Development and evaluation of the America On the Move program for university students

2013 Fall.Includes bibliographical references.To view the abstract, please see the full text of the document

The significance of outdoor recreationists' digital technology engagement in peri-urban settings : A thesis submitted in partial fulfilment of the requirements for the Degree of Doctor of Philosophy at Lincoln University

Outdoor recreation is reported to facilitate a range of benefits including increased physical, social, mental and spiritual well-being by giving individuals an opportunity to disconnect from their day-to-day lives (Driver, 1998b; Manning, 2011). These benefits are realised through activities in specific settings within individual experiences (Driver & Brown, 1978; Manning, 2011; McCool, 2006). A digital technology revolution is reshaping outdoor recreation participation and experience, potentially undermining principal values of nature-based recreation engagements. While the impact of digital technology on the outdoor recreation experience has been researched in remote recreation settings (Amerson et al., 2020; Ewert & Shultis, 1999; Lindell, 2014; Martin, 2016; Pohl, 2006; Shultis, 2001, 2012, 2015), little is known about how outdoor recreationists use digital technology in peri-urban settings. Growing urbanisation has increased demand for, and value of access to outdoor spaces located on the urban fringe. These accessible outdoor recreation spaces, referred to as peri-urban, are the interaction zones where urban and rural activities are juxtaposed, and form an increasingly important component of urban recreational systems (Pigram & Jenkins, 2006). Using a mixed-methods approach, this study examined the significance of digital technology from outdoor recreation users’ perspectives in the context of a peri-urban setting. Quantitative survey data was collected on the use of digital technology by outdoor recreationists (N = 520), evaluating engagement with digital technology and the implications of this engagement. Additionally, qualitative interviews (N = 40) with recreationists, recreation managers, and members of outdoor recreation groups were completed focusing on the digital technology experience and perspectives on the role of digital technology in outdoor recreation. The research was undertaken in the peri-urban recreation area of the Port Hills (Te Poho-o-Tamatea) in Christchurch, New Zealand, known for its importance as a place of recreation and natural resources. This research found that the majority of recreationists carried at least one digital device, the most common of which was the smartphone. During the outdoor recreation experience, digital devices were primarily used for self-logging and quantification, to listen to music, and to communicate and stay connected for safety, for social reasons, or to access information. Findings led to the development of a typology of digital technology engagement in the peri-urban setting. The typology revealed that for a minority of recreationists digital technology was absent from the activity, and that for the majority of recreationists technology acted as a form of reassurance, support, or dependency in the experience. Through drawing on conceptual ideas included in the recreation demand hierarchy framework, and in the literature on technology usage in urban and in outdoor recreation settings, these findings expand our understandings of how and why recreationists engage with technology. Of particular importance is the interconnectivity of the variables such as activity, setting, and outdoor recreationists’ personal preferences and experiences. The varied experiences suggested tensions between our increasingly technologised existence (Lindell, 2014; Shultis, 2001, 2016) and traditional reasons for recreating outdoors, which played out through the range of responses in this study

ENDORSE: Environmental Determinants of Overweight in Rotterdam Schoolchildren

Over the past decades the numbers of children and adults being overweight or obese have increased so rapidly, that overweight and obesity are among the most important and challenging public health problems. It is therefore important to prevent overweight in all age groups. Children and adolescents may however be especially important groups to target. Obesity at young age is associated with a higher likelihood of the development of chronic diseases at an early age or later in life. Furthermore, overweight or obese children and adolescents are more likely to become overweight or obese adults. To be able to develop theory and evidence-based interventions aimed at the prevention of excess weight gain, it is essential to identify which specific energy intake and energy expenditure behaviors contribute most to excess weight gain, and which determinants are associated with engagement in such behaviors. This thesis reports on a number of studies on the identification of individual and environmental correlates of behaviors related to the energy balance (i.e. energy intake and expenditure behaviors). These studies were part of the ENDORSE project (ENvironmental Determinants of Obesity in Rotterdam SchoolchildrEn) which was initiated to contribute to systematic, evidence based research on individual and environmental determinants of overweight and obesity

Public health approaches to measurement, surveillance and the promotion of walking among Australian adults

The aim of this thesis is to demonstrate the importance of walking to public health. The first part is characterized by epidemiological research. First, a typology for the measurement of walking is developed. A systematic review is conducted of observational studies to determine the health benefits of walking in its own right. Studies consistently confirm that 30 minutes walking on most days of the week is sufficient to reduce the risk of cardiovascular diseases and non-communicable disease risk. Then, a series of epidemiological analyses describes the prevalence and correlates of walking, using multiple health and non-health surveillance data sets. Surveillance data indicate that the prevalence of walking at the above recommended levels is low across all domains. Between 1991 and 2001 an increase in walking occurred, and was the main contributor to reductions in leisure time physical inactivity; however, the proportion of the population who achieved the recommended amount of physical activity by walking did not change in leisure and transport domains. The next part of the thesis is characterized by health promotion research examining the impact of three population-based approaches to increasing walking among Australian adults. The first was an evaluation of a conversion of rail to trail, as an environmental change intervention; the second was a mass media campaign promoting walking to work, and the third was a targeted print media walking program. Providing environmental supports with minimal promotion had no effect on walking. A nation-wide mass media campaign promoting walking to work increased walking and other moderate intensity physical activity, but process evaluation indicated other promotional efforts contributed as well. The targeted print media randomised trial had the greatest effect on walking, but the increases were not greater than spontaneous change in the control. Increases in total physical activity were achieved only when the intervention was supplemented by the use of a pedometer. The expectation that broader approaches to the promotion of walking will bring about changes at the population level, were not corroborated by these case studies. There is a need for enhancement of walking-specific interventions to influence total PA at the population levels

Assessment of Physical Activity in Adults with Progressive Muscle Disease

Introduction: Insufficient physical activity is a major threat to global health. Physical activity benefits peoples’ physical and mental health. The general population, including people living with disabilities and muscle wasting conditions, are recommended to avoid excessive sedentary time and engage in daily activity. Adults with progressive muscle disease experience barriers to physical activity participation, including muscle weakness, fatigue, physical deconditioning, impairment, activity limitations and participation restrictions (including societal and environmental factors), and fear of symptom exacerbation. More research is required to understand the inter-relationship between health and physical activity for adults with progressive muscle disease, particularly non-ambulant people who are under-represented in the existing research literature. Accurate measurement of FITT (frequency, intensity, time, and type of physical activity) is vital for high-quality physical activity assessment. The aim of this thesis was to assess the physical activity of ambulant and non-ambulant adults with progressive muscle disease.Systematic review findings identified various measures used to assess physical activity in adults with muscular dystrophy, including accelerometers, direct observation, heart rate monitors, calorimetry, positioning systems, activity diaries, single scales, interviews and questionnaires. None of the measures identified in the systematic review had well established measurement properties for adults with muscular dystrophy.Patient and public involvement interviews highlighted the importance of inclusive, remote, and technology-facilitated research design, the potential intrusion of direct observations of physical activity, the familiarity of questionnaires for data collection, and practical considerations to ensure wearing an activity monitor was not too burdensome.A feasibility study using multiple methods in 20 ambulant and non-ambulant adults with progressive muscle disease revealed satisfactory acceptability, interpretability, and usability of Fitbit and activity questionnaires, in both paper and electronic formats. During supervised activity tasks, Fitbit was found to have satisfactory criterion validity, reliability, and responsiveness and measurement properties were strengthened using multisensory measurement.An observational, longitudinal study that included 111 ambulant and non-ambulant adults with progressive muscle disease showed that:Activity monitoring had satisfactory validity, reliability and responsiveness using Fitbit, but there was considerable measurement error between Fitbit and the research grade GENEActiv accelerometer. Fitbit thresholds and multiple metrics (including accelerometer and heart rate data extrapolations of FITT) were appropriate for physical activity assessment in ambulant and non-ambulant adults with progressive muscle disease.Activity self-report had unsatisfactory concurrent validity, test-retest reliability, and responsiveness with substantial activity overestimation using the modified International Physical Activity Questionnaire. However, self-report properties were improved when used concurrently with Fitbit.Observed physical activity in adults with progressive muscle disease was generally low with excessive daily sedentary time. Activity frequencies, intensities and durations were lower, and activity types were more domestic, for wheelchair users and during the COVID-19 lockdown. Lower physical activity was significantly associated with greater functional impairment, less cardiorespiratory fitness, worse metabolic health, and lower quality of life. Activity optimisation thresholds and minimal clinically important differences were established.Discussion: The implications of this thesis include guidance for selection of appropriate physical activity measures by clinicians and researchers working with adults with progressive muscle disease. Fitbit is suitable in clinical practice and research for interactive, weekly remote activity monitoring or to support activity self-management and may represent an appropriate compromise between potential underestimation by accelerometry alone, and overestimation by self-report alone. A draft conceptual framework for physical activity measurement was also proposed. It includes frequency, intensity, time, and type of physical activity, and incorporates wider aspects of the physical activity construct, including somatic factors (relating to progressive muscle disease and underlying fitness) and contextual factors (relating to personal, social, and environmental situations). Future research will build on the knowledge gained in this thesis, furthering understanding of the inter-relationships between physical activity, health and wider contexts. Implementation will include testing a remote physical activity optimisation intervention that is inclusive of ambulant and non-ambulant participants, featuring Fitbit self-monitoring with a focus on optimisation of daily activity frequency and regularly interrupting sedentary time.</div

Measuring physical activity in obese populations using accelerometry

The thesis is concerned with objectively measuring human physical activity through accelerometry, and compares the effectiveness of algorithms between obese and non-obese groups. The thesis comprises three studies:Classification of Aerobic and Gym-based Exercises from Accelerometer Output. This study investigated whether accurate classification could be achieved from hip- or ankle-mounted accelerometers for a programme of aerobic exercises and free-living activities. It also examined whether accuracy was affected by obesity, and whether a single classifier could be applied across BMI groups. The study achieved high classification accuracies (85% for hip and 94% for ankle) for both obese and normal BMI groups using the same approach across groups.Walking Speed Estimation Using Accelerometry. This study aimed to develop a speed estimation model that was applicable across BMI groups, and which utilised a hip-mounted accelerometer. To achieve this, multiple accelerometer signal features were evaluated for use in a linear speed estimation model, and performance was compared between obese and normal BMI groups. The speed estimation algorithm achieved overall RMSE of 0.08ms-1for a mixed BMI group, which is comparable with previous research using homogeneous groups.Prediction of Energy Expenditure from Accelerometer Output. This study aimed to identify physiological and anthropometric parameters for use in an improved energy expenditure estimation model. Model performance was tested on a mixed BMI group. The energy expenditure prediction model incorporating subject attributes showed around 20% improvement over the standard model. This research found that current approaches to activity classification using accelerometry are equally applicable to obese groups and normal BMI groups. Walking speed prediction was shown to be possible from a hip-mounted accelerometer for both obese and normal BMI groups. Energy expenditure estimation is improved by including subject-specific parameters in the prediction model. Accelerometry is, therefore, a suitable tool for measuring different aspects of physical activity for obese and mixed BMI groups

A grounded theory of the balancing act South Asian mothers engage in to negotiate a healthy family lifestyle

Introduction Overall the evidence is consistent and robust that UK South Asian communities are at elevated risk of lifestyle related disease. A potential worsening of obesity related risk in South Asian children carries implications for persisting disparities in chronic disease across generations making it advantageous to target this specific group for obesity prevention. Psychosocial factors are particularly important in obesity and key to understanding the determinants of dietary and physical activity behaviour, and factors that might influence behaviour modification in South Asians. The study aims to identify beliefs and perceptions that contribute to health risk and health protective behaviours in young UK South Asian families and to develop a theory which can be used to define specific objectives that lead to effective behaviour change to improve health outcomes for this population. Design Grounded theory methodology was applied to investigate how factors influence South Asian mother’s decisions to engage in health behaviours for themselves and their children taking into account specific beliefs and practices influencing health behaviours. Semi-structured interviews were carried out with seven female participants who were mothers to young children aged 5-12 years of age. Results The grounded theory is underpinned by three categories that emerged out of analysis of the data; cultural identity, health beliefs and barriers. These categories and their properties, tell the story of the influences and pressures on South Asian mothers as they attempt to negotiate a healthy family lifestyle. The data emerged to form a grounded theory of the balancing act South Asian mothers engage in to negotiate a healthy family lifestyle. Conclusions This study contributes to an improved understanding of the unique factors influencing young South Asian family’s health behaviours and recognition of the need to help them to find a healthier lifestyle balance. In addition, it has revealed how these factors relate to the initiation and maintenance of a healthy lifestyle and will be of use to health professionals and service providers when designing interventions to address and prevent health inequalities among this group. Emphasising the need to involve both the family and their community in interventions, in order for them to be effective. Limitations of these findings and their implications for future research and practice are considered