Includes abstract. / Includes bibliographical references. / Physical activity (PA) and sedentary behaviour (SB) can be quantified with both self-report and objective measures, using questionnaires and accelerometers, respectively. There is a paucity of research investigating the possible influence that cardiorespiratory fitness and PA might have on the accuracy of self-reported of PA and SB. This is especially important with the increasing evidence around the risks of SB, independent of PA. The aim of this research study is to describe the difference between self-reported measures of moderate PA, vigorous PA and SB against their objectively measured counterparts. The secondary aim is to identify factors influencing the error in self-report measures; including cardiorespiratory fitness and levels of PA.

Includes abstract. Includes bibliographical references.

One of the most common causes of physical disability acquired during childhood is cerebral palsy (CP). Due to improvements in medical care over the past decades, almost all children with CP survive into adulthood nowadays. In addition, based on a stable incidence rate and longevity of individuals with CP, currently most persons with CP are adults. Therefore, it is appropriate to draw awareness to focus on rehabilitation in adults with CP. Due to the nature of their physical disability, adults with CP are at risk to an inactive lifestyle, which can lead to increased health risks. Physical inactivity may be the predisposition to developing a cycle of deconditioning, in which reduced levels of PA (physical activity) may lead to lower levels of physical fitness. Lower levels of physical fitness cause individual’s with CP to expend more energy during daily activities such as walking. As a consequence, individuals with CP may experience earlier fatigue, pain or other factors that increase the impact of the disorder on daily functioning. It is therefore important to intervene in this vicious cycle of physical inactivity. This thesis provides an overview of the methods used to record PA and reports on PA levels in adults with CP. The literature review evidently showed that adults with CP were less physically active compared to TD (typically developed) peers and spent more time in sedentary behaviour compared to TD adults. Various methods have been shown to be available to assess levels of PA, such as questionnaires, pedometers, and more advanced accelerometers that allow for measuring acceleration in three directions (x-y-z axes). Previously, research studies’ most commonly used hip-worn devices among adults with CP to assess PA levels, such as the Actigraph that has been used and validated in various populations with and without disabilities. Unfortunately, the Actigraph is not water resistant, which does not allow individuals to continuously wear the device. Alternatively, wrist-worn devices can be used to assess PA levels, such as the Polar Loop 2, which is convenient to wear and water-resistant. However, no previous research has proven the validity of the Polar Loop 2 to assess PA levels in a cohort with CP. In addition, most studies focused on adults with CP in developed countries, while no studies have been conducted in developing countries. Therefore, the aim of the second study was to determine differences in PA between adults with CP and TD adults living in South Africa, assessed with the Actigraph and Polar Loop 2 accelerometers. In addition, we aimed to determine the validity of the Polar Loop 2 compared to the Actigraph for different levels of PA. This study showed that adults with CP were less physically active than TD adults, based on findings that the number of steps taken per day were substantially lower, they spent more time being sedentary and less time in low and moderate intensity PA. The Polar Loop 2 showed to be a valid measure for PA in adults with CP and TD adults. Since the Polar Loop 2 is water-resistant and convenient to wear it can be a useful tool to measure PA in clinical practice. The reduced levels of PA presented in this thesis highlight that adults with CP are at risk of reduced fitness levels and secondary complications during daily life activities. This cycle of deconditioning may progress during ageing in adults with CP. More PA and exercise, at the correct intensity and duration, can break the barrier of this vicious cycle. Regular exercise can have a variety of beneficial effects on the health of adults with CP. For example, it may reduce the incidence of obesity, improve muscle function and muscle strength. Furthermore, exercise can reduce the incidence of chronic health conditions like diabetes, cardiovascular diseases and osteoporosis. In order to avoid health issues at older ages and to prevent inactive lifestyles, it is important to encourage a healthy and active lifestyle during early adulthood to promote physically active when growing older. Regular exercise also positively influences the development of the musculoskeletal system, which may prevent the decline in mobility.

Background: Rugby Union is an international sport characterized by bouts of short duration, high intensity exercise in which players frequently collide into one another while running at high speeds. Players are commonly required to engage in phases of play involving contact such as tackling, rucking, mauling and scrumming. These phases of play require certain physical qualities, including strength, aerobic power, speed and explosive power. Perhaps, the growth and professionalization of the game has resulted in more emphasis being placed on the physical preparation of the players. Physical preparation of players not only happens at elite senior levels, but has also filtered down into the junior ranks, where it is common for school teams to be trained by professional strength and conditioning coaches. The rules of the game have changed, which have influenced the physical demands. For example, ball-in-play time has increased, players are covering more distance per game, making more tackles and engaging in more scrums. It is therefore important to identify the various physical characteristics that are required to be successful at a particular level of rugby union. The socioeconomic status and ethnicity of the player in association with the physical characteristics can determine the success of an adolescent rugby player. Objective: To determine the association between body mass and stature (referred to as physical characteristics for this study), race, socioeconomic status, and weight training (referred to as non-physical characteristics for this study) on the chances of success among U16 provincial rugby union players. In particular, size, socioeconomic status and ethnicity of players in the U16 national training squad were compared to players who represented their provinces but did not get selected for the national squad. Methods: Data were collected for each player who attended the Coca Cola National Grant Khomo week from 2010 to 2013. Players participating in this tournament had already undergone a process of selection trials to be selected to represent their province at U16 level. The national squad players were chosen based on performances at the Coca Cola National Grant Khomo week. The characteristics of the players selected for the national squad vs. players who did not get selected for the squad from 2010 to 2013 were compared using an ANOVA and the magnitude of the differences were quantified using effects sizes. Results: White players are heavier (ES = 0.59) and taller (ES = 0.8 2) than black players as well as heavier (ES = 0.8 7) and taller (ES = 0.8 2) than coloured players over the four-year period from 2010 to 2013. Players selected into the National squad were on average heavier (ES = 0.5 0) and taller (ES = 0.4 0) than those players not selected into the National squad. White players were the heaviest and tallest of the race groups selected into the National squad (p < 0.0000 2). Players with a high socioeconomic status were heavier (ES = 0.3 0), taller (ES = 0.4 0), and had more playing experience (ES = 0.3 0), than players from a low socioeconomic status background. Grouping according to socioeconomic status did not differentiate between race groups and selection for the national squad. Conclusion: This study showed that the taller and heavier players were more likely to get selected for the national U 16 squad. Since size was also associated with socioeconomic status, the players with a high socioeconomic status had an advantage over players with a low socioeconomic status. These findings have implications for transforming the game to ensure that the representative teams reflect the composition of the South African population.

Includes abstract. / Includes bibliographical references. / The aim of this study was to compare changes in the physical and morphological characteristics of South Africa’s National U/20 rugby union players (Forwards and Backs) over a 12 year period from 1998 - 2010. This period spans an era starting just after the onset of professionalism of the game to the modern era where the influence of professionalism has filtered down to junior (U/20) levels. Any changes in morphology and physical ability of the players can be attributed to the changes in the demands of the game and reflect the characteristics that are required for a player to be successful at that level. Players who were U/20 at the time of representing the Junior South African National Team National over a period spanning from 1998 – 2010 were used for the study. A total of 453 players, split into two groups, Forwards (n = 256) and Backs (n = 197), underwent measurements of body mass, stature, body fat percentage, muscular endurance (pull ups), muscular strength (1RM bench press, sprint times (10m and 40m) and aerobic capacity (Multistage shuttle run test). All Tests were conducted once a year in either January or December of that year. Data are represented as means ± 95 % confidence intervals. A Levene’s test of homogeneity was used to determine whether the variance for each variable was equal. A two-way analysis of variance was used to determine whether there were significant differences for either main effect of ‘year’ or ‘position’ or for the interaction between ‘year x position’. If the main effect of ‘year’ or interaction (“year x position”) was significant, a Tukey post hoc test was used to identify specific differences. Statistical significance was accepted when p &lt; 0.05.

Introduction: The annual rate of rugby-related catastrophic injuries (CIs) in South Africa has been classified as "acceptable". However, of all injuries, CIs are the most traumatic for all involved. Therefore, the BokSmart programme was introduced in South Africa to reduce CIs by training all coaches in safe coaching principles. South Africa presents a particularly difficult implementation context for injury prevention interventions due to large variations in socio-economic statuses (SES) of sport participants. In addition, individuals are known to accept perceived levels of risks and ignore the actual levels of risks. Thus, rugby policy makers, experts, coaches and players may have conflicting views regarding CIs risks associated with the sport. In rugby, objective measures of risks such as risk probability are well defined however; little is known about how rugby coaches perceive the risks of CIs in rugby. This is a concern for rugby governing bodies such as SARU because coaches' perceptions of CIs risks could play a role in their adoption of BokSmart coaching principles. Additionally, risk perceptions of South African rugby coaches may vary by SES. Socio-Ecological Models (SEM) give attention to the intrapersonal, interpersonal and societal influences that affect the perceptions of coaches from various SES settings. Using qualitative methods, the aim of this research was to explore South African rugby coaches' perceptions of CIs, through the lens of a SEM. Methods: Six semi-structured focus groups were conducted with junior and senior coaches from three tiers of SES settings: low, middle and high. An additional focus group was conducted with rugby referees' to corroborate evidence from the coaches' focus groups. For analysis, a thematic framework was developed based on factors that were found to influence risk perceptions from catastrophic event studies. Themes were: 1) SES, 2) Knowledge of rugby and CIs, 3) CIs experience, 4) Cognitive biases, 5) Attitudes and intentions, 6) Coach pressure, and 7) Mass media. Results and Discussion: This study's findings suggest that coaches' perceptions of CI risks vary according to SES. Low SES coaches predominantly implied that lack of adequate rugby infrastructure influenced beliefs that their players are at risks of CIs. For Middle SES coaches, lack of knowledge about CIs prevention influenced perceptions about their players' risks of CIs. Lastly, high SES coaches' were mainly influenced by cognitive biases, perceiving their players to be less vulnerable to CIs than players in lower SES settings. All coaches were influenced by 1) a lack of CIs experience that prompted perceptions of invulnerability to CIs, 2) 'win at all costs' attitudes and intentions, and 3) coaches' pressure, both of which lowered concerns for CIs risks and resulted in players 'playing on' despite injuries. In addition, the SEM provided the overall perspective of the ecological factors that influenced coaches' perceptions of CIs. Conclusion: Perceptions of CIs risk differ among coaches from various SES settings. Therefore interventions such as the BokSmart programme should be tailored towards targeting various SES groups.

Includes abstract. / Includes bibliographical references. / Rugby Union is a popular sporting code in South Africa and the national team (Springboks) has won two World Cups (1995 and 2007). As the pool of players to select the Springboks from has diminished in recent times, it is important for the South African Rugby Union (SARU) to identify and develop young, talented individuals to strengthen the pool of available players. Several talent identification and development programmes have been implemented by SARU with limited success and many of them are not offered anymore.

Background Patients with cardiovascular diseases (CVDs) and non-communicable diseases (NCDs) benefit from participating in cardiac rehabilitation programmes (CRPs). The aim of this research project was to evaluate the factors associated with participation in a phase three CRP, the Prime Time programme (PTP). A secondary aim was to compare attendance and baseline measures between Prime Time (PT) and non-Prime Time (NPT) members at a commercial gym. Methodology The first chapter comprised of focus group discussions (n = 3) and key-informant interviews (n = 5 current members and n = 5 ex-members). Staff participants (n = 9) included the Biokineticists, programme managers and sales consultants who participated in key-informant interviews and provided their perceptions and experiences while working on the programme. Atlas.ti was used for the data analysis and a thematic coding framework was used to analyse the focus groups and interviews. The second chapter, which was a pilot study, employed a case-control research design to compare attendance and baseline data between PT (n = 11) and NPT (n = 40) members at a commercial gym. Three age-matched controls for every case were included in this pilot study. Descriptive statistics (means and standard deviations), one-way analysis of variance (used to determine if there were any significant differences between groups at baseline for continuous variables) and Chi-square analysis (used to determine if there were any significant differences between groups at baseline for categorical variables) were performed. The level of significance was set at p<0.05.

Includes abstract. / Includes bibliographical references. / Chronic diseases of lifestyle are typically diseases of long duration and slow progression and are the major cause of morbidity and mortality globally. In 2008, 57 million people died worldwide of which 33 million deaths were due to chronic diseases. The burden of chronic disease in low and middle income countries is increasing, yet the capacity for prevention and control thereof is inadequate. It has been suggested that more than 50 % of global deaths can be prevented by combining cost effective national and international efforts as well as individual action to target management of well established risk factors including increasing physical activity, improvement of nutrition, decrease tobacco and alcohol use and implementation of strategies to address adverse psychosocial stress. The main aims of this dissertation were 1) to review the existing literature focussing on the prevalence, associated risk factors, management and treatment interventions of chronic disease, and 2) to compare rehabilitation outcomes between a pilot group of patients referred and funded to the CDRRRP by their medical insurer, namely Fedhealth (FH) versus a self funded and referred group (SF) of patients with chronic disease, to determine if any differences exist in their outcomes achieved after completing the 12 week programme, and 3) to evaluate the effect of a chronic disease rehabilitation programme on outcomes after 12 weeks (36 sessions) for chronic disease patients.

Includes bibliographical references / This minor dissertation is comprised of 3 chapters. The first chapter is a meta-analysis that provides a quantitative summary of data from 10 community-based physical activity interventions across 5 countries. The analysis provides evidence for the efficacy of physical activity interventions (standardized mean difference (SMD) = 1.275; percentage increase in physical activity = 29.5%) in increasing levels of physical activity. These findings support the notion that multi-strategic community-wide interventions are able to reach a large proportion of the population regardless of social class and socioeconomic level. Broad-based instead of individual interventions are more cost-effective and help to spread knowledge about the importance of physical activity, stress reduction and nutrition, thereby improving health. The second chapter details the effect of a 3-month pilot Biokinetics primary prevention program ("Sweet Hearts") on health outcome measures. A total of twenty-seven exercise sessions, combined with nutritional advice and stress reduction techniques, were conducted. Despite a small sample size (n = 10), the intervention showed significant improvements in health outcome measures amongst participants (p ≤ 0.05). These improvements include: a decrease in waist circumference and resting respiratory rate, as well as an increase in 1-minute time perception, Global Physical Activity Questionnaire (GPAQ) score, 12-minute walk distance and sit-to-stand test repetitions. Improvements were also noted in cognitive restraint with regards to eating behaviour as well as heart rate variability (HRV), specifically in the low frequency spectrum. The combination of lowered resting breathing rates and improved HRV measures suggests that participant's autonomic nervous system (ANS) regulation improved during the course of the intervention. Correlational analysis revealed that higher income levels were associated with poorer HRV measures. The favourable results of the community intervention show promise for the future expansion of the program into the public health sector and provide proof of concept to dedicate resources to conduct more robust research within a community setting. The final chapter uses a mixed methods approach to explore factors promoting participation and predicting adherence to a community health intervention. The qualitative interviews conducted during this study offers rich and valuable information on how to improve the "Sweet Hearts" intervention. Five main themes were identified from the interviews conducted: 1) Enjoyment of the intervention 2) Benefits of the intervention 3) Obstacles affecting adherence 4) Future improvements to the intervention 5) State of non-communicable diseases in South Africa. Quantitative analysis showed that superior ANS regulation in participants at baseline was indicative of higher attendance rates. This improved regulation is evident through lowered systolic blood pressure and the ability to better regulate (attenuate an increase in) both breathing rate and HRV (low frequency power) from Rest to the Stroop Task s. The detail collected within this analysis will be incorporated into an updated conceptual model that will then form the basis of improving adherence and ensuring the intervention grows from strength to strength in coming years. South Africa is without a focused approach to reduce physical inactivity. The primary function of a Biokineticist is to improve physical functioning and health through exercise as a modality. An alarming number of non-communicable diseases (NCDs), such as cardiovascular disease and type-2 diabetes mellitus, were attributable to physical inactivity among South Africans based on the 1998 South African Demographic and Health survey data. The findings of this dissertation advocate for the support and funding of community-based physical activity interventions in combatting NCDs. The time has come for South African policy makers to act upon the Strategic Plan for Prevention and Control of NCDs (2013-2017). Such action should be A) the inclusion of Biokinetics into the public health sector and B) funding of multi-disciplinary community health programs supporting education, healthy eating and physical activity levels.