The purpose of this doctoral dissertation was to investigate the relationships between mental health and physical activity participation of medical students, as well as their confidence, motivation and frequency in recommending physical activity in future medical practice. Moreover, this thesis involved the implementation and evaluation of a peer support walking intervention aimed at improving the mental health and physical activity participation of medical students. Two separate studies were conducted, including a cross-sectional correlational survey administered to medical students in all four years at three Canadian Universities (Study One; Articles One, Two and Three) and a single-subject study testing the impact of a two-month peer support walking intervention delivered to first and second year medical students at two Canadian universities (Study Two; Articles Four and Five). Article One examined relationships between physical activity, including mild and moderate-to-vigorous physical activity (MVPA), and mental health profiles in a sample of Canadian medical students using latent profile analysis. Three distinct mental health profiles emerged (low, moderate and high ratings of mental health) and individuals in the high mental health profile reported engaging in more mild physical activity than MVPA. Article Two investigated the underlying mechanism(s) contributing to frequency in recommending physical activity, to provide insight into how we can increase physical activity recommendations in future practice as physicians. Findings showed positive relationships between medical students’ physical activity levels and their frequency recommending physical activity to patients. Results also revealed that medical students are significantly more motivated than they are confident to recommend physical activity to patients and only 52% of student participants were aware of and accurately able to recall the Canadian physical activity guidelines. Article Three examined demographic differences in medical students’ motivation and confidence to recommend physical activity to future patients. Results revealed differences according to gender, year of study and academic background. For instance, second year students were more motivated to assess a patients’ level of physical activity compared to third and fourth year students. Article Four evaluated the impact of a two-month peer support walking intervention aimed at improving the mental health and physical activity participation of first and second year medical students using the RE-AIM framework. Findings showed that the peer support walking intervention was delivered as intended and may be an important proactive strategy for maintaining mental health and physical activity levels of medical students during stressful situations, including the COVID-19 pandemic. Finally, Article Five offered evidence-based strategies for conducting mental health research in medical professionals to optimize recruitment, engagement and retention. Ten strategies were provided to help inform the planning of future research aiming to support the mental health of medical professionals, including students. Taken altogether, findings from this dissertation show that peer support and incorporating mild physical activity may be an effective strategy to offer within medical student wellness programs. Additionally, results highlight the need to expand the medical curriculum to include physical activity education in order to prepare students to recommend physical activity to patients in future medical practice as an important preventive and therapeutic strategy for several chronic illnesses.

BACKGROUND: Physical activity for the majority of individuals is below recommended levels despite strong evidence of its significant health benefits. Activity tracker devices present as a promising and affordable tool to help promote physical activity and active choices. Additionally, young adults present as an ideal age group to implement behavior change interventions. OBJECTIVE: To determine what features of activity tracker hardware and software are helpful in motivating active choices. METHODS: This cross-sectional study included 149 participants ranging in age from 18-29 years old who wore an ActiGraph GT3X+ accelerometer for one week. They then continued to wear the accelerometer in addition to a randomly assigned activity tracker (Apple Watch, Fitbit Surge, Basis Peak, or Microsoft Band 2) for an additional week. They also used the corresponding app for their activity tracker. Participants filled out a survey about their experience at the end of the study RESULTS: Overall hardware rating (p = 0.162) and overall software rating (p = 0.125) did not differ between the four devices. Degree of motivation of the hardware (p = 0.177) and software (p = 0.120) was also similar for all the activity trackers. There were 625 positive comments made about tracker hardware with the majority of these comments concerning mode options (n = 149), other (n = 94), and battery (n = 79). There were 287 positive software comments with the majority in the categories of other (n = 78) and information (n = 68). CONCLUSIONS: The analyses of our data did not show a significant difference between devices in any category. Furthermore, results indicated a high number of positive comments for both hardware and software overall. Users also reported device hardware and software to be personally motivating.

Purpose: The purpose of the thesis was to investigate how a ten-week physical activity interventioncould affect the general well-being of employees from a sedentary office environment.Method: 16 employees participated in a ten-week intervention which implementedphysical activity in their workplace. To measure the participant’s well-being, three surveyswas distributed to all. One before, during, and after the intervention. Furthermore,were six interviews with individuals conducted after the intervention ended.Results: The employees created awareness of the importance of being physically active,and experienced changes in their physical and mental well-being.Conclusion: Well-being is an individual feeling, which is affected by external elementschanging a person’s needs.

This study investigated the validity of the Physical Activity Interview (PAI) for assessing children's self-reported physical activity. Third and fifth graders wore an accelerometer and were interviewed using the PAI to determine 12-hour recall accuracy for activity expressed as energy expenditure (EE). Caltrac estimates of EE for the 12-hour day (12-HEE) and activity EE were the validation criteria. 12-HEE correlations were significant (p<.001) between Caltrac and PAI for third (r=.79) and fifth grade (r=.80). Caltrac and PAI Total Activity were significant for fifth grade (r=.82, p<.001) but not for third grade (r=.36, p<.021). Analysis of tertiles based on the Caltrac demonstrated that the PAI significantly (p<.002) discriminated between activity levels for fifth graders but not for third. The use of PAI may be age-dependent.

Physical activity (PA) has numerous benefits for cancer survivors, but limited research exists on PA interventions in young adult cancer survivors. Outdoor adventure therapy is a potential method of increasing PA in this demographic. The primary purpose of this non-randomized parallel group study was to determine whether the outdoor adventure camp experience (vs. wait list control) would increase participants’ PA levels immediately following the 7-day camp, as well as three months later. Secondary aims examined correlates of greater PA, including pre-post camp changes in sedentary behavior, exercise self-efficacy, environmental change self-efficacy, perceived barriers to exercise, physical activity enjoyment, and physical activity variety. Sixty-six control and 50 intervention participants were given validated quantitative questionnaires at baseline, 1 week (end of camp) and at the 3-month follow-up. Repeated measures multivariate analysis of variance (RMANOVA) was used to compare group changes over time. Using intent to treat analysis, adjusting for age, gender, age at diagnosis, and baseline minutes of PA per week, there was a significant difference (p=.0001) in minutes of PA per week between groups at both 1 week and 3 months. Bonferroni adjusted post-hoc analysis indicated that, relative to baseline, the intervention group had significantly (p=.0001) greater increases in PA at both 1 week (577 minutes vs. 9 minute increases) and 3 month follow-ups (133 minute increases vs. 75 minute decreases; p=.001) respectively. Significant intervention-related improvements were also observed in TV viewing hours/week (p=.001), hours sitting/week (p=.001), “Excuses” score of the Perceived Barriers to PA questionnaire (p=.04), Enjoyment of Structured Activities (p=.04), and PA Variety (p=.0001) at 1 week but not at the 3 month follow-up. No significant effects were observed for changes in exercise self-efficacy, environmental change self-efficacy, or the other subscales scores. In conclusion, outdoor adventure therapy has the potential to increase PA levels in cancer survivors both immediately following camp, as well as long-term. However, effects tend to wane after camp termination. Future research should explore the relationship between correlates of PA and PA levels in outdoor adventure therapy camp participants and methods to promote sustained PA after camp termination.

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Physical activity improves health while combating the obesity epidemic. However, quantifying physical activity through self-report questionnaires or objective measures can provide varying results. The purposes of these studies were to determine if time, body mass index, or treatment assignment could affect the validity of physical activity measurements. The data were part of a larger physical activity promotion study conducted at the Miriam Hospital/Brown Medical School in Providence, Rhode Island and in communities in Southeastern Massachusetts from 2002 to 2005. In this trial, 280 women, with a mean age of 47.1 years, were randomly assigned to one of three intervention groups: Choose to Move (n=93), Jumpstart (n=95) and Wellness (n=92). A randomly selected sub sample of participants simultaneously wore an ActiGraph accelerometer and completed a 3-Day Physical Activity Recall questionnaire at baseline, 3 months and 12 months. Body mass index and treatment assignment were also used in-group comparisons. The results indicated that all components of time, BMI and treatment assignment influenced the accuracy of self-reported measurements when compared to objective accelerometer data. Additional research is essential to uncover the independent aspects considered influential to these physical activity measurements to enhance study design and participant outcomes in future trials. / Kinesiology

Yes / A large majority of primary school pupils fail to achieve 30-min of daily, in-school moderate-to-vigorous physical activity (MVPA). The aim of this study was to investigate MVPA accumulation and subject frequency during academic lesson segments and the broader segmented school day. Methods: 122 children (42.6% boys; 9.9 ± 0.3 years) from six primary schools in North East England, wore uniaxial accelerometers for eight consecutive days. Subject frequency was assessed by teacher diaries. Multilevel models (children nested within schools) examined significant predictors of MVPA across each school-day segment (lesson one, break, lesson two, lunch, lesson three). Results: Pupils averaged 18.33 ± 8.34 min of in-school MVPA, and 90.2% failed to achieve the in-school 30-min MVPA threshold. Across all school-day segments, MVPA accumulation was typically influenced at the individual level. Lessons one and two—dominated by maths and English—were less active than lesson three. Break and lunch were the most active segments. Conclusion: This study breaks new ground, revealing that MVPA accumulation and subject frequency varies greatly during different academic lessons. Morning lessons were dominated by the inactive delivery of maths and English, whereas afternoon lessons involved a greater array of subject delivery that resulted in marginally higher levels of MVPA. / This research was funded by Redcar and Cleveland Borough Council.

Yes / The adoption of physically active learning (PAL) in schools is becoming more widespread. To understand how PAL is being used in different countries and explore if and how methods and strategies differ, this paper draws cross-national comparisons in primary school teachers' use of PAL. Thirteen focus groups were conducted with 54 teachers from Norway, the Netherlands and the UK. Four themes were identified using thematic analysis: 1) teachers' values and beliefs about PAL; 2) influence of school context; 3) influence of the national policy context and; 4) managing teacher dissonance when using PAL. Use of PAL was related to teachers' values and beliefs and the degree to which these aligned with the context of the school and the wider educational system. The findings underline the importance of addressing teachers’ competence, opportunity and agency to use PAL in different contexts. / The authors of this manuscript were supported and funded by the European Union ERASMUS + Strategic Partnership Fund as part of the Activating Classroom Teachers project, ACTivate (Grant no 2019-1-N001-KA203-063024).

abstract: Urinary sucrose and fructose has been suggested as a predictive biomarker of total sugars intake based on research involving UK adults. The purpose of this study was to determine the association between total sugars consumption and 24-hour urinary sucrose and fructose (24uSF) in US adult population and to investigate the effect of physical activity on this association. Fifty seven free-living healthy subjects 20 to 68 years old, participated in a 15-day highly controlled feeding study, consuming their habitual diet, provided by the research metabolic kitchen. Dietary sugars were estimated using Nutrition Data System for Research (NDSR). Subjects collected eight 24-hour urine samples measured for urinary sucrose and fructose. Physical activity was assessed daily using a validated 15-day log that inquired about 38 physical activities across six domains; home activities, transportation, occupation, conditioning, sports and leisure. The mean total sugars intake and added sugars intake of the sample was 112.2 (33.1) g/day and 65.8 (29.0) g/day (9.7%EI), respectively. Significant moderate positive correlation was found between 15-d mean total sugars intake and 8-day mean 24uSF (r = 0.56, p < 0.001). Similarly, added sugars were moderately correlated with 24uSF (r = 0.56, p < 0.001), while no correlation was found between naturally-occurring sugars and 24uSF (r = 0.070, p < 0.001). In a linear multiple regression, total and added sugars each explained 30% of variability in 24uSF (Adjusted R2, p value; total sugars: 0.297, 0.001; added sugars: 0.301, p < 0.001). Physical activity had no effect on the association between dietary and urinary sugars in neither the correlation nor the linear regression analysis. 24uSF can be used as a biomarker for total and added sugars consumption in US adults, although its predictability was weaker compared to findings involving UK adults. No evidence was found showing that physical activity levels affect the association between 24uSF and total sugars intake in US adults. More detailed investigation through future feeding studies including subjects with wide range of sugars intake and of different ethnic/racial backgrounds are needed to better understand the characteristics of the biomarker and its uses. / Dissertation/Thesis / Masters Thesis Nutrition 2019