Health-related quality of life among patients attending cardiovascular rehabilitation

Purpose: f i rst , an investigation of baseline differences in Health-Related Quality of l i fe (HRQOl) among adhere and non-adhere patients of Phase III cardiac rehabilitation (CR) was examined. Second, among patients who adhered to the program, effectiveness of t reatment based on HRQOl was evaluated. Methods: Data was collected by the Brock University Heart Institute. Participants completed a questionnaire battery at baseline and again at six months i f they were still a client. Results: The physical dimension of HRQOl differed at baseline between the adhere and non-adhere groups. for everyone point increase in physical HRQOl scores there was an associated 1.06 times greater likelihood that an individual would adhere to the program. Second, in those who adhered to the program for six months, physical HRQOl scores improved 3.18 points. Conclusions: Phase III CR significant improves HRQOl in patients suffering f rom cardiovascular disease.

Mediating Influence of Physical Fitness on the Relationship between Academic Performance and Motor Proficiency

We explored the potential mediating influence of physical fitness on the relationship between academic performance and motor proficiency in children. 1864 students (F:926, M:938, age 11.91 (SD:0.34). Academic achievement was derived from an average of standardized tests of reading, writing, and math. The Bruininks-Oseretsky Test of Motor Performance (short-form) determined motor proficiency. Fitness (peak oxygen uptake) was established with the Léger 20-m Shuttle Run Test. OLS regression identified several significant predictors of academic performance. After controlling for age (p=0.0135), gender (p<0.0001), and parental education (p<0.0001), motor proficiency (p<0.0001), was significant. After adding physical fitness (p=0.0030) to the model the effect of motor proficiency remained significant however the point estimate was reduced from 0.0034 (p<0.0001) to 0.0026 (p<0.0001). These results suggest that physical fitness plays a mediating role on the relationship between academic performance and motor proficiency although both aerobic fitness and motor proficiency have independent roles.

Health-related learning needs and interests of selected non-institutionalized elderly

The research question in this study was "How do the noninstitutionalized elderly in the Hamilton-Wentworth Region perceive their learning needs and interests related to health?" The theoretical foundations of instruction for adults were reviewed as well as learning needs and interests in adult education, the assessment of learning needs in general, and the assessment of the learning needs of the elderly. The methodology used was a descriptive design. A research-based questionnaire-interview was developed, refined, and pilot tested. From a random sampling procedure, a participant group of 23 was secured. The questionnaireinterview was administered in a home visit situation. Data, which were collected, were coded, analyzed, processed, and printed. The results indicated that each participant had many learning needs and interests of varying intensities. The participants had many preferences in the delivery of health promotion. The learning needs and interests had several significant correlations with other variables. The implications of the result~ were discussed.

Participation factors in optional high school health and physical education

Student enrolment rates in optional health and physical education (HPE) classes have been steadily declining, to the point where most Ontario students stop taking HPE after completion of their one required credit, typically taken in grade nine. This study looked at factors that could contribute to HPE enrolment, sampling 227 grade ten students from five schools. These factors included selfefficacy (SE), perceived autonomy support (PAS), task value (TV), motivational regulation (autonomous, AR; controlled, CR), HPE grade average and body size discrepancy (BSD). Qualitative information was also gathered from students regarding likes and dislikes ofHPE, as well as reasons for their HPE enrolment choice. Cronbach Alpha values of each scale fell within acceptable values. ANOVA analysis revealed differences between enrolment groups in SE, TV, AR, HPE grade average, and BSD (p < .05). Reasons students reported for not taking HPE included a dislike of health classes, scheduling challenges, not needing HPE for future endeavors, concerns about social self-presentation, and a dislike of sports and/or competition. This research shows important differences between students and their HPE class choices and calls for a re-evaluation of how HPE classes are structured, advertised and scheduled by high school practitioners. Future works should look toward what other factors could be at play in students' decisions for or against optional HPE and how those factors interact with the constructs that were found to be of significance in this study. Keywords: Health and physical education, high school students, participation.

A needs assessment of public health professionals: supporting the implementation of Ontario 2010 revised elementary health and physical education curriculum

Based on the Comprehensive School Health framework, Ontario's Foundations for a Healthy School (2009) outlines an integrated approach to school health promotion. In this approach the school, community and partners (including public health) are fully engaged With a common goal of youth health. With the recent introductions of the Ontario Public Health Standards (2009) and the revised elementary health and physical education curriculum (2010), the timing for a greater integration of public health with schools is ideal. A needs assessment was conducted to identify the perceived support required by public health professionals to implement the mandates of both policy documents in Ontario. Data was collected for the needs assessment through facilitated discussions at a provincial roundtable event, regional focus groups and individual interviews with public health professionals representing Ontario's 36 public health units. Findings suggest that public health professionals perceive that they require increased resources, greater communication, a clear vision of public health and a suitable understanding of the professional cultures in which they are surrounded in order to effectively support schools. This study expands upon these four categories and the corresponding seventeen themes that were uncovered during the research process.

Health-Enhancing Physical Activity and Well-Being: Is it How Often, How Long, or How Much Effort that Matters? A Test of Basic Psychological Needs Theory

The primary objectives of the present study were 1) to examine the relationship between health-enhancing physical activity (HEPA) and well-being across the previous day and 2) to examine the role of basic psychological need satisfaction as a potential mediator of the HEPA – well-being relationship. Participants (N = 203) were a convenience sample of undergraduate students with data collected cross sectionally. HEPA was generally associated with well-being (r‟s ranged from .18 to .62). Multiple mediation analyses supported psychological need satisfaction as mechanisms underpinning the HEPA – well- being relationship. Subsequent analyses demonstrated that effort put forth in HEPA activities, as opposed to frequency or duration, uniquely predicted well-being. The role of effort was further highlighted in the multiple mediation analyses. As such future research may wish to investigate the utility of a HEPA program that facilitates effortful engagement and fulfillment of basic psychological needs.

Understanding the Integration of Living Skills Through the Context of Health and Physical Education: A Case Study of Educators’ Experiences

The research presented is a qualitative case study of educators’ experiences in integrating living skills in the context of health and physical education (HPE). In using semi-structured interviews the study investigated HPE educators’ experiences and revealed their insights relative to three major themes; professional practice, challenges and support systems. Professional practice experiences detailed the use of progressive lesson planning, reflective and engaging activities, explicit student centered pedagogy as well as holistic teaching philosophies. Even further, the limited knowledge and awareness of living skills, conflicting teaching philosophies, competitive environments between subject areas and lack of time and accessibility were four major challenges that emerged throughout the data. Major supportive roles for HPE educators in the integration process included other educators, consultants, school administration, public health, parents, community programs and professional organizations. The study provides valuable discussion and suggestions for improvement of pedagogical practices in teaching living skills in the HPE setting.

Physical Activity and Fitness in Children with Developmental Disorder

Introduction: Developmental coordination disorder (DCD) is a prevalent condition characterized by poor motor proficiency that interferes with a child‟s activities of daily living. Children with DCD often experience compromised health-related fitness components such as cardiorespiratory fitness (CRF). Purpose: To better understand the physical activity and fitness characteristics of children with probable DCD (pDCD), with a particular focus on CRF. Specifically: (1) to present a synopsis of current literature; (2) to determine the longitudinal trajectories of CRF; (3) to compare the submaximal CRF of children with and without pDCD. Methods: A comprehensive, systematic literature review was conducted of the recent available data on fitness and physical activity and pDCD (Chapter 2). This review provided the background for the other two studies included in this thesis. In Chapter 3, a prospective cohort design was used to assess how CRF in children with pDCD changes over time (56 months) relative to a group of typically developing controls. Using a nested-case control design, 63 subjects with pDCD and 63 matched controls from the larger sample were recruited to participate in the lab-based component of the study (Chapter 4). In this investigation CRF was examined using the oxygen cost of work (VO2) during an incremental test on a cycle ergometer. Results: The literature review showed that fitness parameters, including CRF and physical activity levels, were consistently reduced in children with pDCD. Chapter 3 demonstrated that the difference in CRF between children with pDCD and typically developing children is substantial, and that it tends to increase over time. Results from VO2 assessments showed that children with pDCD utilized more oxygen to sustain the same submaximal workloads compared to typically developing children. Conclusions: Findings from this thesis have made several important contributions to our understanding of children with pDCD. Since differences in CRF between children with and without pDCD tend to worsen over time, this adds to the argument that interventions intended to improve CRF may be appropriate for children with motor difficulties. This thesis also presented the first evidence suggesting that DCD involves higher energy expenditure, and could help explain why children with pDCD perform poorly on tasks requiring CRF.

A physical activity intervention in a workplace setting

Physical inactivity poses a huge burden on Canada's health care system and is detrimental to the health of Canadians (Katzmarzyk & Janssen, 2004). Walking is a viable option for individuals to become physically active on a daily basis and is in fact the most commonly reported leisure time physical activity. It has been associated with many health benefits including weight loss/weight control, reduced risk of coronary artery disease and diabetes, lowered blood pressure, and improved psychological wellbeing (Brisson & Tudor-Locke, 2004). Specifically, individuals' stage of change, selfefficacy and health related quality of life (HRQL) are three psychological constructs that can be greatly improved with increased physical activity (Dishman, 1991; Penedo & Dahn, 2005; Poag & McAuley, 1992). Public health physical activity recommendations exist but many individuals find these difficult to meet due to overly busy lifestyles (Public Health Agency of Canada, 2003). Pedometers are inexpensive devices that can monitor individual bouts of walking so that the incorporation of physical activity into one's daily life is more plausible. They are also excellent tools for motivation, goalsetting, and immediate feedback (Brisson & Tudor-Locke, 2004). Since many people spend a large proportion of their time at their places of employment, workplaces have begun to be a common site for the development of physical activity interventions. These programs have been growing in popUlarity and have shown numerous benefits for both employees and employers (Voit, 2001). The purpose of the current study was to implement and evaluate the use of a pedometer-based physical activity intervention incorporating goal-setting and physical activity logs in a workplace setting, and to examine the relationship between different types of self-efficacy (task, barrier, and scheduling) and different phases of the intervention. Twenty male participants from a local steel manufacturing plant who exhibited health risk factors (e.g. hypertension, diabetes, etc.) were assigned to one of two groups (group A or group B). All participants were asked to wear pedometers on their waists, record their daily steps, set goals that were outlined on a step-tracking sheet (detennined by their baseline number of steps), and keep track of their work days, wakelbed time, sedentary time, and time spent doing other physical activity. Group A began the intervention immediately following the baseline measures, whereas group B continued with their regular routine for 4 weeks before beginning. Physiological measures (height, weight, blood pressure, relative body fat, waist and hip circumference, and body mass index) were taken and a battery of questionnaires that assessed barrier, task and scheduling self-efficacy, HRQL, and stage of change administered at baseline, week 5 (end of intervention for group A), week 9 (end of intervention for group B; follow-up for group A) and week 13 (follow-up for both groups). Results showed that this workplace physical activity intervention was successful at increasing the participants' daily steps, that task self-efficacy is a significant predictor of participants' exercise adherence during the initial stages of participation (intervention phase), and that the participants felt that this intervention was effective. Finally, further exploratory analyses showed that this intervention was effective for all participants, but most valuable for participants most in need of improvement - that is, those who were most sedentary prior to the intervention. This intervention is an inexpensive use of simple and effective tools (e.g. pedometers), has the potential to attract a wide variety of participants and become a pennanent part of any health promotion initiative.

Evaluating the Norfolk physical education program with respect to fitness-level improvement

The grades seven and eight physical education program of the Norfolk Board of Education was evaluated with respect to fitnesslevel improvement, an objective of the Ministry of Education for the province of Ontario. The Canada Fitness Award battery of fitness tests was used to measure fitness levels. It was established that in September the students were unfit, and in May they were fit. This indicated that the Norfolk physical education program was effective, with respect to the criterion used for this research. In addition, it was discovered that fitness-level improvement was significantly related to certain variables: teacher qualifications, teaching experience, school, and participation in extracurricular physical activity. Considering the results of the research, it was recommended that the Norfolk Board of Education hire young, qualified physical education teachers; create the position of Physical Education Consultant; and strive to create equitable resources for physical education instruction, in order that the school to which a student belongs no longer will be a determinant of fitness improvement.

The impact of the Canadian Standardized Test of Fitness and of health counselling on health attitudes and behaviour

The purpose of this research study was to determine whether or not the use of a single day of Personal Wellness Evaluations would be meaningful enough to change the attitudes of participants toward adopting a healthier lifestyle, or if it was necessary to include regular planned health counselling alon-g with the Personal Wellness Evaluations in order to'observe changes in beliefs, attitudes and behaviours toward active living and the adoption of a healthier lifestyle. Attitudes and behaviours toward physical fitness and healthy lifestyle choices were assessed through a questionnaire composed of the following instruments: Fishbein and Ajzen Attitude and Behaviour Questionnaire, Leisure Behaviour Questionnaire, Ten Centimeter Bipolar Health Continuum, Neugarten Life Satisfaction Assessment, Job Description Index, Selected questions from the Ontario Health Survey, and the Symptom Reporting Questionnaire. Physical fitness evaluation consisted of the Canadian Standardized Test of Fitness, measures of blood pressure, and total cholesterol. The participants were divided into three groups: Group 1- CSTF & health counselling, Group 2- CSTF only, and Group 3- a control group. All three groups received the questionnaire both at the beginning and at the end of the study. Group 1 and Group 2 also participated in fitness testing at these same times, with a three-month time interval between test times. Group 1 also received weekly one-hour health education sessions during the three months between fitness testing. While there were some differences found between the three groups in this study, the results of this study suggested that this three-month workplace wellness program had no impact on the participants' attitudes and behaviours toward health and physical activity. There were no significant differences in the physical fitness measures between Group 1 and Group 2 , nor in the participants' questionnaire responses. These results may be due to the participants' lack of compliance to this wellness program. Employees who 11 participate in a workplace weIlness program must be self-motivated to comply with the program in order to receive the full benefits the program has to offer. Some participants in this study did not have the internal motivation necessary to remain in the study for the three-month period. Future research may consider implementing a workplace wellness program for a longer duration as well as incorporating a specific physical fitness program for the participants to follow. An exercise program could improve the participants' physical fitness, while the health counselling would give the individuals the health education necessary to lead a healthy lifestyle.

The role of physical activity and perceived adequacy on cardiorespiratory fitness in children with developmental coordination disorder

Evidence suggests that children with developmental coordination disorder (DCD) have lower levels of cardiorespiratory fitness (CRF) compared to children without the condition. However, these studies were restricted to field-based methods in order to predict V02 peak in the determination of CRF. Such field tests have been criticised for their ability to provide a valid prediction of V02 peak and vulnerability to psychological aspects in children with DCD, such as low perceived adequacy toward physical activity. Moreover, the contribution of physical activity to the variance in V02 peak between the two groups is unknown. The purpose of our study was to determine the mediating role of physical activity and perceived adequacy towards physical activity on V02 peak in children with significant motor impairments. This prospective case-control design involved 122 (age 12-13 years) children with significant motor impairments (n=61) and healthy matched controls (n=61) based on age, gender and school location. Participants had been previously assessed for motor proficiency and classified as a probable DCD (p-DCD) or healthy control using the movement ABC test. V02 peak was measured by a progressive exercise test on a cycle ergometer. Perceived adequacy was measured using a 7 -item subscale from Children's Selfperception of Adequacy and Predilection for Physical Activity scale. Physical activity was monitored for seven days with the Actical® accelerometer. Children with p-DCD had significantly lower V02 peak (48.76±7.2 ml/ffm/min; p:50.05) compared to controls (53.12±8.2 ml/ffm/min), even after correcting for fat free mass. Regression analysis demonstrated that perceived adequacy and physical activity were significant mediators in the relationship between p-DCD and V02 peak. In conclusion, using a stringent laboratory assessment, the results of the current study verify the findings of earlier studies, adding low CRF to the list of health consequences associated with DCD. It seems that when testing for CRF in this population, there is a need to consider the psychological barriers associated with their condition. Moreover, strategies to increase physical activity in children with DCD may result in improvement in their CRF.

Teacher-Student Rapport: Investigating its Impact on the Dropout Rate in Physical and Health Education

This study was an investigation into whether strong teacher-student rapport relates to the drop-out rates of students in grade 9 and 10 health and physical education (HPE). In the study, One hundred and thirty-six grade 9 students from five high schools in Ontario participated in this study. Findings of whether or not rapport related to students’ decision to take an additional HPE credit beyond grade 9 did not prove conclusive. A significant multivariate interaction effect was not found; however, tests of between-subject effects on sex and grade 10 dropouts showed some interesting trends. More research is needed to further illuminate the link between teacher-student rapport and students’ enrollment in optional HPE classes.

The exercise leader's gender and physique salience : effects on self-presentational concerns in an exercise context

Self-presentation is the process by which individuals attempt to monitor and control how others perceive and evaluate them (Leary, 1992; Leary & Kowalski, 1990). Self-presentational concerns have been shown to influence a number of exercise-related behaviours, cognitions, and affective responses to exercise (e.g., social anxiety). Social anxiety occurs when an individual wants to create a specific impression on others, but is unsure (s)he will be successful (Leary & Kowalski, 1995). Social physique anxiety (SPA) is a specific form of social anxiety related the evaluation of one's body (Hart, Leary, & Rejeski, 1989). Both social anxiety and SPA may act as deterrents to exercise (Lantz, Hardy, & Ainsworth, 1997; Leary, 1992), so it is important to examine factors that may influence social anxiety and SPA; one such factor is self-presentational efficacy (SPE). SPE is one's confidence in successfully making desired impressions on others (Leary & Atherton, 1986) and has been associated with social anxiety and SPA (Leary & Kowalski, 1995; Gammage, Martin Ginis, & Hall, 2004). Several aspects of the exercise environment, such as the presence of mirrors, clothing, and the exercise leader or other participant characteristics, may be manipulated to influence self-presentational concerns (e.g., Gammage, Martin Ginis et aI., 2004; Martin & Fox, 2001; Martin Ginis, Prapavessis, & Haase, 2005). Given that the exercise leader has been recognized as one of the most important influences in the group exercise context (Franklin, 1988), it is important to further examine how the leader may impact self-presentational concerns. The present study examined the impact of the exercise leader's gender and physique salience (i.e., the extent to which the body was emphasized) on SPE, state social anxiety (SSA), and state social physique anxiety (SPA-S) of women in a live exercise class. Eighty-seven college-aged female non- or infrequent exercisers (i.e., exercised 2 or fewer times per week) participated in a group exercise class led by one of four leaders: a female whose physique was salient; a female whose physique was non-salient; a male whose physique was salient; or a male whose physique was non-salient. Participants completed measures of SPE, SSA, and SPA-S prior to and following completion of a 30- minute group exercise class. In addition, a measure of social comparison to the exercise leader and other participants with respect to attractiveness, skill, and fitness was completed by participants following the exercise class. A MANOV A was conducted to examine differences between groups on postexercise variables. Results indicated that there were no significant differences between groups on measures ofSPE, SSA, or SPA-S (allp's > .05). However, when all participants were collapsed into one group, a MANOV A showed a significant time effect (F(3, 81) = 19.45,p < .05, 1')2= .419). Follow-up ANOVAs indicated that post-exercise SPE increased significantly, while SSA and SPA-S decreased significantly (SPE: F(I, 83) = 30.87,p < .001,1')2 = .27; SSA: F(I,83) = 11.09,p < .001, 1')2 = .12; SPA-S: F (1,83) = 42.79,p < .001, 1')2 = .34). Further, results of a MANOVA revealed that participants who believed they were less fit than other group members (i.e., made negative social comparisons) reported significantly more post-exercise SSA and SP A-S than those who believed they were more fit than the other participants (i.e., made positive comparisons; SSA: F(2, 84) = 3.46, p < .05, 1')2 = .08; SPA-S: F(2, 84) = 5.69, p < .05, 1')2 = .12). These results may indicate that successfully completing an exercise class may serve as a source of SPE and lead to reduced social anxiety and SPA-S in this population. Alternatively, characteristics of the exercise leader may be less important than characteristics of the other participants. These results also suggest that the types of social comparisons made may influence self-presentational concerns in this sample. Future research should examine how the type of social comparison (i.e., negative or positive) made to the other group members may either generate or reduce anxiety. Also, factors that contribute to the types of social comparisons made with other exercisers should be examined. Implications for practice and research are discussed.

What children value : a scale to guide health promotion programs

Objective. Physical activity is important for the health of all human beings. Although it is important to develop good health promotion programs for children to increase participation in physical activity, to date there appear to be no programs based on what kids value beyond health and physical activity itself. This study proposed to create a scale with strong content and face validity that could uncover what any given population of children value in life regardless of their participation in physical activity and that experts feel could be related to physical activity. These findings will allow the development of targeted health promotion programs to increase children's participation in regular physical activity. Method In this study, a combination of qualitative and quantitative approaches was used. Data were gathered from seven experts in the field, sixty-seven children in grades three to five, five parents, and three teachers. From these data response groupings were created and sent to four experts to be given single word names. The resulting nine theme names were re-worked into "child-friendly" language. Four children were then asked to discuss theme names to see if they liked and understood them. The next step involved asking children and experts to rank order the nine themes, the children in general and the experts in terms of relevance to physical activity. From these results, possible versions of the scale were then created using the combined expert/children rankings. Each version was examined for content validity. Two versions of a scale resulted. These were sent to experts, parents, teachers and children in order to determine which one they liked better and to suggest any foreseeable problems. Once this information was collected, a beta (final prototype) version of the scale was created. Results. Nine common theme names were created from the response groupings. All four children agreed that they did understand and like each of the nine theme names. Experts and teachers agreed that full coverage of the content had been achieved. Children suggested a single wording change from "Being Accepted" to "Being Included". Five themes were selected for inclusion. The beta version of the scale included 12 forced choice statements, the first ten comparing all themes against one another followed by two anchor statements. Conclusion. At the outset it was recognized that it is essential to know what children think is important in their lives in order to serve as potential benefits in the development of effective physical activity promotion programs. This study developed a scale which could be used to determine what a population of children feel is important in order to focus health promotion programs for physical activity. The scale has strong face and content validity.