Suchergebnisse

OBJECTIVES: Public policies impact the amount of physical activity (PA) that children receive at school. These policies are of interest because overweight and obesity among Canadian children have grown at significant rates, and increasing PA among children is one way to reverse this trend. This research investigates the public policy processes that have resulted in Alberta's education system adopting in-school daily physical activity (DPA) and not supporting walk-to-school (WTS) initiatives. METHODS: Using the policy process described by Kingdon and others as a conceptual framework, this research reviews literature and documents on public policy relating to PA in schools and interviews key individuals (N=20) to identify the policy-related facilitators and barriers in Alberta, Canada to increasing PA in school-aged children. RESULTS: DPA was mandated because Kingdon's three policy streams (problem, solution and politics) became joined or linked. DPA was the most viable solution because literature supports and teachers believe in the educational benefits of PA. As well, a physician with personal beliefs about the benefits of PA became the minister of education and coupled the solution with the political stream through his ministerial power. Reasons that WTS programs have not become school or health policy include advocacy led by politically weak organizations, lack of a supportive policy entrepreneur and poor saliency among educators. CONCLUSIONS: This research illuminates the inner workings of the policy process shaping PA in schools, identifying the unseen forces of the policy process that move issues forward. The findings provide valuable insight for building other healthy public policies.

Purpose. The purpose of this study was to evaluate a 12-week workplace e-mail intervention designed to promote physical activity and nutrition behavior. Design. A pre- and post-test design was conducted to compare the effects of e-mail messages between intervention and control groups. Setting. Five large workplaces in Alberta, Canada. Subjects. Employees with access to a personal e-mail address (N = 2121) were randomly assigned to an intervention (n = 1566) or a control group (n = 555). Intervention. Physical activity and nutrition messages were based on social-cognitive theories. The intervention group received one physical activity and one parallel nutrition message per week for 12 weeks. The control group received no weekly messages. Measures. Each participant completed self-report measures of physical activity and nutrition related to knowledge, attitudes, and behaviors 1 week before (time 1) and 1 week after (time 2) the intervention. Results. The intervention group was more efficacious at time 2 on measures of self-efficacy, pros, cons, intentions, and behavior related to physical activity. This group also reported more favorable changes in practicing healthy eating, balancing food intake with activity level, cooking meals with techniques to reduce fat, and avoiding eating high-fat foods. Effect sizes for all significant differences were small. Conclusion. E-mail is a promising mode of delivery for promoting physical activity and nutrition in the workplace. Further theoretically driven studies are needed.

Purpose. To evaluate the effects of a 12-week e-mail intervention promoting physical activity and nutrition, and to describe participant use and satisfaction feedback. Design. A longitudinal, randomized trial. Setting. Five large workplaces in Alberta, Canada. Participants. One thousand forty-three participants completed all three assessments, and 1263 participants in the experimental group provided use and satisfaction feedback after receiving the 12-week intervention. Intervention. Paired physical activity and nutrition messages were e-mailed weekly to the experimental group. The control group received all messages in bulk (i.e., within a single e-mail message) at the conclusion of the intervention. Measures. Self-report measures of knowledge, cognitions, and behaviors related to physical activity and nutrition were used. Satisfaction with e-mail messages was assessed at Time 2. Analysis. Planned contrasts compared the experimental group measures at Time 3 with those reported at Time 2 and with control group measures reported at Time 3. Control group measures at Time 3 were also compared with control group measures at Time 2. Results. The small intervention effects previously reported between Time 1 and Time 2 were maintained at Time 3. Providing the e-mail messages in bulk also had a significant positive effect on many of the physical activity and nutrition variables. Conclusions. E-mail offers a promising medium for promoting health-enhancing knowledge, attitudes, and behaviors. Additional research is needed to determine optimal message dose and content.

OBJECTIVES: The primary objective of this study was to examine whether physical activity, diet, and smoking behaviours are associated with health resource utilization and costs in the Canadian context. A secondary objective was to evaluate demographic and health behavioural characteristics of the participants of the study to assess the degree of respondent bias. METHODS: Self-reported physical activity, diet and smoking status were obtained from a large population-based sample of adults with diabetes (N=2311). Resource utilization and cost information was obtained by linking these data to the provincial government's administrative database. Multiple regression models examined predictors of resource utilization and costs for individuals with type 1 (T1D) and type 2 (T2D) diabetes separately. To assess the degree of responder bias, characteristics of individuals who consented to link data were compared with those who did not consent. RESULTS: Various measures of health care utilization and costs were negatively associated with physical activity behaviour in both T1D and T2D groups. Ever having smoked cigarettes was associated with higher resource utilization in individuals with T2D when controlling for demographic and health variables. Significant differences in demographic and health behavioural characteristics of the participants who provided consent for data linkage and those who did not were also found. CONCLUSION: These findings are of interest considering that PA is a critical but understudied component of individuals with diabetes, and this appears to be one of the first studies to directly examine the relationship between health-related behaviours and health care utilization and costs. The findings may be useful in guiding targeted health promotion programs for individuals with diabetes. The results also indicate that studies involving linkage of administrative and survey data could be over-represented by healthy individuals.

Purpose. Determine the proportion of adults aware of Canada's Physical Activity Guide to Healthy Active Living (Guide) and its specific recommendations (objective 1); whether key demographic factors (objective 2a) and physical activity behavior (objective 2b) are associated with awareness and specific familiarity with the Guide; and if changes in awareness and specific recommendations with the Guide occurred over a 1-year period (objective 3a and 3b). Design. Random selection with computer-assisted telephone interviewing. Setting. Edmonton, Alberta, Canada. Subjects. A total of 2803 adults 18 years or older completed interviews from 4831 telephone contacts (response rate, 58.0%), and after 1 year, 1423 individuals (55%) completed interviews. Measures. Demographic, physical activity, Guide awareness. Analysis. Chi-square, analysis of variance. Results. At baseline, 27.3% were aware of the Guide, and 15.6% were familiar with the Guide's specific recommendations. Younger individuals (p = .01), women (p < .001), and those with a higher education (p < .001) were more likely to be generally aware of the Guide, and women were also more specifically aware (p = .01). Physical activity levels were positively associated with the general (p < .001) and specific (p < .001) awareness of the Guide. Changes in general familiarity and specific recommendations over 1 year were observed. Conclusions. The majority of those surveyed were not familiar with the Guide. Men, individuals with a lower education, and older individuals may need to be specifically targeted. (Am J Health Promot 2011;25[5]:294-297.)

BACKGROUND: Canadian political discourse supports the importance of health promotion and advocates the allocation of health resources to health promotion. Furthermore, the current literature frequently identifies financial and human resources as important elements of organizational capacity for health promotion. In the Alberta Heart Health Project (AHHP), we sought to learn if the allocation of health resources in a regionalized health system was congruent with the espoused support for health promotion in Alberta, Canada. METHODS: The AHHP used a mixed method approach in a time series design. Participants were drawn from multiple organizational levels (i.e., service providers, managers, board members) across all Regional Health Authorities (RHAs). Data were triangulated through multiple collection methods, primarily an organizational capacity survey, analysis of organizational documents, focus groups, and personal interviews. Analysis techniques were drawn from quantitative (i.e., frequency distributions, ANOVAs) and qualitative (i.e., content and thematic analysis) approaches. RESULTS: In most cases, small amounts (<5%) of financial resources were allocated to health promotion in RHAs' core budgets. Respondents reported seeking multiple sources of public health financing to support their health promotion initiatives. Human resources for health promotion were characterized by fragmented responsibilities and short-term work. Furthermore, valuable human resources were consumed in ongoing searches for funding that typically covered short time periods. CONCLUSIONS: Resource allocations to health promotion in Alberta RHAs are inconsistent with the current emphasis on health promotion as an organizational priority. Inadequate and unstable funding erodes the RHAs' capacity for health promotion. Sustainable health promotion calls for the assured allocation of adequate, sustainable financial resources.

Purpose. To compare the effects of stage-matched and standard print materials for physical activity (PA) change. Design. Participants were randomized into (1) a stage-matched intervention group (n = 165), (2) a standard intervention group (n = 176), or (3) a no-contact control group (n = 166). The stage-matched and standard intervention groups both received materials at baseline, 3 months, and 6 months. Assessments of all three groups were conducted at baseline, 6, and 12 months. Setting. Canadian worksites. Subjects. Employees (N = 507). Interventions. Five motivationally targeted booklets were developed for the stage-matched group. The standard group received Canada's Physical Activity Guide and handbook. Measures. The main dependent variable was PA, expressed as metabolic equivalent (MET) minutes and measured using the Godin Leisure-Time Exercise Questionnaire. Demographic characteristics and stages of change for PA were also assessed. Results. At 12 months mean weekly MET minutes for combined moderate and vigorous activity increased from baseline by 223, 67, and 78 for the stage-matched, standard, and control groups, respectively; however, differences were not significant (p > .05). Women in the stage-matched group over the 12-month period significantly increased their activity by 327 weekly MET minutes whereas the standard and control groups declined their activity (F = 3.01, p < .05). Conclusion. PA stage-matched materials delivered in the workplace are efficacious for women but not men. Future interventions should explore the use of these intervention materials in conjunction with multilevel strategies, and particular attention should be paid to possible gender differences.

Purpose: To explore whether there was a difference in objectively measured physical activity and study participation between people who received their preferred study group allocation (matched) and those who did not receive their preferred study group (mismatched). Design: Secondary data from the NewCOACH randomized controlled trial. Setting: Insufficiently active patients in the primary care settings in Sydney and Newcastle, Australia. Participants: One hundred seventy-two adults aged 20 to 81 years. Intervention: Participants indicated their intervention preference at baseline for (1) five face-to-face visits with an exercise specialist, (2) one face-to-face visit and 4 telephone follow-ups with an exercise specialist, (3) written material, or (4) slight-to-no preference. Participants were then allocated to an intervention group and categorized as either "matched" or "mismatched" based on their indications. Participants who reported a slight-to-no preference was categorized as "matched." Measures: Daily step count as measured by pedometers and study participation. Analysis: Mean differences between groups in daily step count at 3 and 12 months (multiple linear regression models) and study participation at baseline, 3 months, and 12 months (χ2 tests). Results: Preference for an intervention group prior to randomization did not significantly (all P's > .05 using 95% confidence interval) impact step counts (differences of <600 steps/day between groups) or study participation. Conclusion: Future research should continue to address whether the strength of preferences influence study outcome and participation and whether the study preferences change over time.

Introduction: Physical inactivity has been described as a global pandemic. Interventions aimed at developing skills in lifelong physical activities may provide the foundation for an active lifestyle into adulthood. In general, school-based physical activity interventions targeting adolescents have produced modest results and few have been designed to be 'scaled-up' and disseminated. This study aims to: (1) assess the effectiveness of two physical activity promotion programmes (ie, NEAT and ATLAS) that have been modified for scalability; and (2) evaluate the dissemination of these programmes throughout government funded secondary schools. Methods and analysis: The study will be conducted in two phases. In the first phase (cluster randomised controlled trial), 16 schools will be randomly allocated to the intervention or a usual care control condition. In the second phase, the Reach, Effectiveness, Adoption, Implementation and Maintenance (Re-AIM) framework will be used to guide the design and evaluation of programme dissemination throughout New South Wales (NSW), Australia. In both phases, teachers will be trained to deliver the NEAT and ATLAS programmes, which will include: (1) interactive student seminars; (2) structured physical activity programmes; (3) lunchtime fitness sessions; and (4) web-based smartphone apps. In the cluster RCT, study outcomes will be assessed at baseline, 6 months ( primary end point) and 12-months. Muscular fitness will be the primary outcome and secondary outcomes will include: objectively measured body composition, cardiorespiratory fitness, flexibility, resistance training skill competency, physical activity, self-reported recreational screen-time, sleep, sugar-sweetened beverage and junk food snack consumption, self-esteem and well-being. Ethics and dissemination: This study has received approval from the University of Newcastle (H-2014- 0312) and the NSW Department of Education (SERAP: 2012121) human research ethics committees.

IMPORTANCE: Cardiorespiratory fitness is an important marker of childhood health and low fitness levels are a risk factor for disease later in life. Levels of children's fitness have declined in recent decades. Whether school-based physical activity interventions can increase fitness at the population level remains unclear. OBJECTIVE: To evaluate the effect of an internet-based intervention on children's cardiorespiratory fitness across a large number of schools. DESIGN, SETTING, AND PARTICIPANTS: In this cluster randomized clinical trial, 22 government-funded elementary schools (from 137 providing consent) including 1188 students stratified from grades 3 and 4 in New South Wales, Australia, were randomized. The other schools received the intervention but were not included in the analysis. Eleven schools received the internet-based intervention and 11 received the control intervention. Recruitment and baseline testing began in 2016 and ended in 2017. Research assistants, blinded to treatment allocation, completed follow-up outcome assessments at 12 and 24 months. Data were analyzed from July to August 2020. INTERVENTIONS: The internet-based intervention included standardized online learning for teachers and minimal in-person support from a project mentor (9-10 months). MAIN OUTCOMES AND MEASURES: Multistage 20-m shuttle run test for cardiorespiratory fitness. RESULTS: Of 1219 participants (49% girls; mean [SD] age, 8.85 [0.71] years) from 22 schools, 1188 students provided baseline primary outcome data. At 12 months, the number of 20-m shuttle runs increased by 3.32 laps (95% CI, 2.44-4.20 laps) in the intervention schools and 2.11 laps (95% CI, 1.38-2.85 laps) in the control schools (adjusted difference = 1.20 laps; 95% CI, 0.17-2.24 laps). By 24 months, the adjusted difference was 2.22 laps (95% CI, 0.89-3.55 laps). The cost per student was AUD33 (USD26). CONCLUSIONS AND RELEVANCE: In this study, a school-based intervention improved children's cardiorespiratory fitness when delivered in a large number of ...