Physical Activity Counseling for Children With Cystic Fibrosis.

BACKGROUND: Physical activity is recommended as a component of the cystic fibrosis (CF) treatment regimen. However, to date, there is limited research examining the effects of behavioral counseling interventions aimed at increasing physical activity. The aim of this study was to assess the feasibility of a theoretically informed, parent-mediated counseling intervention in increasing habitual physical activity and quality of life among children and youth with CF. METHODS: Participants were recruited from the pediatric respirology clinic at the Children's Hospital of Winnipeg. Participants ranged in age between 8 and 18 y. A randomized control feasibility trial was implemented, and participants were randomized to the intervention (n = 7) or control group (n = 6). Intervention group participants engaged in 4 counseling sessions to examine the acceptability and feasibility of physical activity counseling in the care of children with CF. The primary outcome was study feasibility, as measured by recruitment, retention, adherence, acceptability, and the frequency of adverse events. Secondary outcomes included physical activity and quality of life, as measured by accelerometry and the Pediatric Quality of Life Inventory. RESULTS: Thirteen subjects completed the study. No adverse events were found in this trial. The intervention was found to be feasible and acceptable with good recruitment, retention, adherence, and acceptability. Positive trends were also reported in terms of increases in physical activity, reductions in time spent being sedentary, and improvements in most dimensions of quality of life pre- to post-intervention. CONCLUSIONS: The findings suggest that counseling is feasible for the CF community. An appropriately powered randomized controlled trial is required in the future to investigate the utility of counseling as a means to enhance quality of life and physical activity behavior.

They know it's safe - they know what to expect from that face: perceptions towards a cognitive-behavioural counselling programme among caregivers of children with cystic fibrosis.

AIMS AND OBJECTIVES: To explore the experiences of eight caregivers who provide care to children with cystic fibrosis in an eight-week cognitive-behavioural counselling programme at a children's hospital in Winnipeg, Canada. BACKGROUND: Youth with cystic fibrosis experience significant behavioural and psychosocial challenges, such as depression, anxiety and poor treatment adherence. Caregivers are critical to the provision of care and treatment to young people living with cystic fibrosis. Caregivers of youth with cystic fibrosis experience psychosocial morbidity. Thus, the development of counselling interventions is required to enhance psychosocial well-being among the caregivers of youth with cystic fibrosis. DESIGN AND METHODS: This study was informed by the thematic analytic qualitative research tradition. In-depth, semistructured interviews were conducted with eight caregivers who participated in our programme. The audiotaped interviews were then subject to thematic analysis. RESULTS: The counselling sessions were experienced as 'distinctly different' from routine appointments at the hospital and were characterised by a sense of listening and bidirectional communication. In addition to acquiring a sense of trust and accountability through the programme, counselling appeared to enhance caregivers' perception of their time use, leading to greater temporal agency. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: From this evidence-based cognitive-behavioural counselling programme, insights about the complex psychosocial lives of the cystic fibrosis community are discussed within the context of the literature. Integrating cognitive-behavioural counselling into routine clinical CF care should be considered as a method to enhance caregiving capacity in the CF community and should be championed by nurses.

The freedom to explore: examining the influence of independent mobility on weekday, weekend and after-school physical activity behaviour in children living in urban and inner-suburban neighbourhoods of varying socioeconomic status.

BACKGROUND: Children's independent mobility (CIM) is critical to healthy development in childhood. The physical layout and social characteristics of neighbourhoods can impact opportunities for CIM. While global evidence is mounting on CIM, to the authors' knowledge, Canadian data on CIM and related health outcomes (i.e., physical activity (PA) behaviour) are missing. The purpose of this study was to examine if CIM is related to multiple characteristics of accelerometry-measured PA behaviour (total PA, light PA, moderate-to-vigorous PA, time spent sedentary) and whether associations between CIM and PA behaviour systematically vary by place of residence, stratifying by gender and type of day/period (weekdays, after-school, weekend). METHODS: Participants were recruited through Project BEAT (Built Environment and Active Transport; http://www.beat.utoronto.ca). Children (n = 856) were stratified into four neighbourhood classifications based on the period of neighbourhood development (urban built environment (BE) (old BE) versus inner-suburban BE (new BE)) and socioeconomic status (SES; low SES and high SES). Physical activity was measured via accelerometry (ActiGraph GT1M). CIM was assessed via parental report and two categories were created (low CIM, n = 332; high CIM, n = 524). A series of two-factor ANOVAs were used to determine gender-specific differences in PA for weekdays, weekend days and the after-school period, according to level of CIM, across four neighbourhood classifications. RESULTS: Children who were granted at least some independent mobility (high CIM) had more positive PA profiles across the school week, during the after-school period, and over the weekend; they were also less sedentary. The influence of CIM on PA behaviour was particularly salient during the after-school period. Associations of CIM with PA varied by gender, and also by neighbourhood classification. CIM seemed to matter more in urban neighbourhoods for boys and suburban neighbourhoods for girls. CONCLUSION: Our findings highlight the importance of independent mobility to multiple characteristics of children's PA behaviour across the week. Furthermore, they emphasize that independent mobility-activity relationships need to be considered by gender and the type of neighbourhood independent mobility is offered in. Future work will focus on developing a predictive model of CIM that could be used to inform decision-making around alleviating barriers to CIM.

What's "quickest and easiest?": parental decision making about school trip mode.

BACKGROUND: The potential benefits of active school travel (AST) are widely recognized, yet there is consistent evidence of a systematic decline in the use of active modes of transportation to school since the middle part of the 20th century. This study explored parental accounts of the school travel mode choice decision-making process. METHODS: Thirty-seven parents of children (17 who walked; 20 who were driven) from four elementary schools in Toronto, Canada participated in semi-structured interviews. The schools varied with respect to walkability of the built environment and socio-economic status. Thematic analysis of interview transcripts identified a two-stage decision-making process. RESULTS: An initial decision concerned the issue of escorting or chauffeuring a child to/from school. This decision appeared to be primarily influenced by concerns about traffic, the child's personal safety, and the child's maturity and cognitive ability regarding navigating his/her way to/from school safely. Following the escort decision, parents considered mode choice, typically selecting what they perceived to be the easiest and most convenient way to travel. The ascription of convenience to the various modes of transportation was influenced by perceptions of travel time and/or distance to/from school. Convenience became a particularly salient theme for parents who found it necessary to complete multi-activity trip chains. CONCLUSIONS: The school travel mode choice decision process is complex. Future research and practice should continue to address safety concerns that are typically the focus of active school transport initiatives while addressing more explicitly the behavioural cost of competing mode choices.

ParticipACTION: awareness of the participACTION campaign among Canadian adults--examining the knowledge gap hypothesis and a hierarchy-of-effects model.

BACKGROUND: ParticipACTION was a pervasive communication campaign that promoted physical activity in the Canadian population for three decades. According to McGuire's hierarchy-of-effects model (HOEM), this campaign should influence physical activity through intermediate mediators such as beliefs and intention. Also, when such media campaigns occur, knowledge gaps often develop within the population about the messages being conveyed. The purposes of this study were to (a) determine the current awareness of ParticipACTION campaigns among Canadians; (b) confirm if awareness of the ParticipACTION initiative varied as a function of levels of education and household income; and, (c) to examine whether awareness of ParticipACTION was associated with physical activity related beliefs, intentions, and leisure-time physical activity (LTPA) as suggested by the HOEM. Specifically, we tested a model including awareness of ParticipACTION (unprompted, prompted), outcome expectations, self-efficacy, intention, and physical activity status. METHODS: A population-based survey was conducted on 4,650 Canadians over a period of 6 months from August, 2007 to February, 2008 (response rate = 49%). The survey consisted of a set of additional questions on the 2007 Physical Activity Monitor (PAM). Our module on the PAM included questions related to awareness and knowledge of ParticipACTION. Weighted logistic models were constructed to test the knowledge gap hypotheses and to examine whether awareness was associated with physical activity related beliefs (i.e., outcome expectations, self-efficacy), intention, and LTPA. All analyses included those respondents who were 20 years of age and older in 2007/2008 (N = 4424). RESULTS: Approximately 8% of Canadians were still aware of ParticipACTION unprompted and 82% were aware when prompted. Both education and income were significant correlates of awareness among Canadians. The odds of people being aware of ParticipACTION were greater if they were more educated and reported higher income. Awareness of ParticipACTION was also associated with outcome expectations, self-efficacy, intention, and LTPA status. CONCLUSION: Awareness of ParticipACTION is associated with LTPA. Knowledge gaps in awareness are associated with level of education and household income. Thus, future promotion campaigns should include specific strategies to target different segments of the population, especially people who are living in deprived conditions with lower levels of education.