1
Q
What are the top 5 chronic diseases?
A
- Heart disease
- Cancer
- Cerebrovascular disease
- Respiratory disease
- Diabetes
2
Q
What is the Frieden pyramid?
A
- Lists 5 factors influencing public health from strongest contribution to fewer
1. Socioeconomic factors (increasing population impact)
2. Changing the context to make individual’s default decisions health
3. Long-lasting protective interventions
4. Clinical interventions
5. Counseling and education (increasing individual effort needed)
3
Q
What are the various levels of prophylaxis?
A
Primary prevention ⟶ intercept the onset of disease
Secondary prevention ⟶ minimize consequences of disease through early detection and intervention
Tertiary prevention ⟶ mitigating the consequences of disease or an injury after late diagnosis
4
Q
What is the definition of health promotion?
A
Process of understanding individual, environmental, and policy factors that influence health behaviour
5
Q
What is the definition of PA?
A
Any bodily movement produced by contraction of skeletal muscles that increases energy expenditure above a basal level (eg. standing)
6
Q
What are the classifications of PA depending on type of activity?
A
- Household (eg. sweeping the floor, vacuuming)
- Occupational (eg. lifting, carpentry, moving boxes, shoveling)
- Transportation (eg. commuting from place A to place B)
- Leisure-time (eg. exercise, sports, recreational activities)
- Exercise: a type of leisure-time PA that is structured and planned; done specifically to enhance fitness
7
Q
What are the classifications of PA depending on intensity?
A
- Light (eg. slow walk, stretching)
- Moderate (eg. fast walk)
- Vigorous (eg. stationary bike)
8
Q
What is the definition of intensity and the unit used to measure it?
A
- The amount of effort you put in to doing a physical activity
- Use Metabolic Equivalent Level (METs)
9
Q
What is a MET?
A
- Unit is used to estimate amount of oxygen used/consumed by body during PA
- 1 MET = energy (oxygen) used by body as you sit quietly = 3.5 mL oxygen consumption/kg/min = 1 kcal/kg/hr
10
Q
How do you classify intensity levels using MET values?
A
- Light intensity = <3 METs
- Moderate intensity =3-6 METs
- Vigorous intensity = >6 METs
11
Q
What is a calorie? How many calories does a 70 kg person walking at 4 MET level burn per hour?
A
- Measure of energy from food (3500 kcal of food energy = 1 lb of body weight) or amount of energy expended during PA
- 280 kcal per hour (ie. 70 kg x 4.0 METs)
12
Q
How do you calculate the functional capacity of someone using their maximal oxygen uptake?
A
- Remember 1 MET = 3.5 mL oxygen consumption/kg/min
- If someone has maximal oxygen uptake of 35 ml/kg/min, they would have a functional capacity of 10 METs
- Activities involving 10 METs would be this person’s maximum, but not recommended
13
Q
What is the definition of sedentary behaviour?
A
Any waking behaviour with <1.5 MET value in a sitting or reclining position
14
Q
Can sedentary behaviour coexist with high PA? Discuss.
A
- Sedentary behaviour can coexist with high PA (ie. you like to sit a lot but you have bouts of high PA)
- Sitting has negative implications even with PA (all-cause mortality, CVD mortality, CVD itself, type 2 diabetes, cancer)
15
Q
What types of PA are beneficial?
A
- Some PA is better than none; benefits increase as amount of PA increases (intensity, duration, or frequency)
- Substantial health benefits for adults with 140-300 minutes a week of MPA
- Both aerobic and muscle-strengthening PA are beneficial
- Even LPA; best if in bouts of at least 10 minutes rather than sporadic
16
Q
What are the benefits of PA?
A
- Lowers risk of all-cause mortality, CVD, type 2 diabetes, cancers, obesity
- Improves cognition, quality of life, sleep, physical function
- LPA is inversely associated with mortality and can benefit insulin, fat mass, and WC
17
Q
Why is it important to measure PA?
A
- Specify which aspects of PA (eg. cardio) are effective for particular health outcomes
- Determine prevalence of PA in population
- Monitor changes in PA over time
- Monitor effectiveness of interventions!
18
Q
What are important things to consider when evaluating measures of PA?
A
- Validity
- Whether the measure actually assesses the construct you’re trying to measure
- Eg. pedometer may count brushing hair as actual steps - Reliability
- Consistency and stability of your measurements/results - Sensitivity to change
- Being non-reactive
- If you’re trying to see if intervention works, you don’t want the PA to be due to the act of wearing the measure - Being acceptable to respondent
- Acceptable cost of administration
19
Q
What do pedometers measure?
A
Number of steps taken with horizontal, spring-suspended lever arm that is deflected when a subject’s hip accelerates vertically with a force beyond a chosen threshold
20
Q
What are the benefits of pedometers?
A
- Best for documenting relative changes in PA or ranking individuals
- Motivates you to exercise
- Non-invasive, simple, low cost
- Can pick up short durations of PA
- Yield accurate data for running and walking (vertical motion)
21
Q
What are the cons of pedometers?
A
- May be inaccurate for activities
- Can’t pick up all types of movements (horizontal motion)
- People may get obsessive
- Will not capture intensity
- Less data storage capacity than accelerometers
- Can induce reactivity
- Varying sensitivity between brands
22
Q
What do accelerometers measure?
A
- Measures acceleration (how quick body changes speed)
- Single-axis ⟶ measure vertically
- Triaxial ⟶ measure anterior-posterior (forward/backward) + medial-lateral (side/side)
23
Q
What is the unit used for accelerometers? What is the significance of the unit?
A
- Unit = “counts”
- Translated into a metric of interest that can be biological (eg. energy expenditure) or PA patterns (Eg. stationary)
- The higher the number of counts, the greater the intensity of activity
24
Q
What are the benefits of accelerometers?
A
- Accurate
- Able to capture large amounts of data
- Easy
- Good for young children
- High validity
25
What are the cons of accelerometers?
- Expensive
- Require technical expertise
- Can induce reactivity
- Does not provide contextual information
- Cannot differentiate body position (eg. sitting, lying, standing)
26
What are the direct outputs from accelerometers?
1. Volume Indicators
- Steps/day (accumulated or only for a specific time of day)
- Total activity counts/day
2. Rate Indicators
- Cadence (steps/min)
• Relates to intensity
• Time-stamping capability tells you the time of day you did the activity
- Activity counts/min
• Not meaningful without a reference frame
• Can be converted by researchers to classify exercise as light, moderate, or vigorous
27
What are the derived outputs from accelerometers?
Generated by later processing.
1. Peak Effort Indicators
- Peak cadence (rate) ⟶ sum up your most active steps/min
2. Time Indicators
- Time-stamped step accumulation patterns ⟶ analyzing the steps taken for each minute over a period of time (eg. for a 30 minute walk, seeing for each minute, which category you fit in)
• You can see how many minutes you are walking in a each category of idensity (sedentary, low PA, LPA, MPA, VPA) rather than looking at steps you are taking per day or your most active steps/minute
- Time-stamped activity count accumulation patterns
3. Event Counts
- Looks at breaks/transitions in sedentary time
28
What factors influence your choice of motion detector?
- Attachment site (wrist, waist, thigh, ankle)
- Metric (output) choice
• Eg. if you’re interested in steps, you’ll choose a pedometer not an accelerometer because it picks up on PA other than walking
- Epoch choice (time period)
• Eg. children engage in intense bursts of sporadic behaviour so it’s best to collect at fine-tuned epoch interval levels (eg. 30 seconds)
- Monitoring frame (# and types of day)
• May want to include weekday and weekend collection to get an idea of overall PA
- Reactivity
• May choose not display data ⟶ seal or cover device; familiarization so they’re less likely to pay attention to it
29
What are the pros and cons of PA and sedentary questionnaires?
- Easy to collect and analyze, low cost and participant burden
- Only for general information, not sufficient for informing strategies for interventions, possibility of recall bias
30
What does the International PA Questionnaire (IPAQ) assess?
Asks # of days in the past 7 days you did an activity + duration (hrs, mins) on a typical day
LONG VERSION:
- Work-related PA
- Transportation PA
- Domestic and gardening (yard) PA
- Leisure-time PA
- Time spent sitting
SHORT VERSION:
- Vigorous PA
- Moderate PA
- Walking
- Sitting on weekdays
31
What does the PA Recall Questionnaire assess?
- List of common activites and “others”
- Asks whether they did activity, # of days, and # of mins on a typical day they did activity
- Go on compendium of PAs for assigned MET values
- Calculate # of MET-mins/week for MVPA
- For MET-hours, just divide by 60
32
What does the Godin & Shephard Leisure-Time PA Questionnaire assess?
Indicate how many times/week you did exercise for 15 minutes:
- Strenuous
- Moderate
- Mild
Multiply with assigned MET for total weekly leisure activity (in “units”)
33
What does the Behavioural Risk Factor Surveillance System Questionnaire assess?
- By Center for Disease Control (CDC)
- Adults are interviewed on the phone
"Do you do MPA for at least 10 minutes at a time? How many days per week? How long do you do it?"
34
What does the Youth Risk Behaviour Surveillance System Survey (YRBSS) assess?
- By Center for Disease Control (CDC)
- Youth complete a self-administered survey
- Eg. “During the past week, on how many days were you physically active for a total of at least 60 minutes per day?”
35
What does the Sedentary Behaviour Questionnaire assess?
“On a typical WEEKDAY/WEEKEND, how much time do you spend (from when you wake up until you go to bed) doing [SEDENTARY ACTIVITY]?"
OR:
“Amount of time spent sitting or lying down on average in last 7 days in [SETTING; eg. meals]”
36
What does the Past-Day Adults Sedentary Time (PAST) questionnaire assess?
“Estimate total time yesterday you spent sitting down or lying down while ___”:
- Work
- Travel
- TV watching
- Computer
- Reading
- Hobbies
- Other purposes
37
What are some considerations to keep in mind when measuring sedentariness with accelerometers?
- May have error (eg. misclassifying active sitting as weight lifting)
- Should be worn longer than PA for accurate estimations of sedentariness
- When aggregating sedentary time, use a minimum bout length of at least 5 continuous minutes for PROLONGED SITTING; shorter bouts may mask interruptions of sedentariness
- Caution is needed when interpreting results about sedentary breaks in relation to health outcomes
38
What are the PA guidelines from the Public Health Agency of Canada?
* Children = 90 minutes of MVPA (60 min M; 30 min V)
* Youth = “
* Adults = 30 minutes of MPA, 4 days/week
* Older Adults = 30-60 minutes of MPA most days
39
What are the PA guidelines from the Canadian Society of Exercise Physiology for the early years?
- Infants (<1) should be physically active several times daily (particularly through interactive floor-based play)
- Toddlers (1-2) and preschoolers (3-4 years) should accumulate at least 180 minutes PA at any intensity spread throughout the day including:
• Variety of activities in different environments
• Activities that develop movement skills
• Progression toward at least 60 minutes of energetic play by 5 years of age
More daily PA provides greater health benefits
40
What are the PA guidelines from the Canadian Society of Exercise Physiology for children and youth?
Canadian 24-Hr Movement Guidelines for Children & Youth (5-17)
- Accumulate at least 60 minutes of MVPA daily
• VPA and muscle- and bone-strengthening PA incorporated at least 3 days/week
- Several hours of a variety of structured and unstructured light PAs (eg. walking)
41
What are the PA guidelines from the Canadian Society of Exercise Physiology for adults?
18-64:
- Accumulate at least 150 minutes of MVPA (aerobic) per week, in bouts of 10 mins or more
- Beneficial to add muscle- and bone-strengthening PA using major muscle groups, at least 2 days/week
- More PA provides greater health benefits
42
What are the PA guidelines from the Canadian Society of Exercise Physiology for older adults?
65+:
- “
- Those with poor mobility should perform PAs to enhance balance and prevent falls
43
What are the sedentary guidelines from the Canadian Society of Exercise Physiology for the early years?
0-4:
- Minimize time spent being sedentary during waking hours
- Under 2 years = screen time is not recommended
- 2-4 years = screen time should be limited to under 1 hour per day
44
What are the sedentary guidelines from the Canadian Society of Exercise Physiology for children and youth?
Canadian 24-Hr Movement Guidelines for Children & Youth (5-17)
- 9-11 hours of sleep per night for 5-13 year olds and 8-10 hours for 14-17 year olds
- No more than 2 hours/day of recreational screen time; limited sitting for extended periods
45
What are the sedentary guidelines from the Canadian Society of Exercise Physiology for adults?
No Canadian guidelines for adults!
46
What do the Australia's Sedentary Behaviour Guidelines for Adults say?
18-64:
- Minimize amount of time spent in prolonged sitting
- Break up long periods of sitting as often as possible
47
Why are sedentary guidelines so vague?
Vague because research is not at a stage where you can say “x” amount of sitting is bad!
48
What do the PA Guidelines for Americans (PAGA) say for preschool-aged children?
3-5:
- Should be physically active throughout the day
- Adult caregivers should encourage active play that includes variety of activity types
49
What do the PA Guidelines for Americans (PAGA) say for school-aged children and adolescents?
- 60 minutes or more of MVPA daily
- For aerobic PA, most of the mins either MPA/VPA
- Include VPA at least 3 days a week
- Muscle-strengthening PA at least 3 days a week
- Bone-strengthening PA at least 3 days a week
50
What do the PA Guidelines for Americans (PAGA) say for adults?
- Should move more and sit less throughout the day
Substantial benefits:
- At least 150-300 minutes a week of MPA
- Or 75-150 minutes a week of VPA
- Or equivalent combination of MPA and VPA
- 1 min VPA = 2 min MPA
- Preferably, aerobic PA should be spread throughout the week
Additional benefits:
- PA beyond equivalent of 300 minutes a week of MPA
- Muscle-strengthening PA that is moderate or greater intensity on 2 or more days a week
No guidelines for flexibility
- Research on health benefits are unknown
51
What do the PA Guidelines for Americans (PAGA) say for older adults?
- Same as adults
Additional guidelines:
- Do multi-component PA (eg. balance training; aerobic and muscle-strengthening PA)
- Consider fitness level and whether chronic conditions affect safety
- Be as physically active as abilities and conditions allow
52
How do the PAGA guidelines compare to Canada?
- If you don’t have time, you can cut your PA in half by increasing intensity
- More recent (2018 compared to 2012); current research suggests that every minute counts
• American guidelines have no minimum bout time
- Someone who may meet American guidelines may fall short using Canadian guidelines
• “The % of population that are sufficiently active” depends on guidelines used
53
If you are given an adult's participation in PA + intensity, how would determine whether they meet American and Canadian guidelines?
- For Canadian guidelines, only count MPA or VPA that occur in 10+ minutes; see if it adds up to 150 minutes a week
- For American guidelines, convert VPA to MPA; see if it adds up to 150 minutes
MAKE SURE TO USE GUIDELINES FOR AGE GROUP!
54
What did Rowe et al (2011) find about steps?
You need a walking cadence of 100 steps/min to engage in moderate-intensity walking
55
What did Tudor-Locke et al (2019) find about steps?
- Established heuristic (evidence-based, practical) cadence thresholds
• Moderate-intensity walking (3 METs) = 100 steps/min
• Vigorous-intensity walking (6 METs) = 130 steps/min
- For walking within 3-6 MET range, each 10 steps/min increase was associated with increase in intensity of 1 MET
• By knowing the # steps/min, may be able to figure out MET value
- Internationally, 30 mins/day of MVPA is the standard; 100 steps/min x 30 mins = 3000 steps minimum needed
• Add 5000 steps/day as “sedentary lifestyle index” (steps from daily living)
• Recommend 8000 steps/day
56
What did Colley et al (2011) find in their research?
Used time-stamped accelerometers for 7 days to look at intensity and prevalence of PA
Results:
- 15% adults (17% M, 14% W) accumulated 150 minutes per week of MVPA in 10-min bouts
- 5% adults (6% M, 4% W) accumulated 150 mins of MVPA at least 30 mins on at least 5 days a week
- 35% adults (39% M, 30% W) accumulated more than 10,000 steps per day
• If you use walking behaviour, the prevalence of PA appears better
• Does not speak of intensity; would be better to see how many met the guidelines of 100 steps/minute for 30 minutes
57
What were the participACTION report card grades for children and youth?
- Grade for overall PA = D+
- Grade for leisure PA = D
- Grade for organized sport = B
- Grade for active transportation = D-
- Grade for sedentary behaviour = D
58
What were the participACTION report card grades for adults?
- Grade for overall PA = D
- Grade for daily movement = C
- Grade for MVPA = F
- Grade of incomplete for muscle/bone strength + balance + sedentary behaviour (no data)
59
What did the Canadian Community Health Survey look at and find?
Used self-reported data to see whether Canadians are meeting guidelines.
- Males are more physically active than females (according to self-reports)
- The older you get, the less prevalent the PA
- The further west you go in Canada (eg. BC), the more PA you do (due to good weather)
60
What did Colley et al (2018) find in their research?
- 2014-2015 Canadian Health Measures Survey
- Compare self-reported and accelerometer-measured PA among Canadian adults
- When you compare the data, the results are consistent and not much different
1. FOR SELF-REPORTED PA:
- Highest reported PA is in recreation/transportation, then occupational/household
- The older you get, the less active you are
- Hardly anybody is getting VPA compared to MPA
2. FOR ACCELEROMETER PA:
- The older you are, the less active you are
- MVPA is a lot lower when you have to take into account 10 minute bouts
- LPA is where we get most of our PA; VPA is very few
- LPA is not in the guidelines but we know there are benefits
61
What are the health-related components of physical fitness?
- Cardiorespiratory endurance/fitness
- Body composition
- Muscular strength
- Muscular endurance
- Flexibility
62
What are the skill-related components of physical fitness?
* Agility: ability to change body in space quickly and accurately
* Coordination: ability to move body parts in conjunction with senses
* Balance: sense of equilibrium
* Power: ability to exert force quickly
* Reaction time: your ability to react to a stimulus quickly
* Speed: ability to do a movement very quick
63
What is exercise pre-participation health screening based on?
- Current level of PA
- Presence of signs/symptoms of cardiovascular, metabolic, or renal disease
- Desired exercise intensity
64
For exercise pre-participation health screening, what are the recommendations for people who do not participate in regular exercise?
1. None of the diseases and signs suggestive of disease
• Medical clearance not necessary
• L/MPA recommended
• Gradually progress to VPA
2. Known disease and asymptomatic
• Medical clearance recommended
• After clearance, L/MVA recommended
3. Signs suggestive of disease
• “
65
For exercise pre-participation health screening, what are the recommendations for people who DO participate in regular exercise?
1. None of the diseases and signs suggestive of disease
• Medical clearance not necessary
• L/MPA recommended
• Gradually progress to VPA
2. Known disease and asymptomatic
• Medical clearance for MPA not necessary
• Medical clearance (within 12 months if no change in signs) recommended before VPA
• Continue with MPA after medical clearance, can build up gradually
3. Signs suggestive of disease
• Discontinue exercise and seek medical clearance
• May return to exercise following medical clearance, gradually progress as tolerated
66
What are the components of an exercise session?
- Warm-up ⟶ 5 minutes, MPA, stretching to warm up the muscles
- Conditioning ⟶ the actual exercise (MVPA)
- Cool-down ⟶ 5-10 minutes
- Stretching (research says there are more benefits when done AFTER exercise as muscles are warmed up)
67
What is the link between heart rate and fitness?
- Physically active individuals tend to have lower resting heart rates
- May be an indicator of your aerobic fitness
68
How do you measure resting and exercise heart rate?
- Measure resting heart rate as soon as you wake up
- Measure exercise heart rate after you exercise
• Count for 15s and multiply by 4
• Instead of counting for 60 seconds (heart rate slows down during recovery)
69
What are ACSM (2018)'s recommendations for aerobic exercise in terms of frequency?
- Moderate-intensity at least 5 days/week
- OR vigorous intensity at least 3 days/week
- OR weekly combination of 3-5 days/week of moderate & vigorous
• Don’t cram all your exercise into 1-2 days; spread it out
70
What are ACSM (2018)'s recommendations for aerobic exercise in terms of intensity?
- Moderate to vigorous intensity exercise for most adults
- Light to moderate intensity for deconditioned adults (not physically active)
- Interval training may be beneficial
• Especially if you have no time; up the intensity
71
How do you use % of maximal heart rate to prescribe exercise intensity?
- HRmax = 220-age
| - Target HR = HRmax (estimated) x % intensity desired
72
How do you use % of heart rate reserve to prescribe exercise intensity?
- HRR = HRmax - HRresting
| - Target HR = [(HRmax - HRresting) x % intensity desired] + HRresting
73
How is VO2 max measured?
DIRECT:
- Open-circuit spirometry
INDIRECT:
1. Field tests
- 12-min walk/run ⟶ you walk or run for 12 minutes and measure the distance covered
• Plug distance covered into equation to get estimate of VO2 max
- 1.5 mile (2.4 km) walk/run ⟶ you walk or run 1.5 miles and measure the time taken
• Plug time into equation to get estimate of VO2 max
2. Treadmill
3. Cycle ergometers
4. Bench stepping
74
How do you use % VO2 max to prescribe exercise intensity?
Target VO2 = VO2 max x % intensity desired
75
How do you use METs to prescribe exercise intensity?
Target MET = (VO2 max/3.5 ml/kg/min) x % intensity desired
76
What are the specific MET values for each type of intensity?
```
Very light = <2.0
Light = 2.0-2.9
Moderate = 3.0-5.9
Vigorous = 6.0-8.7
Near maximal to maximal = GTE 8.8
```
You could get more specific for each age group (the older you get, the lower the MET for intensity)
77
How do you use rating of perceived exertion to prescribe exercise intensity? What are the 2 scales?
- How hard you feel your body is working
- Based on physical sensations a person experiences during PA
BORG RATING OF PERCEIVED EXERTION:
- Scale ranges from 6 to 20
- 6 = no exertion at all
- 20 = maximal exertion
- Correlated with your HR
- Scale starts off at 6 because HR when you exercise starts off at 60
- Has a table to correlate with exercise intensity
BORG CATEGORY-RATIO:
- Scale ranges from 0 to 10 (maximal)
78
What is relative intensity? What is absolute intensity?
1. Relative intensity
- Intensity is specific to your fitness level (eg. % VO2 max)
- Better measurement
2. Absolute intensity
- Measurement of intensity applied to anyone, independent of any factors
- Eg. list of MET values on compendium
79
What are ACSM (2018)'s recommendations for aerobic exercise in terms of duration?
- 30-60 mins/day (GTE 150 mins/week) of moderate intensity
- OR 20-60 mins/day (GTE 75 mins/week) of vigorous intensity
- OR combination of moderate- and vigorous-intensity exercise daily to reach recommended targeted volumes of exercise
- Accumulate in 1 continuous exercise session or in bouts of at least 10 mins
• PAGA guidelines are different!
80
What are ACSM (2018)'s recommendations for aerobic exercise in terms of volume?
- Combination of frequency, intensity, and duration
- GTE 500-1000 MET-min/week
• Rationale: (150 mins/week)(3-6 METs for MPA) = 450-900 MET-min per week
• Heuristic; round up for a practical guideline people will remember
81
What are ACSM (2018)'s recommendations for aerobic exercise in terms of type?
- Rhythmic, aerobic exercise of at least moderate intensity that involves large muscle groups and requires little skill to perform
- Eg. only recommend swimming if they have the skill
82
What are the components of muscular fitness exercise?
1. Muscular Strength: maximum force that a muscle can generate
- Static (no observable muscular movement; eg. hand grip)
- Dynamic (muscle is contracting; eg. bicep curl)
2. Muscular Endurance: sustainability of your muscles in the correct form
- Eg. push-ups
3. Muscular Power: having strength but with speed
- Eg. standing vertical jump
83
What are the principles of resistance training?
1. Progressive Overload
- Increase # of reps, sets, and resistance over time to build muscular fitness
2. Regularity
- Do it frequently to see improvement; otherwise, you may only maintain
3. Specificity
- Choose exercise for the target muscle group
4. Individuality
- Cater fitness regime to individual’s fitness level
5. Reversibility
- Use it or lose it!
84
What are the goals of resistance training?
- Make activities of daily living less stressful physiologically
- Effectively manage, reduce, or prevent chronic diseases and health conditions
85
What are ACSM (2018)'s recommendations for resistance training in terms of frequency?
Resistance training of each major muscle group 2-3 days/week with at least 48 hours separating exercise sessions for same muscle groups
86
What are ACSM (2018)'s recommendations for resistance training in terms of type?
- Multi-joint exerises affecting more than one muscle group (eg. squats = knee + hip)
- Single-joint exercises targeting major muscle groups (eg. curls)
- Both single- and multi-joint exercises targeting agonist and antagonist muscle groups
• Eg. bicep curl; biceps are agonist (provides force for movement), triceps are antagonists (not moving but activated to stabilize arm)
87
What are ACSM (2018)'s recommendations for resistance training in terms of volume?
- Adults should train each muscle group for a total of 2-4 sets with 8-12 reps per set with a rest interval of 2-3 mins between sets to improve muscular fitness
• For strength ⟶ high weight, low repetition
• For endurance ⟶ low weight, high repetition
- For older adults and very deconditioned persons, 1 or more sets of 10-15 reps of very light to light intensity resistance exercise is recommended
88
What are ACSM (2018)'s recommendations for resistance training in terms of exercise technique?
- Correct technique to reap the most benefits
• Controlled movements through full range of motion
• Working both concentric (muscles that contract to lift weights) and eccentric (muscles that lengthen to release weight) muscles
89
What are ACSM (2018)'s recommendations for resistance training in terms of progression?
Continue to subject muscles to overload to continue to increase strength and mass
90
What are the types of resistance training?
1. Isometrics
- Contraction of particular muscle without moving
- Can prevent atrophy of muscles if you are unable to do full motion
2. Dynamic training
3. Plyometrics
- Exercises in which muscles exert maximum force in short intervals of time
91
What are the components of a good resistance training workout?
1. Warm up
2. Muscle conditioning phase
- Exercise choice
- Exercise order
- # of reps
- # of sets
- Rep velocity (speed)
- Rest period between sets and exercises
3. Cool-down
92
What are ACSM's (2018) recommendations for flexibility?
1. Type: target major muscle-tendon groups using techniques such as:
- Static stretching (eg. holding poses)
- Dynamic stretching (eg. arm circles)
- Proprioceptive neuromuscular facilitation
• Involves stretching, contracting, and then relaxing of the joint
2. Intensity: stretch to point of feeling mild tightness or slight discomfort
3. Time: static stretch for 10-20 seconds
4. Pattern: repeat 2-4 times; most effective when muscles are warm
5. Volume: 60 secs of total stretching time for each exercise
- Collective ability to exercise; time, frequency, and intensity all together
6. Frequency: GTE 2-3 days/week, but daily is most effective
93
What are neuromotor exercises?
Exercises that improve balance and coordination (eg. yoga)
94
What are ACSM's (2018) recommendations for neuromotor exercise?
- GTE 2-3 days/week for older individuals to reduce risk of falls
• Likely beneficial for younger adults also
- GTE 20-30 mins/day may be needed
95
What were the conclusions from the article about PA promotion by non-medical healthcare professionals?
- Factors associated with non-medical health professionals’ engagement with PA promotion:
• Self-efficacy in PA promotion
• Positive beliefs in the benefits of PA
• Assessing patients’ PA
• PA promotion training
- Lack of rumuneration (compensation) and lack of time was not associated with PA promotion among non-medical health professionals
- Inconsistent relationship between higher personal PA level and higher PA promoting practices
- Particular health professions may promote PA more effectively than practitioners (eg. nurses) due to stronger interpersonal communications with patient
96
What were the conclusions from the article about PA programming among cancer survivors?
- PA enhances quality of life and reduces mortality for cancer survivors
- But:
• Majority of cancer survivors do not meet PA guidelines; do less PA than individuals with no previous cancer diagnosis
• Participation in PA decreases during treatment
- To facilitate maintenance of PA, cater to preferences:
• Walking as PA
• PA programs in the morning
• Moderate-intensity PA programs (may progress to high intensity)
• Home-based and unsupervised programs (but supervised PA have greater effect; develop home-based interventions with some guidance)
• No consensus on preferred PA companion
• Start PA program when not currently in treatment
97
What are theories? What forms can the relationships among concepts take?
- Set of concepts/constructs that have been systematically linked together
- Relationship among concepts takes different forms
• Positive relationship
• Negative relationship
• Mediation (3rd variable that is the link between 2 concepts)
• Moderation (3rd variable that influences the strength of association between 2 concepts)
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What are the roles of theory?
- Identifies which constructs to examine
• Theory concepts must be conceptualized (defined in abstract terms) and operationalized (measurable)
- Guides research questions and design
- Helps develop interventions
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What is social cognitive theory?
- First known as social learning theory (learning from social interaction)
- Renamed to SCT (incorporating cognitive psychology)
- Reciprocal determinism: environmental factors influence people and vice versa
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What is another name for reciprocal determinism? What are the components?
Triadic reciprocity
- Personal characteristics (eg. personality, cognition, emotions)
- Environmental factors
- Personal behaviour
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What is the self-efficacy theory?
- Perceived self-efficacy
- Influences:
• Cognition and affect
• Behaviour
- Influenced by:
• Enactive mastery experience (obtaining the experience of achieving your goals)
• Vicarious experience (experiences where you learn by observing others)
• Verbal persuasion (convince people they can perform behaviour)
• Physiological and affective states (diminish fear associated with behaviour)
102
What are the SCT concepts?
1. Psychological Determinants of Behaviour
2. Observational Learning
3. Environmental determinants of behaviour
4. Self-Regulation
5. Moral Disengagement
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What are the SCT psychological determinants of behaviour?
1. Knowledge
- Foundation but cannot alone change behaviours
- Content knowledge: understanding pros/cons of behaviour
- Procedural knowledge: understanding how to perform behaviour
2. Outcome expectations
- Expected outcomes from performing a certain behaviour
- Work with self-efficacy to determine level of motivation to adopt behaviour
3. Outcome expectancies
- Value a person places on expected outcomes that would result from performing a certain behaviour
- May result from extrinsic or intrinsic motivation
4. Self-efficacy
- Beliefs about personal ability to perform behaviours that bring desired outcomes
- BEST able to predict behaviour (confidence)
a) Barriers self-efficacy
- Confidence in your ability to perform the behaviour even in the face of challenges
- “I am confident I could do PA when the weather is bad during the next month”
b) Collective efficacy
- Beliefs about ability of a group to perform concerted actions that bring desired outcomes
- Eg. your confidence to eat healthy plus your parent’s confidence to buy healthy food and cook it
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What is observational learning in SCT?
- Learning by observing others
- More effective if the individual is similar to us
- “Coping models” ⟶ gain confidence by seeing someone overcome barriers and succeed in performing behaviour
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What are the environmental determinants of behaviour for SCT?
- Not constructs; simply strategies that are implemented to change constructs
a) Incentive motivation
- Using rewards to modify behaviour (may change self-efficacy)
b) Facilitation
- Providing tools, resources, or environmental changes that make new behaviours easier to perform
106
What is self-regulation for SCT?
- Capacity to endure short-term negative outcomes in anticipation of long-term positive outcomes
- NOT the same as willpower (innate); can be developed
STRATEGIES:
a) Self-monitoring
- Observe behaviour or outcomes (eg. trackng calories)
- Note patterns and contextual information that guides behaviour and identify barriers
b) Goal-setting
- Once motivation is experienced, person can start formulating goals
- SMART ⟶ specific, measurable, achievable, realistic, time-based
c) Feedback [to others]
d) Self-Reward (when you achieve goals)
e) Self-Instruction (positive thinking to encourage yourself)
f) Seeking Social Support (after identifying significant others who matter)
107
What are the dimensions of health behaviours?
1. Complexity
- Require higher levels of knowledge, skills, or resources
2. Frequency
3. Volitionality
- Degree of personal control over the behaviour
- Low ⟶ rely on external resources (eg. consuming fruits and vegetables)
108
What are the levels of influence?
- Determinants of behaviour
- Ecologic approach
- Outer levels (distal influences) influence inner levels (proximal influences)
1. Societal/cultural
2. Community/peers
3. Relational
4. Family
5. “I”
109
What are the 3 levels in the Threehold Stepwise Implementation Model?
1. Level 1
- High self-efficacy and strong outcome expectations
- Individual is ready to adopt behaviour
- Low intensity intervention efforts are needed
2. Level 2
- Doubts about self-efficacy and weak outcome expectations
- Think about intervention at personal and environmental levels to bring individual to Level 1
3. Level 3
- Belief that personal control over behaviour is lacking
- Individual has no personal agency (perception of having any control in performing the behaviour)
- Must be established before enhancing self-efficacy and outcome expectations
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What is moral disengagement for SCT?
Ways of thinking about harmful behaviours that make it acceptable by disengaging self-regulatory moral standards
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What are the mechanisms for moral disengagement for SCT?
* Moral justification = perceiving the behaviour to be socially valued (eg. doping in sports is “a part of sport)
* Advantageous comparison = comparing harmful behaviour to one you consider to be worse
* Euphemistic labelling = downplaying behaviour via language
* Minimizing or ignoring consequences
* Dehumanization & attribution of blame = eg. blaming individuals for obesity rather than environment
* Displacement of responsibility = eg. “my coaches forced me”
* Diffusion of responsibility = eg. “all my team members do it”
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What is the theory of reasoned action?
- Intention will lead to adoption of health-protective behaviours
- Intention is determined by attitudes toward behaviour and subjective norm
- Behavioural beliefs form attitudes toward a health behaviour
- Normative beliefs (what others think you should do) are weighed with motivation to comply with referent source (source of belief)
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What is the theory of planned behaviour?
- TRA + perceived behavioural control
| - Perceived power: the strength of the facilitating and inhibiting factors
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What is the integrative model of behavioural prediction?
- UPDATED MODEL
- TPB
- Environmental constraints, intention, and skills/abilities predict behaviour
- Other variables impact behavioural beliefs, normative beliefs, and perceived power
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What is intention in the IMBP?
- Readiness to engage in a behaviour
| - May predict actual behaviour
116
According to IMBP, how do you address the intention-behaviour gap?
- Action-planning = list PAs you plan on doing and when/where
- Coping planning = anticipate and identify barriers to doing intended behaviour and develop strategies to overcome these barriers
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What are the moderators of behaviour in IMBP?
1. Environmental Factors (eg. you intend on going to the gym, but it’s closed)
2. Skills and Abilities (eg. you strained your ankle and cannot do your planned exercise)
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What are the determinants of intention according to IMBP? More specifically, what are the proximal constructs?
1) Attitude
- Person’s evaluation of the anticipated positive or negative outcomes associated with engaging in the behaviour
2) Subjective Norm
- “Direct” = “most people” not individual people
- Direct injunctive: perception that most people who are important to me think I should or should not do the behaviour
- Direct descriptive: perception that most people who are like me are or are not doing the behaviour
3) Perceived Behavioural Control
- How much a person feels in control of doing a specific behaviour
- Perceived ease or difficulty in doing a behaviour
- Different from self-efficacy
• Eg. Walking your dog when you are very busy
• High self-efficacy (you are confident you can walk your dog)
• Low behavioural control (environmental constraints make it difficult)
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What is the information-motivation-behavioural skills model?
Behaviour is predicted by:
1) Information
- Having a high degree of relevant knowledge pertaining to behaviour
2) Motivation
- Combined influence of person’s attitude toward the behaviour (includes outcome expectations) and their socially inspired motives to perform the behaviour
3) Behavioural Skills
- Task-specific perception of your personal ability
- Based on the concept of self-efficacy
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What are the distal constructs for IMBP for attitude? What is their link to SCT?
1. Behavioural beliefs: beliefs about outcomes of doing behaviour
- In SCT ⟶ outcome expectations
2. Outcome evaluations: evaluation of outcomes
- In SCT ⟶ outcome expectancies
121
What are the distal constructs for IMBP for subjective norm?
1. “Indirect” injunctive norm: perception that each referent thinks I should or should not do the behaviour
- “Indirect” refers to a SPECIFIC significant other rather than “most people I care about”
2. “Indirect” descriptive norm: perception that each referent is or is not doing the behaviour
3. Motivation to comply
122
What are the distal constructs for IMBP for perceived behavioural control?
1. Control beliefs
- Beliefs that certain circumstances will be present when doing the behaviour
- Eg. “I expect my work will place high demands on my time”
2. Perceived power
- Perception that those circumstances will make behavioural performance easy or difficult
- Eg. “My work placing high demands on my time would make it difficult to do PA”
123
What is the background influence for IMBP? List a few.
Play an indirect role by influencing distal constructs
- Past behaviour
- Demographics and culture knowledge
- Personality, moods, and emotions
- Intervention exposure
124
Why are there mixed results for studies looking at social norms influencing PA in terms of TPB?
1. Conceptualization and measurement of subjective norms
- Most of the studies ignored descriptive norms
- Most studies relied on direct measures (asking participants to rate the degree to which they think their SO think they should be active) instead of indirect (multiply with motivation to comply)
- Most studies used general referent groups (“most important people”), introducing variability
2. Covariates of subjective norms
- Other variables (social support) may be stronger predictors of intention
- Attitudes and subjective norms are linked; so effect of norms on PA intention may have been washed out by effect of attitudes
3. Potential moderators of relationship
- Personality factors (norms influence for neurotic and introverted individuals)
- Individuals’ stages of change within transtheoretical model (stronger for those in earlier stages)
4. Conceptualization of PA
- Studies differ in way PA is operationalized
125
What is a logic model?
- Diagrammatic representation of the program
| - The framework that may incorporate theory
126
What is evaluability assessment?
Process involving extensive stakeholder consultation to create a logic model
127
What do you consider to develop an intervention?
1. Behaviour change theories
2. Stakeholders’ experiences
3. Research (empirical research; what others have done)
128
What are the functions of a logic model?
- Guide to develop a program to achieve certain outcomes
- Guide to plan an evaluation of a program
- Forces developers to reach a consensus
- Communication to stakeholders
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What are the tasks you must do before developing a logic model?
1. Identify purpose, commitment, and work group
2. Set boundaries
- What are the resources you have?
- Where does the program start and end?
3. Identify and analyze documents (eg. literature)
4. Develop model
5. Verify and modify model
6. Determine plausibility
- Are the outcome objectives clear and measurable?
- Are the strategies/activities clear and measurable?
- Are type and amount of activities sufficient to make behaviour change?
- Are causal linkages plausible (eg. knowledge will NOT affect behaviour)
- Are type and amount of resources adequate?
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What is Dwyer's Logic Model Template?
1. Why is the program needed?
- Determine the problem’s nature, depth, and scope
2. Target group(s)
- Specify people/organizations that are to receive the program
3. Strategies
- Group of activities that are conceptually or administratively related to achieve program objectives
- Eg. education/skill development, communication/social marketing
4. Program activities
- The “means” to achieve the outcomes
- Stated with action phrases (“to establish, provide, give, train, develop”)
- WHO provides WHAT to WHOM?
- Eg. “School staff will create promotional print material for youth and family regarding upcoming PA programs”
5. Desired outcomes
- Shorter (eg. acquire knowledge) OR longer term (eg. change behaviour)
- Stated in terms of “increase, decrease, maintain”
- Must be specific, measurable, have purposeful standards (eg. Canadian PA guidelines), realistic, and have a time frame
- Eg. “To increase girls’ and families’ awareness of opportunities to be active in schools”
6. Goal
- Broad statement that gives the general intent of the program
- Idealistic and vague (eg. “to achieve optimal adolescent health”)
NUTR*3070
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