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Purpose: To examine the utility of the theory of planned behavior (TPB) for explaining physical activity (PA) intention and behavior among a large population sample of overweight and obese adolescents (Alberta, Canada), using a web-based survey. Secondary objectives were to examine the mediating effects of the TPB constructs and moderating effects of weight status. Methods: A subsample of 427 overweight and 133 obese participants ("n" = 560), completed a self-administered web-based questionnaire on health and PA behaviors, including assessment of attitude, subjective norm, perceived behavioral control (PBC), and intention to participate in regular PA. Structural equation models were examined using AMOS 17.0. Results: Overall, 62% of the variance in intention was accounted for by attitude, subjective norm, and PBC; whereas 44% of the variance in PA behavior was explained by PBC and intention. When examining the TPB separately in overweight and obese subsamples, 66% and 56% of the variance for PA intention was explained for overweight and obese subsamples, respectively; and 38% and 56% of the variance in PA behavior were accounted for in the overweight and obese subsamples. Overall, attitude was the strongest predictor of PA intention, whereas PBC was the strongest predictor for PA behavior. Intention was not predictive of PA behavior. Conclusions: These results provide partial support for the utility of TPB in explaining PA behavior in a sample of overweight and obese adolescents. In particular, strong associations regarding attitude and PBC were evident across each subsample. These findings have implications for tailoring PA programs in this population. (Contains 3 tables, 3 figures, and 1 note.)

Walking is the most common type of physical activity (PA) and the likely target of efforts to increase PA. No studies, however, have identified the belief-level correlates for walking using the theory of planned behavior. This study elicits salient beliefs about walking and evaluates beliefs that may be most important for walking-promotion campaigns. A random sample of 55 Canadian adults participated in the elicitation study, and the validation study includes 358 participants who completed measures of demographics, beliefs from the elicitation study, and self-reported walking behavior. Belief--behavior relationships show that almost all behavioral expectancies are correlates of intention and behavior, but normative and control expectancies are more select correlates. But when belief--behavior relations are evaluated by participants meeting PA recommendations, only beliefs about feeling good, appearance, stress relief, and time are significant. Public health efforts to promote walking should focus on making time for regular walking and the affective advantages that walking can provide. (Contains 4 tables.)

This study explores the longitudinal and subgroup measurement properties of a 10-item, physical activity decisional balance scale, previously published by Plotnikoff, Blanchard, Hotz, and Rhodes (2001), within a diabetic sample of Canadian adults. Results indicated that a three-factor measurement model consistently improved model fit compared to the previously published two-factor model. Evidence of configural, metric, and scalar measurement invariance across time and among subgroups suggests that the 10-item decisional balance scale is appropriate for investigating associative relationships with other constructs and for comparing group means of the pros and cons subscales among a variety of diabetic population subgroups. (Contains 4 tables, 2 figures, and 3 footnotes.)

Background: Despite the benefits of physical activity (PA), a significant proportion of youth remains inactive. Studies assessing differences in the correlates of PA among urban and rural youth are scarce, and such investigations can help identify subgroups of the population that may need to be targeted for special intervention programs. The purpose of this study was to assess differences in the correlates of PA between Canadian urban and rural youth. Methods: The sample consisted of 1398 adolescents from 4 urban schools and 1290 adolescents from 4 rural schools. Mean age of the participants was 15.6 plus or minus 1.3 years. Hierarchical regression analyses were used to examine the association between self-reported PA and a number of demographic, psychological, behavioral, and social correlates. Results: Common correlates between the 2 locations included gender (with girls being less active than boys) perceptions of athletic/physical ability, self-efficacy, interest in organized group activities, use of recreation time, and friends' and siblings' frequency of participation in PA. Active commuting to school and taking a physical education class were unique correlates of PA at the multivariate level in urban and rural students, respectively. Variance explained in PA ranged from 43% for urban school students to 38% for rural school students. Conclusions: Although more similarities than discrepancies were found in the correlates of PA between the 2 geographical locations, findings from this study strengthen the policies that argue for a coordinated multisector approach to the promotion of PA in youth, which include the family, school, and community.

This study was designed to test the validity of a transtheoretical model's physical activity (PA) stage measure with intention and different intensities of behavior in a large population-based sample of adults living with diabetes (Type 1 diabetes, n = 697; Type 2 diabetes, n = 1,614) and examine different age groups. The overall "specificity" (classified correctly as inactive) for Type 1 diabetes was 69.3% based on the percentage of individuals in precontemplation, contemplation, and preparation not meeting Canada's PA guidelines. "Sensitivity" (classified correctly as active) was 82.5% based on the proportion of active participants in action and maintenance. In the Type 2 diabetes group, the overall specificity and sensitivity was 63.9% and 88.2%, respectively. No significant differences were found between the diabetes groups for stage distribution patterns, and sensitivity and specificity values. The majority of the study hypotheses related to intention and behaviors were confirmed, providing further supportive evidence for the utility of this PA staging measure for the diabetes population. (Contains 2 figures, 4 tables and 2 footnotes.)

The purpose of this study was to test a conceptual model based on theoretical and empirically supported relationships related to the influences of weight perceptions, weight concerns, desires to change weight, friends, age and location in relation to physical activity (PA) and smoking in adolescents. A total of 1242 males and 1446 females (mean age = 15.6 [plus or minus] 1.3) were recruited from rural and urban Canadian schools. Study respondents provided self-reports of PA, "smoking", "perceived body weight", "desire to change weight", "concern about weight gain" and "friends' smoking and PA behaviors". Results revealed an acceptable fitting model [chi][squared] (40) = 155.63, P less than 0.05, root mean square error of approximation = 0.047 and comparative fit index = 0.98. Large effect sizes for both genders were observed between friends' and adolescents' smoking behavior, and between perceived body weight and desire to change weight. Further, significant differences were identified between the male and female models [[chi][squared] difference (24) = 65.28, P less than 0.05]. Several findings of this study point to the need to design programs to motivate adolescent females to adopt healthy weight-control practices and to target young peoples' social networks to promote health behaviors, especially with regard to smoking. (Contains 2 figures and 2 tables.)

This study describes the development and psychometric evaluation of four scales measuring leadership for health promotion at an organizational level in the baseline survey (n = 144) of the Alberta Heart Health Project. Content validity was established through a series of focus groups and expert opinion appraisals, pilot testing of a draft based on capacity assessment instruments developed by other provinces involved in the Canadian Heart Health Initiative, and the literature. Psychometric analyses provided empirical evidence of the construct validity and reliability of the organizational leadership scales. Principal component analysis verified the unidimensionality of the leadership scales of (a) Practices for Organizational Learning, (b) Wellness Planning, (c) Workplace Climate, and (d) Organization Member Development. Scale alpha coefficients ranged between 0.79 and 0.91 thus establishing good to high scale internal consistencies. These measures can be used by both researchers and practitioners for the assessment of organizational leadership for health promotion and heart health promotion. (Contains 1 figure and 2 tables.)

Objective: The purpose of this study was to validate measures of individual and organisational infrastructure for health promotion within Alberta's (Canada) 17 Regional Health Authorities (RHAs). Design: A series of phases were conducted to develop individual and organisational scales to measure health promotion infrastructure. Instruments were designed with focus groups and then pre-tested prior to the validation study. Setting: In 1993 all hospitals and Public Health Units in the province of Alberta were regionalised into 17 RHAs, with responsibility for public health, community health, and acute and long-term care. While regionalisation may offer more opportunity for community participation, reorganisation of the public health system may have fragmented and diluted resources and skills for heart health promotion in some RHAs. Infrastructure (for example, human and financial resources), amongst other items, is believed to contribute to the capacity to promote health. Method: All 17 RHAs participated in the study, yielding a total of 144 individuals (that is board members, senior/middle management, and front line staff). These representative employees completed a self-administered questionnaire on individual- and organisational-level infrastructure measures. Results: Psychometric analyses of survey data provided empirical evidence for the robustness of the measures. Principal component analyses verified the construct validity of the scales, with alpha coefficients ranging from 0.75 to 0.95. Conclusion: The scales can be used by health professionals and researchers to assess individual- and organisational-level infrastructure, and tailor interventions to increase infrastructure for health promotion in health organisations. (Contains 4 tables.)

Introduction: ParticipACTION is a Canadian physical activity communications and social marketing organization relaunched in 2007. This study assesses the capacity of Canadian organizations to adopt, implement, and promote physical activity initiatives. The four objectives were to compare findings from baseline (2008) and follow-up (2013) with respect to: (1) awareness of ParticipACTION; (2) organizational capacity to adopt, implement and promote physical activity initiatives; (3) potential differences in capacity based on organizational size, sector, and mandate; and (4) assess perceptions of ParticipACTION five years after relaunch. Methods: In this cross-sectional study, representatives from local, provincial/territorial, and national organizations completed an online survey assessing capacity to adopt, implement, and promote physical activity. Descriptive statistics and one-way analyses of variance were conducted to examine the objectives. Results: Response rate for opening an email survey invitation and consenting to participate was 40.6% (685/1688) and 540 surveys were completed. Awareness of ParticipACTION increased from 54.6% at baseline to 93.9% at follow-up (Objective 1). Findings at both baseline and follow-up reflected good organizational capacity to adopt, implement and promote physical activity (Objective 2) although some varied by organizational sector and mandate (Objective 3). Most respondents reported that ParticipACTION provided positive leadership (65.3%), but there was less agreement regarding ParticipACTION's facilitation of infrastructure (44.0%) or organizational will/motivation (47.1%)(Objective 4). Conclusion: Canadian organizations continue to report having good capacity to adopt, implement, and promote physical activity. There was no discernible change in capacity indicators five years after ParticipACTION's relaunch although its broader contribution to the physical activity sector was endorsed. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies in cancer survivors have examined behavioral correlates of physical activity (PA), but no study to date has adopted a broader social-ecological framework in understanding PA. This study examined the associations among demographic, medical, social-cognitive, and environmental correlates of meeting PA guidelines among kidney cancer survivors (KCS).Methods: All 1985 KCS diagnosed between 1996 and 2010 identified through a Canadian provincial registry were mailed a survey that consisted of medical, demographic, and social-cognitive measures, as well as PA as measured by the Godin Leisure Time Exercise Questionnaire. Environmental constructs were also assessed for both self-report and objective measures using geographic information systems (GIS). A series of binary logistic regression analyses were conducted in this cross-sectional study.Results: Completed surveys with geographical information were received from 432 KCS with M age = 64.4 ± 11.1 years, 63.2 % male, and 82.2 % having localized kidney cancer. In the final multivariate model, meeting PA guidelines was associated with disease stage (OR = 0.25, p = .005), having drug therapy (OR = 3.98, p = .009), higher levels of instrumental attitudes (OR = 1.66, p = .053), higher levels of intention (OR = 1.72, p = .002), and the perceived presence of many retail shops in the neighborhood (OR = 1.37, p = .032).Conclusions: Meeting PA guidelines in KCS were associated with various aspects of the social-ecological model.Implications For Cancer Survivors: Understanding the social-ecological correlates for PA can provide insight into future interventions designed to increase PA in KCS. Prime targets for PA promotion should consider treatment-related factors, promote the benefits of PA, and enhance positive perceptions of the built environment. [ABSTRACT FROM AUTHOR]

Abstract: Background: There have been very limited long-term prospective studies examining social-cognitive models in the PA domain with large, representative population samples. Objective: The primary objective was to examine the Theory of Planned Behaviour''s (TPB) ability to explain PA behaviour in a randomly selected national sample of Canadian adults over a 15-year period. A secondary objective was to test the moderating effects of gender on TPB. Design: The study employed a longitudinal design. Methods: A cohort of 1427 randomly-selected adults reported TPB constructs and PA behaviour in 1988, and again in 2003. Structural equation modelling techniques were employed to test TPB. Results: The full model including both 1988 and 2003 TPB measures accounted for 29% and 21% of the variance in intention, and 9% and 22% of the variance in PA in 1988 and 2003, respectively. Gender moderated aspects of the TPB in the full model. The core predictive model (1988 TPB constructs predicting 2003 PA behaviour) explained 13% of the variance in 2003 PA behaviour. Conclusions: The TPB''s long-term ability to predict PA behaviour is modest. [Copyright &y& Elsevier]

ParticipACTION is a Canadian physical activity communications and social marketing organization that has been relaunched in 2007 after a 6-year hiatus. The purpose of this study is to qualitatively identify and describe the expectations and challenges the relaunch of the new ParticipACTION may present for existing physical activity organizations. Using a purposeful sampling strategy, the authors conduct semistructured telephone interviews with 49 key informants representing a range of national, provincial, and local organizations with a mandate to promote physical activity. Overall, there is strong support in seeing ParticipACTION relaunched. However, organizational expectations and/or their ideal vision for it are mixed. Organizations envision and support its performing an overarching social marketing and advocacy role, and in providing tools and resources that supplement existing organizational activities. Four major organizational challenges are identified concerning overlapping mandates, partnership and leadership concerns, competition for funding, and capacity concerns. Social marketing initiatives, such as ParticipACTION, may not be able to maximize their impact unless they address the expectations and concerns of competing organizations with a mandate to promote physical activity. [ABSTRACT FROM PUBLISHER]

Objectives: To determine demographic, medical, social cognitive, and environmental predictors of aerobic physical activity and resistance training in a population sample of adults with type 2 diabetes. Methods: Two hundred forty-four (244) participants completed questionnaires with a 3-month follow-up. Multiple and logistic regression models examined predictors of aerobic activity and resistance training. Results: Several factors were associated with higher levels of both aerobic physical activity and resistance training; self-efficacy was the strongest predictor for both modes of activity. Conclusions: The findings can guide physical activity promotion interventions and programs for this population, profiling those who are least active. [ABSTRACT FROM AUTHOR]

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

At a population level, the method used to determine those meeting physical activity guidelines has important implications, as estimating "sufficient" physical activity might be confounded by weight status. The objective of this study was to test the difference between three methods in estimating the prevalence of "sufficient activity" among Canadian adults with type 2 diabetes in a large population sample (N = 1614) while considering the role of weight status as a potential confounder. Our results revealed that estimates of physical activity levels vary by BMI categories, depending on the methods examined. Although physical activity levels were lower in the obese, their energy expenditure estimates were not different from those who were overweight or of a healthy weight. The implications of these findings are that biased estimates of physical activity at a population level may result in inappropriate classification of adults with type 2 diabetes as "sufficiently active" and that the inclusion of body weight in estimating physical activity prevalence should be approached with caution. [ABSTRACT FROM AUTHOR]

A descriptive exploratory study was conducted to gain an understanding of public perceptions of physical activity guidelines and to discover what formats appeal to participants. Canada’s Physical Activity Guide (CPAG) was used as an example of such guidelines. Data were collected from 22 participants in five focus groups (composed of female undergraduate students, female office workers, male office workers, participants in a Type II diabetes rehabilitation program, and participants in a cardiovascular rehabilitation program). Cross-case qualitative analyses were conducted. Six themes emerged under the general categories of familiarity and preferences for PA promotional materials. In terms of familiarity, participants lacked awareness of CPAG and criticized its format. In terms of preferences, participants encouraged the use of stylistically similar messaging to those used by commercial advertisers, wanted personal stories, Internet-based media, and the use of celebrities’ success stories. There was little awareness of CPAG and the current format was unappealing. [ABSTRACT FROM PUBLISHER]

Background -: This pilot study evaluated the feasibility (recruitment, retention, adherence and satisfaction) and preliminary efficacy of a 12-week website and email-linked counselling intervention on physical activity behaviour change in individuals with type 2 diabetes. Methods -: A total of 49 individuals with type 2 diabetes (59% female, average age 54.1 years) were randomized to the Diabetes NetPLAY intervention or control condition. The intervention condition received information grounded in the Social Cognitive Theory (SCT), personalized weekly emails, an on-line logbook and message board. Key outcomes included physical activity behaviour and related cognition changes. The control condition was provided links to the Canadian Diabetes Association's Clinical Practice Guidelines for Physical Activity and Canada's Guide to Physical Activity. Results -: Intervention participants indicated high levels of satisfaction for this mode of delivery and study results demonstrated the feasibility of web-based mediums for the delivery of physical activity information in this population. The intervention group demonstrated a significant improvement in total vigorous and moderate minutes of physical activity (p = 0.05) compared to the control group over the 12-week study. Among the SCT variables, behavioural capacity, showed a significant increase (p < 0.001) among intervention participants. Conclusion -: Web-based interventions for individuals with type 2 diabetes are feasible and show promise for improving positive physical activity outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Applied Physiology, Nutrition & Metabolism is the property of Canadian Science Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Despite the benefits of physical activity (PA), a significant proportion of youth remains inactive. Studies assessing differences in the correlates of PA among urban and rural youth are scarce, and such investigations can help identify subgroups of the population that may need to be targeted for special intervention programs. The purpose of this study was to assess differences in the correlates of PA between Canadian urban and rural youth. Methods: The sample consisted of 1398 adolescents from 4 urban schools and 1290 adolescents from 4 rural schools. Mean age of the participants was 15. 6 ± 1. 3 years. Hierarchical regression analyses were used to examine the association between self-reported PA and a number of demographic, psychological, behavioral, and social correlates. Results: Common correlates between the 2 locations included gender (with girls being less active than boys) perceptions of athletic/physical ability, self-efficacy, interest in organized group activities, use of recreation time, and friends’ and siblings’ frequency of participation in PA. Active commuting to school and taking a physical education class were unique correlates of PA at the multivariate level in urban and rural students, respectively. Variance explained in PA ranged from 43% for urban school students to 38% for rural school students. Conclusions: Although more similarities than discrepancies were found in the correlates of PA between the 2 geographical locations, findings from this study strengthen the policies that argue for a coordinated multisector approach to the promotion of PA in youth, which include the family, school, and community. [ABSTRACT FROM AUTHOR]

The article cites a study that identifies key demographic and health factors associated with physical activity (PA) participation in adults diagnosed with type 1 or type 2 diabetes recruited from the Canadian Diabetes Association of Alberta, Canada. The study uses multiple and logistic regression models to identify demographic and health factors related to PA levels, and the analyses were conducted separately for type 1 and type 2 groups. The study shows that a 63.7% of those with type 1 and 71.9% for those with type 2 diabetes were not achieving recommended PA levels.

This paper describes the development and psychometric evaluation of scales measuring the dimensions of ‘will’ (belief, confidence, prior action and desire) for heart health promotion specifically and health promotion in general at both an individual and organizational level. Content validity was established through a series of focus groups and expert opinion assessments, based on a compilation of capacity-assessment instruments developed by other provinces involved in the Canadian Heart Health Initiative and the literature. Psychometric analyses of questionnaire data provided empirical evidence of the construct validity and reliability of the 16 individual and 21 organizational level ‘will’ scales. A series of principal component analyses assisted in verifying the unidimensionality of the measures and all scales yielded high internal consistencies with Cronbach's alpha coefficients ranging between 0.73 and 0.96. These measures can be used by both researchers and practitioners for assessing the ‘will’ to promote heart health specifically and health promotion in general. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Public Health is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Climate change has received recent extensive media attention (e.g., Kyoto Protocol) and is currently on the international public health agenda. The purpose of this study was to survey knowledge, attitudes and behaviours related to climate change in the province of Alberta, Canada. A random sample of 600 Alberta households, using proportional quotas based on the Canada Census of the Alberta population, was surveyed on knowledge, attitudes and behaviours related to climate change using a computer-assisted telephone interviewing protocol. Albertans are highly concerned, particularly about health problems related to the environment and air pollution; yet are only moderately informed about a variety of environmental issues. While the great majority of Albertans appear to be engaged in environmental behaviours at home, fewer consider energy efficiency when purchasing consumer goods. An even smaller percentage makes environmentally conscious transportation decisions. To encourage the population to make recommended environmental behaviours, mass media approaches may do well to target the specific beliefs that were deemed salient (e.g., promote the association between environment issues and health). The public health sector has a major role in working with inter-sectoral groups to address this significant public health issue. [ABSTRACT FROM AUTHOR]

One of the important implications of a population health perspective in public health is an increase in the need for transdisciplinary ways of working. The Community Health Research Unit (CHRU) is presented as an example of an environment where psychology and psychologists work with other disciplines to conduct applied research in population health. Research activities were examined to identify how the disciplines collaborate and to provide evidence of successful interdisciplinary and transdisciplinary approaches which incorporate health psychology. The strengths and challenges of multi-, inter-, and transdisciplinary approaches were examined through a poll of CHRU members. Further, members' views about the contributions of psychology to their work were gathered. Issues of working with different disciplines in a transdisciplinary approach are highlighted and future directions are suggested. [ABSTRACT FROM AUTHOR]

Purpose. The purpose of this study was to assess rural and urban differences in the dietary intakes, physical activity levels and weight status of a large sample of Canadian youth in both 2005 and 2008. Materials and Methods. A cross-sectional study of rural and urban adolescents (n = 10, 023) in Alberta was conducted in both 2005 and 2008 using a web-based survey. Results. There was an overall positive change in nutrient intakes between 2005 and 2008; however, rural residents generally had a poorer nutrient profile than urban residents (P < .001). They consumed less fibre and a greater percent energy from saturated fat. The mean physical activity scores increased among rural youth between 2005 and 2008 (P < .001), while remaining unchanged among urban youth. Residence was significantly related to weight status in 2005 (P = .017), but not in 2008. Conclusion. Although there were small improvements in nutrient intakes from 2005 to 2008, several differences in the lifestyle behaviours of adolescents living in rural and urban areas were found. The results of this study emphasize the importance of making policy and program recommendations to support healthy lifestyle behaviours within the context of the environments in which adolescents live. [ABSTRACT FROM AUTHOR]

Abstract: Objective . : To examine the American–Canadian difference in physical activity and its association with diabetes prevalence. Methods . : We used cross-sectional data from nationally representative samples of adults (8688 persons aged ≥18years) participating in the 2004 Joint Canada/U.S. Survey of Health. Using data on up to 22 activities in the past 3months, we defined 3 physical activity groups (in metabolic equivalents-hours/day) as low (<1.5), moderate (1.5–2.9), and high (≥3.0). We employed logistic regression models in our analyses. Results . : Self-reported diabetes prevalence was 7.6% in the U.S. and 5.4% in Canada. The prevalence of low physical activity was considerably higher in the U.S. (70.9%) than in Canada (52.3%), while levels of moderate and high physical activity were higher in Canada (24.6% and 23.1%, respectively) than in the U.S. (14.3% and 14.8%, respectively). Using nationality (Canada as reference) to predict diabetes status, the adjusted odds ratio was 1.48 (95%CI, 1.22–1.79), and became 1.38 (95%CI, 1.15–1.66) when additionally adjusting for physical activity level. We estimate that 20.8% of the U.S.-Canada difference in diabetes prevalence is associated with physical activity. Conclusions . : The difference in the prevalence of diabetes between U.S. and Canadian adults may be partially explained by differences in physical activity between the two countries. [Copyright &y& Elsevier]

Background: Achieving system-level, sustainable 'scale-up' of interventions is the epitome of successful translation of evidence-based approaches in population health. In physical activity promotion, few evidence-based interventions reach implementation at scale or become embedded within systems for sustainable health impact. This is despite the vast published literature describing efficacy studies of small-scale physical activity interventions. Research into physical activity scale-up (through case-study analysis; evaluations of scale-up processes in implementation trials; and mapping the processes, strategies, and principles for scale-up) has identified barriers and facilitators to intervention expansion. Many interventions are implemented at scale by governments but have not been evaluated or have unpublished evaluation information. Further, few public health interventions have evaluations that reveal the costs and benefits of scaled-up implementation. This lack of economic information introduces an additional element of risk for decision makers when deciding which physical activity interventions should be supported with scarce funding resources. Decision-makers face many other challenges when scaling interventions which do not relate to formal research trials of scale-up; Methods: To explore these issues, a multidisciplinary two-day workshop involving experts in physical activity scale-up was convened by the University of Newcastle, Australia, and the University of Ottawa, Canada (February 2019); Results: In this paper we discuss some of the scale-up tensions (challenges and conflicts) and paradoxes (things that are contrary to expectations) that emerged from this workshop in the context of the current literature and our own experiences in this field. We frame scale-up tensions according to epistemology, methodology, time, and partnerships; and paradoxes as 'reach without scale', 'planned serendipity' and 'simple complexity'. We reflect on the implications of these scale-up tensions and paradoxes, providing considerations for future scale-up research and practice moving forward; Conclusions: In this paper, we delve deeper into stakeholders' assumptions, processes and expectations of scaling up, and challenge in what ways as stakeholders, we all contribute to desired or undesired outcomes. Through a lens of 'tensions' and 'paradoxes', we make an original contribution to the scale-up literature that might influence current perspectives of scaling-up, provide future approaches for physical activity promotion, and contribute to understanding of dynamic of research-practice partnerships.

The Community Health and the Built Environment (CHBE) project investigated the role of place in interventions for chronic disease prevention in order to identify contextual factors that may foster or inhibit intervention success. This paper presents a project model comprising objective-outsider and subjective-insider perspectives in a multi-method, community-based participatory research approach with an emphasis on knowledge exchange. The collaborative process generated valuable lessons concerning effective conduct of community-based research. The CHBE project model contributes a mechanism for investigating how place influences health behaviours and the outcomes of health promotion interventions.

The authors conducted a secondary analysis on 202 adults from the Physical Activity Workplace Study. The aim of this analysis was to examine demographic characteristics associated with reading Canada's Physical Activity Guide (CPAG), being motivated by the guide, and whether participants in the Physical Activity Workplace Study who read the CPAG increased their physical activity levels over 1 year. Results revealed that less than 50% of participants read the full version of CPAG, and less than 10% were motivated by it. The CPAG also appears to be more appealing to and effective for women than for men. Although the CPAG had some influence in increasing mild physical activity levels in a workplace sample, there was also a decrease in physical activity levels among some members of the group. Overall, the effectiveness of CPAG was not substantial, and the findings of this analysis could help guide future targeted intervention materials and programs.

Background: Physical activity (PA) improves quality of life (QoL) in several cancer survivor groups, but no study to date has focused on kidney cancer survivors (KCS). The purpose of this study was to estimate the prevalence of PA in KCS and determine any associations with QoL., Methods: All 1,985 KCS diagnosed between 1996 and 2010 identified through a Canadian provincial Registry were mailed a survey that consisted of the Godin Leisure Time Exercise Questionnaire and several Functional Assessment of Cancer Therapy QoL scales. Standard demographic and medical variables were also reported., Results: Completed surveys were received from 703 (43%) of the 1,654 KCS that received the survey. Over half (56.3%) were completely sedentary (CS), 17.6% were insufficiently active, 11.9% were active within public health guidelines, and 14.1% exceeded public health guidelines. After adjustment for key demographic and medical covariates, analyses of covariance indicated a dose-response association between PA and most QoL outcomes from CS to within guidelines (WG) with no further improvements for exceeding guidelines. For the primary QoL outcome of patient-reported physical functioning, the overall difference between CS and WG was 8.6 points (95% CI: 4.2-12.9, P < 0.001) which exceeds the minimally important difference of 5.0 points for this scale. Few associations were moderated by demographic or medical variables., Conclusion: Over half of KCS are CS; however, even some PA may be beneficial for QoL., Impact: PA is a modifiable lifestyle factor that may have implications for QoL and disease outcomes in KCS., (©2011 AACR.)

Objectives: Physical activity (PA) improves health-related quality of life (HRQL) in several cancer survivor groups but no studies have focused on young adult cancer survivors (YACS). This study determined the prevalence of PA in YACS and examined dose-response associations with HRQL., Methods: A random sample of 2,000 YACS between the ages of 20-44 were identified through a Canadian provincial cancer registry and mailed a survey that included the Leisure-Time Exercise Questionnaire, the Medical Outcomes Study 36-Item Short Form (SF36) survey, and several validated psychosocial scales. The primary endpoint was the physical component summary (PCS) of the SF36., Results: Completed questionnaires were received from 588 YACS. In terms of PA prevalence, 23% were completely sedentary, 25% were insufficiently active, 22% were active within public health guidelines, and 29% were active above public health guidelines. Analysis of covariance adjusted for important medical and demographic covariates showed a statistically significant and clinically meaningful dose-response association between PA and the PCS that spanned 6.3 points (95% confidence interval [CI] 3.7 to 8.8; p < 0.001) from completely sedentary to within guidelines. Similar associations were found for the mental component summary scale (p = 0.002), depression (p < 0.001), stress (p < 0.001) and self-esteem (p < 0.001). Associations between PA and HRQL were stronger for YACS that had previously received chemotherapy., Conclusions: PA is strongly associated with HRQL in YACS but only half of YACS are meeting public health guidelines and almost a quarter are completely sedentary. Randomized controlled trials examining intervention strategies to increase PA and improve health outcomes in this understudied patient population are warranted.

Physical activity (PA) is a key management strategy for type 2 diabetes. Despite the known benefits, PA levels are low. Whether the low level of PA is related to lack of knowledge or support is not fully understood. This study was conducted to describe where and how often adults with type 2 diabetes receive and seek information related to PA and examine the relationships between the source and quality of PA information with PA behaviors. A series of questions related to the source and quality of PA information were added to a baseline survey distributed to the participants (N = 244) of the Canadian Aerobic and Resistance Training in Diabetes (CARED) study. Physicians and television were found to be the main sources of PA-related information. In our cross-sectional model, sources of PA-related information other than that from health care professionals explained 14% (p = .05) and 16% (p < .05) of the variance for aerobic-based and resistance training behaviors and 22% (p < .01) and 15% (p < .05) for these behaviors in our longitudinal model. Physical activity (PA)-related information is widely available to adults with type 2 diabetes. Neither the quantity nor the quality of the PA information provided by health care professionals predicted PA behavior. These data provide further insight into the modes with which PA can be promoted to adults with type 2 diabetes.

Childhood obesity has reached epidemic levels in the developed world. Recent research and commentary suggest that an ecological approach is required to address childhood obesity, given the multidimensional nature of the problem. We propose a Canadian prototype, the Child Health Ecological Surveillance System, for a regional health authority to address the growing obesity epidemic. This prototype could potentially be used in other jurisdictions to address other child health issues. We present 8 guiding principles for the development and implementation of a regional framework for action.

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

Physical activity plays a key role in diabetes management, and in reducing the risk factors related to the development of co-morbid conditions. This study examined predictors of physical activity (Static Model) and activity change (Change Model) for individuals with type 1 (T1D) or type 2 diabetes (T2D) in a population sample of 1662 adults (510 type 1; 1152 type 2) using self-reported measures of co-morbidities, perceived difficulties in performing tasks of daily living (TDL), time since diagnosis, and selected demographic factors. Since the motivation for physical activity could be influenced by the initial diagnosis of diabetes, analyses were conducted separately for newly diagnosed individuals (diagnosed with diabetes < or =1 year), and those that have been diagnosed for sometime (diagnosed with diabetes >1 year). In the Static Model, a younger age (beta=-.11, p<.05) and having less perceived difficulties in performing TDL (beta=-.12, p<.05) were associated with a higher physical activity in individuals with type 1 diabetes. The presence of difficulties in TDL (beta=-.08, p<.05) and co-morbidities (beta=-.08, p<.05) were associated with physical activity participation in type 2 individuals diagnosed for >1 year, but not in newly diagnosed individuals. A shorter duration of disease (beta=-.07, p<.05), a higher body mass index (BMI) (beta=.09, p<.05) and female gender (beta=.07, p<.05) was associated with physical activity increase in individuals with type 2 diabetes. A higher BMI predicted physical activity change in both newly diagnosed individuals and those diagnosed for sometime. However, both genders were equally likely to increase their physical activity among newly diagnosed individuals. Although the magnitude of the study results are relatively modest, they could potentially guide and encourage future investigations in this area that could lead to useful insights in designing PA intervention programs for these specific populations.

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

Purpose: The purpose of this research is to examine the organizational stages of change construct of the transtheoretical model of behavior change., Design/methodology/approach: Data on organizational and individual stages of change for tobacco reduction, physical activity promotion, and heart healthy eating promotion were collected from service provider, senior management, and board level members of provincial health authorities across three data collection periods., Findings: Results revealed significant correlations between individual and organizational stages of change for management level respondents, but inconsistent relationships for service providers and no significant correlations for board level respondents. There were no significant differences between respondent levels for organizational stage of change for any of the promotion behaviors. In general, changes in stage failed to predict whether there was a belief in an organization's capability of addressing any of the health promotion activities. There was also a large amount of variance between individual respondents for most health authorities in their reported organizational stages of change for physical activity and healthy eating., Practical Implications: Based on the results of the present study it is concluded that there is little evidence that the organizational stages of change construct is valid. The evidence indicates that assessing individual readiness within an organization may be as effective as asking individuals to report on organizational stages of readiness., Originality/value: This paper reports on the validity of the organizational stages of change construct in a health promotion context and provides information for those who are considering using it.

Background: The Internet is a potential medium to attain large groups of Canadians for physical activity monitoring and interventions, however, little is known about the characteristics of participants who could be recruited on a national level. Our objectives were to determine: 1) the extent to which our sample was representative of the Canadian population; 2) the demographic, social-cognitive and physical activity behaviour, and environmental characteristics of one-time and multi-time users of the Canada on the Move website; and 3) whether certain recruitment strategies were more likely to reach specific demographic subgroups., Methods: Web-based self-report measures were collected on demographic, social-cognitive, physical activity behaviour, and environmental factors. Descriptive statistics were employed to address the study's research objectives., Results: Significant differences (p<0.001) were found between our total sample and 2001 Canadian census/Canadian Community Health Survey (CCHS) data on all demographic and physical activity behaviour measures. One-time and multi-time users significantly differed on age (p<0.005) and being responsible for children under age 13 (p=0.01). No differences existed between the groups on any of the social-cognitive, behavioural or environmental variables. Source of knowledge about the Canada on the Move website between one-time and multi-time users was not significantly different., Conclusion: The Canada on the Move website presents a viable approach to reaching diverse demographic groups. Further work needs to be undertaken to: 1) develop engaging websites; 2) detail the monitoring of the web-based access information; 3) integrate the website with other organizations promoting physical activity; and 4) expand the number of recruitment sources.

Background: The purposes of this study were to: 1) explore the potential role of sex in the association between the perceived environment and walking; and 2) determine the efficacy of an Internet-based research platform for collecting population-level physical activity and correlates data., Methods: Visitors to the Canada on the Move website were asked questions about their demographics, physical activity participation and perceptions of their neighbourhood environment. A total of 3,144 Canadians (2,036 women; 609 men) completed the survey. Level of walking was regressed on eight measures of perceived neighbourhood environment in a series of logistic regressions., Results: Individuals who reported interesting scenery (OR=1.41, 95% CI 1.17-1.71) and many places to go that were within easy walking distance (OR=1.39, 95% CI 1.18-1.64) were more likely to report walking at a level sufficient to derive health benefits. For women, interesting scenery in and around their neighbourhood (OR=1.40, 95% CI 1.13-1.74) and the presence of many places to go within easy walking distance (OR=1.42, 95% CI 1.17-1.72) were associated with walking at a sufficient level. Among men, no significant associations were found between the perceived environment measures and walking., Conclusions: The results from this study provide additional support for the use of models in which sex is treated as a potential moderator of the link between the perceived environment and physical activity. Further, the results support the use of an Internet-based research platform to collect data on the correlates of physical activity.

Background: The purpose of this study was to: 1) evaluate the quality of promotional pedometers widely distributed through cereal boxes at the time of the 2004 Canada on the Move campaign; and 2) establish a battery of testing protocols to provide direction for future consensus on industry standards for pedometer quality., Methods: Fifteen Kellogg's* Special K* Step Counters (K pedometers or K; manufactured for Kellogg Canada by Sasco, Inc.) and 9 Yamax pedometers (Yamax; Yamax Corporation, Tokyo, Japan) were tested with 9 participants accordingly: 1) 20 Step Test; 2) treadmill at 80m x min(-1) (3 miles x hr(-1)) and motor vehicle controlled conditions; and 3) 24-hour free-living conditions against an accelerometer criterion., Results: Fifty-three percent of the K pedometers passed the 20 Step Test compared to 100% of the Yamax. Mean absolute percent error for the K during treadmill walking was 24.2+/-33.9 vs. 3.9+/-6.6% for the Yamax. The K detected 5.7-fold more non-steps compared to the Yamax during the motor vehicle condition. In the free-living condition, mean absolute percent error relative to the ActiGraph was 44.9+/-34.5% for the K vs. 19.5+/-21.2% for the Yamax., Conclusions: K pedometers are unacceptably inaccurate. We suggest that research grade pedometers: 1) be manufactured to a sensitivity threshold of 0.35 Gs; 2) detect +/-1 step error on the 20 Step Test (i.e., within 5%); 3) detect +/-1% error most of the time during treadmill walking at 80m x min(-1) (3 miles x hr(-1)); as well as, 4) detect steps/day within 10% of the ActiGraph at least 60% of the time, or be within 10% of the Yamax under free-living conditions.

Purpose: This purpose of this research was to develop and establish psychometric properties of scales measuring individual leadership for health promotion., Design/methodology/approach: Scales to measure leadership in health promotion were drafted based on capacity assessment instruments developed by other provinces involved in the Canadian Heart Health Initiative (CHHI), and on the literature. Content validity was established through a series of focus groups and expert opinion appraisals and pilot testing. Psychometric analyses provided empirical evidence of the construct validity and reliability of the leadership scales in the baseline survey (n = 144) of the Alberta Heart Health Project., Findings: Principal component analysis verified the construct of the leadership scales of personal work-related practices and satisfaction with work-related practices. Each of the theoretically a prior determined scales factored into two scales each for a total of four final scales. Scale alpha coefficients (Cronbach's alpha) ranged between 0.71 and 0.78, thus establishing good scale internal consistencies., Research Limitations/implications: Limitations include the relatively small sample size used in determining psychometric properties. In addition, further qualitative work would enhance understanding of the complexity of leadership in health organizations. These measures can be used by both researchers and practitioners for the assessment leadership for health promotion and to tailor interventions to increase leadership for health promotion in health organizations., Originality/value: Establishing the psychometric properties and quality of leadership measures is an innovative step toward achieving capacity assessment instruments which facilitate evaluation of key relationships in developing health sector capacity for health promotion.

Background: The majority of the population is inactive, and strategies to date for promoting regular physical activity have been limited in their effectiveness. Further research is needed to identify correlates of physical activity in different subgroups to design more efficacious interventions. This study sought to identify correlates of physical activity across men and women, urban and rural geographical locations, and four distinct age groups (18-25; 26-45; 46-59; and 60+)., Methods: This study employed data from a large provincial household random sample (N = 20,606) of Canadians. Analyses were utilized to examine the amount of variance explained in self-reported physical activity by a number of demographic and/or biological, psychological, behavioral, social, and environmental variables within each subgroup., Results: Proportion of friends who exercise, injury from past physical activity, educational level, perceived health status, and alcohol consumption were among the strongest correlates across subgroups., Conclusions: A number of correlates were identified as being significant across all subgroups examined. Most differences in the correlates of physical activity were found within different age groups rather than among urban and rural residents and gender.