There were three broad aims for this thesis. These included (1) an investigation of the relationships between the intensity and directional dimensions of trait anxiety, state anxiety and performance in sport, (2) a detailed exploration of mechanisms mediating observed relationships, using the theory of Rational Emotive Behaviour Therapy (REBT) as a framework, and (3), based on the findings of this exploration, an assessment of the efficacy of a tailored REBT treatment as a means of modifying harmful trait anxiety directional interpretations, resulting in changes at the state level and ultimately changes in performance. A total of 189 competitors from the sports of freestyle skiing, athletics, and ten-pin bowling participated in Study 1. Each competitor provided general demographic information, information pertaining to their overall skill level, and also completed the Competitive Trait Anxiety Inventory version 2 – directional (CTAI-2-D), Sport Anxiety Scale (SAS), and Competitive State Anxiety Inventory version 2 – directional (CSAI-2-D) just prior to a competition. Following competition they went on to rate their performance on a scale from very poor to excellent. The results of Study 1 revealed that measures of anxiety correlated as predicted, and provided further support to the utility of directional measures of anxiety as a more precise predictor of skill level and performance than intensity alone measures. In Study 2, six bowlers who obtained negative directional trait anxiety scores on both of the cognitive and somatic subscales of the CTAI-2-D, and six bowlers who obtained positive directional trait anxiety scores on both of the cognitive and somatic subscales of the CTAI-2-D were interviewed on two separate occasions. Interviews were designed to assess the presence and typology of cognitions associated with emotional responses based on the ABC framework adopted in the theory and practice of REBT. Findings from Study 2 provided insight into specific cognitive mechanisms behind directional measures of anxiety, and highlighted the value of REBT as a theoretical model for conceptualising various components of anxiety in sport. In particular, competitors with debilitative interpretive styles were found to endorse self-directed demands, and awfulising, and exhibited secondary emotional disturbance most frequently associated with somatic and behavioural interpretations. In the final study, a total of 60 ten-pin bowlers were allocated to either a six-week course of REBT, a six-week course of a more traditional treatment entailing imagery and relaxation, or a control condition entailing six weeks of befriending. REBT was found to significantly moderate negative directional interpretation scores of anxiety symptoms, and to reduce competitors’ endorsement of irrational beliefs (whilst concurrently increasing their endorsement of rational or non-judgemental thinking styles) to a greater extent than the traditional intervention (relaxation and mental imagery), and control condition. Further, although not statistically significant, competitors who underwent the course of REBT showed greater performance gains than the bowlers in the other two conditions. The main implications of these findings are that anxiety research and management practices should focus on the causal role of underlying beliefs, and the relationship competitors have with these beliefs, in the experience of anxiety. Further, the results of this study highlighted that REBT has a significant role to play in the theory and management of anxiety in sport.

This thesis uncovers the rational and Romantic assumptions about the relationship between objects and identity that are embedded in occupational therapy, and critiques current practice from that perspective. It is based on an initial assumption that there is in fact a relationship between people's identity and the objects they make, have, use and are associated with. This assumption is explored through an interpretive examination of the fields of literature that are commonly identified as informing occupational therapy, supplemented by selected popular literature. The exploration takes a philosophical approach, guided by notions from philosophical hermeneutics, including pre-understandings, the hermeneutic circle and fusion of horizons. The conclusion reached is that people informed by Western philosophies interpret the identity meanings of objects in both rational and Romantic ways. To inform the study, the nature of rationalism and Romanticism are then explained, and the implications of these philosophical traditions in relation to objects and identity are teased out. This interpretation is guided by a history of ideas methodology, which entails approaching historical texts from a new perspective, in this case the identity meanings of objects. Thus informed, occupational therapy literature, primarily that published in Britain between 1938 and 1962 is examined from the perspective of objects and identity. What is revealed is that rational and Romantic understandings of objects, and of patients' and their own identity are clearly discernible. Such understandings afforded early occupational therapists both ways to organise their growing knowledge of the therapeutic application of crafts and the transformative outcomes of occupational therapy intervention. Gradually however, factors both internal and external to the profession served to undermine therapists' Romanticism. Primary amongst these were World War II, which saw a redeployment of occupational therapists from mental health to physical rehabilitation settings; advances in rehabilitative medicine, which brought a reduction in secondary complications and the adoption of teamwork; and the development of new practice areas including domestic rehabilitation using gadgets to enhance function and pre-vocational rehabilitation. As a result, tensions between rational and Romantic understandings crystallised around two long-standing controversies. These were whether or not craft equipment such as weaving looms should be adapted to serve specific remedial purposes, and whether it was the process of making a crafted object or the quality of the finished product that was more important. In the event, these contested ideologies became largely irrelevant as craftwork was sidelined from mainstream practice. With it, occupational therapists' Romantic vision of transforming people's lives through creative activity also slipped away. Several reasons for this loss of one of the profession's founding philosophies are proposed. They include the substantial absence of the professions' philosophical foundations from its education, and the paucity of theory and research methodologies that might have informed the nature and process of transformative change that earlier occupational therapists had observed and reported. The thesis concludes by arguing for the importance of recovering a balance between rationalism and Romanticism. A call to action is issued, addressing change in educational practice, concerted research effort to identify and articulate transformative processes within occupational therapy, and political action focusing on the inclusion of Romantic perspectives within policy and strategic documents.

Reviews of clinical practice for paediatric pacemaker implantation and follow-up are necessary to provide an evidence-base for future policy and practice in this field. Epicardial pacing data available through Green Lane Hospital, New Zealand's (NZ) primary referral centre for paediatric cardiac surgery and pacemaker implantation, was reviewed with the following aims: Assessment of pacemaker lead performance over time in relation to the type of epicardial lead implanted - steroid-eluting (SE) and non steroid-eluting (NSE). Determination of the survival rate of epicardial leads. Identifying factors predicting or associated with lead failure.A database of pacing and sensing thresholds and lead impedance data at implant, 2, 6 and 18 weeks and 6 monthly intervals thereafter, was compiled and the prevalence and timing of complications in relation to lead type, location and implant route determined. In total 192 leads (155 SE, 37 NSE) were implanted in 96 patients (52 male) aged 3 days to 71 years (y) (median 1.7y), 74 patients were < 17 years of age at implant. Congenital heart defects were present in 82% of patients. Follow-up (f/u) was possible for 180 leads. Mean f/u duration for the 150 SE leads was 3.1y (2 weeks - 8.8y) and for the 30 NSE leads was 4.5y (2 weeks - 27y).SE and NSE pacing thresholds were similar at implant. NSE pacing thresholds peaked at 6 weeks post implant and remained significantly higher than SE leads throughout f/u in surviving leads, although the difference was small at 2 and 4 y. SE and NSE leads had similar ventricular sensing thresholds and lead impedances throughout the study period.Survival at 5 years for all leads was 61% (66% for SE leads and 41% for NSE leads). Primary causes of failure in the leads receiving f/u were exit block and lead fracture. The occurrence of exit block was significantly higher (p<0.0001) in NSE leads (57%) compared to SE leads (5%). Lead fracture occurred in 15% of leads with the highest fracture rate at 2-3 y post implant. Patient age and weight at implant, gender, previous cardiac surgery, lead polarity, indication for pacing and implant route were not predictors of lead failure. NSE leads were 6 times more likely to fail compared to SE leads (p <0.0001).The main study findings were: SE leads maintain lower pacing thresholds and a reduced incidence of exit block compared to NSE leads. It is therefore recommended that SE leads be developed which can penetrate fibrosed, scarred or fatty epicardial surfaces. Where SE lead use is contraindicated, alternative surgical techniques for SE lead placement should be attempted rather than implanting NSE leads. Lead fracture is a significant complication of epicardial pacing in paediatric patients. Using stronger bipolar leads implanted by the subxiphoid route may reduce the risk of fracture. Medium term survival (5 y) of SE epicardial leads is acceptable and therefore the continued use of these leads is recommended, particularly in young patients, allowing their veins to be saved for transvenous leads later in their life.

Physical activity is now a key strategy for preventing or minimising numerous chronic diseases. Worksites are an ideal location to promote regular physical activity. For workers, a large portion of waking hours is spent at work where numerous opportunities exist to accumulate physical activity. Consequently, the aims of this thesis were to: 1) systematically review worksite physical activity literature, especially in the New Zealand context; 2) identify the contribution of worksite activity to total activity levels, and the correlates contributing to physical activity levels for professional occupations; and 3) objectively measure physical activity changes with point of decision prompt visibility in professional worksites. Accordingly the thesis incorporated one systematic review and two separate studies.Effect sizes calculated in an analysis of previous worksite physical activity health promotion studies show inconclusive evidence for increased employee retention and job satisfaction, and no evidence of reduced absenteeism or productivity increases. A major criticism of worksite research is that many unvalidated and unreliable designs are used, limiting study efficacy. Research initiatives need to identify the determinants of physical activity for different occupations, ethnicities, and gender in New Zealand worksites.Study 1 (N=56) consisted of participants wearing two pedometers over a three-day block, and subsequently completing a Three-Day Physical Activity Recall (3DPAR). A moderate, positive Spearman correlation (r=0.28) existed between the METs (3DPAR) and total pedometer values. Contributions of (mean + SD)worksite (14 283 +4761), non-work (12 516 +4 172), and total (26 798 +8 933) pedometer values were analysed. The sample was divided into tertiles according to total step counts. The high activity group (HAG) achieved more physical activity outside the workday (56%) when compared to the lowest activity group (LAG) (29%). Physical activity correlates were identified using binary logistic regression and simple correlation analyses. Relationships between physical activity and active transport, manual work, sport and exercise, and individual exercise were shown.Study 2 evaluated the National Heart Foundation (NHF) point of decision prompts for increasing physical activity levels in professional worksites. Forty-six participants (27 men and 19 women) wore two pedometers for three days, over four occasions to monitor changes in physical activity. The study was a crossover design with Worksite 1 receiving the treatment for three weeks, followed by a six-week wash out period, then a three-week control. Worksite 2 was given the control prior to the treatment period. Results indicate that the NHF point of decision prompts were ineffective at increasing objectively measured work and total physical activity levels, showing trivial positive (0.04) to moderate negative Cohen effect sizes (-0.79). When point of decision prompts were visible in the worksites overall mean step counts decreased. On the basis of these findings, the NHF's point of decision prompts had no effect, or were potentially detrimental to physical activity.Nevertheless, both studies were limited by some traditional worksite design problems, including low participation and sample contamination. However, by incorporating an objective measure of physical activity (pedometers) and a robust study design, these findings are the first objective measures of worksite physical activity, and the effects of point of decision prompts in a confined sample.

The objective of this study was to investigate the influence of cyclic loading on the extensibility of hamstring muscle-tendon units in vivo.Study Design: A test-retest randomised controlled trial with repeated measures was undertaken.Background: Stretching has been commonly promoted to increase the passive extensibility of the muscle-tendon units, yet the mechanism behind its proposed effects remains ambiguous. In vivo studies of stretching have mostly been limited to the viscoelastic characteristic of stress-relaxation. Few studies have investigated the characteristic of creep. Animal and cadaver in vitro creep experiments have consistently shown increases in the length of the soft tissues, with associated changes in their resistance and stiffness. These results however, might not be representative of human muscle-tendon units under in vivo conditions. Additionally, those in vivo human studies that have investigated creep phenomenon have contrasting results. To date, no known in vivo study has examined passive cyclic loading of human hamstrings to a constant load level.Method: Using a repeated measures design the extensibility of the hamstring muscles were assessed by a passive knee extension test (PKE) to maximal stretch tolerance using a KinCom® dynamometer. Those participants in the intervention group underwent 45 continuous passive cyclic loadings as the KinCom® dynamometer moved the knee joint into extension until torque reached 85% of maximal passive resistance torque measured in the passive knee extension test. The control group sat quietly relaxed during the intervention period. Measurements of hamstring passive extensibility using the PKE test were repeated at the end of the intervention.Results: Following the intervention, the PKE test showed for the cyclic loading group there was a significant (p < 0.05) increase in both maximal passive resistance torque (mean 23%) and knee joint angle (mean 6.3%). A significant (p < 0.05) decrease in passive resistance torque (mean 11.8%) when re-measured at the baseline position of maximal passive knee angle was observed. A significant increase (p < 0.05) was found for passive stiffness over the final 10% of the knee torque-angle curve. No significant difference (p > 0.05) was found for passive stiffness for the full (100%) of the torque-angle curve. Of the control group, no significant differences (p > 0.05) were observed for all variables of the PKE test. Analysis of cycle one compared to forty-five of the cyclic loading intervention procedure showed a significant (p < 0.05) increase in both passive knee joint angle (mean 5.2%) and passive stiffness (mean 28.6%) over the final 10% of the knee joint torque-angle. No significant difference (p > 0.05) was found for passive stiffness across the full (100%) knee joint torque-angle.Conclusion: The findings of the current study demonstrated that after cyclic loading the hamstring muscles lengthened and became stiffer over the final gained range of knee joint motion. Although the current study cannot determine the mechanism behind the changes in the variables of interest, these findings do provide some evidence that most likely a combination of altered stretch tolerance and local mechanical effects within the muscle-tendon unit, i.e. creep lengthening were responsible.

Caffeine is now an unrestricted ergogenic aid for competitive athletes. Previous reviews of caffeine's effects on exercise performance have been limited to qualitative analysis. The purpose of this paper was therefore to quantitatively meta-analyze the effects of caffeine on exercise performance. We identified 90 estimates of performance effects of caffeine in 32 peer-reviewed studies. All estimates were converted to mean power in an equivalent time trial then subjected to a mixed-model meta-analysis. The fixed effects were gender, training status (elite athlete, non-elite athlete, non-athlete), dietary caffeine status (habitual consumer, non-consumer), caffeine abstention period, caffeine dose (mg/kg body mass), type of caffeine (pure or in coffee), delay between ingestion and performance test, duration of test, and presence or absence of fatiguing exercise before the test. The random effects accounted for within- and between-study variance. We found that caffeine enhanced mean power by 2.8% (90% confidence limits ± 1.1%) in male non-elite athletes who are habitual caffeine consumers abstaining from caffeine for 2 d before consuming 6 mg/kg of caffeine capsules 1 h before performing a 30-min time trial without intervening fatiguing exercise. The effects for other athletes and conditions were: females, 3.1% (± 2.7%); elite athletes, 2.9% (± 1.4%); non-athletes, 1.3% (± 1.2%); habitual non-consumers, 4.0% (± 1.4%); 7 d of abstention, 3.4% (± 2.6%); 0.3 mg/kg of caffeine, 1.6% (± 5.3%); caffeinated coffee, 1.0% (± 1.6%); 2-h delay before exercise, 2.9% (± 1.2%); 6-s exercise test, 1.6% (± 1.7%); prior fatiguing exercise, 3.0% (± 1.6%). Each of these effects of caffeine varied typically between studies by ± 1.4% (the between-study random effect; 90% confidence limits ± 0.9 to ± 3.5%). We conclude that caffeine has a greater effect on performance with athletes, with habitual non-consumers of dietary caffeine, when administered as pure caffeine, and in endurance exercise, but there is considerable uncertainty about the magnitude of the effects on individuals. More research is needed to reduce this uncertainty and to determine the performance effects of caffeine with females, following longer periods of dietary abstention, in low doses, and for brief exercise. There has also been no research on effects of caffeine on the repetitive fatiguing exercise typical of team sports.

This PhD thesis is concerned with sports tourism as a way of experiencing a sense of self, belonging and location in the social world. It is about how identity is developed, expressed and experienced when gymnasts interact within their specific sports community while travelling to take part in a non-competitive, international group gymnastics event. In particular, the research aim is to identify and make sense of the meaning participants attach to their involvement in sports event tourism in the context of the 2011 World Gymnaestrada in Lausanne/Switzerland, the purely non-competitive, official world event of the International Gymnastics Federation (FIG).

Objective: To determine the extent to which coaching over the telephone is an effective method in promoting the loss of body weight and body fat percentage. Research Methods and Procedures: Over a period of four months, in a randomized, double blind, placebo-controlled study, 120 overweight and obese (BMI 25-35 kg/m²) adults either received telephone coaching or no coaching. In addition, each participant was randomly assigned to take a supplement or placebo daily. Body weight and body fat percentage were measured at baseline, two months, and four months. Body weight was measured on an electronic scale and body fat percentage was assessed using dual energy x-ray absorptiometry (DEXA). Participants in the coaching group each received a minimum of 10 coaching sessions, each at least one week apart. Age, gender, and supplement use were controlled statistically using partial correlation. Results: When using repeated measures ANOVA, telephone coaching had a significant and favorable effect on body weight loss over the three time periods when compared to participants who received no coaching (F = 3.9, p = 0.0216). Also, when weight changes from baseline to four months were compared, ignoring the two-month time period, those in the coaching group lost significantly more weight than their counterparts (F = 4.75, p = 0.0315). When weight changes from baseline were compared to the halfway mark (two months), telephone coaching resulted in significantly greater weight loss at the trend level (F = 3.42, p = 0.0671). However, during the second half of the study (two months compared to four months), the effect of coaching was weaker and non-significant. Controlling statistically for age, gender, and supplement use, individually and collectively, had no effect on the impact coaching had on body weight loss. Telephone coaching did not play a significant role in helping participants lose body fat percentage across the three time periods compared to those who received no coaching (F = 1.28, p = 0.2797). Similarly, baseline body fat percentage means contrasted with four-month means (F = 1.65, p = 0.2018) were not significant, and findings from the two halves of the study showed that telephone coaching did not have a significant effect on the loss of body fat percentage. Discussion: Telephone coaching is an effective and inexpensive method of helping overweight and obese adults lose body weight, but not body fat percentage, over a four-month period.

BACKGROUND: Chronic ankle instability (CAI) patients have varying levels of mechanical and sensorimotor impairments that may lead to disparate functional movement patterns. Current literature on landing biomechanics in a CAI population, however, considers all patients as a homogeneous group. In our prior work, we identified 6 subgroups of movement patterns using lower extremity kinematics during a landing/cutting task and that showed promise in furthering understanding of movement patterns in a laboratory-based environment. To increase the utility of this methodology in clinical settings, there is a need to find easily administered clinical tests that can help identify multiple subgroups of movement patterns in a CAI population. The purpose of the present study was to identify clinical tests that would help identify frontal and sagittal kinematic movement pattern subgroups during a landing/cutting task. We hypothesized that clinical tests would help predict group assignment; which CAI patient is assigned to frontal and sagittal kinematic movement pattern subgroups, respectively. METHODS: We recruited 100 CAI patients from a university population. We used three-dimensional instrumented motion analysis to capture ankle, knee and hip kinematics as subjects performed a single-leg maximal jump landing/cutting task. We used sagittal and frontal joint angle waveforms to group CAI patients. We then used 12 demographic and clinical measures to predict these subgroups of CAI. These consisted of gender, Star Excursion Balance Test-Anterior (SEBT-ANT), Biodex static balance, figure 8 hop, triple crossover hop, dorsiflexion range of motion (DFROM), number of failed trials, body mass index, a score of Foot and Ankle Ability Measure-Activities of Daily Living (FAAM-ADL), a score of FAAM-Sports, number of "yes" responses on Modified Ankle Instability Index, and number of previous ankle sprains. First, we used functional principal component analysis to create representative curves for each CAI patient and plane from the 3 lower extremity joint angles. We then used these curves as inputs to a predictor-dependent product partition model to cluster each CAI patient to unique subgroups. Finally, we used a multinomial prediction model to examine the accuracy of predicting group membership from demographic and clinical metrics. RESULTS: The predictor-dependent product partition model identified 4 frontal and 5 sagittal movement pattern subgroups. Six predictors (e.g., gender, SEBT-ANT, figure 8 hop, triple crossover hop, DFROM, and FAAM-ADL) predicted group membership with 55.7% accuracy for frontal subgroups. Ten predictors (minus Biodex static balance and number of previous ankle sprains) predicted group membership with 59% accuracy for sagittal subgroups. CONCLUSION: Novel statistical analyses allowed us to predict group membership for multiple frontal and sagittal kinematic movement patterns during landing/cutting using a series of clinical predictors. However, due to relatively lower accuracy (56–59% accuracy), the clinical utility of the current prediction model may be limited. Future work should consider including other clinical predictors to maximize prediction accuracy for identifying multiple kinematic movement patterns during a landing/cutting task.

Biomechanical and physiological parameters related to running performance are usually studied separately. However, evaluating both aspects together could be beneficial in improving athletic performance. The purpose of this study was to observe the change in peak vGRF and asymmetry as speed increases, while observing physiological responses during a O2maxtest. Data from athlete monitoring of 12 cross-country and triathlon athletes were analyzed. The athlete monitoring protocol included three unweighted countermovement jumps and a O2maxtest performed by the athletes. The athletes had an average O2maxof 53.4 ± 7.7 mL/kg/min, while their average vGRF asymmetry throughout the O2maxtestwas 1.38 ± 0.68%. A strong, positive correlation was found between average vGRF and average blood lactate (r=0.93), indicating that as vGRF increased so did blood lactate. It was concluded that physiological and biomechanical parameters are related in athletic performance. Therefore, athlete monitoring should include analysis of both physiological and biomechanical parameters in order to form a more well-rounded analysis of athlete performance.