Literatura académica sobre el tema "Active lifestyle promotion"

ABSTRACT Objective: To analyze the reality of the development of the national active lifestyle, clarify its limitations and countermeasures. Methodology: Official data and consultations in updated bibliographic references were employed for the survey of the main problems with a sedentary lifestyle and their possible solutions. Results: The three urgent problems to be solved in public services are the construction of sports facilities, the organization of regular sports activities, and the establishment of sports organizations. Only a few sports have been promoted in concrete operations. Inadequate physical education and deficient essential public services are also factors affecting national health. Conclusion: Building sports facilities and providing environments with sports equipment are not sufficient against sedentary lifestyles. Relevant policies must be implemented along with massive advertising about the benefits of active lifestyles. Continuous orientation of social workers in community sports groups to promote mass participation is also key to health promotion through sports interventions.

Background Physical inactivity is a major risk factor for chronic disease. Primary health care practitioners are well placed to promote a physically active lifestyle. The perceptions and practice of physical therapists on their role in physical activity promotion are not well known. Objective The objective of this study was to determine the knowledge, confidence, role perception, barriers, feasibility, and counseling practice of physical therapists and physical therapist students regarding the promotion of nontreatment physical activity for better health. Design A cross-sectional survey was conducted. Methods In 2008, 321 (54%) of a random sample of all physical therapists registered in New South Wales, Australia, responded to a survey on their knowledge, confidence, role perception, barriers, feasibility, and counseling practice with regard to promoting a physically active lifestyles to their patients. Physical therapist students (n=279) completed the same survey but without the questions on barriers and counseling practice. Results Physical therapists and physical therapist students consider that it is part of their role to give their patients nontreatment physical activity advice. Overall, they reported having adequate knowledge and skills to undertake this role. Incorporating advice into normal consultations is deemed the most feasible form of lifestyle physical activity promotion in physical therapist practice. Limitations The cross-sectional nature of this study makes it difficult to determine cause and effect relationships. Some selection bias may have occurred, as the physical therapists who completed the questionnaires may have been those most interested in physical activity promotion. Conclusions Physical therapist practice appears to be an excellent avenue for promoting a physically active lifestyle and could potentially play an important public health role.

Aim: The aim was to review studies examining the effectiveness, acceptability, and feasibility of mobile-based technology for promoting active lifestyles in people with type 2 diabetes (T2D). Background: Benefits of leading an active lifestyle following a diagnosis of T2D, including improved glycemic control, have been reported. Studies examining the specific use of mobile-based technologies to promote an active lifestyle in T2D have not previously been reviewed. Methods: Research studies examining effectiveness, feasibility or acceptability of mobile-based technology for active lifestyle promotion for T2D management were included (n = 9). The databases searched included PubMed, Medline, ScienceDirect, and ACM Digital Library (January 2005 to October 2015). Studies were categorized as (1) informing, (2) monitoring, (3) provoking, or (4) sustaining behavior change. Results: Technologies used included smartphone or tablet apps, diabetes personal digital assistant, continuous glucose monitor and accelerometer, pedometer, and a website delivered by a smartphone. No articles examined the effectiveness of mobile-based technology in monitoring health behaviors and behavior change. Four of the studies found mobile-based technology to be motivational and supportive for behavior change. The visual reinforcement was identified as motivational. The feasibility and acceptability of using mobile-based technology to provide sustained lifestyle change and the effectiveness of mobile-based technology in monitoring health behaviors and behavior change have not been investigated. No studies examined all 3 of the outcomes or focused decreasing the participants’ sedentary behavior. Conclusions: Limited research has examined the feasibility, acceptability, and effectiveness of mobile-based technology to promote active lifestyles and subsequently good diabetes management in people with T2D.

In 2015, the Centers for Disease Control in the United States declared that 7 of 10 deaths per year are caused by chronic diseases; in Israel, the situation is consistent with this assessment. Healthy Israel 2020, an Israeli Ministry of Health initiative, places physicians at the forefront of health promotion and preventive medicine. In 2012, the Israeli Society of Lifestyle Medicine (ISLM) was established under the auspices of the Israel Association for Family Physicians. This decision was taken because we, the authors, wanted to promote change in the primary care services through the recruitment of key leaders for implementation of lifestyle medicine (LM), including improved attitudes, knowledge, motivation, and skills of primary care physicians and health providers. Today, the ISLM is an active member of the Israeli Medical Association, promoting educational activities, physician’s health, and well-being initiatives; developing tools for health-promoting clinics; and more. Our future plans are to incorporate LM as an integral part of daily practice in all sectors of the medical profession in Israel. This is challenging, but we see this as the only way to effectively combat the noncommunicable disease epidemic.

The article presents data on sports, active forms of leisure, travel among elderly Russians. An important conclusion is made that health promotion by means of active recreation and sports among senior citizens in Russia is one of the directions of active longevity policy. An overview of charitable foundations for senior citizens of the Russian Federation and their activities in promoting an active lifestyle among elderly citizens is presented.

Abstract Sen’s capability approach (CA) has found its way into health promotion over the last few years. The approach takes both individual factors as well as social and environmental conditions into account and therefore appears to have great potential to explore opportunities for (‘capabilities’) and barriers to active lifestyles. Thus, our objective in this study was to investigate which capabilities senior citizens perceive to have available to them in order to be physically active. In Southern Germany, we conducted 26 semi-standardized interviews with senior citizens aged 66–97, as well as 9 interviews with key persons who have close contact to senior citizens in their work life. We identified 11 capabilities which the interviewees considered as important in leading an active lifestyle. They could be grouped into four domains: (1) individual resources, (2) social interactions and norms, (3) living conditions and (4) organizational environment. Results highlight the need for health-promoting interventions that widen the range of capabilities on social and environmental levels in a way that individuals can freely choose to be as physically active as they like. The results make clear that interventions should not only target and involve older adults themselves, but also their families, nursing home staff or community representatives, because these groups are important in shaping older adults’ capabilities for an active lifestyle.

Fitness as a healthy lifestyle implementation helps to improve the social, mental and physical well-being components. Several scientists have indicated that there is a connection between social belonging and physical activity (PA) as the structural component of a healthy lifestyle (Walseth, 2006; Walseth & Fasting, 2004; Antonsich, 2010; Yuval-Davis, 2006; Anthias, 2006; Pinquart & Sorensen, 2001; Everard et. al., 2000). That is why the goal of the research is to develop and apply a social belonging promotion programme for women in fitness programme and to determine the changes in the lifestyle structural component health promoting PA. 10 women involved in fitness classes in small groups (2-4 people) participated in the case study, where in addition to PA social belonging promotion events were organized for all women together. In order to evaluate the structural components of social belonging and PA level and type, questionnaires adapted in Latvia and a semi-structured interview was used. Applying the social belonging promotion programme for women in fitness creates statistically significant changes in such structural components as sense of commitment (p<0.01), perception of interpersonal relations (p<0.01). By additionally promoting social belonging in fitness, women perceive the group better, are willing to spend more time with it; that, in turn, positively affects the willingness to be physically and socially active on a daily basis.

It is clearly established in the scientific literature that an appropriate lifestyle is key to achieving and maintaining optimum health and functional status in old age. In this frame, the practice of physical activity on a regular basis fits into the active aging paradigm, a notorious shift away from aging as a dependent stage of life. Through a longitudinal case study conducted in the outskirts of Monterrey, Nuevo Leon, Mexico, an aspect of the lifestyle –physical activity – of a centenarian who lives permanently in senior-only housing, has been documented in contrast to his coresidents’ lifestyles. Extensive open-ended interviews and direct observations of a convenience sample of residents of a community of aging, from 1999 to the present, allowed for a triangulation and saturation of data.In contrast to his peers, who predominantly displayed sedentary lifestyles, the centenarian consistently had a related physically and socially active lifestyle. I suggest that the attitudes of fellow residents can be understood in light of the Theory of Planned Behavior (Fishbein and Ajzen 1975). Fieldwork also provided the opportunity to document how fitness and independenceaffected the quality of life of the centenarian. This individual is atypical in his environment and the external validity of this study is analytical rather than statistical. However, it suggests that non-institutional barriers may challenge the promotion of an active aging paradigm.

Abstract Introduction. In the face of the more and more general threat with civilization diseases the promotion of healthy lifestyle should be one of main activities of educational and medical institutions. Aim. The aim of the work was comparison of chosen elements of healthy lifestyle between the young physically active women and non-sports ones. Material and methods. The survey was carried out on 156 women aged 18-35 years, divided into two groups. Persons physically active were classified into Group 1 (n=72), whereas into Group 2 - non-active ones (n=84). The investigative tool was the Inventory of Health-Related Behaviours by Juczyński (where health-related behaviours were rated in four categories: proper nutrition habits, prophylaxis behaviours, and positive attitude and health practices). Differences between the data were qualified with the t-student test for independent groups; level p≤0.05 was accepted as of minimum significance. Results. The results show that physically active persons pay greater attention to healthy lifestyle than non-sports people. The general indicator of health-related behaviours was noticeably higher in Group 1 (p=0.007). Greatest differences (p=0.008) were noted within the range of nutritional habits, and the least significant ones - in positive attitude (p=0.546). Conclusion. The positive influence of the physical activity on other aspects of the healthy lifestyle has been proven. It seems legitimate to promote physical activity among women of every age

This study aimed to examine the multi-faceted lifestyle profiles of community-dwelling middle- and older-aged adults based on their physical activity, participation in various activities, and nutrition. It identified the association of lifestyle profiles with demographic variables, quality of life, and mental health. The analysis included 569 participants (mean age = 60.2; SD = 4.3). Latent profile analysis identified three distinctive lifestyle profiles: “inactive and unbalanced” (36.4%), “basic life maintenance” (54.6%), and “active and balanced” (9.1%). Sex (p < 0.001), age (p < 0.001), and regular medication intake (p < 0.01) were statistically significantly different among the three profiles. Of the “inactive and unbalanced” lifestyle group, 63.3% of it was comprised of by females, and a relatively large distribution was aged over 65. In the “basic life maintenance” subgroup, males showed a relatively large distribution, and 92.6% of participants were aged 55–64. People with active and balanced lifestyles demonstrated high quality of life levels (p < 0.001) and low loneliness levels (p < 0.01). Multinomial logistic regression revealed a statistically significant positive association between lifestyle profiles and quality of life (p < 0.001) as well as mental health (p < 0.01). Therefore, health promotion that considers multi-faceted lifestyle factors would need to improve health and quality of life among community-dwelling middle- and older-aged adults in South Korea.

Cardiovascular disease (CVD) is a major public health problem and a primary cause of morbidity and mortality in the United States. Regular physical activity is recommended for prevention and management of CVD. Despite the cardiovascular health benefits of physical activity most adults are physically inactive. Therefore, the aim of this dissertation was to examine the factors associated with adherence to physical activity among individuals with or without CVD. The first paper is a report of a study conducted to examine which baseline demographic (age, gender, marital status, socioeconomic status, and place of residency), psychosocial (social support, depression, anxiety, and fatalism), and clinical (past history of exercising, comorbidity, and health literacy) variables predicted successful adoption of the active lifestyle recommendation of increasing moderate-to-vigorous physical activity by an accumulated 15 minutes or more each day following a CVD risk reduction intervention and 2) to identify which of those same factors predicted dropout from the CVD risk reduction intervention among at-risk individuals in rural America. The study sample consisted of 399 rural Americans. The results revealed that a higher anxiety level was a predictor of active lifestyle modification following a CVD risk reduction intervention. In contrast, younger age and low health literacy were predictors of dropout from a CVD risk reduction intervention. The second paper is a literature review of studies investigating the factors that affected enrollment in cardiac rehabilitation in patients with heart failure (HF). The aims of this review were to: (a) describe enrollment rates of patients with HF in cardiac rehabilitation programs, (b) review the literature on factors affecting enrollment of patients with HF, and (c) identify areas for future research. It is difficult to draw conclusion about enrollment rates because the period of time after hospital discharge that enrollment was measured varied across studies. A wide array of demographic, psychosocial, and clinical variables have been identified as potential barriers of enrollment in cardiac rehabilitation programs. Additional research including patients with HF is needed. The third paper is a report of a cross-sectional study of 279 patients with HF. The aims were to determine 1) the amount of variance in the functional status predicted by depressive symptoms, perceived control, self-rated health, HF self-care maintenance behaviors, and serum N-terminal pro-B-type natriuretic peptide ( NT-pro-BNP) biomarker of cardiac dysfunction in patients with HF and 2) whether NT-pro-BNP mediated the relationship between self-care maintenance behaviors and functional status. Depressive symptoms, poor self-rated health, non-adherence to physical activity, and greater serum NT-pro-BNP levels were independently associated with worse perceptions of functional status. Serum NT-pro-BNP levels partially mediated the association between adherence to physical activity and perception of functional status. The findings from this dissertation provided further evidence of the importance of adherence to physical activity and identify key variables that promote participation in interventions to promote heart healthy lifestyles and adherence to physical activity.

Physical inactivity has become a global health concern and is among the 10 leading causes of death and disability. This has led to increased concern for chronic diseases of lifestyle (CDL). 
Studies have revealed that regular physical activity is effective in combating several CDL such as cardiovascular disease, diabetes, cancer, hypertension and obesity. Physiotherapists are in a 
position to combat inactivity and effectively promote physical activity to their clients. Studies however have shown that participation in physical activity among physiotherapists could have an 
impact on the promotion of physical activity and their health practices. This study therefore sought to establish the relationship between physical activity levels of physiotherapists and their 
physical 
activity promotion strategies and barriers to promoting physical activity. Sequential Mixed Method Design was used in this study. Data was collected by means of a self administered 
questionnaire and a total of 92 physiotherapists voluntarily answered the questionnaire. A focus group discussion comprising of 10 purposively selected physiotherapists was conducted. The 
questionnaire assessed physical activity levels 
and physical activity promoting strategies of the participants while the focus groupdiscussion looked at the barriers to promoting physical 
activity. The Statistical Packages for Social Sciences (SPSS) version 18 was used for data capturing and analysis. Descriptive statistics were employed to summarize demographic information 
as means, standard deviation, frequencies and percentages. Inferential statistics (chi-square) was used to test the associations between different categorical variables (p<
0.05). For the qualitative data, focus group discussions were used to collect data. Tape recorded interviews were transcribed verbatim, field notes typed, sorting and arranging data was done and themes 
 
were generated. Thematic analysis was then done under the generated themes. Ethical issues pertaining to informed consent, anonymity, confidentiality and the right to withdraw from the 
study were respected in this current study. The findings in the current study revealed that a big number of the participants were physical active both at work and recreation domains. However, 
there was no statistically significant association between physical activity and the demographicvariables. The results in this study revealed that the majority of participants were good 
physical activity promoting practices, although there was no significant association between physical activity levels and the physical activity promoting practices. The finding in this study revealed that discussing physical 
activity and giving out information regarding physical activity to their clients were the most common methods used in promoting physical activity. However, participants also highlighted barriers they 
ace in promotion of physical activity such as policies on physical activity, cultural influence, nature of work, time management as well as environmental barriers. The study demonstrates the 
need for all stakeholders to come up with solutions to break the barriers to promotion of physical activity. In return it will bring about enormous health 
benefits to the general population.

Morbidity due to noncommunicable diseases (NCDs) has become a worldwide epidemic. As a result, the United Nations (2015) Sustainable Developmental Goals (SDGs) included goal (3.4) that aims to reduce the premature mortality from NCDs by one third. All countries, regardless of income, are required to develop strategies and achieve a reduction in the burden of NCDs. This study, conducted in the Sultanate of Oman, aimed to explore individuals' knowledge, perceptions, actions and intentions to modify their lifestyle to reduce their risk of stroke. The Health Belief Model (HBM) was used as the underpinning theoretical framework to provide a broader conceptual understanding of the Omani sociocultural and structural influences on individuals' lifestyles. A convergent mixed methods design within a realist social constructionism methodology was used. Both quantitative (344 questionnaires) and qualitative (10 interviews) data were integrated using a narrative weaving approach. The study results confirm that both agency and structure influenced the adoption of healthy behaviours in Oman. The study indicates that the study participants are likely to engage in health-related behaviours when they perceived the benefit of such a course of actions in term of it reducing their risk of stroke. The study found that in the Omani setting, individual factors such as fear, family experience and physical sickness, the psychological status of chronic conditions and a cost-benefit analysis of the behaviour influence the individuals' decisions to practise a healthy lifestyle. The major finding in the study showed that perceptions of risk vary among individuals who share the same culture and religion, particularly individual perception of religious belief was found to influence their susceptibility to stroke risk. In addition, the study identified some sociocultural and structural factors that influenced the individuals' decisions to engage in a healthy lifestyle. This study presents an extended HBM to incorporate the role of individual religious beliefs as an individual factor. The study suggests that health improvement plans are needed in Oman to develop both individual- and community- level interventions to achieve the target of SDGs for NCDs.

Many of the known risk factors associated with low birth weight, such as socio-economic status, ethnicity, genetic makeup, and obstetric history, are not within a women's immediate control. However, there are many things that a woman can do to improve her chances of having a normal healthy child. Lifestyle behaviours, such as cigarette smoking, nutrition and the use of alcohol, play an important role in determining the growth of the fetus. The aim of this study was to establish the knowledge, attitudes and practices related to lifestyle factors such as alcohol use, smoking and nutrition among childbearing women and health care workers on the farms in Stellenbosch and Vredendal.

Résumé : Introduction L’adoption de saines habitudes de vie (SHV) dès le jeune âge constitue une stratégie gagnante contre l’excès de poids (EP). Or, la promotion d’un mode de vie sain auprès des parents visant à les encourager et les soutenir auprès de leur enfant pour qu’ils adoptent de SHV est essentielle. À ce titre, l’infirmière occupe une position privilégiée. En ce sens, elle doit se questionner sur les approches à privilégier. But Mettre en lumière, en partenariat avec des infirmières œuvrant auprès de familles avec jeunes enfants, des pistes de solution afin de soutenir les parents dans l’adoption de SHV pour leurs enfants. Objectifs 1) informer les infirmières en estimant la prévalence de l’EP des jeunes enfants de leur région; 2) décrire les représentations sociales (RS) du poids et des habitudes de vie selon les parents d’un enfant d’âge préscolaire; 3) explorer le point de vue des infirmières concernant des stratégies d’intervention visant à promouvoir les SHV à la lumière des résultats des objectifs précédents et 4) déterminer les priorités parmi les stratégies proposées en collaboration avec des parents, experts et intervenants du réseau de la santé. Méthode Recherche-action en 4 cycles. Chaque cycle correspond à un objectif de l’étude. L’amorce de la réflexion le cycle 1 - Enquête transversale en contexte de vaccination - 259 enfants de 4-5 ans pesés et mesurés. Nourrir la réflexion, le cycle 2 - Entrevues semi-dirigées - 14 parents d’enfants âgés de 4-5 ans de poids normal et en EP. Passer à l’action les cycles 3 et 4, le cycle 3 - Groupe de discussion - 8 infirmières et 2 nutritionnistes et le cycle 4 - En 3 séquences 1) groupe de discussion auprès de parents, 2) questionnaire acheminé par courriel aux experts et 3) groupe de discussion auprès de participantes ayant collaboré au cycle 3. Résultats Cycle 1 - prévalence estimée de 26,3 % d’EP (20,1 % embonpoint - 6.2 % obésité). Cycle 2 - RS du poids, 1) le poids est un enjeu de santé pour les parents d’un enfant de poids normal ou 2) l’apparence potelée s’avère normale pour les parents d’un enfant en EP. RS des habitudes de vie, pour tous les parents il s’agit d’un défi exigeant. Cycle 3 et 4 - Pistes de solution proposées : viser la conscientisation et la sensibilisation des parents fondées sur leur point de vue et celui des intervenants impliqués en se basant sur le développement des aptitudes des personnes (familles) à faire des choix éclairés, l’accessibilité à l’information et la réorientation des services à la communauté. Conclusion L’étude illustre un processus de concertation en regard d’une problématique de santé pour arriver à dégager une action efficace basée sur les besoins du milieu. // Abstract : Introduction Adopting healthy lifestyle habits (HLH) starting at a young age has proven to be successful in preventing overweight (OW). It is therefore vital to present a healthy lifestyle to parents in such a way as to encourage and support them and their young child as they adopt HLH. Nurses are in an ideal position to fulfill this role; to do so, they must find the best possible ways of proving support to parents. Objective In conjunction with the nurses working with the families of young children, highlight possible solutions that will support parents in their efforts to adopt a healthy lifestyle for their children. Goals 1) inform nurses of the prevalence of OW in young children in their region of intervention; 2) describe the social representations of weight and lifestyle, according to the parents of preschool-age child; 3) explore nurses’ opinions on the intervention strategies aimed at promoting HLH, given the results of goals 1 and 2; and 4) in collaboration with parents, experts and members of the health-care system, prioritize the proposed intervention strategies. Method Action research in four phases. Each phase corresponds to a study goal. Phase 1 – Initiate Planning – Cross-sectional survey during preschool vaccination - 259 children aged 4-5 years are weighed and measured. Phase 2 – Planning Continues – Semi-structured interviews - 14 parents of normal-weight and OW children aged 4-5 years. Phases 3 and 4 – From Planning to Action - Phase 3 – Discussion group with 8 nurses and two dieticians and Phase 4 – In three parts 1) discussion group with parents, 2) questionnaire e-mailed to experts, and 3) discussion group with individuals who participated in Phase 3. Results Phase 1 – estimated incidence of OW is 26.3% (20.1% had excess body weight; 6.2% were obese). Phase 2 - Social representations of weight, 1) weight is a health issue for parents of normal-weight children or 2) the chubbiness of OW children seems normal to their parents. Social representations of lifestyle: for all participating parents, this was a difficult challenge. Phase 3 and 4 - Proposed solutions: based on input by the parents’ and nurses involved, devise initiatives aimed at raising parental awareness, and focus on developing the skills that people (i.e., families) need to make informed choices, making information more accessible and redirecting community services. Conclusion The study illustrates a consultation process on a health issue that led to identifying effective action based on community needs.

Background e obiettivi L’intolleranza all’esercizio fisico (ES), la sintomatologia e gli effetti extra-polmonari incrementano il rischio di disabilità, bassa qualità della vita (QoL) e sedentarietà nel paziente affetto da Broncopneumopatia Cronica Ostruttiva (BPCO). In riabilitazione respiratoria l’ES è considerato il principale intervento non farmacologico per incrementare la salute e la capacità di esercizio nei pazienti. Sfortunatamente, si rilevano pochi interventi strutturati di attività fisica (AF). Inoltre, un numero elevato di pazienti declina la partecipazione. Le ragioni di abbandono o non partecipazione sono state poco investigate. Inoltre, esiste un considerevole dibatto riguardo l’efficacia dei diversi modelli applicativi di AF nell’incrementare i parametri salute correlati (PSC) dei pazienti BPCO e il loro impatto sul mantenimento a lungo termine di uno stile di vita attivo. Infine, l’AF quotidiana, i PSC, la forza muscolare e la performance motoria dei pazienti BPCO sono intimamente correlati. Sebbene la disfunzione muscoolare sia presente in tutti i pazienti BPCO, è stato osservato che la contrazione eccentrica (ECC) è più elevata nei BPCO rispetto ai soggetti sani (HC). La maggior parte delle ricerche del settore hanno utilizzato parametri isometrici i concentrici (CON), però poco è conosciuto riguardo all’associazione tra forza ECC e alte velocità di contrazione nei pazienti BPCO. Pertanto gli studi proposti vogliono evidenziare le motivazioni e le barriere che riducono il reclutamento e impediscono a pazienti BPCO di acquisire uno stile di vita attivo. Inoltre, si vogliono verificare le modifiche ai PSC ottenute da due modelli di attività fisica adattata (AFA) specifici per BPCO e il loro impatto nell’acquisizione di uno stile di vita attivo. Infine si vogliono investigate le performance muscolari CON ed ECC degli arti inferiori dei pazienti BPCO a diverse velocità di contrazione. Metodi 1° studio: single-centre, multi-practice, parallel-group trial clinico randomizzato. 269 maschi affetti da BPCO males sono stati sottoposti a screening per individuare 132 pazienti elegibili. I 38 soggetti reclutati hanno compilato il questionario EMI-2. 2° studio: trial longitudinale, randomizzato. Sono state effettuate valutazioni ad inizio (T1), dopo 3 mesi (T2), 6 mesi (T3) and a 3 mesi di follow up (T4). La composizione corporea e il contenuto minerale osseo (BMC) tramite DXA, i parametri motori (6MWT, Leg press, leg extension, chest press e biceps curl 1RM, flessibilità del cingolo scapolo-omerale e della schiena, e l’equilibrio), lo stile di vita (IPAQ e registrazione SenseWear PRO-2) e la QoL (questionario MRF-26) sono stati investigati. 3° stadio: studio osservazionale, caso/controllo, cross over. Misure di architettura muscolare, contrazione CON ed ECC del quadricipite a diverse velocità (30deg/sec, 210 deg/sec), stile di vita e PSC di 35 pazienti con BPCO sono state confrontati con quelli rilevati in 25 soggetti sani di controllo (HC). Risultati 1° studio: la principale causa che impedisce la partecipazione è dovuta al non rispetto dei criteri di inclusione (65.53%). La mancanza di interesse (8.94%), di tempo disponibile (6.81%) e la difficoltà a raggiungere le strutture sportive (1.7%) sono le principali ragioni che inducono il paziente ad abbandonare il programma. Il reclutamento dello studio ha un’aderenza molto elevata (25.7%) in confronto alla letteratura di riferimento, confermato anche dal numero esiguo di drop out (10.52%). Bassi livelli iniziali di motivazione intrinseca da parte dei pazienti con BPCO sono stati rilevati (media 81.69pt ±48.08), sebbene miglioramenti statisticamente significativi si osservino solo nel gruppo FC dopo la partecipazione ad interventi di AF dopo 3 mesi (+43.99%, p<0.05) e 6 mesi (+47.42%, p<0.05). A 3 mesi modificano gli item socio/emotivi (p<0.01), di gestione ponderale (p<0.05) e di piacevolezza (p<0.01), riconfermandosi a 6 mesi (socio/emotivi p<0.01, piacevolezza p<0.05). 2° studio: 7 pazienti abbandono il programma nei 9 mesi. A breve termine, il gruppo FC incrementa significativamente i parametri di %BMC (0.112 ±0.029, p<0.01), Biceps curl 1RM (1.9kg ±0.6, p<0.05), Chest press 1RM (8.1kg ±1.7, p<0.001) ed equilibrio (48.5sec ±14.2, p<0.05). Modificazioni significative si rilevano nel gruppo EDU, i.e. grasso corporeo (-736.4g ±240.0, p<0.05), BMI (-0.332 ±0.106, p<0.05), Leg Extension 1RM (7.2kg ±2.4, p<0.05), Chest Press 1RM (6.1kg±1.7, p<0.05) e mobilità della spalla (2.7cm ±0.7, p<0.01). Il gruppo CG modifica i parametri di BMI (-0.588 ±0.157, p<0.01), grasso corporeo (-1086.4g ±365, p<0.05), and massa totale (-1849.8g ±494.1 p<0.01). A lungo termine, FC modifica significativamente %BMC (0.071 ±0.024 p<0.05), Chest Press 1RM (9.8kg ±2.4, p<0.01), equilibrio (57.0sec±13.3, p<0.01), quantità di attività moderata (1024 ±272, p<0.01), tempo totale in attività sedentaria (-3.3 ±0.7, p<0.01) and MRF-26 (-2.3 ±0.7, p<0.05). Il gruppo EDU riduce la percezione di sforzo al 6MWT (-1.37 ±0.41 p<0.05) e il tempo totale in attività sedentaria (-3.6 ±0.7, p=0.000), aumentando l’attività di cammino (618 ±208, p<0.05) e l’MRF-26 (-2.1 ±0.7, p<0.05). Al termine del follow up, il gruppo FC riduce i parametri di %BMC (-0.069 ±0.020 p<0.05), 6MWT (-48.2 ±14.8, p<0.05), Leg Extension 1RM (-9.3 ±2.8, p<0.05), Chest Press 1RM (-11.6 ±2.1, p=0.000), flessibilità del busto (-3.8 ±0.9, p<0.01) ed equilibrio (-21.0 ±7 p<0.05). Il gruppo EDU group riduce i parametri di Leg Press 1RM (-32.6 ±9.1, p<0.05), Leg Extension 1RM (-10+5 ±1.9, p<0.001), Chest Press 1RM (-14.3 ±1.3, p=0.000), flessibilità del cingolo scapolo-omerale (-4.3 ±1.3, p<0.05), tempo totale in attività sedentaria (-3.5 ±0.9, p<0.01) and MRF-26 (-2.9 ±0.8, p<0.05). anche il gruppo CG dimostra riduzioni al Chest Press 1RM (-10.9 ±2.6, p<0.01). Nessuna modificazione è stata osservata con il SenseWear PRO-2. 3° studio: I soggetti del gruppo HC presentano valori più elevati in termini di capacità d’esercizio, i.e. 6MWT (p<0.001) e 1RM alla Leg Press (p<0.05), rispetto ai pazienti BPCO. Solo il torque CON a 30deg/s è più elevato nei soggetti HC rispetto ai BPCO (p<0.05). Nessuna differenza statisticamente significativa è stata rilevata tra i gruppi per i parametri di architettura muscolare, torque CON a 210 deg/sec e nei toque ECC. Differenze significative si evidenziano nel rapporto tra torque ECC e CON (30 deg/sec p<0.001; 210 deg/sec p<0.01). Correlazioni significative sono state osservate tra FEV1 e 6MWT (0.719 p<0.001), 1RM Leg Press (0.449 p<0.001), torque a 30 deg/sec (0.427 p<0.01; 0.280 p<0.05), a 210 deg/sec (0.285 p<0.05; 0.276 p<0.05) and rapporto ECC/CON di torque ad entrambe le velocità (-0.562 p<0.001; -0.292 p<0.05). Le medesime osservazioni sono state rilevate tra FEV1/FVC e i parametri investigati. Conclusioni La principale barriera è rappresentata dai criteri di inclusione. La pratica di reclutamento effettuata da un singolo specialista sembra essere la più efficace. La supervisione dello specialista in AFA e l’aumento della collaborazione tra clinici e specialisti AFA potrebbe incrementare la partecipazione dei pazienti BPCO. Semplici modelli applicativi di AFA possono risultano efficaci ad incrementare sia la motivazione all’ES e sia alcuni dei PSC specifici per BPCO. Questi miglioramenti sembrano essere apportati prevalentemente dai “well rounded program”. Il supporto dello specialista APA risulta necessario per poter mantenere a lungo termine i guadagni ottenuti con l’ES. Invece, i miglioramenti di capacità funzionale non sembrano modificare lo stile di vita. Sebbene i pazienti BPCO siano caratterizzati da basse performance dei PSC, ridotta capacità di contrazione CON e stile di vita inattivo rispetto ai soggetti HC, sembrano preservare la contrazione ECC e il torque nelle contrazioni ad alta velocità. Ulteriori ricerche sembrano essere necessarie.
Background and aims Exercise intolerance, symptoms and extra-pulmonary effects may increase patients disabilities, affecting quality of life (QoL) and reducing maintenance of an active lifestyle. Exercise training (ExT) is considered the most effective non-pharmacological intervention to improve COPD patients health and exercise capacity. Unfortunately, there are few available health-care structured programs of physical activity (PA) and a considerable proportion of eligible patients decline participation or drop out. Reasons for decline and drop-out from ExT programs have seldom been investigated. Moreover, a considerable debate continues about what kind of model of PA and ExT intervention is more effective to improve COPD patients’ health related parameters (HRQL), and to maintain long-term active lifestyle. Finally, evidences support notions that daily physical activity (DPA), HRQL, muscle strength and performance are likely intimately interlinked. Although, muscle wasting is common in COPD patients across all disease stages, it has been observed that eccentric contraction (ECC) results greater compared to healthy control subjects. Majority of COPD leg muscle function’s research has used isometric or concentric (CON) quadriceps torque, but there is lack of knowledge about associa¬tion between ECC muscle strength and fast-velocity muscle contractions in COPD patients. Therefore, we would to outline motivation and barriers which reduced COPD patients recruitment in ExT program and hindered an active lifestyle acquisition. Secondly, it would be verify short and long-term modifications of several HRQL provided by two different and easily applied-field models of adapted fitness activity (APA) for COPD patients to evaluate long-term active-lifestyle maintenance. Finally, we would to investigate COPD patients lower limb strength performances as a function of contraction modalities and velocities comparing with healthy control (HC). Methods Fist study: single-centre, multi-practice, randomized, parallel-group clinical trial. 269 COPD males were screened to establish 132 eligible patients. 38 recruited COPD patients were administrated by EMI-2 questionnaire. Recruitment steps were recorded in order to assess patients’ motivation of decline or drop out. Second study: longitudinal randomized controlled trial, in which baseline (T1), 3 months (T2), 6 months (T3) and 3 months of follow up (T4) evaluations were performed. Body composition and bone mass content, i.e. BMC (DXA scanner), functional health-related (6MWT, Leg press, leg extension, chest press and biceps curl 1RM, shoulder and lower back flexibility and balance), lifestyle (IPAQ questionnaire and SenseWear PRO-2 assessment) and quality of life (MRF-26 questionnaire) parameters were administrated. 38 COPD patients were randomized and assigned to one of the three evaluation groups: Fitness Center based group (FC=13), Educational PA group (EDU=12) and Control group (CG=13). Third study: case/control research, cross over and observational trial. Architectural muscle measurements, CON and ECC quadriceps contractions at different velocities (30deg/sec, 210 deg/sec), lifestyle and health-related parameters of COPD patients (N=35) and HC (N=25) subjects were recorded. Results First study: major cause of not-participation was mismatched inclusion criteria (65.53%). No-interest in exercise training (8.94%), lack of available time (6.81%) and inability to access at the PA structures (1.7%) were most commonly cited reasons to drop out. Recruitment showed higher adherence (25.7%) compared to literature, also confirmed by lower number of drop out (10.52%). Low score of intrinsic motivation towards PA were recorded (mean 81.69pt ±48.08) and significant improvements in EMI-2 were observed after 3 months (+43.99%, p<0.05) and 6 months of ExT (+47.42%, p<0.05) by FC group. Significant increases in Socio/Emotional (p<0.01), Weight management (p<0.05) and Enjoyment items (p<0.01) were recorded after 3 months. Socio/Emotional aspects (p<0.01) and Enjoyment items (p<0.05) improved after 6 months. Second study: 7 patients dropped out. At short term, FC group shows significant improvement in %BMC (0.112 ±0.029, p<0.01), Biceps curl 1RM (1.9kg ±0.6, p<0.05), Chest press 1RM (8.1kg ±1.7, p<0.001) and Balance test (48.5sec ±14.2, p<0.05). EDU group shows significant modification in Fat (-736.4g ±240.0, p<0.05), BMI (-0.332 ±0.106, p<0.05), Leg Extension 1RM (7.2kg ±2.4, p<0.05), Chest Press 1RM (6.1kg±1.7, p<0.05) and Shoulder flexibility (2.7cm ±0.7, p<0.01). The CG group shows significant differences in BMI (-0.588 ±0.157, p<0.01), Fat (-1086.4g ±365, p<0.05), and Total Body Mass (-1849.8g ±494.1 p<0.01). At long-term, FC modified significantly %BMC (0.071 ±0.024 p<0.05), Chest Press 1RM (9.8kg ±2.4, p<0.01), Balance (57.0sec±13.3, p<0.01), IPAQ moderate activity (1024 ±272, p<0.01), IPAQ sedentary hours (-3.3 ±0.7, p<0.01) and MRF-26 (-2.3 ±0.7, p<0.05). EDU group recorded modifications in 6MWT Borg scale (-1.37 ±0.41 p<0.05), IPAQ walking activity (618 ±208, p<0.05), IPAQ sedentary hours (-3.6 ±0.7, p=0.000) and MRF-26 (-2.1 ±0.7, p<0.05). CG group did not shows significant differences. At follow up, FC shows significant changes in %BMC (-0.069 ±0.020 p<0.05), 6MWD (-48.2 ±14.8, p<0.05), Leg Extension 1RM (-9.3 ±2.8, p<0.05), Chest Press 1RM (-11.6 ±2.1, p=0.000), Sit & Reach (-3.8 ±0.9, p<0.01), Balance (-21.0 ±7 p<0.05). EDU group shows significant modification in 6MWT Borg score (-1.36 ±0.41 p<0.05), Leg Press 1RM (-32.6 ±9.1, p<0.05), Leg Extension 1RM (-10+5 ±1.9, p<0.001), Chest Press 1RM (-14.3 ±1.3, p=0.000), Back Scratch (-4.3 ±1.3, p<0.05), IPAQ sedentary hours (-3.5 ±0.9, p<0.01) and MRF-26 (-2.9 ±0.8, p<0.05). CG group shows significant difference in Chest Press 1RM (-10.9 ±2.6, p<0.01). No significant modification were observed in SenseWear PRO-2 administration. Third study: HC subjects were significantly different in exercise capacity, i.e. 6MWT (p<0.001) and 1RM Leg Press (p<0.05), than COPD patients. Only CON 30deg/s peak torque was significantly higher in HC compared to COPD (p<0.05). No differences in muscle architecture, fast CON and/or e ECC torque were observed between groups. Significant differences were found between groups in ECC/CON torque ratio (30 deg/sec p<0.001; 210 deg/sec p<0.01). Finally, significant correlations were found between FEV1 and 6MWT (0.719 p<0.001), 1RM Leg Press (0.449 p<0.001), peak torque contraction at 30 deg/sec (0.427 p<0.01; 0.280 p<0.05), at 210 deg/sec (0.285 p<0.05; 0.276 p<0.05) and ECC/CON peak torque ratio at both velocities (-0.562 p<0.001; -0.292 p<0.05). Same results were observed between FEV1/FVC and parameters assessed. Conclusions Recruit COPD patients becomes very challenging. Cause of not-participation was related to mismatched inclusion criteria. Great effort practice of recruitment, managed by only one person, seems to be more effective. Supervision of ExT specialist and incresed level of liaison between specialist physicians and healthcare professionals could be useful to increase participation. An easily applied-field models of COPD specific APA training could be efficient in order to improve some of COPD-specific HRQL. These improvements seem to be better provide by a “well rounded” APA program. APA exercise specialist support is necessary to maintain long-term significant health’s gains. Whereas, improvement in functional exercise capacity does not automatically turn into a more active lifestyle. COPD patients are characterized by lower health related parameters and lifestyle. Also COPD performed lower CON contraction compared to HC. COPD preserved ECC contractions and fast concentric torque. We hypothesize that COPD males develop a favorable profile to minimize strength loss likely due to neural-muscular modification. Further studies are aimed.

Doctoral Thesis in Child Studies (Specialty in Child Health)
Objective: The general purpose of this research work was to create an educational health promotion model, called “Planning Health in School” programme (PHS-pro), and evaluate its effect among school grade-6 children. This PHS-pro was developed aiming to fill the lack of preventive programmes in Portugal and find effective strategies to reduce obesity rates in Portuguese children. The PHS-pro was designed based on the Transtheoretical Model of Change and integrated eight learning modules to guide children towards healthy eating and active living. The following five specific research goals to evaluate the PHS-pro were the core of this research: 1) effectiveness on children’s nutritional status, eating and physical activity habits and knowledge; 2) changes in eating behaviours throughout learning modules; 3) longterm effects on a pair of twins; 4) economic costs of programme’s implementation; 5) process evaluation from the participants’ views. Methods: To evaluate the effectiveness of the PHS-pro, a non-randomized control group pretest-posttest study was conducted. A total of 449 children of four elementary schools of a Portuguese Municipality were enrolled and divided into two groups, intervention group (IG) and control group (CG). The PHS-pro was applied to the IG. Anthropometric measurements were performed, and eating habits, physical activity and food basic knowledge data collected before and after the programme implementation. To study how children changed their eating behaviours over the PHS-pro intervention, a repeated time-series design was carried out using food records and attitudes, preferences and expectations were analysed through participatory activities. It was also evaluated the PHS-pro impact on a pair of obese twins carried out in three evaluation moments (baseline, after PHS-pro and 12 months later) by analysing: the nutritional status assessed by the anthropometric measurements; food records and questionnaire answers collected eating behaviours and physical activity. To estimate the costs of the PHS-pro implementation, a standard economic evaluation was conducted and the results compared with the direct costs of treating obese adults in Portugal. To evaluate the overall programme implementation, a process evaluation was undertaken regarding children and teachers’ views obtained by questionnaires and focus group. A SWOT analysis was also performed. Results: The PHS-pro was effective in improving anthropometric outcomes leading to a better children nutritional status and healthier lifestyle behaviours. In fact, the IG showed significant reductions in waist circumference and waist-to-height ratio followed by an increased height compared with the CG. Furthermore, fruit and vegetables daily intakes increased, and soft drink consumption significantly decreased in IG children compared with CG. Also, physical activity time increased significantly in IG, while it decreased significantly in the CG. Substantial changes were found on eating behaviours throughout the eight learning modules programme, supported by children’s new attitudes and expectations. Significant changes were observed with higher consumption of vegetable soup, milk products and fruit, while high-energy dense food, and soft drink consumption significantly decreased. No positive healthy effects were found on the consumption of fried food, water, vegetables and bread. The case study conducted with the twins, who were considered obese according to Cole and collaborators’ standards before the PHS-pro onset, showed that at the end of the PHS-pro they improved their attitudes, behaviours and anthropometric parameters; results also showed that while the boy remained in the obese category, the girl moved from the obese to the overweight one. Furthermore, at follow-up time (12 months after PHS-pro ended), although there was a slight increase in the anthropometric parameters in both twins, none of them returned to their baseline values, and the girl kept her nutritional status in the overweight category. Therefore, PHS-pro promoted positive changes on twins and had at least one-year long-term effect. Regarding the PHS-pro costs, the cost-benefit analysis showed to be a cost saving programme, being a beneficial investment to prevent childhood obesity. The PHS-pro costs were estimated as 36.14€/child per school year, which is much lower than treating one obese adult in Portugal (3849.15€/year; Ribeiro 2010). Moreover, scaling up the programme to a larger population, it allows to lower the intervention costs to 18.18€/child, which is even more economically feasible. The overall intervention had good acceptance and compliance regarding its educational components, with a high participation rate which achieved the entire sample. Teachers confirmed children’s views and were very enthusiastic about extending the PHS-pro to other school grades. Conclusion: The behavioural-change model used in PHS-pro revealed to be an appropriate methodology to prevent the rise of childhood overweigh and obesity. Anthropometric measures, eating behaviours, physical activity, attitudes and knowledge towards a healthy lifestyle improved. However, such programme model, implemented as a sole effort during a one school year does not change health behaviours endlessly, thus a long-term implementation of PHS-pro should be ensured. To conclude, this research demonstrated that the PHS-pro methodological approach and its strategies are promising for promoting healthy behaviours among children, contributing to prevent obesity.
Objetivo: Esta investigação teve como objetivo principal criar um modelo educativo para a promoção da saúde, denominado programa “Planear Saúde na Escola” (PSE), e avaliar os seus efeitos em crianças do 6º ano de escolaridade. O PSE procurou desenvolver estratégias eficazes para diminuir a prevalência da obesidade infantil e contribuir para o desenvolvimento de programas de prevenção em Portugal. Este programa foi desenvolvido com base no Modelo Transteórico de Mudança de Comportamento e integrou oito módulos educativos para orientar as crianças na adoção de hábitos alimentares saudáveis e um estilo de vida ativa. Na avaliação do PSE estabeleceram-se cinco objetivos específicos: 1) avaliação da eficácia sobre o estado nutricional das crianças, seus hábitos alimentares, atividade física e conhecimentos sobre alimentação; 2) avaliação das alterações ocorridas no comportamento alimentar ao longo dos módulos educativos; 3) avaliação dos efeitos a longo-prazo em dois gémeos obesos; 4) avaliação dos custos de implementação do programa; 5) avaliação do processo de implementação pelas perspectivas dos participantes. Métodos: Para avaliar a eficácia do PSE realizou-se um estudo baseado no modelo préteste/ pós-teste com grupo de controlo não aleatório. Participaram 449 crianças das quatro escolas EB 2/3 de um Município Português, distribuídas em dois grupos: grupo de intervenção (GI) e grupo de controlo (GC). A implementação do PSE realizou-se no GI. Os parâmetros antropométricos, os hábitos alimentares, a atividade física e os conhecimentos sobre alimentação foram obtidos antes e depois do PSE. As alterações no comportamento alimentar das crianças ao longo do PSE foram avaliadas através de um estudo de séries temporais com a aplicação de diários alimentares. Também foram analisadas as atitudes, as preferências e as expectativas sobre a alimentação saudável com atividades participativas. O impacto do PSE nos gémeos obesos foi avaliado em três momentos (antes do PSE, no pós PSE e doze meses depois) analisando: o estado nutricional por avaliação antropométrica e os dados do comportamento alimentar e da atividade física, através de diários alimentares e questionários. A avaliação dos custos do PSE, foi realizada com uma análise económica convencional e os resultados comparados com os custos diretos do tratamento da obesidade em Portugal. Para avaliar a implementação do programa, recolheram-se as perspectivas dos participantes através de questionários, por um grupo focal e uma análise SWOT. Resultados: O PSE mostrou-se eficaz na melhoria das medidas antropométricas das crianças e dos seus comportamentos. O GI apresentou uma redução significativa no perímetro da cintura, na razão cintura-estatura, acompanhadas por um aumento significativo da estatura, comparativamente com o GC. Também a ingestão diária de fruta e vegetais aumentou significativamente e o consumo de refrigerantes diminui no GI comparativamente com o GC. O tempo dedicado à atividade física aumentou significativamente no GI, enquanto no GC diminuiu significativamente. Encontraram-se alterações substanciais nos comportamentos alimentares durante os módulos educativos, apoiadas por novas atitudes e expectativas das crianças; observou-se um consumo significativamente superior de sopa de legumes, produtos lácteos e fruta, enquanto o consumo de produtos de elevada densidade energética e refrigerantes diminuíram significativamente. Não houve efeitos positivos no consumo de fritos, água, produtos hortícolas e pão. O estudo dos gémeos considerados obesos (Cole,2000) antes do PSE, mostrou melhorias nas atitudes, comportamentos e parâmetros antropométricos no pós PSE; o rapaz manteve-se na categoria de obeso, a rapariga passou da categoria de obesa para excesso de peso. Doze meses depois, os parâmetros antropométricos dos gémeos sofreram um ligeiro aumento, mas não voltaram a valores próximos dos registados antes do PSE e a gémea continuou na categoria excesso de peso. Portanto, o PSE promoveu alterações positivas nos gémeos e o efeito prolongou-se até um ano depois do seu término. Sobre os custos do PSE, a análise custo-beneficio sugere ser um programa económico e um investimento para prevenir a obesidade infantil. O custo estimado de 36.14€/criança por ano escolar, um valor muito reduzido relativamente a tratar um adulto obeso em Portugal (3849.15€/ano; Ribeiro 2010). Além disso, ao implementar o programa a uma população maior, o efeito de escala permite baixar os custos para 18.18€/criança, tornando-se ainda mais viável. A intervenção obteve boa aceitação e adesão quanto aos componentes educacionais e alcançou um índice elevado de participação. Os professores validaram as perspectivas das crianças sobre o PSE e mostraram-se entusiasmados quanto à sua ampliação a outros anos lectivos. Conclusão: O modelo de mudança de comportamentos utilizado no PSE revelou-se uma metodologia adequada para prevenir a obesidade infantil. Os parâmetros antropométricos, os comportamentos alimentares e a atividade física, as atitudes e os conhecimentos melhoraram. No entanto, este modelo aplicado apenas num ano escolar, não modifica comportamentos de modo permanente, e a implementação a longo prazo deve ser assegurada. Para concluir, a abordagem metodológica do PSE e suas estratégias demonstraram ser promissoras na promoção de comportamentos saudáveis, contribuindo para a prevenção da obesidade infantil.
According to the Art 15 of the FCT Regulation for advance training, this research received financial support by granting the scholarship SFRH/BD/79512/2011.

The present project derives from insurers paradigm shift from reactors to preventers, with the purpose of discouraging sedentarism and stimulate healthy and active routines on its clients. This work project focus on Gen Xers and Millennials’ physical exercise habits, preferences, objectives and barriers. In order to address this challenge, the work project contains several analysis comprehending the internal and external context, and culminates on a set of recommendations to answer the project’s ultimat objective, whilst guaranteeing strategic fit with the insurer.

Lifestyle-related diseases can reduce their risk by improving their lives. Therefore, various efforts are being made, such as health education, to prevent lifestyle-related diseases. However, lifestyles are complicated and their prevention is not easy. Local residents who are active in health promotion are often working to improve their lifestyles. It is possible for residents to have excessive expectations for disease prevention simply by changing their lifestyles, paying attention only to the limited aspects of their lifestyles. However, if you pay attention to only one point and lack consideration for the whole, you cannot always expect the effect of lifestyle-related improvement. Therefore, it is necessary to understand how the subject perceives his/her lifestyle. This is also important for continued intervention. In addition, it is necessary to examine how health consciousness is related to the parameters of lifestyle-related diseases in such a health-conscious group. In this chapter, we would like to discuss the previously reported reports on the awareness of local residents regarding the prevention of lifestyle-related diseases, the need for health counseling, and issues in future efforts.

This chapter focuses on the association between the proximity of a physical environment suitable for recreation and physical activity, which is a public health priority in communities. After the COVID-19 lockdown, tourism destinations experienced an increased number of visitors who showed the need for physical activity. To ensure the health of visitors and promote physical activity, destinations try to provide safe infrastructure and distribute recreation load in time and space by managing visitor flow. With the newly imposed health standards, it is essential to identify overcrowding for eventual visitor management interventions by spatial planning or other regulation; thus, a pilot measurement of recreation load was carried out to compare the differences between weekday and weekend physical activity on a chosen location in tourism destination. The findings represent a basis for actions of visitor management with the aim to accommodate the recreation needs of locals and other visitors.

The introduction of new technologies into childrenʼs daily routines is in many cases associated with negative health impacts. However, technology may also be used to promote healthy practices by way of so-called serious games. Several studies have confirmed that the use of such tools can result in significant health gains, the adoption of healthy eating habits, the practice of an active lifestyle, increased energy expenditure and decreased adiposity. In this context, the authors report a case study that portrays the process of designing and developing an interactive digital mobile game, designed to motivate children to adopt exercise and healthy eating habits. The player interacts with the game through health metrics, the evolution of the main character, notifications/messages about healthy foods and exercise, and virtual and real-life rewards. The development of a health promotion game is not a simple task and requires a multidisciplinary team.

The introduction of new technologies into children's daily routines is in many cases associated with negative health impacts. However, technology may also be used to promote healthy practices by way of so-called serious games. Several studies have confirmed that the use of such tools can result in significant health gains, the adoption of healthy eating habits, the practice of an active lifestyle, increased energy expenditure and decreased adiposity. In this context, the authors report a case study that portrays the process of designing and developing an interactive digital mobile game, designed to motivate children to adopt exercise and healthy eating habits. The player interacts with the game through health metrics, the evolution of the main character, notifications/messages about healthy foods and exercise, and virtual and real-life rewards. The development of a health promotion game is not a simple task and requires a multidisciplinary team.

Sedentary behavior (SB) is one of the common leading modifiable risk factor for cardiovascular (CV) morbidity and all-cause mortality. However, not much is known concerning the relationship between SB and CV risk factors. This chapter aimed to explore the scientific knowledge that examines the association between SB and CV risk factors and its association with the development of CVD. Besides, the focus on preventing the SB by avoiding prolonged sitting and breaking-up the extended periods of sitting, and participating in physical activity (PA) are usually highlighted in this chapter, explaining how these intervention protocols can reduce the burden of CVD due to SB. Regardless of the known benefits of both PA and taking frequent breaks when engaging in sedentary tasks, the adaptation of a physically active lifestyle has remained very low because of various reasons; habitual behavior, insufficient or lack of time, misconceptions of CVD related health benefits from PA. Thus, it is very important to break these barriers associated with PA and encourage the physically inactive population, especially those who practice prolonged sitting to actively participate in PA and break the prolonged sitting time with regular interval breaks. Therefore, promotion of PA and limiting the sedentary tasks which would lead to improved levels of cardiorespiratory fitness (CRF) and better quality of living is necessary among all age groups, gender and ethnicities to prevent many chronic illnesses, specifically CVD and its associated risks related to SB.

Financial technology (FinTech) is new innovation to create a better financial ecosystem for both consumers and business. The research proposes a modeling framework on how to connect public and business to promote social work activities and at the same time financially reward through a FinTech as a platform. The study deployed a mixed methods to assess public perspectives on FinTech's ecosystem in promoting a healthy lifestyle. It is expected to encourage people who are physically active to participate in raising funds for social work activities and at the same time generate income for the participants. The ecosystem provides people more meaning to collect their distance in kilometers by either walking, running, or cycling that will impact physically, socially, and financially to promote a healthy society.

The moderate and periodic practice of physical exercise promotes cell protection against viral infection due the balance between cellular immune response, determined directly by T lymphocytes, and humoral cells in which specific antibodies participate, produced by mature B lymphocytes. The countries members of the United Nations Organization (UNO) approved the Aging International Action Plan (AIAP) where are proposed strategies to support the prevention of mental disorders, the treatment of aged illness, as well the strengthening of a care network and support to aged people with the participation of the family, volunteers, and community. Following the UNO tendency, Campos dos Goytacazes/RJ governance started the 60+ health project developed by the superintendence of the Elderly's Rights under to the active and healthy aging for promotion of an active lifestyle to aged population. Given the above, the study goal was to verify the effectiveness of physical exercises proposed virtually on the individual lifestyle of aged people. 458 individuals of both sexes, with age above 60 years were introduced in the study. 356 aged people participated in the physical exercises program, and 102 non-participated in the virtual activities. As a data collection device was used the Individual lifestyle profile questionnaire known as wellness pentacle, a conceptual basis for the evaluation of lifestyle of individuals or groups. Videos with physical exercises proposed were uploading to the Youtube platform, and also directly sent to aged people on social isolation imposed by COVID-19, from app messages. In front of the found results, it is possible to claim that the practice of physical activity with online guidance and prescription impacted positively in the aged people's quality of life inserted on 60+ health project making evident the importance of physical activity practice during the COVID-19 pandemic.

The paper is produced based on the authors’ research “Assessment of the Introduction of the Rural Development Programme 2007–2013 Activity “Local Development Strategy” by the Partnership of Rezekne District Communities and Proposals for its Further Development”. Research on the activity of local action groups (LAGs) and their influence on the overall development of regional territories became urgent in recent years, given the implementation of the European programme LEADER. The research object of the paper is a LAG – the Partnership of Rezekne District Communities – that is located in Latvia, Latgale region. The research aim is to assess the strategy of the local action group. The research employed the monographic and descriptive methods as well as analysis, synthesis, the graphic method, data grouping and a sociological research method – a questionnaire survey. A survey of project submitters identified three major fields in which it is planned to submit and implement projects in the next programming period in the LAG’s territory. They are: promotion of active recreation and sports; reconstruction of the territory; and organisation of and contribution to cultural events. The surveyed residents agreed with the following assertions regarding their lifestyle: an enhanced surrounding environment and natural, cultural and other significant historical objects foster tourism; the establishment and functioning of youth centres contribute to useful spending of leisure time by youths and their communication; the availability of sport and fitness equipment and of sports grounds increases local residents’ interest and wish to practise a healthy and physically active lifestyle. Based on the data acquired and the interpretation of findings, proposals were made for the further development of the territory as well as the research methodology was explained for the purpose of carrying out analogues research studies in the future.

This text presents one of the steps in the dissemination process of the ‘HEPAS’ project in the Czech Republic. HEPAS (Healthy and Physically Active Schools in Europe) was funded under the Erasmus+ Programme, Key Action 2: Strategic Partnerships led by the University of Luxembourg. HEPAS Associated Partners (according to the service agreement) was to perform the activities specified in the agreement to successfully promote and implement the project results in their respective country. In the Czech Republic, the Czech Society of PE Teachers (CSPET) was the HEPAS associated partner. The objective of this paper is to point out an unpublished report elaborated by the HEPAS project team and use the data to consider the specifics of the Czech curriculum currently being revised. The report brought evidence from the last ten years of the contributions of schoolbased physical activity, physical education, and school sport on the promotion of healthenhancing physical activity. The study used a 'rapid reviewing' method, in which sources were identified and analysed using systematic reviewing techniques, but subsequent stages were adapted to facilitate flexible and practical interpretation. The authors used the results to discuss the plausibility of introducing an 'Active Schools' concept in the Czech curricula, in which physical education lessons designed to equip students with the prerequisite knowledge, skills, attitudes, and values supportive of a physically active lifestyle are augmented by other school-based contexts which provide the opportunity to meet the recommended guidelines for physical activity participation.

As urbanization progresses in China's rural areas, so do the severity of social issues, including the decline of social assets, the recession of agricultural industries, the lack of community cohesion, and a weak sense of belonging. A decline in cultural awareness is the reason behind such phenomena, which stems from changes to residents' lifestyles and a lack of cultural beliefs. This issue also results in insufficient cultural awareness, weak cultural inheritance, and neglect of cultural values among community residents. To this end, this paper aims to examine an educational model to enhance the cultural awareness of local community residents.At present, there are two types of education methods to enhance cultural awareness: passive types and active types. For example, passive education refers to the enhancement of participants’ cultural qualities through the problem-solving style lesson and ‘implicit’ curriculum, while an active education might use reflective writing or PD to promote cultural awareness. Of the two, active education, represented by PD, is more conducive to participants' acceptance of cultural knowledge. PD is also an effective method for developing humanitarianism in developing countries. It can be applied to the special scenario of rural communities in China as a new solution for raising the cultural awareness of residents. This paper shares a specific case study of enhancing residents' cultural awareness in community collective memory using participatory game design.A total of eight subjects were selected in this study. Since children are the future of the community's cultural development, the subjects included 6 children and 2 adults. Unlike traditional PD, this study focused on attracting the interests of subjects and enhancing their abilities to inherit traditional culture through participatory game design. The study consisted of three workshops: the cultural exploration workshop, the game design workshop, and the game testing workshop. Activity theory was used as a basis to guide the choice of time, location, and power dynamics, from which a framework of participatory activities covering the four approaches of "probing", "telling", "acting", and "making" was developed for the workshops. To further enhance collaboration, participants were also provided with a complete set of toolkits during the three workshops, including role-playing tools, game idea cards, house of cards, scaffolding, etc. At the end of each workshop, the Cultural Awareness Scale, which contains the three elements of cultural cognition, cultural heritage, and cultural values, was administered to measure the change in cultural awareness of the subjects. A mixed methods approach was used in analysis to uncover underlying cultural associations. The study qualitatively analyzed the transcribed spoken words and behaviors of the subjects using multimodal analysis, and quantitatively analyzed the variations in the word count of the text and the level of detail in the elaboration. In summary, this case study is important for examining cultural education models and improving the cultural awareness of the population. It also provides a framework of activities for participatory design workshops, which can serve as a reference for further research.

This contribution describes the final part of the development process of PLEINAIR (Free and Inclusive Parks in Networks for Recreational and Physical Intergenerational Activity), a two-years multidisciplinary research project financed by the POR FESR 2014-2020 program regulated by Emilia Romagna Region in Italy.The PLEINAIR project aims to develop a smart outdoor park, specifically designed for encouraging positive socio-recreational interactions among different generations and for promoting the adoption of active lifestyles for all and at any stage of their life.This is because, according to WHO, sedentary lifestyle is increasing worldwide and it risks to produce more cardiovascular diseases compared to the past, but also because most of the urban parks nowadays are composed of arbitrary and selective areas that do not stimulate interaction between different generations.The purpose of PLEINAIR is to provide real solutions through operational products called OSOs (Outdoor Smart Objects). Monitoring a series of parameters ­– through an IoMT (Internet of Medical Things) infrastructure – related to people’s motor or ludic activities, the OSOs aim to find the most suitable and customizable motivational strategies to stimulate a positive health lifestyle for any user at any age.PLEINAIR is based on a Human-Centered Design approach and it utilizes participative Co-Design techniques to discover and satisfy the real needs of people.Due to the COVID-19, the first part of the needs analysis was conducted remotely. Despite there were no chances to interact with users in person, the on-line activities collected many insights to develop the early concepts of the OSOs.When the Italians lockdown restrictions in public education were temporally less severe, two Co-Design workshops were organized involving two schools in Province of Bologna, Italy, to collaboratively validate and refine the concept ideas with young users.Considering this, the paper describes two Co-Design activities performed in both schools.The first workshop collaborated with an elementary school and it was divided in two parts: the first stage collected the children’s and expectations about the OSOs’ early concepts through a visual questionnaire; the second stage used free drawing to collect children’s ideas, dreams and expectations about their personal concepts of PLEINAIR outdoor park.The second workshop involved an high school and it was divided in three main round tables, each one focused on a specific aspect of the PLAINAIR IoTM system: the first table co-designed the graphical interface and the navigation system of PLAINAIR application; the second table co-designed and co-validated the motivational strategies that the app uses to encourage people to improve their health conditions; the third table co-designed digital and analogic interactions for dialoguing with the OSOs. The activities were based on an open debate and free drawing session because they let young users free to express themselves around the three themes of the workshop. The final results produced qualitative data that were difficult to collect during the remote activities and they were used, as guidelines, to improve many aspects of the User Experience of the PLEINAIR IoTM system.

An important factor that positively influences people's health is regular exercise. Because of their repetitiveness, however, they can be considered boring, a fact that is discouraging for some practitioners. Serious games have been introduced as a solution to the problem of physical inactivity that is said to be partly caused by traditional video games and have become increasingly popular due to the emergence of consoles such as Nintendo Wii, Xbox One or Playstation that use gesture interaction interfaces. In this new method, traditional games are combined with user-generated moves that help achieve the goals of the game. This paper explores the use of computer games for both improving physical mobility of user and promoting a healthy life style. We describe two different type of exergames developed especially for elderly people. These games aim to motivate users to make exercise at home and does not require medical knowledge. The users will have to make a series of movements in front of a sensor, which will influence the action that an avatar will do in the scene where the game takes place. The first one is composed by two avatars: the avatar of a trainer and the user avatar. The user must reproduce the trainer movements. The user movements are mapped on his avatar and the user can see how he is performing the exercises. The second type of exergame places the user into a scene where he can make different actions, eg. running, picking objects. These actions are made based on the users' movements. In both cases users' movements are captured using the Kinect one sensor. Type of movements are selected based on user profile: age, preferences and medical condition. We evaluate both type of exergames on users of different ages and different medical conditions. In both cases the exergames aim to encourage people to lead an active lifestyle, combining the amusement and the pleasure to play with the benefits of performing specific physical exercises.

Purpose: Bodybuilding becomes more visible and acceptable within mainstream society thanks to social media, which is promoting, and developing grooving interest in bodies, fit-ness and active lifestyle. However, this is concerning knowing that according to the latest world anti-doping agency report bodybuilding is one of two sports with the highest number of Anti-Doping Rule Violations (ADRVs) committed by athletes. This study aimed to evaluate doping attitudes and correlates of doping attitudes in top level body builders. Methods: Study included 26 competitive bodybuilders form Croatia. Variables were collect-ed by a previously validated Questionnaire of Substance Use (QSU). Statistical procedures included means and standard deviations (for parametric variables), frequencies and percent-ages (for ordinal and nominal variables). Spearman’s correlations were calculated to deter-mine associations between studied variables. Results: The most positive attitudes are found towards injectable anabolic steroids (mean ± standard deviation; 4.00 ± 1.52), followed by fat burners (3.73 ± 1.46), growth hormone (3.69 ± 1.64), and estrogen blockers (3.60 ± 1.22), oral anabolic steroids (3.58 ± 1.27). Sig-nificant correlation was identified between: (i) result achieved in bodybuilding (RBB) and alcohol consumption, (R= -0.57 p < 0.05) (ii) RBB and subjective knowledge on nutrition (R=0.66, p < 0.05), (iii) RBB and subjective knowledge on doping (R=0.72, p < 0.05). Conclusion: The lack of correlation between self-perceived competence and objectively eval-uated knowledge on nutrition is alarming due to the possible “anchoring effect”, accordingly even though objective knowledge is not correlated with attitudes towards doping substances, it is important to properly educate athletes who are in the misconception of their true knowl-edge.