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.

Bakgrund:Fysisk inaktivitet orsakar ohälsa och sjukdom i dagens samhälle. I Sverige introducerades, år 2001, fysisk aktivitet på recept (FaR) som en metod för att öka den fysiska aktiviteten bland befolkningen. Att undersöka hur distriktssköterskan uppfattar FaR är värdefullt eftersom det är en metod som distriktssköterskan kan använda i det hälsofrämjande arbetet. Syfte: Syftet med studien var att beskriva distriktssköterskors uppfattningar om fysisk aktivitet på recept (FaR). Metod: Semistrukturerade intervjuer med 18 distriktssköterskor genomfördes. Intervjumaterialet analyserades genom kvalitativ innehållsanalys. Resultat: Distriktssköterskorna uppfattade att FaR kunde främja både hälsa och ekonomi i samhället men att metoden begränsar jämlik hälsa. Metoden hade ett brett användningsområde men det framkom skilda meningar om metodens användbarhet för patienterna. En motiverad patient, tvärprofessionellt samarbete, samverkan med andra FaR-aktörer och organisatoriskt stöd uppfattades av distriktssköterskorna som förutsättningar för att använda FaR. Uppfattningar om FaR:s framtidsutsikt visade att det fanns tveksamhet om metodens hållbarhet och ett behov av utveckling. Slutsats: Studien visar att ett flertal omständigheter påverkar om distriktssköterskorna ska uppfatta FaR som en metod värd att använda. Resultatet kan användas som vägledning för att se över dessa faktorer och vidareutveckla metoden FaR. / Background:Physical inactivity causes ill-health and disease in today’s society. As a method for increasing physical activity among the population, physical activity on prescription (PaP) was introduced in Sweden in 2001. PaP is a method which the district nurse can use in promoting health and it is therefore valuable to explore how the district nurses perceive this method. Objective: The aim of the study was to describe district nurses’ perceptions about physical activity on prescription (PaP). Method: The study was based on semi structured interviews with18 district nurses. The material was analyzed using qualitative content analysis. Results: District nurses felt that PaP could promote both health and economy in society, but that it restricts equal health. The method was understood to have a broad scope but there were differences of opinion about the method's usefulness for patients. A motivated patient, cross-collaboration, interaction with other PaP-actors and organizational support were perceived by the district nurses as prerequisites for using PaP. Opinions about the future of PaP showed that there was uncertainty about the sustainability and a need for development. Conclusion: The study shows that a number of factors affect the district nurses’ perception of whether PaP is a method worth using. The result can be used as a guide to surveying these factors and developing the PaP method.