Guided by the expectancy value model of achievement choice, this study examined the relationships among expectancy value constructs (expectancy related beliefs and subjective task values), effort and intention for future participation in a culturally specific dance, soul line, among African American adult women in the church setting. Participants were 100 African American women who were members of the women’s ministries from four predominantly African American churches in the Dallas/Ft. Worth metropolitan area. Participants completed a 20-minute soul line session and responded to survey questions, validated in previous research, assessing their expectancy-related beliefs, subjective task values, effort, intention for future participation and physical activity. This was the first study to use the expectancy value model as a guide to determine motivations attached to physical activities among African American adult women. Usefulness, a component of subjective task values, emerged as a predictor of intention for future participation. Eighty-one percent of the women did not meet physical activity guidelines for aerobic activity. Of those inactive women 60% indicated an interest in doing soul line dancing often at their church after one short exposure to the activity as indicated by the strongest possible response to both intention questions. A slightly smaller percent of the active women provided with a strong positive response for future intention. These findings suggest that soul line dancing is a practical avenue to increase physical activity among African American women in the church. Future research should test this theoretical model on a wider variety of individuals who are sedentary to physically active, measure actual participation, and directly measure BMI and physical activity.

Background. Childhood overweight and obesity is a serious health issue. Childhood obesity is associated with asthma, hepatic steatosis, sleep apnea, psychosocial complications, increased presence of cardiovascular disease risk factors, and increased medical costs. A decrease in physical activity, an increase in sedentary behavior, and unhealthy eating likely contribute to childhood overweight and obesity. Over the last 3 decades, the prevalence of early childhood obesity has also risen. The level of physical activity that preschoolers engage is influenced by policies and practices of childcare centers they attend. Given the large number of children enrolled in preschool settings and the variability of physical activity among centers, these environments provide a promising opportunity to engage more children in health promoting levels of physical activity. Preschool students are highly sedentary and very little is known about how to significantly increase physical activity in childcare environments with structured, teacher-led activity. Methods. Activity levels among children aged 4-5 in four childcare centers were measured before and after a one-day preschool physical activity teacher training by accelerometry for approximately 5 hours per child over two mornings. Observers coded individual child activities by time. Accelerometer measures of activity levels in METs and related indicators were linked at one-minute intervals with child activity codes. Data were evaluated using single-group repeated measures analysis of variance. Results. After six weeks of implementation the intervention, average MET levels in preschoolers in three of the four centers increased by 11.5% from baseline to follow up. The average MET level per minute for these children at baseline was 2.69±0.40 and at follow-up was 2.98±0.52 (p value= .001). Teachers from all four centers reported spending 24.6 ±13.0 minutes per activity session with up to two sessions completed per day. Teachers reported following the curriculum closely and indicated that the children were generally enthusiastic. Conclusions. These results justify larger trials to determine the impact of physical activity teacher training on the intensity and duration of preschool students' physical activity in childcare settings

Neighborhood design affects lifestyle physical activity, and ultimately human wellbeing. There are, however, a limited number of studies that examine neighborhood design types. In this research, we examine four types of neighborhood designs: traditional development, suburban development, enclosed community, and cluster housing development, and assess their level of walkability and their effects on physical activity and wellbeing. We examine significant associations through a questionnaire (n = 486) distributed in Tucson, Arizona using the Walkability Model. Among the tested neighborhood design types, traditional development showed significant associations and the highest value for walkability, as well as for each of the two types of walking (recreation and transportation) representing physical activity. Suburban development showed significant associations and the highest mean values for mental health and wellbeing. Cluster housing showed significant associations and the highest mean value for social interactions with neighbors and for perceived safety from crime. Enclosed community did not obtain the highest means for any wellbeing benefit. The Walkability Model proved useful in identifying the walkability categories associated with physical activity and perceived crime. For example, the experience category was strongly and inversely associated with perceived crime. This study provides empirical evidence of the importance of including vegetation, particularly trees, throughout neighborhoods in order to increase physical activity and wellbeing. Likewise, the results suggest that regular maintenance is an important strategy to improve mental health and overall wellbeing in cities.

Background: Physical activity (PA) poses an additional burden on people living with type 1 diabetes (T1D) as it increases the risk of hypoglycemia, if performed at a moderate intensity. It is hypothesized that adding vigorous PA (VPA) into moderate PA (MPA) may help attenuate exercise-related hypoglycemia. Methods: Seventeen participants with T1D (23.7±6.6 years) completed an observational study of six days with continuous glucose monitoring and accelerometer-derived measures of PA to determine the association between PA intensity and both hypoglycemia risk and glucose variability (GV). Results: Higher evening moderate-to-vigorous PA (MVPA) increased the risk of overnight hypoglycemia (OR 1.03; 95% CI 1.002-1.047, p=0.031). Increased evening VPA was not associated with reduced hypoglycemia, but decreased overnight GV (3.20±0.25 for low vs 2.27±0.29 for high; p=0.022). Conclusions: Performing evening MVPA increases hypoglycemia risk overnight, but incorporating VPA did not prove to be protective. However, VPA reduced GV, which is a predictor of hypoglycemia. / May 2016

Background: Physical inactivity has been identified as the fourth leading risk factor for global mortality. Despite public health guidelines advising children and adolescents to spend a minimum of 60 minutes per day of at least moderate intensity physical activity, a large proportion of children and adolescents fail to meet these guidelines. Interventions promoting physical activity show varying degrees of success, and more detailed evaluations of such interventions are essential. The aim of this research was to conduct an in-depth evaluation of a community-based physical activity program aimed at children and adolescents, specifically the Tribe Project. Methods: The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) was used to evaluate the individual and organisational-level impact of the Tribe Project. A single mixed method case study was used based on five sources of evidence: interviews, questionnaires, documentation, archival records and direct observations. Participants included the Tribe managers and coaches implementing the program and the Tribe parents and children/adolescents who attended. Results: The Tribe Project reached approximately 2.5% of the eligible population living within Bath and North East Somerset. The program successfully met some of its objectives although feedback procedures were poor and the program aims were unclear. The community-level adoption of the program was high, however, the implementation and adherence to the program principles at the setting-level varied. The program was successfully institutionalised within the University of Bath yet pathways after the program into the community varied, and were mostly competitive only. Nonetheless, a combination of social, psychological and physical benefits was reported following participation. Conclusion: To assess accurately the potential impact of physical activity interventions a combined assessment of individual and organisational-level factors is necessary. This will help inform policy on effective strategies to promote physical activity in the community, and develop interventions that are more effective as a result.

College is an important time for young adults, but most college students fail to meet the daily recommendations for physical activity. Social support is associated with positive health practices, but limited research is available on the role of perceived support from specific relationships, (e.g., peers and parents). The purpose of this study was to evaluate the effect of perceived support from parental and peer relationships on health-related beliefs and behaviors. Participants (N = 333) completed the Quality of Relationships Inventory, Multidimensional Scale of Perceived Social Support, Satisfaction With Life scale, and a short version of the Physical Self-Description Questionnaire. While highly active students did not necessarily have more socially support relationships, females self-reported more conflict with both parents and more depth and support with a special person in their life than males, and parental and peer relationships appeared to be a greater influence on females' perceptions of satisfaction and self-worth.

Large-scale assessments of children and youth physical activity (PA) behaviors are regularly conducted in school settings. In addition to assessing actual fitness, the FITNESSGRAM® assesses self-reported PA behaviors for aerobic, strengthening, and flexibility activity within the past 7 days. The purpose of this study was to examine the reliability and validity of the three PA items. Participants included 1010 students in grades three through twelve and were either tested under a teacher – teacher condition, an expert - expert condition, a teacher – expert condition, or a trained teacher – expert condition. Comparisons of the responses to the PA items indicated adequate reliability for teachers, but the reliability improved with training. Likewise, the validities for teachers are moderate to fair; however, they improved when teachers received additional training.

This research sought to develop and test a health behaviour change intervention for overweight and inactive UK adults, aged 35-74 years, using the concept of an evolutionary mismatch to frame health information. The mismatch concept posits that human culture has evolved too rapidly for biological evolution to keep up, meaning the human body is poorly adapted to cope with the modern environment, predisposing us to chronic disorders. The first study explored whether using the mismatch concept to frame health information would be acceptable and engaging to target users. Mismatch-based text and graphic resources were shown to participants in semi-structured interviews. They had good acceptability, generated interest and seemed to provide a meaningful rationale for behaviour change. Following further development, the second study tested whether the resources could improve people's understanding of the effects of physical activity and diet on health and bring about change in theory-based cognitive determinants of behaviour. This questionnaire-based study found the resources enhanced knowledge and effected positive changes in most of the targeted cognitions. The mismatch resources were then developed into an online intervention also incorporating evidence-based behaviour change techniques. The third study evaluated this intervention in a pilot randomised controlled trial. The intervention did not lead to significantly greater improvement in physical activity or diet than a minimal intervention comparison, however the behavioural and health changes achieved in the intervention group were of meaningful effect size. Process evaluation provided partial support for hypothesised mechanisms of behaviour change. The findings suggest the mismatch concept could be a useful frame to stimulate initial interest and motivation in health interventions; combined with additional behavioural techniques this can help promote healthy lifestyle change. Further work is needed to test the efficacy of a mismatch-framed intervention among populations of different ages, ethnicities and religious beliefs.

Body weight perceptions remain an important area of study. Beauty ideals have changed significantly with more emphasis on thinness. According to sociocultural perspectives, the pressure to be thin results in negative psychological consequences in most Western societies. Evidence, however, suggests that certain cultural and ethnic groups retain a traditional preference for plumpness. This thesis aimed to understand cultural perceptions of body weight and its influence on body dissatisfaction, self-esteem, body appreciation and physical activity in Jamaica. The research employed a mixed methodology approach. Qualitative inquiry using thematic analysis unearthed various beliefs about body weight and its health consequences. Specifically, it identified varying body ideals for women in Jamaica. These are the 'fluffy' body ideal and the slim ideal. The term 'fluffy' referred to women with larger bodies who were perceived to be confident and attractive. The novel Fluffy Rating Questionnaire (FRQ) was developed and was subjected to both exploratory factor analysis (parallel analysis) in study 2 and later confirmatory factor analysis in study 3. It was determined that the FRQ was best suited to examine impressions of fluffy women's personality which was a significant contribution to knowledge on fluffiness in Jamaica. Data were analyzed using Pearson's correlation, regression analysis, and analysis of variance. There were no relationships between impressions of fluffy women's personality, self-esteem, body appreciation or body dissatisfaction. However, the results support existing knowledge on the relationship between body mass index and body dissatisfaction, self-esteem and body appreciation. Impressions of fluffy were simulated and results suggest impressions of fluffy were related to lower recall of physical activity compared to impressions of obesity and the control. Overall, the findings indicate that there are influences of Western body ideals in Jamaica; however, there is still a traditional preference for plumpness which is conveyed through local expressions such as 'Fluffy'.

Background: Chronic obstructive pulmonary disease (COPD) is an important common chronic lung condition that is a leading cause of morbidity and mortality worldwide, resulting in a substantial and increasing economic and social burden to health care systems. Physical activity (PA) is the strongest predictor of mortality in this population, playing an important role determining the quality of life in COPD, with better outcomes being reported by those who have higher levels of PA. Therefore, improving PA levels has been considered a key component in the management of patients with COPD. Likewise, it is important to understand the mechanisms that lead to inactivity, as it is to develop accurate methods of measuring PA in this population. Aims of the thesis: 1) To identify and to summarize the interventions able to increase PA levels in patients with COPD; 2) To understand the longitudinal interaction between muscle mass and function and PA levels in COPD; 3) To study the acceptability and the suitability of a new activity monitor (TracMor D - Philips, the Netherlands) for home coaching in daily routine of patients with COPD; and 4) To investigate whether a PA enhancing programme with set targets and feedback would constitute a successful intervention to increase PA levels in patients with COPD attending pulmonary rehabilitation (PR). Methods: To achieve the first aim of the thesis I performed a systematic review summarizing interventional studies that assessed PA as an outcome in patients with COPD. For the second aim, I analysed some multicentric longitudinal data (one year follow-up) on PA and muscle mass/function in COPD. The third aim was achieved with a pilot study I conducted in Edinburgh, where patients with COPD wore three TracMor D in different body places simultaneously with the criterion method (Actigraph GT3x activity monitor) for a week. To accomplish the fourth and main aim of my PhD, I conducted a randomised controlled trial (RCT) where patients with COPD undergoing PR were randomised to either receive PR only or PR plus a PA coaching programme using the TracMor D activity monitor for 12 weeks. Main Results: Study 1: Sixty studies were considered for data extraction in the systematic review. Seven types of intervention with the potential to increase PA levels in patients with COPD were identified. PR programmes with more than 12 weeks of duration and PA coaching programmes with feedback of an activity monitor are promising interventions to increase activity levels in patients with COPD. Overall, the quality of evidence across interventional studies was graded as very low. Study 2: The longitudinal study showed that there were weak correlations between PA levels and muscle strength at baseline (0.19 ≤ r ≤ 0.33 p < 0.001 for all). No correlations were found between changes in PA and muscle strength (-509 [-1295-362] vs -0.4 [-3.5-2.6] - 12 months minus baseline - respectively) and future muscle mass (p > 0.05). Baseline PA levels are related to future muscle strength (0.30 ≤ r ≤ 0.41, p < .0001) but not with muscle mass. Study 3: This study showed that TracMor D had strong correlations with Actigraph GT3x in terms of Kcal consumption in all three positions (necklace, pocket and hip) (0.84 ≥ r < 0.86, p < 0.001 for all). TracMor D was considered comfortable and easy to use at home, receiving a mean usability score of 98 out of 100 maximum points. Study 4: My RCT showed that the proposed PA intervention was effective in changing steps/day (1251 ± 2408 vs control -410 ± 1118, p=0.01), time spent in light activities (21 ± 60 vs -37 ± 55, p=0.004), exercise capacity (99 ± 139 vs 3 ± 83 meters; 85 ± 114 vs 2 ± 62 seconds, p < 0.03 for both) and muscle strength (15 ± 20 vs -5 ± 18, p=0.01) among others when compared to the control group. Conclusions: Strategies focussing specifically on increasing PA and longer PR programmes may have greater impacts on PA levels in COPD. Well-designed clinical trials with objective assessment of PA in patients with COPD are needed. PA levels are not related to one-year changes in muscle mass and muscle strength in patients with COPD. However, higher PA levels at baseline are related to having higher muscle strength at one-year. TracMor D strongly correlated with the criterion method and was highly accepted by patients with COPD in their daily routine, being considered comfortable and easy to use at home. The combination of PR with a physical activity enhancing programme using a PA monitor to set targets and give feedback on activity levels significantly improves PA, exercise capacity, muscle strength, quality of life, and anxiety and depression levels in patients with COPD.