestyle and the Environment Overall, this work showed the majority of children around the world are accumulating large amounts of sedentary time, and exceeded current screen time guidelines. We found that the large majority of Canadian children are not aware of screen time guidelines; however, a greater proportion of children could identify physical activity guidelines. We also identified a number of correlates of SED, and ST in Canadian children, and in children around the world. The most common correlates included weight status, and access to electronics in the house. Taken together, this work suggests that public health messaging should focus on increasing awareness of screen time guidelines. While increasing awareness of the guidelines, messaging can be tailored to promoting healthy weight status, and reducing (or removing) children’s access to electronic devices in hopes of reducing overall time spent sedentary.

Aim: To assess if there is an association between sitting time and obesity among adult Peruvian population, using three different anthropometric measurements. Methods: A secondary analysis using data from a population-based study, the National Household Survey (ENAHO, in Spanish), was conducted enrolling adults aged ≥18 years from the 25 regions of Peru using a multistage random sampling technique. The outcome of interest was obesity, determined by body mass index (BMI > 30 kg/m2), waist circumference (WC > 80 and >90 cm in women and men, respectively) and waist to height ratio (WHR > 0.5); while the exposure was sitting time, measured using the last domain of the International Physical Activity Questionnaire and then categorised in <4 hours/day, 4 to <8 hours/day and 8+ hours/day. Associations were estimated using Poisson regression models, reporting prevalence ratios (PRs) and their respective 95% CI. Results: Data from 8587 subjects were analysed; mean age was 38.4 (SD: 13.5) and 53.6% were females. The prevalence of obesity was 16.3% (95% CI: 15.2–17.5%) by BMI, 58.5% (95% CI: 56.9–60.0%) by WC, and 78.0% (95% CI: 76.5–79.3%) by WHR. In the multivariable model, subjects reporting a sitting time of 8+ hours/day were more likely to be obese than those reporting <4 hours/day according to BMI (PR: 1.38; 95% CI: 1.15–1.65), WC (PR: 1.20; 95% CI: 1.12–1.28) and WHR (PR: 1.05; 95% CI: 1.01–1.10). Conclusions: Subjects with greater sitting time were more likely to be obese, and this association was evident with three different anthropometric indicators. Findings suggest the need of generating public health actions to reduce sedentary behaviour. / Revisión por pares / Revisión por pares

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Master of Science in Medicine, Johannesburg, 2017 / Objective: Physical activity (PA) is recommended in the management of osteoarthritis (OA) to reduce pain and improve function. Total volumes of PA and sedentary behaviour (SB) have been described in people with knee OA, but detailed information about the patterns of accumulation of PA and SB in knee OA populations is lacking. The purpose of this study was to objectively assess the patterns of accumulation of PA and SB and to explore associations with subjectively measured functional outcomes and quality of life in patients with knee OA. Methods: End-stage knee OA patients (n = 87, 65 ± 8.8 (mean ± SD) years, body mass index 34.4 ± 7.8 kg/m2) with Kellgren-Lawrence-defined grade 3-4 radiographic OA, wore an Actigraph and an activPAL accelerometer for 24 hours a day for 7 consecutive days. Total volumes of SB, light physical activity (LPA), moderate to vigorous physical activity (MVPA), and different bouts of SB, LPA, and MVPA were assessed. Self-report questionnaires were used to assess patient-experienced pain, function, quality of life and activities of daily living were the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and the Knee Injury Osteoarthritis Outcome Score (KOOS). Results: Of the 87 knee OA patients only 76 and 65 had complete Actigraph and activPAL data respectively. The participants had a mean (SD) age of 65.0 (8.8) years, were mostly women and most were classified as being obese with an average BMI of 34.4 (7.8) kg/m2. The Actigraph mean (95% CI) of awake wear time was 15.6 (15.1-16) hours/day, SB 10.9 (10.5-11.4) hours/day, LPA 4.5 (4.1-5) hours/day and MVPA 8.2 (3.3-13) min/day. Approximately 7% of patients met the current recommended PA guidelines. The activPAL mean (95% CI) of sitting time, standing time, stepping time and number of steps were 9.3 (8.5 – 10.1) hours per day, 5.0 (4.4 – 5.6) hour per day, 76.5 (66.6 – 86.3) minutes per day and 2489 (2130 – 2848) minutes per day respectively. There were variations in the hourly patterns of movement behaviours. Participants were significantly less sedentary between 6 am and 9 am compared to the grand mean of sedentary time per hour over the day (p<0.01) and were significantly more sedentary per hour from 3 pm to 7 pm (p<0.05). Significant correlations were found between WOMAC pain scores and Actigraph measured SB (r=0.277, p=0.031), LPA (r=-0.240, p=0.043), MVPA (r=-0.242. p=0.042), number of steps (r=-0.282, p=0.020), number of breaks in bouts of SB greater than 20 minutes (r=-0.292, x p=0.016), average duration of breaks in SB (r=-0.277, p=0.024), average duration of MVPA bouts (r=-0.326, p=0.012). Significant correlations were also found between WOMAC activity of daily living scores and Actigraph measured LPA (r=-0.206, p=0.048), MVPA (r=-0.246, p=0.029), number of steps (r=-0.286, p=0.010) and average duration of MVPA bouts (r=-0.383, p=0.002). Significant correlations were found between WOMAC pain scores and activPAL sitting time (r=0.029, p=0.02), and stepping time (r=-0.029, p=0.01), between self-reported WOMAC activity of daily living score and stepping time (r=-0.309, p=0.02), between KOOS activity of daily living score and stepping time (r=-0.276, p=0.004), and between KOOS quality of life score and stepping time (r=-0.263, p=0.008). Conclusion: This study describes novel detail of the patterns of activity and sedentary behaviour in patients with knee OA. The use of two accelerometers gives a detailed account of daily activity and the variation throughout the day, highlighting when interventions to improve activity might be most effective. Therefore, interventions should target the long bouts of inactivity in this population. Since even healthy populations of older adults struggle to meet current recommended PA guidelines, it may be important to shift attention from meeting recommendations of MVPA to creating feasible suggestions of doing more light activity and breaking more sedentary time in knee OA patients. / XL2018