This study determined whether a cadenced-based exercise prescription (CBEP) enabled participants to increase the time they spend doing moderate-to-vigorous intensity physical activity (MVPA) to a greater extent than Standard Care (SC). Forty-six participants were recruited from the ENCOURAGE study and were allocated to SC (n=25) or CBEP (n=21). Data was collected at baseline (T0), prior to the intervention (T1) and then again at 16 (T2) and 24 (T3) weeks. Moderate-to-vigorous physical activity was assessed by accelerometry in 10 minute (MVPA10min) and sporadic bouts (MVPASpor) as well as step counts (StepsTotal, StepsMVPA). Although participants reported that CBEP helped them to increase their motivation to become more active, none of the accelerometer parameters differed between SC and CBEP at baseline, 8, 16, or 24 weeks. These data suggest that CBEP did not have an added benefit for influencing physical activity over time amongst a population of previously sedentary adults.

All humans desire to have a good quality of life i.e. living in relation to their goals, expectations, standards and concerns in life. The quality of life is related to healthy lifestyle, therefore, practicing health behavior is crucial for children and adolescents as the habits developed in early life persist in later life. However, in the contemporary world it has become quite a challenge to practice health behavior due to exposure to technology, electronic devices and social media which has adversely affected two important components of health behavior i.e. sleep and vigorous physical activity. This study aimed at investigating the impact of sleep duration during school days and vigorous physical activity during the week on quality of life. The data collected from 7700 students aged 11,13 & 15 from Swedish schools within the HSBC study in 2014. ANOVA, linear regression and mean comparison were used to test the hypotheses. The results show that age, gender, long-term disability and physical activity effects sleep duration of children and adolescents. Moreover, children and adolescents who sleep longer hours and do vigorous physical activities have a higher quality of life. Sleep duration have also been found to be associated with a higher quality of life.

All humans desire to have a good quality of life i.e. living in relation to their goals, expectations, standards and concerns in life. The quality of life is related to healthy lifestyle, therefore, practicing health behavior is crucial for children and adolescents as the habits developed in early life persist in later life. However, in the contemporary world it has become quite a challenge to practice health behavior due to exposure to technology, electronic devices and social media which has adversely affected two important components of health behavior i.e. sleep and vigorous physical activity. This study aimed at investigating the impact of sleep duration during school days and vigorous physical activity during the week on quality of life. The data collected from 7700 students aged 11,13 & 15 from Swedish schools within the HSBC study in 2014. ANOVA, linear regression and mean comparison were used to test the hypotheses. The results show that age, gender, long-term disability and physical activity effects the sleep duration of children and adolescents. Moreover, children and adolescents who sleep longer hours and do vigorous physical activities have a higher quality of life. Sleep duration have also been found to be associated with a higher quality of life.

Problem: Mostly attributed to lack of time, only about 15% of Canadian adults are currently reaching the Canadian Physical Activity Guidelines (CPAG). Recently, studies have suggested that any bout of aerobic exercise reaching moderate to vigorous intensity has the potential to improve health. Methods: Sixty adults (20 young non-overweight adults, 20 overweight adults, 20 older adults) already doing some resistance training (RT) were recruited. Participants performed eight RT exercises during three visits. The objective was to identify the proportion of time spent at moderate to vigorous intensity during RT sessions. Results: Overall, the participants were at moderate to vigorous intensity during 82% of the time. However, the older adult group compared to the young adult group spent lower proportion of time at moderate to vigorous intensity during RT sessions. Conclusion: Most Canadian adults can reach HR equivalent to those achieved during moderate to vigorous aerobic activity by doing RT.

Obesity is a public health concern and obesity rates increase from adolescence to adulthood. Therefore, the period between 18-24, known as emerging adulthood, may be a crucial period in the development of obesity. Physical activity (PA) is one component of obesity and levels of physical activity decline significantly during emerging adulthood. Additionally, stress is inversely associated with PA, with greater levels of PA associated with lower levels of stress. While most research has focused on whether or how PA may improve stress, much less has focused on how the experience of stress may be related to levels of PA. The limited existing research with a focus on the latter has found that stress negatively impacts PA. However, even less research has examined the associations between stress and vigorous PA (VPA) in emerging adulthood, a crucial period in the development of obesity. Additionally, research as not explored the potential role of perceived stress management ability in the relationship between perceived stress and VPA. Linear regression analyses were run to examine the relationship between perceived stress and days and minutes of past week VPA among first-year college students and to test whether the relationship between perceived stress and VPA was moderated by perceived stress management ability. In unadjusted models, perceived stress was significantly negatively associated with both minutes and days of VPA, indicating that perceived stress may be a barrier to VPA, but in models adjusted for gender and body mass index (BMI), these associations were no longer significant, indicating that there was no association between perceived stress and VPA taking into account gender and BMI. Moderation of the relationship between perceived stress and VPA was not found, indicating that and that the relationship between perceived stress and VPA did not differ by perceived stress management ability in this population. These results are inconsistent with previous research that has found a significant negative relationship between perceived stress and physical activity. Additionally, gender was significantly associated with minutes of VPA. Possible reasons for the inconsistency of these findings and previous research, along with limitations of the current study and future directions are discussed. / text

Regular moderate-vigorous physical activity (MVPA) is associated with significant physiological and psychological health benefits (Department of Health, DoH, 2004). However, many children are not undertaking recommended levels of physical activity (PA) (DoH, 2009). This research examined relationships between physiological health parameters, psychological determinants and PA levels in 10-14 year old schoolchildren (N = 249) and assessed the influence of three school-based PA interventions on these constructs in the context of the Health And Physical activity Promotion in Youth (HAPPY) study. Study 1 revealed that sedentary behaviours, moderate PA (MPA), vigorous PA (VPA) and MVPA levels were higher on weekdays than weekend days (p < .001). However, schoolchildren’s PA is often difficult to measure accurately. The self-report measure utilised in study 2 underestimated total MVPA versus accelerometry for both sexes on weekdays and girls on weekend days (p < .01). However, study 3 highlighted a lack of agreement between two RT3® triaxial accelerometer cut-offs for all activity categories. The importance of VPA for promoting health was highlighted in the updated PA guidelines (DoH, 2011). Study 4 reported that cardiorespiratory fitness (CRF) was positively associated with VPA but not MPA (β = .27, p < .01) and inversely correlated with measures of body composition (% body fat; body mass index; waist circumference) (r = -.74, r = -.60, r = -.39, p < .001). Knowing the health benefits of regular MVPA and VPA, it is important to understand the determinants of PA intentions and behaviours to more effectively promote PA in less active children (studies 5 and 6). An exploratory analysis of the constructs in the Revised Theory of Planned Behaviour and the Modified Social Learning Theory for children predicted PA intentions (R2 = .38, F(5, 171) = 20.19, p < .001; R2 = .13, F(6, 147) = 3.4, p < .01, respectively) but the constructs in either model were unable to predict PA. Recognising the need to promote PA levels, study 7 investigated the effectiveness of three school-based interventions (vs. control) on outcome variables included in studies 1, and 4-6. The Health Education and Psychology Health Promotion conditions produced significant positive change scores between data collection 2 and 3 for CRF (vs. control) whereas the Youth-Led condition produced significant change scores between baseline and data collection 2 for generalised self-efficacy (vs. control). No significant change scores were reported for PA, the RTPB constructs or intentions. In conclusion, this research has emphasised the importance of employing a multidisciplinary approach to aid understanding of schoolchildren’s PA levels. Specific highlights include low weekend day PA as a possible future PA promotion target, although it is vital that accelerometry cut-points are standardised, and the relevance of VPA and body composition in predicting CRF. The psychological models identified some important determinants of PA intentions, but a prominent intention-behaviour gap and a need for more intensive interventions to promote PA levels was apparent.

Background: Physical inactivity has been consistently associated with numerous negative health outcomes that track from childhood into adulthood, making physical activity a special concern in the pediatric population. Dose-response studies are particularly useful when trying to understand the minimal and optimal amounts of physical activity needed to reduce the risk of negative health outcomes. Unfortunately, previous work within youth has relied on self-reported measures of physical activity, and this research does not provide a clear picture of the true relation between physical activity and health. Objectives: Manuscript 1. Describe the dose-response relation between dyslipidemia and moderate-to-vigorous physical activity (MVPA) in youth. Manuscript 2. Quantify the difference between self-reported and objectively measured MVPA in youth. Taken together, the overall objective of this thesis was to examine the dose-response relation between objectively measured MVPA and dyslipidemia in youth and determine how this may affect current Canadian physical activity guidelines. Methods: Both manuscripts used data from the U.S. National Health and Nutrition Examination Survey. Fractional polynomial regression modeling was used to fit the dose-response curves between MVPA and lipid/lipoprotein measurements. Regression analysis as well as a Bland-Altman plot was used to explain the discrepancy between self-reported and objective measures of MVPA. All analyses were completed using SAS statistical software. Results: Manuscript 1. Risks for high-risk HDL-cholesterol and triglyceride values decreased in a curvilinear manner with increasing minutes of MVPA. The greatest reduction in risk occurred within the first 30 min/d of MVPA. The relation between level of MVPA and LDL-cholesterol was unclear. Manuscript 2. The average youth over-reported their MVPA by ~30 min/d. The over-reporting was not mediated by basic demographic factors; however, the difference in reporting was systematic in nature such that inactive youth over-reported to the greatest extent. Conclusions: Manuscript 1. Youth need to accumulate 30 min/d of MVPA to greatly reduce their risk for dyslipidemia. Manuscript 2. Youth tend to over-report their daily MVPA by approximately 30 min/d. Combined, the results from this thesis suggest that physical activity recommendations for cardiovascular health in youth should suggest a minimum of 30 min/d of MVPA and preferred level of 60 min/d. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2009-09-07 08:48:03.896

BACKGROUND: Atherosclerotic cardiovascular (ASCVD) disease is the leading cause of death in the United States. Longstanding poor nutrition habits and lack of exercise contribute to chronic inflammation and promote the development ASCVD. In clinical trials, the Dietary Approaches to Stop Hypertension (DASH) eating pattern, a diet rich in nutrients with anti-inflammatory and antioxidant properties, has been shown to reduce the risk of hypertension. Its role in overall cardiovascular (CV) health, both alone and in combination with an active lifestyle, is less clear. OBJECTIVES: The primary goal of this study is to examine the relationships between the DASH eating pattern, physical activity, the development of incident cardiovascular disease (CVD). Specifically, we will evaluate the independent and combined effects of DASH and moderate to vigorous physical activity (MVPA) on cardiovascular event risk among men and women in the Framingham Heart Study Offspring (FOS) cohort. METHODS: The DASH score was derived from two sets of three-day dietary records gathered during examination visits 3 and 5 in the prospective FOS cohort. Activity was self-reported and used to generate a composite score for MVPA. Scores were constructed for each individual by multiplying the number of hours spent during each day in sedentary, light, moderate, and vigorous activity by a standard weights reflecting the intensity of that activity. Subjects included 2503 individuals (1137 men and 1366 women), aged 30 years and older. Individuals were free of type II diabetes mellitus (T2DM), cancer, and cardiovascular disease at baseline. The DASH score was categorized according to adherence to the eating pattern, first as low, moderate, or high adherence and then dichotomized (DASH score <4.45 vs. ≥4.45). The MVPA score was classified into quintiles and also dichotomized (MVPA score <6.1 vs. ≥6.1). The dichotomous DASH and MVPA scores were then cross-classified and each subject was assigned to one of the following categories: (1) low DASH score / low activity (referent), (2) low DASH / high activity, (3) high DASH / low activity, and (4) high DASH / high activity. Follow-up started at exam 5 and continued through the ninth examination cycle in 2014. Cox proportional-hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all subjects and for men and women independently, adjusting for confounding by age, BMI, cigarettes smoked per day, and grams per day of alcohol consumed. Factors found not to confound the effects of DASH and MVPA on CV risk were excluded from final models. RESULTS: During a median follow-up of approximately 20 years, 286 and 177 incident CVD cases were documented among men and women, respectively. Women in the highest DASH adherence category had approximately 28% lower total CVD risk than women in the lowest adherence group (HR, 0.72; 95% CI: 0.48-1.10). Effects in men were weaker. Women in the highest quintile of MVPA score had approximately 44% lower risk of CVD than women in the lowest quintile (HR, 0.66; 95% (0.40-1.10). Overall, CVD risk was 26% lower (HR: 0.74 (95% CI: 0.55-0.99) for those in quintile 5 vs. quintile 1. Women in the High DASH/High MVPA category had a 43% lower total CVD risk than women in the Low DASH/Low MVPA group (High DASH/High MVPA: HR, 0.57; 95% (0.36-0.90)). These associations ere generally stronger in women than men. CONCLUSIONS: In this prospective cohort study, active individuals with higher adherence to DASH was associated with a lower atherosclerotic CVD risk compared to those with lower activity and DASH adherence. The beneficial effects of diet in particular were stronger among women than men.

Health literacy (HL) is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Low HL has been associated with poorer self-reported health status, inability to manage chronic conditions, and less use of preventive services. More research is needed to explore the relationship between HL and sugar-sweetened beverage (SSB) intake and physical activity (PA). Although numerous HL interventions are evident in the literature, those that test HL as a moderator of effectiveness are lacking. Additionally, it has been recognized that systems-level HL efforts are necessary to lessen the burden of low HL. This dissertation addresses these needs with three unique studies that took place within the rural, medically underserved southwest Virginia region. Study 1 was a secondary analysis that examined the relationship and responsiveness of the Stanford Leisure-Time Activity Categorical Item (L-Cat) and adapted Godin Leisure-Time Exercise Questionnaire (GLTEQ) and determined if baseline HL status moderated intervention effects. There was high agreement L-Cat and adapted GLTEQ for classifying individuals as meeting PA recommendations. Baseline HL status did not moderate change in L-Cat or adapted GLTEQ measures. Study 2 was a secondary analysis that determined if 6-month change in SSB intake predicted 6-month change in body mass index (BMI), weight, and quality of life (QOL), and determined if HL moderated these relationships. The regression models for weight and QOL were not significant. The BMI model was significant. Six-month change in SSB intake, experimental condition, and age were significant predictors for the BMI model. As hypothesized, HL did not moderate relationships in any models. Study 3 details a multilevel mixed-methods needs assessment and collaboratively developed organizational HL improvement plan within the Virginia Department of Health (VDH). Staff responses revealed about half reported doing well across HL domains (written communication, oral communication, self-management and empowerment, supportive systems). However, needs were observed across all domains, with most improvement needed in written communication domain. There were significant correlations between clients' HL status and their perceptions of VDHs' HL practices, indicating potential areas of improvement within VDH. / Ph. D. / Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Low health literacy has been associated with poorer self-reported health status, inability to manage chronic conditions, and less use of preventive services. More research is needed to explore the relationship between health literacy and sugar-sweetened beverage intake and physical activity. Specifically, interventions that test the moderation of health literacy (i.e., how health literacy affects the strength of a relationship) are needed. Additionally, it has been recognized that systems-level health literacy efforts are necessary to lessen the burden of low health literacy. This dissertation addresses these needs within the rural, medically underserved southwest Virginia region. Study 1 aimed to test the utility of two physical activity measures (Stanford Leisure-Time Activity Categorical Item and adapted Godin Leisure-Time Exercise Questionnaire) with a population of varying health literacy status with hopes of coming closer to identifying pragmatic standardized assessment of and detection of clinically meaningful change in physical activity behaviors, and to determine if health literacy moderated this change. Study 2 expanded upon existing research that has determined that a decrease in sugar-sweetened beverage intake can result in a decrease in weight and body mass index (BMI), and improvement in quality of life (QOL) by aiming to determine if six-month change in SSB intake predicted six-month change in BMI, weight, and QOL and if health literacy moderated these relationships. Study 3 responds to national and state-wide initiatives by detailing the first use of the AHRQ Toolkit within a public health setting, Virginia Department of Health, to conduct a needs assessment and organizational health literacy improvement plan.

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.