Published Article / Objective: To determine the relationship between body mass index (BMI), energy intake and levels of physical activity of HIV negative and HIV positive women. Design: Cross sectional study. Methodology: A random sample of 500 pre-menopausal women within the two age group categories of 25-34 and 35-44 years was selected. Data on physical activity was obtained using an adapted Baecke questionnaire and categorized into low, medium, and high levels of physical activity. Weight and height were used to calculate BMI. Dietary intake was determined by means of a standardized food frequency questionnaire. Results: Sixty-one percent of younger women and 38% of older women were HIV infected. The vast majority of women (91%) had low levels of physical activity, while only 9% of the sample had physical activity levels that fell within the normal to high category. More than 50% of respondents were either overweight or obese (BMI above 25 kg/m2). BMI of HIV positive younger women was, however, significantly lower than that of HIV negative women. Median energy intakes were high (more than 10 000 kJ) for both HIV positive and HIV negative women. Conclusions: Reverting to a more traditional lifestyle, including diet and physical activity, could assist in addressing unfavorable BMI parameters of these women and improve health status and quality of life of HIV infected women.

Systematic reviews have consistently found that moderate intensity physical activity levels at or above a threshold value of 150 minutes per week reliably deliver cardiovascular, metabolic and musculo-skeletal health benefits. As a result, this threshold value has been widely adopted as an aspirational, public health goal throughout the world. However, while epidemiological and laboratory studies have established clear links between physical activity and sleep outcomes, the evidence base does not yet provide guidelines on minimum levels of exercise likely to reduce insomnia symptoms and improve sleep quality. Such a guideline, if evidence based, could greatly clarify advice, and accelerate the use of physical activity goals to improve sleep outcomes in behavioural sleep medicine and public health. This thesis examined the current public-health recommendation of 150 minutes of moderate intensity activity per week in relation to sleep outcomes. To commence, it established a population-level pattern of the relationship between levels of physical activity and sleep quality by reviewing relevant epidemiological evidence. Exploratory analyses were then conducted using data from an ongoing longitudinal study of physical activity and health outcomes among older people (aged 65 years and above) in which respondents were classified as walking at or above, or below the recommended threshold of 150 minutes per week. In regression models controlling for health and demographic factors, these analyses showed that higher levels of walking were significantly and independently associated with a lower likelihood of either reporting insomnia symptoms (OR = 0.67 (95% CI = 0.45 0.91) p=0.04), or experiencing poor sleep efficiency (OR = 0.70 (95% CI = 0.52 0.94 p=0.02). Using the same data, the predictive validity of this activity threshold was then confirmed in a 27-year survival analysis which showed a significantly decreased all-cause mortality risk associated with the higher level of walking (HR = 0.75 (95% CI = 0.65 - 0.86) p<0.01). These findings offered proof of concept that physical activity-sleep relationships operated on a continuum, with sleep benefits possible even at relatively low levels of activity. Experimental evidence on the acute and sustained effects of physical activity on sleep quality was then analysed and discussed. Outcomes from this review, together with the preliminary analyses described above, were then used to inform the design of a randomised controlled trial to investigate the effects on sleep quality of increasing physical activity to currently recommended levels among sedentary people with insomnia. A total of 41 sedentary adults meeting DSM-IV criteria for insomnia (30 female; mean age 59.8??9.5) were randomised to a physical activity group (???150 minutes moderate intensity activity/week) or a waiting list control group. The principal outcome was Insomnia Severity Index (ISI) change 6 months post baseline; secondary outcomes were anxiety (using the State Trait Anxiety Inventory) and depression (Beck Depression Inventory II). Physical activity was assessed using Actigraph GTX3+ accelerometers. Outcomes were assessed in univariate general linear models, adjusted for baseline confounders. Activity and sleep assessments did not differ at baseline. At 6 months post baseline the intervention group engaged in 213 min/week of moderate intensity PA, compared to the control group (82 min/week). Compared to the control group, the intervention group showed significant improvement in the ISI score at 6 months F(1,28) = 5.16, p=0.03), adjusted means difference = 3.37, with an adjusted Cohen's d =.78 (95% CI 0.10 1.45). There was a significant improvement in trait anxiety, and depression outcomes post-intervention, F(6,28)=4.41, p=0.05, and F(6,28)=5.61, p=0.02, respectively. The results showed that increasing activity in line with current guidelines could deliver clinically significant improvements in sleep quality and mood outcomes among inactive adults with insomnia. While the effect sizes are modest, the pattern of results reported here allow for two conclusions with clear implications for public health: 1) measures to increase levels of physical activity above the currently recommended threshold of 150 minutes per week could usefully be added to other approaches to insomnia management; and 2) the likelihood of improved sleep quality should be routinely added to those evidence-based cardiovascular and metabolic benefits most frequently associated with increased physical activity in behaviour change initiatives.

Physical activity guidelines have become a focal point of mass media messages promoting physical activity to the adult population. Messages regarding sedentary behaviour have also emerged. Further, Chapter 3 identified knowledge of just 18% within a large sample of highly educated and employed UK adults. Of concern is the further finding that knowledge is likely to be higher within this group than within the general population and many groups within society may therefore have even lower knowledge. As many individuals are seemingly not likely to know the current physical activity guidelines, disseminating messages to promote them appears to be a reasonable strategy. However, Chapter 1 of this thesis highlighted the lack of research investigating the efficacy of messages designed around physical activity guidelines. Chapters 4, 5 and 6 began to explore some of the possible motivational implications of messages prominent in mass media campaigns promoting physical activity guidelines. Chapter 4 describes a cross-sectional study which compared the effects of messages using the threshold of 150 minutes a week with a generic message on perceived benefits of physical activity. Messages were representative of those found in mass media campaigns. Those receiving a threshold message held significantly less positive views of the benefits of physical activity at durations below 150 minutes a week. While a threshold message may be motivationally damaging in certain contexts, they tend not to be provided in isolation. Intensity of physical activity i.e. moderate-to-vigorous (MVPA) is another key aspect of physical activity guidelines featured in mass media campaigns. Subsequently, Chapter 5 employed an online survey of highly educated adults to investigate associations between threshold and generic messages describing MVPA as either walking or using a physiological description, with motivational constructs. Interestingly, the message incorporating a threshold was motivationally advantageous when MVPA was described as walking. On the other hand, inactive adults tend to overestimate their physical activity with walking behaviour being serially overestimated. This could result in reduced motivation to engage in MVPA. The influence of regular walking speed on misperceptions was therefore investigated in Chapter 6. Further, accurate knowledge of physical activity requirements has been theorised to reduce misperceptions. Chapter 6 reports findings that regularly slow walkers are more likely to overestimate their physical activity levels while knowledge of guidelines has no effect. This leaves a complex picture of the motivational qualities of messages promoting physical activity guidelines. Finally, Chapter 7 describes a content analysis which broadens the investigation of mass media messages by scrutinising the introduction of messages promoting reductions in sedentary behaviour. Sticking closely to guidelines, combining messages on sedentary behaviour with those on physical activity, the relative omission of standing and the demonisation of sitting emerged as common themes. This thesis highlights the problem of low knowledge of physical activity guidelines within a sample of UK adults and points towards a lack of evidence-based messaging. With knowledge being low, the provision of a threshold is desirable on an informational level. The provision of walking as an exemplar appears to make the threshold more amenable, however, for inactive adults the use of this exemplar in messages may lead to overestimation of physical activity and decrease motivation. Clearly, the motivational implications of these messages are complex and require further investigation.

The United Kingdom has a long history of using outdoor activities as a vehicle for recreation, rehabilitation and education for people with disabilities. However, there has been little empirical research into the value placed on the experiences by those who organise the activities or by the participants. The Calvert Trust was one of the first organisations to specialise in outdoor activities for this population and through their three Centres is currently the largest provider of outdoor education for people with disabilities within the UK. Through four separate but linked research phases covering data collected between 2002 and 2013, the present study investigates the value of Calvert Trust programmes for both organisers and participants. The first phase involved the analysis of an existing data-set of post-course evaluation questionnaires (n=502) completed by visiting leaders of groups of participants (n=2,843) with a variety of disabilities who had attended one of the three Calvert Trust Centres. The activities and factors contributing to the perceived benefits of participation were identified, and visiting leader evaluations were compared with the internal reports on the same courses and participant groups completed by Centre instructors (n=702). There were differences in aims for the visits dependent on the sector of the respondent (education, recreation or rehabilitation) but an increase in confidence and independence were those most frequently reported outcomes across sectors. There was general agreement between visiting leaders and instructors as to the role of challenge, achievement and teamwork in delivering these benefits. The limitations of having respondents from only one Centre were addressed in the second phase of the research. This investigated post-course evaluation questionnaires from all three Centres returned both by visiting leaders (n=397) and participants (n=2,507). Comparisons were made across the Centres and differences were found to exist in the aims and domestic aspects of the provision reported on by the visiting leaders but not in aspects of the activity delivery. The participants, however, showed small but significant differences across the Centres in their reporting of development of communication skills, social skills, self-esteem and independence. A third research phase employed iterative email interviews with representatives from visiting organisations (n=17) and the Calvert Trust (n=17) to relate participant experiences to the aims of both the purchasers and providers. Both sets of informants saw participant recognition of personal ability as a key aim of the visit. Other frequently reported aims were to provide new social opportunities, develop interpersonal skills and increase confidence, but these had different relative weightings across informants. In the fourth phase of the research the direct voices of the participants on the value of their outdoor experiences was accessed through interviews with participants (n=23) and with a ‘significant other’ (n=18). Differences in the reporting of personal experiences were noted between those with physical and intellectual disabilities. A number of those with physical disabilities, and/or their ‘significant others’, considered that the outdoor education experience had made an important difference to the participant’s life that might have a long-lasting impact. Those with intellectual disabilities reported a positive experience that may have given them the confidence to take part in similar events, undertake more exercise or widen their social circle. A post-visit increase in independence was reported by a number of the ‘significant others’ for this latter group. The findings overall suggest that participation in the outdoor education courses at the Calvert Trust was generally a very positive experience, with outcomes valued by purchasers, by participants and by those with close knowledge of them. The principal reported benefits relate to themes of confidence, independence and realisation of personal ability. These are discussed in relation to the specific outdoor education programmes experienced and the impact that these may have on the everyday lives of participants with disabilities.

Introduction: The prevalence of childhood and adolescent obesity in the U.S. and in other countries has continued to rise over the last several decades. Health behaviors such as physical activity and inactivity patterns have been shown to influence rates of obesity among adolescents. Racial/ethnic disparities related to adolescent obesity have been recognized through existing research, and differences in socioeconomic and cultural backgrounds have been noted as possible contributing factors to the risk of adolescents becoming overweight or obese. The primary purpose of this study was to analyze the association of physical activity and sedentary activity with obesity prevalence among adolescents aged 12-15 years old across ethnic groups in the U.S. Methods: This study utilized data from the combined 2007-2012 National Health and Nutrition Examination Survey (NHANES). Descriptive characteristics of the study population were analyzed for both ethnicity and BMI status, and Chi-square tests were used to assess differences among the variables. The association between BMI status categories and ethnicity were evaluated. A univariate analysis was conducted to evaluate the association of the independent and covariate variables with obese status among adolescents. A multivariable logistic regression was also performed to determine the association between BMI status and physical activity, controlling for the covariate variables. For sedentary activity, the frequency statistics were analyzed between each of the ethnicities and BMI status, and t-tests were conducted to determine statistical significance. Results: The sample size for this population included 939 adolescents. Approximately 40% of adolescents were categorized as obese, according to age- and sex-specific BMI percentiles. Among ethnicity, Non-Hispanic white adolescents had the greatest prevalence of obesity, compared to Non-Hispanic Black and Mexican-American adolescents. There was not significant association between BMI status and demographic characteristics, including ethnicity, in the sample. Regarding physical activity, there was some indication that those who engaged in moderate and vigorous physical activity were less likely to be obese, however these findings were not found to be significant. Non-Hispanic black obese adolescents reported significantly less moderate activity compared to Non-Hispanic white adolescents(p=0.02). Obese adolescents in this sample had reported slightly less mean sitting time per day, compared to those who were not obese. Conclusion: Although the findings of this analysis showed some indication of differences in physical activity and sedentary behavior patterns among obese adolescents, the overall findings did not provide a statistically significant association between the variables and ethnicity. Further studies related to this topic could analyze differences in cultural and social norms across ethnicities that could influence physical activity behaviors in adolescents. Also, access to exercise facilities and differences in dietary behaviors among adolescents could be considered.

Physical Activity and Health Abstract: More research is needed in physical activity and sedentary behaviour and their associations with mental health in young people. Study 1 examined the effect size for the association between sedentary behaviour and mental health in young people aged 5-18 years of age, using a meta-analysis. Results from 37 independent studies (n=373, 512) showed a small but significant effect size (r=-0.30, 95% CI= -0.20, -0.45, p<0.001), indicating that sedentary behaviour is associated with mental health problems in young people. Study 2 examined the association between sedentary behaviour and mental health in African young people. Participants were 296 adolescents (150 males, 146 females) aged 13 to 18 years (mean=14.85 years) living in Ghana. Participants physical activity levels were assessed using the Physical Activity Questionnaire for Older Adolescents (PAQ-A) and sedentary behaviour, using the Adolescents Sedentary Activity Questionnaire. Depression was assessed using the Children Depression Inventory and aspects of self-esteem were measured with the Physical Self-worth test and body image silhouette test. There was a significant negative correlation between physical activity and mental health [depression (r= -0.78, p<0.001); physical self-worth (r=0.71, p<0.001); body dissatisfaction (r= -0.76, p<0.001)]. Moreover, sedentary behaviour was significantly associated with higher depression (r=0.68, p<0.001). Affluence was a significant contributing factor of sedentary behaviour in African young people [t (294)= -7.30, p<0.001]. Moreover, Study 3 examined the impact of physical activity on cognitive functioning in African young people. An experimental design was used with 60 adolescents (27 males, 33 females) aged 13 to 18 years (mean=14.83 years) living in Ghana. Participants physical activity and health were assessed both at baseline and at the end of the intervention. Physical activity levels were measured using the PAQ-A and by pedometer; cognitive functioning was assessed with the Raven s Progressive Matrices test, with additional psychological variables of physical self-worth being measured with a subscale of the Physical Self Perception Profile, and body dissatisfaction using the body image silhouette test. The participants in the experimental group participated in aerobic physical activities, twice a week for 6 weeks. Results from the study showed that participants in the experimental school scored significantly higher on cognitive functioning [F (1,56)=34.77, p<0.001]; and self-esteem than those in the control group. From this current research the new finding seems to be associated with affluent behaviour being a significant contributing factor of sedentary behaviour in African youth, whereas other findings in the Western culture show that the weather is one of the contributing factors for sedentary behaviour in young people.

Dementia is a common cause of disability in the elderly and, in the absence of a successful long-term treatment, it is important to investigate possible lifestyle interventions to help reduce an individual s risk of developing the condition. This thesis investigated the relationship between physical activity and dementia risk, finding that not all research supports the link. The literature review presented in this thesis (Chapter 2) highlighted several possible mediating factors, specifically the type of physical activity performed, the cognitive domains being studied and participant characteristics. Women seemed most susceptible to the effect of physical activity and some other forms of midlife interventions, possible mechanisms for which were discussed in another review (Appendix A). The cognitive test battery to be used in later studies was evaluated for its relevance to dementia and treatment during a 6-month study of Alzheimer's disease patients and their carers (Chapter 3). Memory tasks were found to be especially sensitive to clinical outcomes of dementia treatment (Chapter 4). An observational study of Indonesian elderly found a positive relationship between physical activity and memory performance on the same tests. This effect was strongest in women and in those with no pre-existing cognitive impairment (Chapter 5). However, the relationship could be further modified by other demographic factors, such as education. Health was independently affected in this model by exercise and its association with engaging in physical activity in this cohort was further investigated in Chapter 6. A randomised controlled trial (Chapter 7) was conducted to assess the effect of a 12-week programme of non-aerobic physical activity in sedentary middle-aged adults. Results indicated that resistance training, but not flexibility exercises, influenced memory but not executive function. Overall, this thesis suggests that several types of physical activity may be effective at slowing cognitive decline in elderly groups who are at increased risk of dementia, such as those in middle age and elderly women (Chapter 8). These findings should be expanded with the aim to improve healthcare advice and influence policy-making.

Syfte: Att undersöka hur mycket fysisk aktivitet barn i åldrarna 14-17 år registrerade vid överviktsenheten på ett barnsjukhus i Mellansverige utför samt att jämföra flickors och pojkars fysiska aktivitet. Vidare har barns självskattning av fysisk aktivitet jämförts med hur det sedan ser ut när de registrerat sin fysiska aktivitet i en aktivitetsdagbok. Metod: En kvantitativ tvärsnittsstudie utfördes. Femtiotre barn inskrivna på överviktsenheten vid ett sjukhus i Mellansverige, varav 27 var pojkar och 26 var flickor, inkluderades i studien. Relevant data för studiens syfte samlades in från de enkäter som fylls i vid nybesök samt från deltagarnas aktivitetsdagböcker. Deltagarna kategoriserades och delades in i grupper efter fysisk aktivitetsnivå samt deras uppskattade fysisk aktivitetsnivå varpå statistiska analyser genomfördes. Resultat: Drygt 22 % av deltagarna uppnådde den mängd fysiska aktivitet som rekommenderas i Sverige för den aktuella ålderskategorin. Ingen statistiskt signifikant skillnad fanns mellan kön och fysisk aktivitet, däremot fanns en signifikant skillnad mellan hur enkäterna besvarades och kön som visade att flickor överskattar sin fysiska aktivitet. De flesta av studiens deltagare trodde sig utföra mindre fysisk aktivitet än jämnåriga vilket också stämde överens med hur mycket fysisk aktivitet de faktiskt utförde. Slutsats: Enligt utförd studie är det få av de barnen inskrivna på överviktsenheten som kommer upp i NNR:s rekommendationer om fysisk aktivitet, dock krävs mer omfattande studier för att kunna generalisera detta på en större befolkning. Det fanns ingen statistiskt signifikant skillnad gällande utövande av fysisk aktivitet mellan könen, för att undersöka detta mer noggrant krävs vidare studier med större urval. En signifikant skillnad fanns i hur flickor och pojkar skattade sin egna fysiska aktivitet där flickor skattade sin fysiska aktivitet högre än jämnåriga pojkar. Det krävs vidare studier för att undersöka anledningen till detta. Det är viktigt att en förståelse för detta fenomen finns hos vårdgivare för att optimera samarbetet med patienten och för att på bästa sätt kunna hjälpa denne i sin situation och i sitt lidande. / Objective: To examine how much physical activity the children at the Obesity Unit at a hospital in the middle of Sweden, between the ages of 14-17, registered and to compare differences between boys and girls and differences in how the children perceive their physical activity compared to the physical activity that they registered in an activity diary. Methods: A quantitative cross-sectional study was performed. Fifty-three children enrolled at the Obesity Unit at a hospital in central Sweden were included in the study, of whom 27 were boys and 26 were girls. Relevant data for the purpose of the study was collected from the questionnaires filled out by the participants during their first visit to the Obesity Unit and from their activity diaries. The participants were categorized and divided into groups according to their physical activity level and imagined physical activity level, whereupon statistical analyses were performed. Results: A little bit more than 22% of the participants attained the amount of physical activity recommended in Sweden for that age category. No statistically significant difference was found between gender and physical activity, however, a significant difference was found between how the questionnaires were answered and gender, which showed that girls overestimated their physical activity. Most of the study participants believed they performed less physical activity than their peers which is also accurate with how much physical activity they actually performed. Conclusions: In the study conducted, few of the children enrolled at the Obesity Unit attained NNR's recommendations for physical activity, however more extensive studies are acquired to be able to generalise this on a larger population. There was no statistically significant difference regarding the practice of physical activity between the sexes, to investigate this further deeper studies are required. A significant difference was found in how girls and boys rated their own physical activity where girls rated their physical activity higher than their male peers. Further studies are required to examine the reasons why. Comprehension about this phenomena is important to optimise interactions with this patient group.

Autism spectrum disorder (ASD) is pervasive neurodevelopment disorder characterized by a broad range of social abnormalities and deficit in motor skills, many times referred to as clumsiness. These abnormal social characteristics result in a restricted repertoire of activity and interests that also may affect the motor learning process. Therefore, fewer opportunities to practice motor skills can lead to a delay in achieving motor proficiency. It is well known that physical activity and motor proficiency are positively correlated and the amount of time spent in a physical activity is directly related to the level of expertise in neurotypical children. Hence, the specific aim of this study is to quantify the amount of physical activity in children with ASD and compare this value to that of non-diagnosed siblings (ASD siblings) and neurotypical controls (NT), as well as to compare the amount of physical activity between neurotypical controls and ASD siblings. In this study, it was hypothesized that: 1) children with ASD would have lower scores than their non-diagnosed sibling and also than the NT controls in the amount of physical activity; 2) non-diagnosed siblings and neurotypical children would not be different in the amount of physical activity; 3) children with ASD's general score on the motor skills assessments would be lower than the non-diagnosed siblings and lower than NT controls; 4) There would not be a difference in the general score on motor skills assessments between non-diagnosed siblings and neurotypical children and 5) the motor assessments scores would be positively correlated (p < 0.05) to the amount of physical activity. There were differences between ASD and NT groups regarding to the amount of physical activity and also regarding to the motor proficiency scores. Although those differences were not statistically significant, they definitely are clinically relevant as showed that the children on the autism spectrum presented a clear motor delay. Likewise, the correlation between amount of physical activity and motor proficiency was showed not to be significant. These results can be explained by the small sample size. Further studies with a larger sample size would be crucial to verify these hypotheses proposed in the present study. / text

The purpose of this study was to identify barriers that contribute to a disparity in utilization across different segments of an urban trail. To achieve this aim, subjective ratings of trail characteristics for high-use areas (western sections of the trail) were compared to subjective ratings of lower-use areas (eastern sections of the trail). These ratings were compared between those who reported primarily traveling the western, high-use sections vs. those who primarily travel the eastern, low-use sections. Data were collected through self-report and a cross-sectional analysis based on sections of primary use. Ratings for each trail characteristic from an online survey were compared for different trail segments as a function of these groups. Comparisons were conducted through ANOVA and showed that perceptions of trail characteristics varied strongly as a function of which sections of the trail were used most by the respondents. Users of the high-traffic, western sections held significantly more negative views of the eastern sections. In contrast, users of the low-traffic, eastern sections held similar views of the eastern and western sections. Objective measurements of trail characteristics were conducted on all six segments of trail to compare to user perceptions. A trail count and researcher evaluation/audit of all trail characteristics provided data for comparison. A descriptive analysis of the differences between trail user perceptions and objective measures was reported. The trail count and survey results showed similar patterns of usage. The western sections exhibited the highest number of trail users representing 80% of the people on the trail. The central sections contained 14% and the eastern sections 6%. Mode of travel observed was 94% walking or running and 6% cycling. In addition, these numbers are similar to those of the earlier, pilot study (TEMBA, 2011). Given the similarities between the online survey, and both the objective trail count for usage and the earlier TEMBA study, it is hoped that the online sample is representative of the population of regular trail users. A comparison of subjective and objective ratings revealed different patterns of agreement depending on east vs. west group membership. Overall, west users are misinformed about crime and amenities on the east side but are in general agreement on other characteristics. This suggests that their concerns about trail continuity, directional clarity, and loop options may be warranted. Overall, east users showed general agreement with objective measures on the west side except for exposure to traffic, which they rated more poorly than objective measures. / text