L’évolution croissante de l’obésité n’épargne pas les adolescents présentant une déficience intellectuelle. Nos travaux reposent sur le principe d’une « recherche- action » avec pour but l’amélioration de la prise en charge des personnes en situation de handicap mental. Réalisées dans 5 instituts médico-éducatifs, notre première étude montre que plus de 40% des adolescents déficients intellectuels présentent un excès de masse grasse. Plus de 30% des adolescents rapportent un faible niveau d’activité physique et seule la moitié pratiquerait suffisamment d’activité physique pour lutter contre le développement de l’obésité. De plus, les adolescents les plus actifs présentent moins de risques de développer un excès de masse grasse. Leur faible niveau de condition physique observé est un facteur de risque élevé pour la santé. Pour ces jeunes présentant un handicap mental, cela constitue un « sur-handicap » qui peut accentuer la restriction de participation sociale et altérer la qualité de vie. Etre actif au quotidien permettrait de limiter les risques pour la santé, notamment de limiter le développement de l’obésité. De ce fait, un programme d’Activité Physique Adaptée a été proposé aux jeunes repérés en situation de sur-adiposité. Celui-ci a permis d’augmenter les temps de pratique d’activité physique et de stabiliser l’évolution du poids, tout en diminuant la masse grasse et le tour de taille. L’approche interdisciplinaire de cette recherche nous a permis de considérer l’évolution du concept de soi chez ce public spécifique et de constater qu’il n’était pas altéré par cette prise en charge visant le contrôle du poids. / The growing evolution of obesity has not spared children and adolescents with intellectual disabilities. Ours studies based on "research-action", with the aim of improving care for people with mental disabilities. Conducted in 5 specialized schools, our first study shows that over 40% of adolescents with intellectual disabilities have an excess body fat. More than 30% of adolescents report a low physical activity level, and only half reaches enough physical activity to avoid an excess of body fat. Moreover, the most active adolescents are less likely to develop an excess body fat. Their low level of physical fitness is a high risk factor to health. For these adolescent with intellectual disabilities, this is an "extra-handicap" which may increase the restriction of social participation and impair quality of life. Being active daily would reduce the health risks, including limiting the obesity development. Thus, we proposed an Adapted Physical Activity program to over-fatness adolescents. This program has helped to increase level of physical activity and stabilize weight, while decreasing fat mass and waist circumference. The interdisciplinary approach of this research has allowed us to consider the evolution of self-concept and to note that it was not altered by this weight management program.

Syftet med studien var att undersöka på vilket sätt personalen inom ett utbildnings- och aktiveringsprogram i en kommun i Sverige arbetade för att öka de tre olika komponenterna; begriplighet, hanterbarhet och meningsfullhet i deltagarnas känsla av sammanhang (KASAM). Metoden som användes var en kvalitativ intervjuundersökning där personal inom ett utbildnings- och aktiveringsprogram intervjuades. Det insamlade materialet blev analyserat med hjälp av en teoristyrd tematisk analys. Genom analysen utkristalliserades olika subteman med utgångspunkt från våra tre förutbestämda huvudteman som var: begriplighet, meningsfullhet och hanterbarhet. Resultatet visade att personalen till exempel arbetade med språkundervisning, motivationsarbete och praktiskt utförande. Personalen uppgav att språkundervisningen bidrog till deltagarnas känsla av begriplighet, motivationsarbetet bidrog till en känsla av meningsfullhet och praktiskt utförande bidrog till en känsla av hanterbarhet. Studien visar att verksamheten arbetade för att öka alla tre komponenterna i begreppet KASAM, men personalen önskade att arbeta ännu mer med det som skapar en känsla av meningsfullhet. / Our purpose with the study was to investigate in what way the personal at a municipal education- and activity program worked to increase the three components; comprehensibility, manageability and meaningfulness in the participants sense of coherence (SOC). The method used was a qualitative interview study in which the personal at an education- and activity program was interviewed. The collected material was processed by a theoretical thematic analysis. By analyzing the result, six sub-themes were crystallized, with a starting point from our three predefined main themes were: comprehensibility, meaningfulness and manageability. The result showed that the staff for example worked with teaching language, motivational work and practical training. The staff stated that teaching language contributed to the participants sense of comprehensibility, motivational work contributed to a sense of meaningfulness and practical training contributed to a sense of manageability. The study showed that the program worked to increase all three components in the participants SOC, but the staff wished to work even more with the parts that increase the sense of meaningfulness.

Ce travail doctoral propose d’étudier les troubles de l’image du corps et les troubles psychologiques associés, chez des patientes anorexiques, comparées à des femmes sans trouble du comportement alimentaire (TCA), et d’examiner l’impact des facteurs socioculturels sur l’émergence de ces troubles, ainsi que l’influence d’un programme d’activés physiques adaptées (APA) sur leur régulation. L’étude 1 indique que l’insatisfaction corporelle des femmes sans TCA augmente significativement en fonction de l’âge et de la corpulence, démontrant de l’importance de l’image du corps sur la santé mentale des femmes dans nos sociétés occidentales. L’étude 2 montre que les patientes anorexiques ont une insatisfaction corporelle significativement plus importante, des scores d’anxiété physique sociale et de dépression significativement plus élevés, ainsi que des scores d’estime de soi globale et de soi physique globale significativement plus faibles que les femmes sans TCA, traduisant la coexistence de troubles psychologiques chez les patientes anorexiques. L’étude 3 révèle que les mécanismes de comparaison sociale et d’internalisation des messages sociaux sont significativement plus activés chez les anorexiques comparées aux femmes sans TCA. Toutefois, il apparaît qu’une amorce « idéal de minceur » n’a aucun effet significatif sur l’insatisfaction corporelle et la silhouette idéale, chez les deux groupes. Enfin, l’étude 4 montre que, même si le programme d’APA ne permet pas de réguler les troubles de l’image du corps et les troubles psychologiques, il n’interfère pas négativement dans le traitement thérapeutique de l’anorexie mentale. Ces différents résultats sont ensuite discutés, et des perspectives de recherche sont proposées. / The present doctoral research aims to investigate body image disturbances and associated psychological troubles, in patients with anorexia nervosa as compared to healthy controls, and to examine the impact of sociocultural factors on the emergence of the aforementioned troubles, as the effects of an adapted physical activity program (APA) on their regulation. Study 1 indicates that body dissatisfaction of women without eating disorders (ED) increases significantly according to age and shape, enlightening the role of body image in women’s health in Western societies. Study 2 shows that anorexics present significantly more body dissatisfaction and significantly higher scores of social physical anxiety and depression, but also a global self-esteem and a global physical self significantly lower, as compared to women without ED. Study 3 reveals that social comparison and social messages internalization are more relevant in anorexics than in women without ED. However, we observed no significant effect of thin ideal priming on body dissatisfaction and ideal body size in both groups. Finally, Study 4 shows that, even if APA program reveals no significant effect on body image disturbances and associated psychological troubles, it does not interfere negatively with the therapeutic treatment for anorexia nervosa. These results are then discussed and perspectives of research are presented.

The present knowledge of factors associated with older adults’ physical activity behaviour is limited. Therefore, this study trialled an innovative physical activity program for older adults, investigating effective recruitment and retention strategies, and exploring the adults’ perceptions of physical activity. A total of 573 subjects were recruited into the quasi-randomised controlled trial, located in 30 intervention and 30 control neighbourhoods in the Perth metropolitan area. The initial response rate was 74% (260/352) in the intervention group and 82% (313/382) in the control group. Self-reported questionnaires administered at three time points (baseline, 3-months, 6-months) measured physical activity levels, personal and demographic information, including perception of financial struggle, proximity to friends, and other psychosocial data. Descriptive statistics, repeated measure analysis of variance, logistic regression and generalised estimating equations were used in the analysis. Qualitative data on the participants’ perceptions of physical activity were collected through one-on-one interviews (n=16). The results showed that: 1. This cost-effective recruitment procedure facilitated the selection of a reasonably representative sample of 65 to 74 year olds from the Perth metropolitan area. Names of 7378 older adults were obtained from the Federal Electoral Roll, then 6401 potential subjects were matched to telephone numbers and phoned with subjects meeting the screening criteria invited to join the program (n = 4209). From this sample, 573 subjects were recruited. More females (63%) than males (37%) were recruited. / The study attracted a greater proportion of ‘obese’ older adults (27%) relative to state averages. 2. Over the intervention period there was a significant increase in participants’ total physical activity of 2.25 hours per week (p >.001). The General Estimating Equation analysis confirmed significant increase in physical activity from baseline to midpoint (p=.002) and to post intervention (p=.0031). Perceptions of financial struggle (p=.020) were positively correlated with physical activity time spent by participants, whereas having friends or acquaintances living nearby (p=.037) had a significant negative correlation with physical activity time. 3. At the end of the intervention, 32% of the intervention group and 25% of the control group had dropped out, resulting in an overall drop out rate of 28%. Most of the attrition occurred in the first 3 months (77%). Characteristics of individuals lost to attrition (n=86, 35%) were compared with program completers (n=162, 65%). Logistic regression analysis showed that those lost to attrition came from areas of lower socio-economic status, were overweight, were less physically active, and had a lower walking self-efficacy score and a higher loneliness score. The results suggest that to improve retention and to avoid potential bias, early assessment of these characteristics should be undertaken to identify individuals at risk of attrition. 4. Based on the finding of this research, future intervention studies should consider: the role of tertiary students as a skilled resource; the use of volunteers to contain costs; the importance of a tailored program; the appropriateness of walking as a form of physical activity for this age group; the enjoyment associated with a walking group; and the usefulness of social support. / This practical program is potentially effective and sustainable for mobilizing physically inactive older people. 5. Qualitative research highlighted the need for older adults to receive more specific information on: the benefits of physical activity; the role of pain management in physical activity; and the concept that involvement in physical activity in younger years leads to involvement when older. The older adults also expressed a desire to engage in less age appropriate activities. These results suggest that the intervention was successful in recruiting older adults into and retaining them in the intervention, documenting a need for early identification of individuals at risk of attrition. The program significantly increased the participants’ weekly mean time for physical activity and identified factors that affect their commitment to physical activity programs. This program was practical and could be used as a model for physical activity programs aimed at older adults.

The purpose of a rhythm activity program in the Thomas A. Edison School is to achieve the following: 1. The building within each child a better coordination of mind and body. 2. The satisfying of each child with a knowledge that he has the ability of achievement. 3. A healthful, happy, and social relationship between the sexes. 4. For the pupil the realization of the pure joy and exhilaration of living. 5. Poise and self confidence within the child. 6. The carrying over of this program into other closely related classes such as, playground, art, auditorium, and music. 7. An ambition within each pupil to make his community life more desirable.

Les activités parascolaires sont de plus en plus reconnues comme un contexte favorisant le développement positif des jeunes, et ce, particulièrement pour les jeunes en milieu défavorisé. Toutefois, l’efficacité de ces interventions varie selon les programmes, leur contexte d’implantation, ainsi que les caractéristiques et l’engagement des jeunes. La présente étude se situe dans l’évaluation du programme La classe enchantée (CE), un programme d’activités parascolaires musicales offert depuis 2017 aux élèves de 4e année d’une école primaire montréalaise pluriethnique en milieu défavorisé. La CE vise spécifiquement à influencer positivement l’épanouissement des jeunes par l’apprentissage collectif de la musique ainsi que par un accès démocratique à ce programme. De façon à mieux comprendre le fonctionnement et les conditions optimales d’implantation de cette initiative novatrice, la présente étude a comme objectif général d’évaluer la mise en œuvre du programme. De façon plus précise, le premier objectif est de décrire le programme et d’identifier les obstacles et facilitateurs en lien avec son implantation. Le deuxième objectif vise ensuite à relever les composantes essentielles de la mise en œuvre favorisant l’engagement des jeunes, et plus largement, leur développement positif. Les données ont été recueillies sur un peu plus de deux ans auprès de quatre groupes d’acteurs, soit les participants, leurs parents, les enseignants de musique ainsi que l’équipe de direction du programme, et ce, principalement à partir d’entrevues. Dans une visée formative, les analyses descriptives et thématiques ont permis de dresser un portrait détaillé de la mise en œuvre de la CE et de ses facteurs d’influence à partir de la structure d’ensemble du modèle psychoéducatif. Parmi ceux-ci, l’instabilité du financement est ressortie comme étant un obstacle constant avec lequel la direction doit composer. Les résultats mettent également en valeur l’importance des enseignants, de la relation qu’ils créent avec les jeunes, mais également de leur expérience avec la clientèle qui est déterminante pour l’instauration d’un climat propice aux apprentissages. Enfin, certaines aptitudes de la direction ainsi que l’ajout d’une coordination à l’interne ressortent comme étant particulièrement importants au sein du programme pour que les acteurs de sa mise en œuvre s’ajustent efficacement aux obstacles rencontrés et répondent aux besoins des jeunes. L’étude dégage également des réflexions quant à l’utilisation de la structure d’ensemble du modèle psychoéducatif comme outil d’évaluation de la mise en œuvre. / Extracurricular activities are increasingly recognized as a context that promotes youth positive development, especially for those living in disadvantaged areas. However, the effectiveness of these interventions varies from one program to another, based on their implementation context, and according to youth characteristics and commitment. This study is part of the evaluation of the La classe enchantée (EC), an extracurricular music program offered since 2017 to 4th graders attending a multi-ethnic Montreal school located in a disadvantaged area. The EC specifically aims to positively influence youth development through collective music learning as well as through a democratic access to the program. In order to better understand the functioning and optimal conditions for implementing this innovative initiative, the present study aimed as a general objective to evaluate the implementation of the program. More specifically, our objectives were to describe the program and identify the obstacles and facilitators related to its implementation, as to identify the essential implementation components promoting youth engagement and positive development. Data were collected over two years among four groups of actors, namely the participants, their parents, the music teachers, and the program management team. Data were mainly collected from interviews. We relied on the psychoeducational model to draw a detailed portrait of the implementation of EC using descriptive and thematic analysis. Among the main factors associated with the program implementation, funding instability has emerged as a constant barrier for the management team. Our results also highlight the importance of the teachers and the relationship they create with their students, but also their experience with the clientele, which was decisive for the creation of an efficient learning climate. Finally, the management team skills as well as the addition of internal coordination stand out as being particularly important to allow program promoter to effectively adjust to obstacles and better meet student needs. The study also highlights important insight regarding the relevance of the psychoeducation model as an implementation tool as well as broader recommendations on the implementation of extracurricular activity programs.

Le cancer du sein est la forme de cancer la plus souvent diagnostiquée chez les femmes. Elles doivent vivre avec des séquelles qui nuisent à leur qualité de vie. Plusieurs études ont montré les bienfaits de l’activité physique (AP) sur les composantes physiques et psychologiques des patientes. Toutefois, elles réduisent souvent leur pratique d'AP suite aux traitements en raison de la détérioration de leur condition physique. Or, le maintien à long terme de la pratique d’AP est essentiel pour en conserver les bénéfices. La première section du mémoire présente une recension des écrits sur les bienfaits de l’AP auprès des femmes atteintes d'un cancer du sein et la seconde rend compte d'une étude expérimentale ayant pour objectif d'évaluer l’impact d’un programme d’AP sur le sentiment d’efficacité personnel et sur le plaisir associé à la pratique d'AP. Une enquête de suivi a été menée trois mois après la fin du programme afin d’évaluer le maintien à long terme de la pratique d'AP. L'étude a été réalisée auprès de 18 patientes en cours de traitement. Le groupe expérimental a suivi un programme supervisé d’AP combiné à des séances de counseling sur une période de 16 semaines. Le groupe témoin avait la possibilité de suivre un programme de yoga. Nos résultats indiquent une amélioration statistiquement significative des trois composantes mesurées, soit le sentiment d'efficacité personnelle, le plaisir à faire de l'AP et le maintien de la pratique après la participation au programme. / Breast cancer is the most common type of cancer in women. They have to live with the negative impacts of the disease on their quality of life. Many studies have shown that exercise benefits women with breast cancer in several ways, including improved quality of life. However, women reduce their physical activity levels following the treatment due to the relative deterioration of their physical condition. To keep the benefits of participation in an exercise program, breast cancer patients need to maintain their physical activity involvement. The first part of this thesis presents a literature review of the physical activity benefits among women with breast cancer, and the second part assesses the impact of a circuit training and counseling program on exercise self-efficacy and physical activity enjoyment as well as the level of physical activity involvement at 3-month follow-up. Eighteen women undergoing treatment participated in this study. The experimental group followed a 16-week supervised circuit training and counseling program. The control group was offered yoga lessons. The results showed statistically significant improvements on the three patient-rated outcomes. The results showed that a supervised circuit training program combined with counseling enhances exercise self-efficacy. This suggests that it can be a promising program to maintain physical activity involvement.

Le cancer du sein est la forme de cancer la plus souvent diagnostiquée chez les femmes. Elles doivent vivre avec des séquelles qui nuisent à leur qualité de vie. Plusieurs études ont montré les bienfaits de l’activité physique (AP) sur les composantes physiques et psychologiques des patientes. Toutefois, elles réduisent souvent leur pratique d'AP suite aux traitements en raison de la détérioration de leur condition physique. Or, le maintien à long terme de la pratique d’AP est essentiel pour en conserver les bénéfices. La première section du mémoire présente une recension des écrits sur les bienfaits de l’AP auprès des femmes atteintes d'un cancer du sein et la seconde rend compte d'une étude expérimentale ayant pour objectif d'évaluer l’impact d’un programme d’AP sur le sentiment d’efficacité personnel et sur le plaisir associé à la pratique d'AP. Une enquête de suivi a été menée trois mois après la fin du programme afin d’évaluer le maintien à long terme de la pratique d'AP. L'étude a été réalisée auprès de 18 patientes en cours de traitement. Le groupe expérimental a suivi un programme supervisé d’AP combiné à des séances de counseling sur une période de 16 semaines. Le groupe témoin avait la possibilité de suivre un programme de yoga. Nos résultats indiquent une amélioration statistiquement significative des trois composantes mesurées, soit le sentiment d'efficacité personnelle, le plaisir à faire de l'AP et le maintien de la pratique après la participation au programme. / Breast cancer is the most common type of cancer in women. They have to live with the negative impacts of the disease on their quality of life. Many studies have shown that exercise benefits women with breast cancer in several ways, including improved quality of life. However, women reduce their physical activity levels following the treatment due to the relative deterioration of their physical condition. To keep the benefits of participation in an exercise program, breast cancer patients need to maintain their physical activity involvement. The first part of this thesis presents a literature review of the physical activity benefits among women with breast cancer, and the second part assesses the impact of a circuit training and counseling program on exercise self-efficacy and physical activity enjoyment as well as the level of physical activity involvement at 3-month follow-up. Eighteen women undergoing treatment participated in this study. The experimental group followed a 16-week supervised circuit training and counseling program. The control group was offered yoga lessons. The results showed statistically significant improvements on the three patient-rated outcomes. The results showed that a supervised circuit training program combined with counseling enhances exercise self-efficacy. This suggests that it can be a promising program to maintain physical activity involvement.

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