Maternal obesity is associated with adverse effects for mothers and offspring. The primary aim of this thesis was to assess food intake and physical activity (PA) using validated self-administered questionnaires, and whether these were associated with gestational weight gain (GWG) and birthweight (BWT), in severely obese (body mass index, BMI≥40kg/m2) compared with lean pregnant women (BMI 20-25kg/m2). The secondary aims were to validate self-reports against food diary (FD) and accelerometry; to assess the prevalence of under or over-reporting of energy intake; and to carry out a pilot study to assess total energy expenditure, as well as self-reporting accuracy, by using doubly-labelled water (DLW) technique, in subgroups of participants. Pregnant women were recruited from an ongoing study of severe obesity in pregnancy at the Royal Infirmary of Edinburgh, UK. Assessments were done in early (12-20 weeks) and late (28-32 weeks) pregnancy. A subgroup of women also completed questionnaires on appetite, general nutrition knowledge, and eating behaviours. All results were adjusted for age, parity, ethnic origin and deprivation category score. Self-reported total energy intake was not significantly different between obese and lean during early (median 2,444 vs 2,312 kcal/day) and late (2,173 vs 2,354 kcal/day) pregnancy. However when validated with FD, the relative validity of the food frequency questionnaire was lower in obese compared to lean. Under-reporting of total energy intake was higher in obese compared to lean (49% vs 15%, P<0.01) through comparison of selfreported energy intake with estimated total energy expenditure, and this was supported by the DLW pilot study results. The DLW also showed possible over-reporting of PA by the obese group. Obese women reported significantly lower appetite than lean throughout pregnancy (P<0.01). They also had lower scores in general nutrition knowledge, but these were no longer significant after controlling for confounders. Obese women had significantly higher scores of restrained and emotional eating behaviours than, and similar scores of external eating behaviours to, lean. Appetite, nutrition knowledge, restraint and emotional eating behaviours scores were not associated with food intake in either obese or lean. On the other hand, increased intakes of total calories and fats were influenced by increasing score of external eating behaviour in both groups. Obese women reported doing similar amounts of total PA but significantly less of vigorous and sports and exercise activities than lean (P<0.05). Accelerometry showed obese women had lower average activity counts/day, although they did have significantly greater energy expenditure in light-intensity activity than lean (P<0.01). Obese women had less GWG than lean (Mean ± SD, 5.3± 52 vs 10.8±3.7kg, P<0.001). Increased GWG was associated with increased self-reported total energy intake in lean, but this was not seen in obese. GWG was not associated with PA in either group. BWT was not significantly different between obese and lean (3,547±549g vs 3,567±516g). In lean, increased BWT was associated with increased energy intake and total PA. BWT in obese was not associated with diet but with increased with PA in early pregnancy. In conclusion, self-reported methods were less reliable in assessment of diet and PA in severely obese compared to lean pregnant women. These exploratory studies found that obese women did not appear to have the same factors as lean women affecting GWG and BWT, though this may be complicated by the poor reliability of self-reports. Therefore, quantitative assessments such as measurement of serum micronutrient levels (to evaluate nutritional status), and accelerometry (to assess physical activity) may be necessary in this poorly understood population.

While the health benefits of physical activity are commonly recognised, increasing evidence indicates that significant percentages of children, particularly girls, are not sufficiently physically active. Children spend a large proportion of their waking day at school; however their opportunities to be physically active during the school day, beyond the traditional PE lesson and break times, are limited. Increasing children’s levels of physical activity during their time at school may be a key approach to increasing children’s overall levels of physical activity. The aim of this study was to evaluate the outdoor education programme ‘Forest School’ as a source of school based physical activity. A review of existing research showed that there had been no rigorous evaluation of physical activity during Forest School sessions. A two phase mixed method design was used. The first phase used a repeated measures controlled design to objectively measure the amount, intensity, duration and frequency of the participants’ (n26 age 9-10) physical activity during Forest School. The second phase used semi-structured paired interviews (n24 age 10-11) to understand the subjective experience of the Forest School physical activity. The study was conducted in the central belt of Scotland. The results showed that during Forest School sessions the participants engaged in a significantly greater total amount of physical activity, at a higher intensity, and with a greater frequency of longer bouts, in comparison to the typical school days. The children were also shown to reach the recommended hour of MVPA during the Forest School sessions. The children reported enjoying and appreciating the opportunity to be physically active in an environment they had little previous experience of using. Existing barriers to physical activity in other contexts, in particular bad weather and low motivation, did not appear to be relevant at Forest School. The inequality in levels of physical activity and motivation to be physically active, between males and females, was shown to typically be lower on the Forest School days. The findings suggest participation in Forest School resulted in greater quantities of inclusive and enjoyable physical activity at higher intensities than otherwise experienced at school.

Background Maintenance of lean muscle mass and related strength is associated with lower risk for numerous chronic diseases of aging in women. Objective Our aim was to evaluate whether the association between dietary protein and lean mass differs by physical activity level, amino acid composition, and body mass index categories. Design We performed a cross-sectional analysis of a prospective cohort. Participants/setting Participants were postmenopausal women from the Womens Health Initiative with body composition measurements by dual-energy x-ray absorptiometry (n=8,298). Main outcome measures Our study measured percent lean mass, percent fat mass, and lean body mass index. Statistical analyses performed Linear regression models adjusted for scanner serial number, age, calibrated energy intake, race/ethnicity, neighborhood socioeconomic status, and recreational physical activity were used to determine the relationship between protein intake and body composition measures. Likelihood ratio tests and stratified analysis were used to investigate physical activity and body mass index as potential effect modifiers. Results Biomarker-calibrated protein intake was positively associated with percent lean mass; women in the highest protein quintile had 6.3 percentage points higher lean mass than the lowest quintile (P<0.001). This difference rose to 8.5 percentage points for physically active women in the highest protein quintile (P-interaction=0.023). Percent fat mass and lean body mass index were both inversely related to protein intake (both P<0.001). Physical activity further reduced percent fat mass (P-interaction=0.022) and lean body mass index (P-interaction=0.011). Leucine intake was associated with lean mass, as were branched chain amino acids combined (both P<0.001), but not independent of total protein. All associations were observed for normal-weight, overweight, and obese women. Conclusions Protein consumption up to 2.02 g/kg body weight daily is positively associated with lean mass in postmenopausal women. Importantly, those that also engage in physical activity have the highest lean mass across body mass index categories.

Research from multiple domains has provided insights into how neighborhood design can be improved to have a more favorable effect on physical activity, a concept known as walkability. The relevant research findings/hypotheses have been integrated into a Walkability Framework, which organizes the design elements into nine walkability categories. The purpose of this study was to test whether this conceptual framework can be used as a model to measure the interactions between the built environment and physical activity. We explored correlations between the walkability categories and physical activity reported through a survey of residents of Tucson, Arizona (n=486). The results include significant correlations between the walkability categories and physical activity as well as between the walkability categories and the two motivations for walking (recreation and transportation). To our knowledge, this is the first study that reports links between walkability and walking for recreation. Additionally, the use of the Walkability Framework allowed us to identify the walkability categories most strongly correlated with the two motivations for walking. The results of this study support the use of the Walkability Framework as a model to measure the built environment in relation to its ability to promote physical activity. (C) 2017 The Authors.

Expertise and training in fine motor skills has been associated with changes in brain structure, function, and connectivity. Fewer studies have explored the neural effects of athletic activities that do not seem to rely on precise fine motor control (e.g., distance running). Here, we compared resting-state functional connectivity in a sample of adult male collegiate distance runners (n = 11; age = 21.3 +/- 2.5) and a group of healthy age matched non-athlete male controls (n = 11; age = 20.6 +/- 1.1), to test the hypothesis that expertise in sustained aerobic motor behaviors affects resting state functional connectivity in young adults. Although generally considered an automated repetitive task, locomotion, especially at an elite level, likely engages multiple cognitive actions including planning, inhibition, monitoring, attentional switching and multi-tasking, and motor control. Here, we examined connectivity in three resting-state networks that link such executive functions with motor control: the default mode network (DMN), the frontoparietal network (FPN), and the motor network (MN). We found two key patterns of significant between-group differences in connectivity that are consistent with the hypothesized cognitive demands of elite endurance running. First, enhanced connectivity between the FPN and brain regions often associated with aspects of working memory and other executive functions (frontal cortex), suggest endurance running may stress executive cognitive functions in ways that increase connectivity in associated networks. Second, we found significant anti-correlations between the DMN and regions associated with motor control (paracentral area), somatosensory functions (post-central region), and visual association abilities (occipital cortex). DMN deactivation with task-positive regions has been shown to be generally beneficial for cognitive performance, suggesting anti-correlated regions observed here are engaged during running. For all between-group differences, there were significant associations between connectivity, self-reported physical activity, and estimates of maximum aerobic capacity, suggesting a dose-response relationship between engagement in endurance running and connectivity strength. Together these results suggest that differences in experience with endurance running are associated with differences in functional brain connectivity. High intensity aerobic activity that requires sustained, repetitive locomotor and navigational skills may stress cognitive domains in ways that lead to altered brain connectivity, which in turn has implications for understanding the beneficial role of exercise for brain and cognitive function over the lifespan.

Bakgrund: Personer på äldreboende uppnår sällan allmänna rekommendationer för fysisk aktivitet. Detta kan medföra förlust av viktiga funktioner, något som fysisk aktivitet till viss del kan motverka. Syfte: Att utforska äldre personers uppfattning om fysisk aktivitet på ett äldreboende med inriktning ”sport och spa”. Syftet var även att undersöka de upplevda möjligheterna till fysisk aktivitet för personer på äldreboendet. Metod: En kvalitativ studie med semistrukturerade intervjuer. Två kvinnor och tre män mellan 67-97 år intervjuades. Deltagarna rekryterades via bekvämlighetsurval. Intervjumaterialet bearbetades med en kvalitativ innehållsanalys inspirerad av Graneheim och Lundman. Resultatsammanfattning: Utifrån frågeställningen uppfattning av fysisk aktivitet framkom följande tre kategorier: ”fysisk aktivitet nu och tidigare”, ”negativa effekter av fysisk aktivitet” samt ”positiva effekter av fysisk aktivitet”. Uttalanden gällande frågeställningen upplevelsen av möjlighet till fysisk aktivitet gav upphov till fyra kategorier: ”boendets resurser”, ”yttre förutsättningar”, ”individens förutsättningar” och ”grad av autonomi”. Slutsats: Stora variationer förekom i uppfattningen av fysisk aktivitet. Allt ifrån den egna vardagsmotionen till en mängd olika organiserade aktiviteter beskrevs. Fysisk aktivitet associerades även med biologiska och psykologiska effekter av träning. Möjligheten till att vara fysiskt aktiv påverkades av individens motivation och grad av autonomi. / Background: Elderly in nursing homes rarely achieves general recommendations for physical activity (PA). This may result in the loss of important functions, which PA can partially reduce. Purpose: To explore older people's perception of PA in a nursing home with the focus "sport and spa". The purpose of this study was also to investigate the perceived opportunities for PA for the elderly in a nursing home. Method: A qualitative study using semi-structured interviews were used. Three men and two women, between 67-97 years old, were interviewed. Qualitative content analysis was conducted. Results: Based on the informants􏰀perception of physical activity, the following three categories emerged: "physical activity now and earlier", "adverse effects of physical activity" and "positive effects of physical activity". Four categories described the experience of the possibility of physical activity among the informants, "the property's resources," "external conditions", "individual circumstances" and "degree of autonomy". Conclusions: Everyday exercise to a variety of organized activities were associated with PA. The concept of PA was also reported to include biological and psychological effects. The ability to be physically active was influenced by the individual's motivation and degree of autonomy.

Background Physiological and psychological changes appear during pregnancy, these affect the well-being of the pregnant woman. Physical activity and exercise has shown positive effects to improve and maintain health.  Aim To investigate the experience of women accomplished physical activity and physical exercise during pregnancy. Design and method The investigation has a descriptive qualitative design. Five women participated in semi-structured interviews. The data processing consisted of a qualitative content analysis with an inductive approach. Results The informants described positive experiences with physical activity and exercise during pregnancy. The participants felt more prepared for childbirth, improved self confidence and more energy. However, to maintain the level of physical activity, it was necessary to adjust the actual physical activity. The decrease in mobility, lead to an increase of mental stress. It was difficult to prioritize between exercise and work. The questioning attitude from family members and others made the woman feel insecure. Conclusion The informants described positive experiences from exercising during pregnancy and also its difficulties. This study can contribute to a better understanding for women who would like to stay active during pregnancy.

This study was conducted on a family of nine ranging in age from thirteen to fifty-two, to examine dark adaptation during physical activities.

A spinal cord injury is a serious medical condition, often caused by a physical trauma. An injury to the spinal cord affects the neurotransmission between the brain and spinal cord segments below the level of injury. The SCI causes a loss of motor function, sensory function and autonomic regulation of the body, temporary or permanent. Significantly improved acute care, primary comprehensive rehabilitation and life-long structured follow-up has led to persons with spinal cord injury (SCI) living longer than ever before. However, increased long-time survival has allowed secondary conditions to emerge, like diabetes mellitus and where cardiovascular disease (CVD) now is the most common cause of death among SCI patients. Other possible CVD-related comorbidities in this patient group have been reported to be pain and mood disturbances. There is still lack of, and need for more knowledge in the field of CVD-related screening and prevention after SCI. The overall aim of this thesis was to contribute to a scientific ground regarding the need for CVD-related screening and prevention after SCI. In Paper I and Paper II, patients with wheelchair-dependent post-traumatic SCI (paraplegia) were assessed. The results in paper I showed that 80% of the examined patients had at least one cardiovascular disease risk marker irrespective of body mass index (BMI). Dyslipidemia was common for both men and women at all BMI categories. The study also showed a high prevalence of hypertension, especially in men. Paper II showed a low frequency of self-reported physical activity, where only one out of 5 persons reported undertaking physical activity &gt;30 min/day. The physically active had lower diastolic blood pressure but no significant difference in blood lipids. In paper III and IV, patients with SCI (tetraplegia and paraplegia) participated in the studies. Eighty-one percent of the patients had dyslipidemia, where also a majority of the patients with normal abdominal clinical measures had dyslipidemia. Self-reported physical activity &gt;30min/day was reported by one third of the patients. No differences were found between physically active and not physically active patients when it came to blood glucose, serum lipid values and clinical measures (paper III). Pain was common in the patient group, however, most often on a mild to moderate level. Anxiety and depression was less common than reported in other studies (paper IV).

The promotion of an active lifestyle has become a priority in Western societies and school plays a dominant role. The primary objectives of this thesis were i) to examine the lifestyle and physical activity (PA) patterns of a sample of Greek children and ii) to examine the applicability of a school based intervention programme in promoting PA and sport participation. For the purposes of this study the Physical Activity and Lifestyle Questionnaire (PALQ) was developed and examined for its validity and reliability to assess habitual PA of Greek students. Afterwards, a need analysis was carried out in a) a cross sectional sample of 911 students from an urban area (11, 14 and 17 years olds, b) 103 elementary and secondary PE teachers, and c) 17 schools. The students answered the PALQ in order to depict a profile of their lifestyle and PA patterns. The teachers answered a questionnaire in order to evaluate their knowledge, attitudes and self-efficacy towards teaching health related exercise (HRE). A checklist has been used in order to establish the nature and extent of PA promotion in a sample of elementary and secondary schools. The results showed that: a) a large proportion of students adopted a sedentary lifestyle and were inadequately active to obtain health benefits, b) teachers' had limited ability in promoting effectively HR issues, and c) schools provided limited sport programmes and facilities. The overall finding of the need analysis justified the need for intervention and advocated the adoption of an ecological approach to promote PA Based on the Active School initiative (Almond & McGeorge, 1995), a school based intervention programme has been set up in order to a) promote students' participation in physical activity and sport and to enhance their knowledge on health related (HR) issues, b) increase teachers' knowledge and effectiveness on teaching HR exercise. The decisions about the intervention contents and priorities were based on the findings of the need analysis taking into consideration the cost and the resources. The intervention strategy and the implementation process focused on: a) the teachers' training, b) the creation and the provision of the necessary resources (PE curriculum, a handbook and a CD-Rom for the teachers and two books for the students), c) the creation of a positive and enjoyable learning PE environment, and d) the co-operation between school and out of school health and sport alliances. The intervention programme was applied in 9 elementary and 5 secondary schools for a period of six months and involved 15 PE teachers. A quasi-experimental design with a control group was applied (experimental group N1=699 and control group N2=213). A number of different parameters were estimated at the beginning, during and at the end of the program. The intervention process was monitored on a weekly basis by the author and the school teachers. The effectiveness of the intervention was evaluated in terms of: a) students' behaviour, fitness, self-efficacy, intrinsic motivation, intentions, and attitudes related to PA, b) teachers' knowledge, attitudes and self-efficacy on teaching HR issues, and c) the broader impact of the programme on the school ethos. The intervention implementation and effectiveness was also assessed by an external evaluator. The overall purpose of the intervention was to examine the applicability of promoting PA throughout school environment by creating an innovative and realistic framework for school physical education lesson. The findings of this thesis were very encouraging. Significant differences have been observed in most of the evaluated variables both, for students (fitness, attitudes, self-efficacy, PA level), for teachers (knowledge) and schools' ethos. However, this pioneer study revealed a number of key considerations and issues in designing intervention programmes to promote PA throughout schools in urban areas.