The purpose of this thesis was to determine the effectiveness of strategies to reduce sedentary behaviour (SB) and to communicate these strategies to healthy adults working in academic occupations using an educational video. Study One was a systematic review and meta-analysis of published literature on strategies to reduce SB in the home and workplace environments for healthy adults. Study Two was a single group pre-post study design to determine the effect of an educational video on viewers’ health beliefs related to reducing SB and daily sitting time. The information gained from these studies could be used to inform future interventions to reduce SB in the adult population. / Thesis / Master of Science Rehabilitation Science (MSc)

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.

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.

avaliar, em mulheres idosas, os efeitos agudos do tempo sentado prolongado (TSP) de 5 horas na curva glicêmica e insulinêmica e comparar com os efeitos de diferentes padrões de interrupção do TSP por meio de atividade física (AF), nestes mesmos marcadores. Materiais e Métodos: participaram do estudo mulheres, com idade >= 65 anos, não obesas e não diabéticas. As voluntárias realizaram uma pré-avaliação na qual foram analisadas variáveis clínicas, antropométricas e padrão de AF espontânea. Em seguida, foram propostas 4 diferentes fases de intervenção. 1) TSP: composto por 300 minutos ininterruptos na postura sentada; 2) Intensidade Leve e Curta Duração (ILCD): TSP interrompido a cada 20 minutos por 2 minutos de AF de baixa intensidade (50 a 60% da FC máx prevista para a idade); 3) Intensidade Moderada e Curta Duração (IMCD): TSP interrompido a cada 20 minutos por 2 minutos de AF de moderada intensidade (65 a 75% da FC máx prevista para a idade); 4) Intensidade Moderada e Longa Duração (IMLD): TSP interrompido a cada 75 minutos por 10 minutos de AF de moderada intensidade (65 a 75% da FC máx prevista para a idade). As áreas sob a curva (ASC) glicêmica e insulinêmica foram verificadas por meio de coleta seriada de sangue, após a ingestão de refeição padrão e calculada pelo método do trapézio. Para as comparações entre os grupos foi proposto o modelo de regressão linear com efeitos mistos e controlado para idade, peso e classificação de NAF. Resultados: 16 idosas da comunidade com média de 69,2 ± 4 anos participaram do estudo. Na fase pré-avaliação as voluntárias passaram cerca de 9 horas/dia em posturas sedentárias. O TSP foi a fase de intervenção que apresentou os maiores valores de ASC de glicemia e insulina (555,9 ± 75,4 mg / dl) e (220,1 ± 76,2 µIU/mL), respectivamente. As fases de interrupção do TSP apresentaram menores valores de ASC de glicemia (ILCD: 514,0 ± 55,1; IMCD: 531,7 ± 69,1; IMLD: 530,0 ± 45,5 mg/dl) e insulina (ILCD: 155,0 ± 53,1; IMCD: 169,5 ± 81,7; IMLD: 164,9 ± 54,4 µIU/mL) em comparação com a fase de TSP (p < 0,05). No entanto, quando comparadas entre si, não houve diferença entre as fases ILCD, IMCD e IMLD (p > 0,05). Conclusão: o TSP foi relacionado a piora dos níveis de glicemia e insulinemia, enquanto a interrupção por meio de AF de intensidade leve ou moderada, de curta ou longa duração mostraram-se potenciais estratégias de redução desses marcadores de risco cardiovascular. Nenhum padrão de interrupção mostrou-se significativamente superior ao outro, sendo interrupções de curta duração e leve intensidade eficazes na redução dos níveis da ASC glicêmica e insulinêmica. / assess the acute effects of uninterrupted sitting time compared to sitting interrupted by physical activity (PA) bouts (light and moderate intensity, short and long duration) in relation to blood glucose and insulin responses, in older women. Subjects and Methods: community- dwelling women aged >= 65 years, non-obese and non-diabetic. The volunteers performed a pre-evaluation in which clinical, anthropometric and spontaneous PA patterns were analysed. Four different phases of intervention were proposed. 1) Uninterrupted sitting: 300 minutes in sitting posture 2) Sitting + 2 min Light Breaks: sitting time break every 20 minutes for 2 minutes of low intensity PA (50 to 60% of predicted HR max for age). 3) Sitting + 2 min Moderate Breaks: sitting time break every 20 minutes for 2 minutes of moderate intensity PA (65 to 75% of predicted HR max for age).4) Sitting + 10 min Moderate Breaks: sitting time break every 75 minutes for 10 minutes of moderate intensity PA (65 to 75% of predicted HR max for age). The glucose and insulin area under curve were verified by serial blood collection after the ingestion of a standard meal. Results: 16 older women, aged 69 ± 4 years were evaluated. In the pre-evaluation phase the volunteers spent about 9 hours / day in sedentary postures. The participants had lower values of blood glucose AUC during interrupted sitting time (2 min light 514.0 ± 55.1 vs 2 min moderate 531.7 ± 69.1 vs 10 min moderate 530.0 ± 45.5 mg / dl) and of insulin AUC ( 2 min light 155.0 ± 53.1 vs 2 min moderate 169.5 ± 81.7 vs 10 min moderate 164.9 ± 54.4 ?UI / mL) when compared to the uninterrupted phase (555.9 ± 75.4 mg / dl, 220.1 ± 76.2) (p <0.05). There was no significant differences between the different interruption patterns physical (p > 0.05). Conclusion: Uninterrupted sitting was associated with worsening blood glucose and insulin response, while breaking up prolonged sitting by bouts of short or long duration, light or moderate intensity showed to be potential strategies for improving blood glucose and insulin responses to a meal. No interruption pattern was found to be better than other, with even short breaks of light intensity being effective in reducing blood glucose and insulin levels.

Introduction: Obesity during pregnancy is linked to many negative health effects for mothers and offspring. The majority of interventions with obese pregnant women based on physical activity have had limited success suggesting alternative approaches are needed. Sedentary behaviour is defined as waking activities that expend very low energy, 1.5 metabolic equivalents or below, while reclining, lying or sitting. Spending too much time sedentary has been identified as a risk factor for health, regardless of physical activity levels. We hypothesised that targeting sedentary behaviour may be a suitable alternative to reduce health risks during gestation among pregnant women who are morbidly obese (defined as body mass index, BMI > 40 Kg/m²). Aim and objectives: The aim was to explore sedentary behaviour among obese pregnant women and to propose an intervention to reduce the time obese pregnant women spend sedentary, through an active sitting exercise intervention. To conduct a systematic review of the literature to determine the proportion of time spent in sedentary behaviour among pregnant women, and the association of sedentary behaviour with pregnancy outcomes in mothers and offspring. To estimate total energy expenditure, and energy expended in sedentary activities in morbidly obese and lean pregnant women. To assess the feasibility of an active sitting exercise intervention for morbidly obese pregnant women, designed using a patient involvement in research method. Systematic Review: A systematic review of the literature reporting sedentary behaviour during pregnancy and its effects on pregnancy outcomes was conducted. Twenty six publications were included in the systematic review up until October 2015, and a further 18 were identified in the update completed in April 2018. Pregnant women spent at least 50% of their time in sedentary activities. Associations between increased time sedentary and higher risk of macrosomia, higher risk of pre-eclampsia, higher risk of developing gestational diabetes mellitus, and larger new-born abdominal circumference were observed, as the main findings. Most of included studies scored an intermediate quality, only two of the 44 studies scored a good quality. Cross-sectional study. A cross-sectional study was conducted, using the Pregnancy Physical Activity Questionnaire (PPAQ), and the Actical accelerometer, to assess energy expenditure, and energy expended in sedentary behaviour. Based on the PPAQ, women who were morbidly obese expended significantly more energy per day, as total expenditure, than lean pregnant women, which was confirmed by the Actical. During sedentary behaviour lean pregnant women expended significantly less energy than morbidly obese pregnant women, based on the PPAQ. No differences were observed between lean and morbidly obese pregnant women in the proportion of time spent in sedentary activities, nor in time sedentary. Exercise Intervention Design A patient involvement in research approach was used to design an active sitting exercise intervention for morbidly obese pregnant women. Twenty three women took part in the design of the intervention, enabling design of a final protocol including six exercises, to be performed in two sets of 10 repetitions. Active sitting exercise intervention An intervention based on active sitting exercises for morbidly obese pregnant women to reduce sedentary time was conducted to assess the feasibility. Thirty morbidly obese pregnant women were recruited of whom 20% completed the exercise intervention. The main reason not to complete the intervention was lack of time. Conclusion: A better understanding of sedentary behaviour is needed for the design of effective interventions to help to reduce the adverse effects of morbid obesity on pregnancy, especially as prevalence is growing. More time spent in light intensity activities rather than in sedentary behaviour may play a role as contributing to reduce those risks associated with obesity during pregnancy, and to reduce time spent sedentary. Participants have shown real interest in helping to design an effective exercise intervention. Involving and empowering participants in how to take care of themselves as part of the intervention helps to increase their commitment. Giving participants the tools to take care of their own health and their babies' should be considered as part of the intervention with very obese pregnant women. Providing the information in how and why exercise might help, and basing the intervention in giving participants easy and realistic tasks that they could do on their own and around their own environment, will help to increase their commitment. This appears to be a feasible and effective strategy.

The purpose of this study was to examine the effectiveness of combining implementation intentions (II) and regulatory fit in the context of two important health goals: increasing leisure time physical activity and decreasing leisure time sedentary behaviour. Implementation intentions specify exactly how, when, and where a behaviour will occur and can be an effective method of increasing goal enactment. Regulatory fit occurs when a goal or strategy used to achieve the goal matches an individual’s regulatory orientation. University students (N = 180) were randomly assigned to a goal (increase activity/decrease screen time) and an experimental condition (II/non-II). Participants formed a goal to increase their physical activity or decrease their screen time over the following four weeks according to their random assignment. Participants’ commitment to their goal was monitored over the course of the study. The II group also formed a detailed plan regarding how they would accomplish their goal. Regulatory fit was determined based on group assignment and score on the regulatory focus questionnaire. Physical activity and screen time were assessed with self-report questionnaires. Follow-up occurred online four weeks after baseline. Data were analyzed separately by goal type using linear regressions to examine the effects of regulatory fit, experimental condition, and goal commitment on the behaviour variables. The regulatory fit manipulation was not successful. Among those with the physical activity goal, no significant effects emerged for the experimental variables. Among those with the screen time goal and in the fit, II group, stronger goal commitment tended to be associated with increased participation in moderate physical activity, β = .17, t(22) = .94, p = .36. Also, participants who set II for the screen time goal and were committed to this goal tended to report less screen time than participants with lower goal commitment (β = -.40, t(69) = -2.05, p = .05). Findings provide preliminary insight into the effectiveness of II and the importance of goal commitment in interventions aiming to reduce sedentary behaviour. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2010-07-02 11:32:18.716

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Emerging evidence suggests that sedentary behaviour is independently associated with cardiometabolic disease risk in school-aged children and youth. This thesis includes 4 related studies in the pursuit of 2 objectives: 1) To determine the cross-sectional association of sedentary time, interruptions in sedentary time, sedentary bout length, and total movement variability with markers of cardiometabolic disease risk among children and youth, and 2) To examine the impact of 1-day of prolonged sedentary behaviour, with and without interruptions or structured physical activity, on markers of cardiometabolic disease risk, hunger, food intake and spontaneous physical activity levels in children and youth. In Study 1, we found that interruptions in sedentary time and short bouts of sedentary time were beneficially associated with clustered cardiometabolic disease risk in boys and girls aged 8-11 years, independent of total sedentary time, moderate-and-vigorous physical activity (MVPA), and other confounders (all p<0.05), while the opposite was true for screen based sedentary behaviours. In Study 2, we found that movement variability (minute-to-minute changes in movement intensity) was negatively associated with clustered cardiometabolic disease risk and systolic blood pressure independent of MVPA, sedentary time and other covariates in a representative sample of American children and youth aged 12-17 years (all p<0.05). In Studies 3 and 4, we found that prolonged sitting, with or without interruptions and structured MVPA did not result in acute changes in markers of cardiometabolic disease risk, nor subsequent ad libitum food intake or physical activity levels in healthy children aged 10-14 years (all p ≥0.05). Taken together, the studies that make up this thesis suggest that optimal levels of cardiometabolic disease risk are most likely to be seen in children who limit their time engaging in screen-based sedentary behaviours, who frequently interrupt their sedentary time, and who have high levels of variability in their movement behaviours.

Children are becoming more inactive and are spending a significant proportion of their time participating in screen-time sedentary behaviours. New generation active video games may provide an opportunity to convert traditional sedentary screen-time into active screen-time. The aims of this thesis were to: 1) determine the metabolic costs of different activities; 2) determine whether experience and fitness influence the metabolic costs of active video games; and 3) determine children's enjoyment of active video games. Accordingly, this thesis is presented as two papers. Twenty-six boys' (11.4 ± 0.8 yr) participated in the study. Each performed sedentary activities (resting, watching television and sedentary gaming), active video games (Nintendo® Wii Bowling, Boxing, Tennis, Skiing and Step Aerobics), traditional physical activities (walking and running) and a maximal fitness test. During all activities oxygen uptake and heart rate were measured and energy expenditure (EE) calculated. The active video games resulted in a significantly higher EE compared to rest (63-190%, p<0.05). No significant differences in EE were found between the most active video games (Wii Boxing and Wii Step) and walking. The intensities of the active video games were low (≤ 3 METSmeas). There was no evidence to suggest that gaming experience or aerobic fitness influenced EE during active video game play. Using the same sample, the aim was to determine the participants' enjoyment of active video games sedentary activities and physical activities. Participants' enjoyment was measured using the Physical Activity Enjoyment Scale immediately after the activities. The percentages of children that enjoyed each activity were: walking (39%), television (58%), running (60%), PS3 (73%), Wii Boxing (88%), Wii Tennis (77%), Wii Fit (75%) and Wii Bowling (89%). The active video games were the most enjoyable activities irrespective of participants' weight status, fitness and experience. The metabolic costs of active video games suggest that they may be suitable for future interventions which are aimed at decreasing time spent in sedentary behaviour. However, as they are low intensity activities, active video game play time should not be accumulated as part of the 60-minutes of daily moderate to vigorous physical activity that is currently recommended for children.

With the introduction of the technological age, increasing mechanisation has led to labour saving devices which have all-but engineered physical activity out of our lives and sedentary behaviour has now become the default behaviour during waking hours. Interventions that previously focused on improving levels of physical activity are now attempting to concurrently increase levels of physical activity and decrease time spent in sedentary behaviour. One method that has shown promise in interventions to increase physical activity and healthy eating in adults is the behaviour change technique of self-monitoring. There is now a robust set of literature indicating self-monitoring as the most promising behaviour change technique in this area. Self-monitoring is tied inherently into the recent rise in wearable technology. These new devices have the ability to track a variety of behavioural and physiological parameters and immediately make the information returnable to the user via connected mobile applications. The potential pervasive nature of these technologies and their use of robust behaviour change techniques could make them a useful tool in interventions to reduce sedentary behaviour. Therefore the overall purpose of this three study dissertation was to identify and validate technology that can self-monitor sedentary behaviour and to determine its feasibility in reducing sedentary behaviour. Study 1 Purpose: The aim of this study was to review the characteristics and measurement properties of currently available self-monitoring devices for sedentary behaviour and/or physical activity. Methods: To identify technologies, four scientific databases were systematically searched using key terms related to behaviour, measurement, and population. Articles published through October 2015 were identified. To identify technologies from the consumer electronic sector, systematic searches of three Internet search engines were also performed through to October 1st, 2015. Results: The initial database searches identified 46 devices and the Internet search engines identified 100 devices yielding a total of 146 technologies. Of these, 64 were further removed because they were currently unavailable for purchase or there was no evidence that they were designed for, had been used in, or could readily be modified for self-monitoring purposes. The remaining 82 technologies were included in this review (73 devices self-monitored physical activity, 9 devices self-monitored sedentary time). Of the 82 devices included, this review identified no published articles in which these devices were used for the purpose of self-monitoring physical activity and/or sedentary behaviour; however, a number of technologies were found via Internet searches that matched the criteria for self-monitoring and provided immediate feedback on physical activity (ActiGraph Link, Microsoft Band, and Garmin Vivofit) and sedentary behaviour (activPAL VT, the LumoBack, and Darma). Conclusions: There are a large number of devices that self-monitor physical activity; however, there is a greater need for the development of tools to self-monitor sedentary time. The novelty of these devices means they have yet to be used in behaviour change interventions, although the growing field of wearable technology may facilitate this to change. Study 2 Purpose: The aim of this study was to examine the criterion and convergent validity of the LumoBack as a measure of sedentary behaviour compared to direct observation, the ActiGraph wGT3X+ and the activPAL under laboratory and free-living conditions in a sample of healthy adults. Methods: In the laboratory experiment, 34 participants wore a LumoBack, ActiGraph and activPAL monitor and were put through seven different sitting conditions. In the free-living experiment, a sub-sample of 12 participants wore the LumoBack, ActiGraph and activPAL monitor for seven days. Validity were assessed using Bland-Altman plots, mean absolute percentage error (MAPE), and intraclass correlation coefficient (ICC). T-test and Repeated Measures Analysis of Variance were also used to determine any significant difference in measured behaviours. Results: In the laboratory setting, the LumoBack had a mean bias of 76.2, 72.1 and -92.3 seconds when compared to direct observation, ActiGraph and activPAL, respectively, whilst MAPE was less than 4%. Furthermore, the ICC was 0.82 compared to the ActiGraph and 0.73 compared to the activPAL. In the free-living experiment, mean bias was -4.64, 8.90 and 2.34 seconds when compared to the activPAL for sedentary behaviour, standing time and stepping time respectively. Mean bias was -38.44 minutes when compared to the ActiGraph for sedentary time. MAPE for all behaviours were < 9%, and the ICC were all > 0.75. Conclusion: The LumoBack has acceptable validity and reliability as a measure of sedentary behaviour. Study 3 Purpose: The aim of this study was to explore the use of the LumoBack as a behaviour change tool to reduce sedentary behaviour in adults. Methods: Forty-two participants (≥25 years) who had an iPhone 4S or later model wore the LumoBack without any feedback for one week for baseline measures of behaviour. Participants then wore the LumoBack for a further five weeks whilst receiving feedback on sedentary behaviour via a sedentary vibration from the device and feedback on the mobile application. Sedentary behaviour, standing time, and stepping time were objectively assessed using the LumoBack. Differences in behaviour were determined between baseline, week 1 and week 5. Participant engagement with the LumoBack was determined using Mobile app analytics software. Results: There were no statistically significant differences in behaviour between baseline and the LumoBack intervention period (p > 0.05). Participants engaged most with the Steps card on the LumoBack app with peaks in engagement seen at week 5. Conclusion: This study indicates that using the LumoBack on its own was not effective in reducing sedentary behaviour in adults. Self-monitoring and feedback may need to be combined with other behaviour change strategies such as environmental restructuring to be effective. General Conclusion This thesis found that there are currently an abundance of technologies which self-monitors physical activity but a lack of devices which measuring sedentary behaviour. One such device, the LumoBack, has shown to have acceptable validity as a measure of sedentary behaviour. Whilst the use of the LumoBack as a behaviour change tool did not elicit any significant changes, its ability to be a pervasive behavioural intervention and the use of user-defined nudging can make the LumoBack, and other similar low cost, valid objective sedentary behaviour self-monitors key components in multi-faceted interventions.