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The relationship between selected program component combinations and adherence in a twelve week employee… MacLeod, Michael Dee 1980

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THE RELATIONSHIP BETWEEN SELECTED PROGRAM COMPONENT COMBINATIONS AND ADHERENCE IN A TWELVE WEEK EMPLOYEE FITNESS PILOT PROGRAM by MICHAEL DEE MacLEOD B.P.E., University of British Columbia, 1977  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PHYSICAL EDUCATION in the School of Physical Education and Recreation  We accept this thesis as conforming to the required standard  THE UNIVERSITY OF BRITISH COLUMBIA July,. 1980 ( c j Michael Dee MacLeod, 1980  In p r e s e n t i n g  t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f the r e q u i r e m e n t s f o r  an advanced d e g r e e a t the U n i v e r s i t y o f B r i t i s h C o l u m b i a , I a g r e e t h a t the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and I f u r t h e r agree that permission f o r s c h o l a r l y p u r p o s e s may by h i s r e p r e s e n t a t i v e s .  for extensive  study.  copying of t h i s thesis  be g r a n t e d by the Head o f my Department o r I t i s u n d e r s t o o d t h a t c o p y i n g or p u b l i c a t i o n  o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be a l l o w e d w i t h o u t my written  permission.  Department o f  Physical Educati  The U n i v e r s i t y o f B r i t i s h Columbia 2075 Wesbrook P l a c e V a n c o u v e r , Canada V6T 1W5  •3,  DE-6  BP  75-51  1E  /ffo  ii  ABSTRACT The purpose of this study was to determine which of several selected combinations of components within an employee fitness program would positively effect female hospital workers' rate of adherence to a regular physical activity routine.  Additional problems included:  Ci) >studying;f the. jef f ects ydf ithe itweive^week^amplpyeef f itness^pilbt program on the measured dependent variables performed on the employee sample and^(ii) jletermining a feiationshxp between adherence rates(high or low) and the amount of change in the hypothesized improvements. Fifty physically inactive female employees from Peace Arch District Hospital in White Rock, B.C. volunteered to take part in the employee fitness program.  The subjects were randomly assigned to  one of three groups. Each group participated i n a lifestyle and fitness assessment but was otherwise distinguished as follows: Group 1 was assigned to the exercise f a c i l i t y , exercise classes and the education and motivation program;  Group 2 was assigned to the exercise  f a c i l i t y and exercise classes, and Group 3 was assigned to the education and motivation program.  An attempt was made to determine i f the  maximal stimulus program available to Group 1 resulted in (i) a superior rate of adherence to a regular exercise routine and ( i i ) a greater improvement in the dependent variables, compared with Groups 2 and 3.  .iii  The Employee Fitness Program was conducted over a twelve week period and the subjects were pre and post tested for physical activity levels, physical fitness (as indicated by predicted oxygen uptake, f l e x i b i l i t y and percent body fat), lifestyle risk factors and self concept which were then analyzed by separate ANOVA's. used were:  Instruments  the Action B.C. Nutrition Evaluation to determine physical  activity levels, the Dynavit computerized bicycle ergometer, the Action B.C. norms for f l e x i b i l i t y , the Kuntzelman method for determining percent body fat, the Health Hazard Appraisal and the Tennessee Self Concept Scale. Adherence data was collected on self reported progress charts.and analyzed by the use of the Chi-square test of independence. The results indicated a significant improvement in the physical activity and physical fitness of the employee sample.  There were no  significant improvements in the lifestyle risk factors and self concept over the course of the study.  As well, no significant differences  were noted among the three groups i n adherence and in the improvements in the dependent variables.  Only three variables ^::pfedicted::pxygen  uptake, back extension and percent body fat - were considered appropriate for statistical analyses regarding high vs. low adherence due to the unequal number of subjects in the two groups and the large differences among c e l l variances.  In these three variables, the high adherence  participants showed a significant improvement over the low adherence participants.  This trend was also noted i n the other five variables  inappropriate for statistical analyses.  •iv TABLE OF CONTENTS CHAPTER 1  2  3  PAGE INTRODUCTION TO THE PROBLEM  1  STATEMENT OF THE PROBLEM  3  DEFINITIONS  6 <•  DELIMITATIONS  .8  ASSUMPTIONS AND LIMITATIONS  8  HYPOTHESES.  4  SIGNIFICANCE OF THE STUDY  9  REVIEW OF LITERATURE  10  FACTORS INFLUENCING EXERCISE PROGRAM ADHERENCE  16  STRATEGIES FOR INCREASING ADHERENCE  24  COMPONENTS OF AN EMPLOYEE FITNESS PROGRAM  30  SUMMARY  32  METHODS AND PROCEDURES  .•  33  Subjects  33  Time and Duration of the Study  33  Personnel  34  PRE-PROGRAM PROCEDURES  ..  34  LIFESTYLE AND FITNESS ASSESSMENT  36  TESTS  38  The Dynavit Test for Cardiovascular Fitness  38  V  TABLE OF CONTENTS CHAPTER  4  PAGE Tennessee Self Concept, Scale  40  The Health Hazard Appraisal  42  Action B.C. Nutrition Evaluation  44  EMPLOYEE FITNESS PROGRAM  45  EXPERIMENTAL DESIGN  46  DATA ANALYSIS  47  RESULTS AND DISCUSSION. RESULTS OF THE EMPLOYEE FITNESS PILOT PROGRAM  48 50  RESULTS: THE SELECTED PROGRAM COMPONENTS AND ADHERENCE  56  RESULTS: HIGH VS. LOW ADHERENCE PARTICIPANTS  59  DISCUSSION OF THE EMPLOYEE FITNESS PILOT PROGRAM RESULTS  67  DISCUSSION OF THE PROGRAM COMPONENTS AND  5  ADHERENCE RESULTS  69  DISCUSSION OF HIGH VS. LOW ADHERENCE RESULTS  73  SUMMARY AND CONCLUSIONS  75  SUMMARY  75  RESULTS  78  CONCLUSIONS  80  RECOMMENDATIONS  81  vi TABLE OF CONTENTS CHAPTER  PAGE  REFERENCES  •  APPENDICES  ' 83  89  APPENDIX 1: P.A.D.H. EMPLOYEE FITNESS PROGRAM PROPOSAL  90  APPENDIX 2: LIFESTYLE AND FITNESS ASSESSMENT MATERIALS  99  APPENDIX 3: EMPLOYEE FITNESS PROGRAM SCHEDULE AND , FITNESS LEADERS SCHEDULE APPENDIX 4: LIFESTYLE EDUCATION AND MOTIVATION PROGRAM  104 1077  APPENDIX 5: BIBLIOGRAPHY OF HEALTH EDUCATION  APPENDIX 6:  LITERATURE AND "FITNESS MEMOS"  112  INDIVIDUAL RAW SCORES  122  APPENDIX 7: ANOVA TABLES FOR DEPENDENT VARIABLES (GROUPS 1, 2 AND 3)..'.  127  APPENDIX 8: ANOVA TABLES FOR DEPENDENT VARIABLES (HIGH AND LOW ADHERENCE GROUPS)  130  yli LIST OF TABLES TABLE  PAGE  1.  Subject Data  49  2.  Observed Cell Means for Groups 1, 2 and 3  50  3.  Marginal Means and F Values  51  4.  Chi-Square Test of Independence (Crosstabulation of Groups by Adherence)  .  5.  ANOVA Table for Sit and Reach  6.  Observed Cell Means for High vs. Low Adherence  7.  57 58  Participants  66  Health Hazard Appraisal (Pretest Mean Ages)  68  viii LIST OF FIGURES FIGURE  PAGE  1.  Predicted Oxygen Uptake (3 Groups)  52  2.  Sit and Reach (3 Groups)  52  3.  Shoulder Extension (3 Groups)  53  4.  Back Extension (3 Groups)  53  5.  % Body Fat (3 Groups)  54  6.  "Appraised" Age (3 Groups)  54  7.  Caloric Expenditure (3 Groups)....  55  8.  Tennessee Self Concept Score (3 Groups)  55  9.  Sit and Reach  60  10.  Predicted Oxygen Uptake (High vs. Low Adherence)  62  11.  Sit and Reach (High vs. Low Adherence).  62  12.  Shoulder Extension (High vs. Low Adherence)  63  13.  Back Extension (High vs. Low Adherence)  63  14.  % Body Fat (High vs. Low Adherence)  64  15.  "Appraised" Age (High vs. Low Adherence)  64  16.  Caloric Expenditure (High vs. Low Adherence).}  65  17.  Tennessee Self Concept Score (High vs. Low Adherence).  65  ix  ACKNOWLEDGEMENTS The author wishes to thank the members of his thesis committee; Dr. S.R. Brown (Committee Chairman), Dr. C.E.H. Venables, , Dr. G.D. Sinclair and Dr. R.E. Mosher.  Special thanks to Dr. Brown  for his technical assistance i n the preparation of the final draft, to Dr. R.W. Schutz for his advice regarding statistical matters, and to Mr. J. Tyson for his assistance with the computer analyses. Finally, a very special thank you to Action B.C. who provided the author with the opportunity to work with the employees of Peace Arch District Hospital.  Chapter 1 INTRODUCTION In recent years much interest has been directed to the formation of employee fitness programs i n business and industry by both the private and public sectors in Canada and the United States.  This  interest reflects a growing awareness of and concern for the health hazards associated with  modern sedentary living, where the cost of  physical inactivity has resulted in the increase of "hypokinetic disease".  This term includes the conditions of obesity, coronary,  heart disease, hypertension, bone, muscle and joint problems, premature aging and various vaso-regulatory disturbances Raab, 1961).  (Kraus,  Hypokinetic-related diseases constitute approximately  40% of a l l Canadian illnesses (Kavanagh, 1974). Thirty-eight percent of a l l deaths i n Canada can be attributed to heart disease (Taunton, 1978).  This figure represents thousands  of lost working years to Canadian employers.  The cost to Canadian  employers for compensation showed a national increase of 72% in the ten year period between 1965 and 1974. increased 59% (Megalli, 1978).  During the same period, wages  The estimated economic drain of  cardiovascular disease on Canadian National Resources is 1.7 b i l l i o n dollars annually.  Loss of productivity, wages and disability  insurance constitute 90% of this figure (Shephard, 1969). ;i.  1  2 Less prevalent than heart disease, the common backache costs . Canadian industry millions of dollars each year in worker's compensation claims. Provincial health care costs are rising yearly.  The Ontario  Health Insurance Plan (OHIP) raised i t s ' spending from $1.23  billion  in 1970-71 to $3.8 b i l l i o n in 1977-78. An Ontario provincial:.study.ititled "The: Relationship between Physical Fitness and the Cost of Health Care" (Collis, 1977) 1.  concluded:  People with higher levels of physical fitness tend to have lower OHIP medical claims.  2.  An estimated reduction of $31 million in OHIP medical claims could be expected i f a l l adults age 20-69 years of age were of at least average level of phyiscal fitness-  3.  People with higher levels of physical fitness tend to have reduced incidence of coronary heart disease.  A number of researchers has reported both physiological and psychosocial benefits of an employee fitness program (Cox, 1978; Peepre, 1978; Fogle, 1975; Koerner, 1973; Roth, 1978;. Garson, 1977; Yarvote, 1974; Yuhasz, 1977, 1978; Heinzelman, 1974; Durbeck, 1972). A premise that the f i t employee i s absent less frequently and i s more productive has been supported by several European studies (Raab and Gilman, 1964; Keelor, 1976; Pravosudov, 1976) and a Canadian project (Peepre, 1978).  3 Haskell (1978) has.proposed that: "Sufficient data currently exist in support of health benefits resulting from a physically active l i f e style to justify including exercise as an integral component of health promotion programs i n industrial settings". Although hundreds of employee fitness programs do exist i n Canada and the United States, long term adherence to supervised or unsupervised exercise has been a major problem for many of these programs. A strong, positive and consistent association exists between the beneficial results of exercise and adherence to an exercise program. Adherence rates are especially important for employee fitness programs when accumulating cost-effectiveness data::for presentation :to> management. A number of factors which influence the initiation of and _. adherence to exercise programs by adults has been reported.  Much of  the data available on factors important for adherence to exercise programs have..been obtained from asking participants or drop-outs about program characteristics that influence their participation and not from controlled t r i a l s where selected program characteristics are systematically varied and their effects evaluated  (Haskell, 1978).  STATEMENT OF THE PROBLEM The purpose of this study was to determine which of several selected combinations of components within an employee fitness program would positively effect female hospital workers rate of adherence to  4  a regular physical activity routine.  Based on a review of literature  of past research the specific program components studied were: 1.  a lifestyle and fitness assessment and retest (Groups.1, 2 and 3)  2.  an on-site exercise f a c i l i t y with scheduled exercise classes (Groups 1 and 2)  3.  an education and motivation program (Groups 1 and 3).  Sub-Problem A sub-problem of this investigation was to determine i f changes in functional physical fitness, self concept and lifestyle were related to the adherence rate of the employees.  HYPOTHESES Employee fitness programs i n Canada and the United States range from educational campaigns to on-site f a c i l i t i e s and exercise opportunities.  Regardless of the nature of the program, adherence to  supervised or unsupervised exercise has been a major problem for many employee fitness programs.  The question arises as to what i s  necessary to e l i c i t long term participation by a significant number of the employee group?  Based on a review of the literature, three selected program components were included in the employee fitness program.  Employees  were assigned to various combinations of the program components in order to study the relationship between the components and adherence. Although each of the components can be considered a program in i t s e l f and could result in the initiation of and adherence to a regular exercise routine by the participants, the investigator-felt.  that a  combination of a l l three components was: necessary to effect a high rate of adherence to a regular exercise routine by the employee group.  Hypothesis I As a group, the participants in the employee fitness program w i l l significantly: a)  increase their daily physical activity as indicated by their reported caloric expenditure on the nutrition analysis.  b)  increase their physical fitness as indicated by changes in their predicted maximal oxygen uptake, f l e x i b i l i t y and percentage body:.: fat.  c)  increase their self concept as indicated by increases in their raw scores on the Tennessee Self Concept Scale.  d)  decrease their lifestyle risk factors as indicated by decreases in the "appraised" age on the Health Hazard Appraisal.  6  Hypothesis II The employees who are involved in a l l three components of the employee fitness program (Group 1) w i l l demonstrate: a)  a higher rate of adherence to a regular exercise routine when compared to employees involved i n only two components of the program (Groups 2 and 3).  b)  a significantly greater change i n the measured dependent variables when compared to Groups 2 and 3.  Hypothesis III 1  High adherence participants in a l l three groups w i l l show a significantly greater change i n the measured dependent variables when compared to low adherence participants i n a l l three groups.  DEFINITIONS Employee Fitness Program - the term used to describe the physical activities, fitness assessments, exercise opportunities and educational sessions which were provided within the'liospital to satisfy the needs and desires of the employees. Lifestyle and Fitness Assessment - a program offered by Action B.C., which includes standardized physical fitness tests, nutrition evaluation and a Health Hazard Appraisal.  Personalized pre-  scriptive exercise suggestions and lifestyle modifications schemes are included.  7  Action B.C. - a private, non-profit organization registered under the Societies Act of the province of British Columbia.  Action B.C.'s  objectives are to create and promote opportunities for lifestyle change through increased physical activity, sound nutrition and positive living habits.  Action B.C.'s Health Promotion  Program for Business and Industry has provided testing, counselling and consulting services for a number of organizations throughout the province.  The investigator i s employed by  Action B.C. as an employee fitness consultant. Health Hazard Appraisal - a tool used to assess one's potential health problems.  The H.H.A. allows computation of an individual's  "physiological" or "appraised" age based on lifestyle risk factors derived from a short and simple  questionnaire.  Adherence - i n this study, high.adherence participants are those employees who are physically active three times a week or more according to the activity-need standards published by the American College of Sports Medicine (1978).  Low adherence  participants are those employees who are physically active less than three times a week. Maximal Stimulus Program - the program available to Group 1 participants which included a l l three employee fitness program components.  8  DELIMITATIONS 1.  The subjects for this study were full-time female employees i n a general hospital, ranging in age from 20-59 years.  2.  The length of the Employee Fitness Program was twelve weeks.  3.  The Health Hazard Appraisal was used to assess the lifestyle risk factors of the employees.  4.  The nutrition evaluation was used to measure the activity levels of the employees based on an averaged caloric expenditure for a three day period.  ASSUMPTIONS AND LIMITATIONS 1.  It i s assumed that the Health Hazard Appraisal i s a reliable tool for the assessment of one's "appraised age" based on lifestyle risk factors.  2.  It i s assumed that the Dynavit bicycle ergometer i s a valid and reliable measure of cardiovascular fitness.  3.  It i s assumed that the activity levels reported on the nutrition evaluation yield a reliable measure of caloric expenditure.  4.  It i s assumed that the Tennessee Self Concept Scale i s a valid and reliable measure of self concept.  5.  The study was limited by the number of employees who volunteered for the Employee Fitness Program.  9  6.  It i s assumed that the employees kept accurate attendance records on their monthly exercise progress cards.  SIGNIFICANCE OF THE STUDY The information from this study should prove valuable to those organizations which wish to improve the adherence rate of employees to a company-sponsored fitness program.  As employee fitness programs range  from educational campaigns to on-site f a c i l i t i e s with f u l l time directors, this study may demonstrate basic program components necessary to effect a positive adherence rate to exercise.  To the  knowledge of this investigator, very l i t t l e research has been done to show a cumulative effect of an educational program with the availability of a fitness f a c i l i t y and exercise opportunities on the adherence rate of an employee fitness program. In addition, no other study has dealt with the implementation of an employee fitness program in a general hospital setting.  As  various programs do vary in scope and expense, those organizations with similar philosophy, finances, f a c i l i t i e s and occupational settings may draw from the following information to effectively implement new programs or to enhance existing programs.  Chapter 2 REVIEW OF LITERATURE  1  A number of studies on employee fitness programs has reported a positive and consistent relationship between program effects and program adherence. Heinzelman and Durbeck (1970) conducted one of the f i r s t major studies on the effects of physical fitness programs using employees of the National Aeronautics and Space Administration Headquarters in Washington, D.C.  The program participants were expected to exercise  for thirty minutes, three times a week, at an exercise f a c i l i t y located at the workplace.  After one year, the subjects were asked to  f i l l out a questionnaire with respect to perceived changes in attitudes, health and behaviour.  In addition to the measured physiological improve-  ment by participants, significant effects were reported on health attitudes and behaviour.  In general, the program resulted in feelings  of better health and stamina.  Other effects reported included weight  loss, decreased food consumption, more positive work attitude, less stress and tension, improved work performance, increased outside physical activity",.: more adequate sleep and rest and reduction in smoking.  The subjective responses concerning the perceived changes  in these areas corresponded very well with the measured levels of cardiovascular functioning.  In general a highly consistent and  positive relationship was observed between the subjective and objective  10  measures of program effects.  Reported program effects were positively  correlated with program adherence.  Those who consistently participated  in the program reported greater effects than those with poor adherence. Yarvote et al. (1974) looked at cholesterol and triglyceride levels i n relation to the degree of attendance of the participants in an Exxon Corporation employee fitness program.  The program was  established to provide a highly organized physical and cardiovascular conditioning system that combined scientific objectives, procedures and equipment.  The program made exercise accessible to the participants  through a concentrated schedule of activities and was closely supervised by the Medical Department Staff.  The employees were encouraged to  participate i n the program at least three times a week. At the end of one year, the results indicated that those who attended two or more\times per week on the average, had a decrease i n serum cholesterol. The relationship between frequency of attendance and the level of triglyceride decrease was even more apparent.  The mean change i n  triglycerides was directly related to the participant's attendance with maximum improvement seen i n the group that attended, on the average, three exercise sessions per week. They concluded that a minimum average attendance of two times per week was necessary to produce the desired physiological improvement that occurred in the participants. Fogle and Verdesca (1975) i n a cardiovascular fitness program for employees at the Western Electric Company, divided the participants  into three groups:  Group 1, those persons attending more than two  sessions per week; Group 2, those persons attending more than one but fewer than two sessions per week; and Group 3, those attending fewer than one session per week. Physiological baseline data was collected and retesting took place approximately seven months after the program was initiated.. The participants, executives ranging in age from 30-57 were permitted to exercise up to three times per week on company time and were encouraged to do so by the company medical staff.  Their  results showed that the ten subjects in Group 1 significantly improved their level of cardiovascular fitness.  Mean heart rates were lower  at rest, at a l l levels of exercise, and at recovery on the criterion stress test. Weight loss was significant and may have had an effect on the significant mean (26.5%) increase in predicted maximal oxygen uptake.  Group 2 displayed a significant increase in maximal oxygen  uptake, although less than the improvement in Group 1.  Results for  Group 3 were insignificant throughout, displaying no trends in the parameters examined.  The researchers concluded that extensive  improvement i n cardiovascular fitness can be attained by active participation i n a supervised exercise program, i.e. two to three times per week. In a 10 week pilot employee fitness program established by Yuhasz (1977) for Alcan Smelters and Chemicals Ltd., significant improvements in physical fitness were demonstrated by those parties ipants who attended a minimum of twice a week. Fitness measurements included a cardiovascular endurance test (PWC 170), body fat, body  13 weight, f l e x i b i l i t y and grip strength. In a similar project for 3M Canada Ltd.,  the average attendance  for the pilot employee group was 2.2 times a week. The test-retest data indicated improvements i n cardiovascular condition of 34% for men and 51% for women. Both sexes showed significant losses i n body fat and body weight as well as significant improvements i n back extension and forward hip flexion. 7% respectively.  Waist and calf girths decreased by 6% and  Participants reported improved attitudes and confidence.  The ten week program was conducted three days per week after work. Each exercise session emphasized jogging, f l e x i b i l i t y , muscular endurance and strength (Yuhasz, 1978). Koerner (1973) ascertained the cardiovascular benefits derived from an employee fitness program conducted by the Xerox Corporation. Two groups of male executives were subjected to stress testing on a treadmill and their performances were compared.  The program group was  composed of men who had been i n the fitness program for approximately 27 months.  This group was subdivided into three categories based upon  the frequency of participation.  Participation i n the program three or  more times a week resulted i n a "trained" classification; two but less than three times was classified "partially trained"; at least once but less than twice were classified "untrained".  The pre-program  group consisted of men who were tested as part of their screening examination prior to acceptance i n the fitness program.  A l l of this  group were considered "untrained" based on their lack of regular exercise.  14 The program group was compared with the preprogram group by the duration of time the subjects performed within the limits of the test. The results indicated that the program group was able to perform an average of 19% longer than the preprogram group.  A l l three categories  of the program group surpassed the performance of the preprogram group. The "trained" individuals within the program group exercised the longest.  The investigator concluded that the program groups appeared  to have developed a greater aerobic capacity as well as better inotropic and chronotropic mechanisms for adaptation to greater work loads. A six month Employee Fitness and Lifestyle Project (Peepre, 1979) conducted at the Canada Life Assurance Company i n Toronto showed significant positive results in several measures of physical fitness, including cardiorespiratory fitness, reduction in percent body fat and an increase in f l e x i b i l i t y .  Stratification by fitness program  participation showed that the changes in physical fitness were greatest in the "high-adherence" employees.  "High adherers" were those that  attended two or more classes per week, with "low adherers" attending less than two classes per week. The high adherence participants showed a reduction i n absenteeism relative to both the control group and to the low adherence participants. When total days absent were averaged for pre and post intervention, the "high adherers" had a 22% decline in absenteeism during the research period, beyond the seasonal.trends control employees.  for the rest of the experimental and  Male participants showed the most improvement, by  a 60% decline, while females showed a 38% decline overall and a 22%  15 decline on Monday and Friday absences.  According to the researchers,  this decline i n absenteeism represents approximately 6,000 less days absent annually, or $300,000 direct salary savings i n a company of 1400 employees. The high adherence group also demonstrated gains on a number of attitudinal questionnaires, particularly those concerned with the relationship of sport and physical activity to health.  Females i n  this group also demonstrated a higher degree of satisfaction with their work environment. The American College of Sports Medicine Position Statement on The Recommended Quantity and Quality of Exercise for Developing and Maintaining Fitness in Healthy Adults (July, 1978) has concluded that endurance training less than two days per week, less than 50% of maximum oxygen uptake and less than 10 minutes per day is inadequate for developing and maintaining fitness for healthy adults. The recommendations for the quantity and quality of training for developing and maintaining cardiorespiratory fitness and body composition i n the healthy adult are: 1.  Frequency of training:  3 to 5 days per week.  2.  Intensity of training:  60% to 90% of maximum heart rate reserve  or, 50% to 85% of maximum oxygen uptake. 3.  Duration of training:  15 to 60 minutes of continuous aerobic  activity. 4.  Mode of activity:  Any activity that uses large muscle groups,  that can be maintained continuously, and i s rhythmical and aerobic in nature.  16 FACTORS INFLUENCING EXERCISE PROGRAM ADHERENCE Researchers have identified a number of factors which influences the initiation and the maintenance of exercise programs by adults. Heizelman and Bagley (1970) have examined social and psychological factors that influence the effectiveness of programs in terms of how they are organized and administered.  The following factors can influence  the decision which individuals make about program participation, as well as their response over time: The use of a small group discussion-decision approach during recruitment  can influence the decision to participate as well as the  adherence pattern over time.  In their NASA study, the researchers used  a recruitment method involving small group discussions and decision making and systematically compared i t with a large group lecture approach.  The findings indicated that the effectiveness of the small  group discussion and decision method was not limited by the personal and social characteristics of the audience, or by difference i n level of s k i l l , or personal style of the group discussion leaders.  This  approach was more effective than a lecture approach regardless of the social class and lifestyle characteristics of the audience.  The active  involvement of the participants in the group discussion i s likely to increase understanding and learning compared with the more passive reception of information obtained from a lecture.  The small group  context provides an individual with the opportunity to explore and evaluate the benefits and demands of the program participation.  17 Program participants should be able to maintain regular contacts with medical and other program personnel.  The social-psychological  value of this type of relationship cannot be overemphasized:  i t makes  i t possible to provide participants with the feedback, clarification, and support they need and want.  In a study by Faulkner and Stewart  (1977) on female employees, a "follow-up personal contact" by the program directors was found to be an effective technique in retaining participants i n the fitness program. Individuals may be motivated to exercise or participate i n a physical activity program for other than health reasons.  Some persons  may participate because the program allows a change of routine, provides an opportunity for recreation or social contacts, increases their fitness for other, games or sports (skiing, hiking, etc.) or ehances appearance.  When efforts are made to promote exercise participation,  the focus should be diverse and take into account a variety of motivating factors, health related or not. Factors influencing an individual's decision to take part i n an exercise program frequently differ from factors influencing his/her adherence to the program over time.  Factors that influence i n i t i a l  participation in an exercise program may be concerned with health, desire for recreation, or a change in routine.  Factors such as the  organization and leadership of the program, the;types of activities offered, and the comaraderie or social support that i s generated may  18  be more instrumental i n promoting adherence over time.  Major efforts  should be made to ensure that exercise programs organized on a group basis are administered  i n a manner to support rather than impede  social development. Volunteer participation i n a supervised exercise program i s positively related to level of socioeconomic status.  Although this  finding i s consistent with the general social learning theory that the more highly educated are more likely to particpate i n a new health oriented behaviour, persons i n higher social classes may simply have more time available to participate in exercise programs.  Also,  persons with a higher socioeconomic status may have more flexible schedules than those i n lower social classes who are engaged i n occupations requiring a more routine and fixed work role.  This  relevant factor highlights the need to establish exercise programs that allow flexible times for participation, as well as programs that can be conducted within various employment settings. The attitude and reaction of those with whom an individual interacts determine whether or not he/she w i l l participate, as well as influence the pattern of adherence over time.  In order to promote  effective exercise programs, the attention should focus not only on the participant, but also those to whom the individual relates most directly, and who are, therefore, likely to influence his/her attitudes and behaviour.  A participant's spouse, friends and colleagues can play  important roles i n this sense.  Persons who serve as "significant  others" should be adequately informed about the nature of the program, and be involved in i t on a regular basis i n order to support the individual's participation, rather than influence i t negatively. Collis (1977) has suggested that employee fitness programs provide educational materials for the participants to take home to their spouse or friends so that they w i l l encourage the person to adhere regularly to the program. Wanzel and Danielson  (1977) determined a number of factors  which led to participant withdrawal from a company exercise program. A total of 480 questionnaires were distributed to employees who .were . known to have withdrawn from the company fitness program.  Completed  replies were received from 254 of the employees (52.9%). Major reasons for withdrawal from the program included: 1.  crowded conditions during exercise sessions (14%)  2.  the distance of the f a c i l i t y from home or place of work (42.5%)  3.  the necessary rearrangement of a participant's daily schedule to accommodate exercise sessions (40.2%)  The exercise program was operated during non-job hours and the respondents to the survey were asked i f the availability of exercise classes during office hours, two or three times a week, would have been a suitable alternative to their after-hours exercise periods and thus would have kept them in the program.  65.3% of the drop-outs were i n  agreement with this idea and 78% of the respondents felt that this type of scheduling would not have decreased their normal office productivity.  These results led the investigators to conclude that  20 employers should investigate the possibility of adjusting individual work schedules to incorporate the workout periods of interested employees.  This arrangement would ease the strain of fitness part-  icipation on an employee's daily schedule thus enhancing program adherence.  As well, i t would ease the strain of training during  office hours and reduce the crowding of f a c i l i t i e s .  Other factors  identified in this study which could help increase program adherence included: 1.  A "buddy system"  i n which participants enroll and exercise  with another person.  This could prove especially effective  with those who traditionally exercise alone,^i.e. older participants and those with greater corporate responsibility.  Only 34.9%  of the respondents exercised with a friend or spouse. 2.  Improve the motivational style of the fitness instructors. The instructor should ask each participant what motivational approach, i f any, would be most helpful. well to motivation by an instructor.  Some people respond  Others work best with a  friend's encouragement while s t i l l others respond best to peer group motivation.  Participants should be consulted on how  they wish to be motivated. 3.  Participants should develop realistic objectives or steps that can be attained within a two-week period.  One variable signify  icantly related to withdrawal was attainment of exercise objectives. People who did not attain their objectives tended to drop out of  21 the program much faster than those who did attain them.  General  conditioning was the most often stated objective (70.9%) followed by improved heart and lungs (52.8%) and weight loss (46.5%).  The researchers felt these objectives might be too  general and should be further developed.  Bjurstrom and Alexiou (1978) have reported that 61% of the participants starting an employee exercise program were s t i l l p a r t i c i pating at the end of one year.  The retention rates for years two through  five were 52%, 42%, 37% and 25% respectively and at year five the retention rate was significantly different for men (45%) and women (11%). Of those who dropped out during the f i r s t 15 weeks, 7 9% reported doing so because of lack of interest.  Included were reasons of lack or loss  of motivation, logistical d i f f i c u l t i e s associated with the program schedule and problems encountered with supervisors regarding time for program participation.  Another 13% dropped out because of physical  or medical problems and 8% because of changes in job status.  During  the remainder of the f i r s t year 81% of the drop-outs were reportedly due to lack of interest, change of job status increased to 18% and medical reasons decreased to 1%.  Attrition occurring after one year  of program participation resulted increasingly from changes in job status and decreasingly from lack of interest and motivation, particularly among male employees.  In addition to the decrease in the percentage of  attrition associated with medically related problems, the type of medical problems causing attrition became increasingly the type not likely attributable to program participation.  Foss (1979) investigated factors related to urban female population in physical activity programs. Major factors supporting or inhibiting the initiation and maintenance of physical activity programs were identified through a questionnaire  survey of a random sample  (N = 700) of nonstudent and nonretiree females. Active versus inactive respondents differed significantly for several variables.  Early sports experiences, particularly in elementary  and junior high or middle school physical education classes and . instruction in leisure-time sports and dance were important supportive factors.  A greater proportion of active women than inactive women  received encouragement to be physically active during childhood from their fathers, siblings and friends.  Seventy percent of the active  women participated in unsupervised physical activity programs, while thirty percent were supervised in programs provided by commercial and community agencies.  Older women were more dependent upon exercise  leaders to provide technical assistance.  The investigator found that  awareness of the aging process influences women to initiate programs, and health related factors motivate them to continue. Many (50%) of the inactive women were interested in initiating physical activity programs (three times per week, thirty minutes per session) i f time permitted.  Their activity choices were the same as  those practised by active women, namely jogging, calisthenics, swimming and tennis.  The investigator concluded that program directors and exercise leaders should consider previous and current motivational factors during the development and implementation of physical activity programs for female participants, so as to improve compliance, adherence and maintenance. At a recent meeting of fitness directors in business and industry, Colacino (1979) identified factors that influence adherence to corporate health management programs.  Factors included the organiz-  ation and administration of the program, accessibility, corporate incentives, social aspects, evaluation and personal feedback.  Reasons  for dropping-out included time problems, lack of motivation, injury, poor f a c i l i t i e s , poor leadership, intimidation by peers and other sources of activity. Oldridge (197 9) has recently reported several factors which influence compliance with cardiac exercise rehabilitation programs. Poor compliance rates have been associated with programs that require many restrictions or changes in personal habits.  One of the main  reasons for dropping out of an exercise therapy program has been lack of interest or motivation.  Oldridge suggests that exercise programs  should include moire than an exercise prescription. He concluded that the exercise program should provide feedback to the participant and spouse about progress or lack of progress in cardiovascular fitness and explain the need for lifestyle changes. Additions to a wellrounded program should include relaxation and nutrition advice and social gatherings.  24 Collis (1977) has identified the following factors which influence attendance at adult fitness programs: 1.  pre and post program testing  2.  organization and leadership of the class  3.  regularity and punctuality  4.  rewards and recognition  5.  knowledge of purpose  6.  "espirit de corps"  7.  variety  8.  symbols of participation  9.  use of motivational techniques  10.  permissiveness and informality  11.  easily accessible venue  12.  personal attention  STRATEGIES FOR INCREASING ADHERENCE Faulkner and Stewart (1977) have proposed that knowledge and understanding of effective promotional and motivational techniques in "recruiting" participants and "retaining" them i n a fitness program would be invaluable to a l l sectors of society concerned with fitness programs. They evaluated the effectiveness of various recruitment in motivating  techniques  an ; occupationally sedentary group of female employees  to begin a fitness program.  They also evaluated the effectiveness of  various "short term" retention techniques in motivating participants to continue in an exercise program.  Their results indicated that a combination of a fitness assessment and educational seminars was the most effective technique for the "recruitment phase" of the project.  A "follow-up" personal contact  technique appeared to be most effective in retaining participants i n the program.  The participants received at least two follow-up phone  calls regarding their involvement and progress i n the program. The second most effective retention technique was the "test-retest". A l l the subjects received an i n i t i a l fitness assessment and were aware that they would be retested for improvement.  Only those subjects who  attended at least an average of two sessions per week were considered retained.  The investigators concluded that simple, direct appeals and  procedures appeared to e l i c i t a good response i n terms of recruitment and retention. Reid and Morgan (1979) studied compliance with exercise prescriptions among city firefighters.  They hypothesized that adherence to  regular exercise over a period of six months would increase with each of the following additions to the exercise prescription: 1.  printed exercise instructions and a ten minute consultation with a physician (Groups 1, 2, 3).  2.  a one-hour period of film and discussions (Groups 1 and 2).  3.  knowledge of pulse taking, quantifying, recording of daily exercise, and reporting of this information (Group 3).  The subjects were tested after three and six months for change i n aerobic capacity, indicating adherence to regular exercise.  After  three months, the subjects i n the control group (Group 1) had a 29%  compliance rate, compared with 56% and 55% for Groups 2 and 3 respectively (p = .02). However, after 6 months, Groups 2 and 3 lost 40% of previous compilers, while the rate for Group 1 remained the same. At the end of six months, only about a third of a l l three groups that started the program were exercising regularly. The  investigators concluded that "while a one-hour educational  presentation i n i t i a l l y motivated twice as many to comply as the control prescription, this effect was temporary". Collingwood  (1979) has reported than an "educational fitness  program", i.e. an education program with l i t t l e opportunity available for physical activity, had an effect on increasing activity levels of police officers. 1.  Two program goals were identified:  to provide an educational program to teach fitness program development and revision skills so that an officer can adhere to an individual program the rest of his l i f e .  2.  to provide a starter program whereby the officer starts getting used to physical activity.  Officers were taught exercise skills and management, and were provided with a training manual and other learning materials.  The program was  conducted over a two week academy course of which eight hours was devoted to the fitness educational curriculum •. The follow-up period was nine to eleven months and consisted of a written questionnaire which the officers f i l l e d out and sent back for tabulations.  The results indicated that the education program by itself with l i t t l e opportunity for physical exercise at the workplace had an effect in increasing the activity levels of the participants. Approximately half of the subjects dropped out of an exercise program after the six to nine month period.  <  The author reported three major factors to assure adherence: 1.  education/training on individual program development and maintenance  2.  reinforcement  from administration  3.  supervision for the i n i t i a l conditioning period to monitor the most c r i t i c a l period - 6 weeks.  •  He concluded that with a l l three factors accounted for, the probability of adherence could be increased. In 1975, the Dickshire Distributing Company of E l Paso, Texas, initiated a program to encourage the maintenance and development of physical health of their employees (Hardin, 1979). cardiovascular  The availability of  fitness f a c i l i t i e s and exercise opportunities, plus  in-service education accompanied by prescriptive exercise suggestions resulted in a significant increase i n the estimated Maximum Oxygen Uptake levels of the participants. Pfeiffer (1977)- has emphasized that the most direct and practical route to minimize the threat of cardiovascular disease i s preventive health maintenance in the form of employee fitness programs and education programs which emphasize proper l i f e s t y l e practices.  '  Using basic economic concepts and models of human health behaviours, Everett (1979) found that the time and effort costs of exercise may exceed the  present value of the economic benefits of  improved physical fitness.  According to the researcher, these high  costs help explain the small incidence of consistent adult exercise and the lack of in-house, on-worktime employee exercise programs. He maintains that while health education campaigns may be useful, employers must find ways to reduce the time and effort costs of exercise by making i t a low-cost byproduct of more immediately desired outputs or goals. 1.  He has suggested three ways to accomplish this:  Reintegrate physical activity into productive work. Most of the epidemiological studies showing a relationship between physical activity and reduced GHD workers.  studied productively employed  In spite of advanced mechanization, some opportunities  for efficiently increasing physical activity on the job may exist.  Employers could encourage executives, sales personnel  and others who work on their own hours to u t i l i z e in-house exercise f a c i l i t i e s as places to meet and exchange information, for example, rather than using coffee breaks and extended cocktail lunches.  Since such informal meetings are essential  for conveying information in many organizations, the time costs could be quite low and the potential benefits for highly paid employees substantial, i f the exercise f a c i l i t i e s were conveniently located.  Some executives keep exercycles with reading  stands in their offices for combining exercise and routine reading.  29 2.  Facilitate and encourage labour-intensive transportation such as bicycling and walking combined with transit and carpooling. These modes may save employees substantial monetary cost's and ^  in congested areas may take no more time than driving, thus providing exercise as a low cost byproduct.  3.  Support and encourage vigorous sports,such as competitive hand and racquetball, swimming, basketball, soccer and running instead of golf, baseball, bowling and other light physical activities. Long-run health benefits from exercise become a low effort and low time-cost byproduct of the immediate competition and social interaction.  Brown (1979) has identified four groups, and strategies to market fitness to them when developing an employee fitness program: 1.  Highly committed group:  or "fitness buffs" who already exercise  and w i l l continue, regardless of what the program offers. About 20% of any given employee population f a l l s in this group. The fitness director should feed supportive information to this already convinced group. 2.  High-receptivity group:  estimated to be about 40% of the  population, this group i s the most receptive to change. For one reason or another, they seem ready to commit themselves to a fitness program.  Approaches to influence this group include  healthy hazard appraisal or risk factor analysis, educational sessions, specific data feedback, counselling and peer support.  30 3.  Low-receptivity group:  usually about 30% of the population who,  for one reason or another are not as "primed" as the high receptivity group.  Emphasis should be given to the enjoyment  aspect of exercise. Also, because many people i n this third category tend to come into the program to lose weight, a steady flow of information on weight control helps motivation. 4.  Professional dropouts:  about 10% of the employee population,  this group w i l l drop out of the program within the f i r s t four weeks. They have experienced a great deal of failure when attempting to modify behaviour.  One of the most important  factors for attracting and keeping members of this group i s the enthusiastic leader who takes special interest i n their progress.  Individual counselling should be stressed with this  group.  COMPONENTS OF AN EMPLOYEE FITNESS PROGRAM Collis (1977) i n the Canadian government publication Employee Fitness identified ten steps to the development of an employee fitness program: 1.  demonstrated requirement for fitness program, e.g. questionnaire  2.  formation of fitness committee (medical, union, managerial and employee involvement)  3.  appointment of a fitness director  4.  establishment of i n i t i a l exercise testing f a c i l i t y and activity areas  31 5.  awareness campaign and sensitization process  6.  fitness testing and exercise counselling  7.  pilot program of limited numbers and duration  8.  collection and analysis of pilot program data  9.  publicize i n i t i a l success and create a demand  10.  expand program and f a c i l i t i e s and institute leadership training.  In addition, Collis noted twelve common features of successful programs: 1.  strong leadership  2.  administrative support, with personal and financial committment  3.  accessibility (on-site or nearby f a c i l i t i e s )  4.  availability  5.  assessment (continuing evaluation of fitness, anthropometry and performance)  6.  recording (techniques should be devised for monitoring the progress of participants)  7.  group exercise  8.  challenging physical programs  9.  continued motivation, stimulation and incentive  10.  organization  11.  v i s i b i l i t y and variety  12.  continuity and extension (the program should work with related company and community organizations).  ~N  32 Haskell (1978) summarized the following components of a successful employee fitness program:  (a) the involvement of knowledgeable and  enthusiastic leadership; (b) a program in which participation i s reasonably convenient; (c) adequate instruction on why and how to exercise; (d) provisions for a variety of appropriate activities to meet different needs and interests; (e) support by peers, supervisors and family for continued participation; (f) establishment  of short  and long range goals with periodic assessment and appropriate nition or awards.  He emphasized that these arrangements:  recog-  "...appear  important in order to e l i c i t long-term participation by a substantial percentage of employees".  SUMMARY A positive and consistent relationship exists between employee fitness program effects and program adherence. Numerous studies have identified a variety of factors which influence the initiation and the maintenance of exercise programs by adults.  Investigators have proposed  a number of strategies for increasing the rate of adherence to employee fitness programs.  It appears necessary to include certain components  when designing and implementing an employee fitness program in order to e l i c i t long-term participation by a significant number of the employee group.  Chapter 3 METHODS AND PROCEDURES Subj ects Fifty female employees from Peace Arch District Hospital i n White Rock, B.C., volunteered  to take part i n the pilot employee  fitness program.  Each of the subjects was ; randomly assigned to one  of three groups.  The mean ages were 36.6 years for Group 1, 36.0  years for Group 2 and 36.7 years for Group 3. Thirty-three subjects, representing 66% of the sample, were married.  The subjects were  physically inactive according to the recommended activity-need standards published by the American College of Sports Medicine (1978). Each group participated i n a lifestyle and fitness assessment but was otherwise distinguished as follows:  Group 1 was assigned to  the exercise f a c i l i t y , exercise classes and the education and motivation program.  Group 2 was assigned to the exercise f a c i l i t y and  exercise classes.  Group 3 was assigned'to the education and motiva-  tion program.  Time and Duration of the Study The Employee Fitness Program was conducted over a twelve week period, from the beginning of March, 1979, to the end of May, 197,9. The lifestyle and fitness assessment was held one week prior to the implementation of the program.  Post testing was conducted during the  week following the cessation of the program. 33  Personnel The  investigator, a fitness consultant for Action B.C., was  appointed as the Employee Fitness Coordinator for Peace Arch District Hospital.  Action B.C. staff assisted the investigator during the  testing period.  PRE-PROGRAM PROCEDURES Action B.C. was contacted i n November, 1978 by a group of employees from Peace Arch District Hospital (P.A.D.H.) who were interested i n the implementation of an employee fitness program. A tour of the hospital by Action B.C. consultants revealed a large, generally unused area which would prove acceptable for exercise testing and classes. conducive  The area surrounding the hospital was found to be  to. jogging and walking classes.  .•Upon the recommendation of Action B.C., the. group formed a Fitness Committee whose purpose'it_was to demonstrate a requirement for a fitness program by the employees of the hospital. The committee was to determine the number of staff interested i n participating, the number of exercise classes and proposed times, and the types of activities which would appeal to the employees.  Also, the committee  was to determine available resources, establish a budget and obtain approval from the administration of the hospital. Involvement from 5% of the staff, i.e., 22 employees, was considered a minimum number  35 for starting a program. Action B.C. emphasized to the committee, the importance of this i n i t i a l groundwork i n the construction of a successful pilot program. In December, 1978, a memorandum describing the proposed employee fitness program was distributed to the administration, department heads and staff of P.A.D.H. by the chairman of the Fitness Committee. The memorandum outlined the formation of the proposed pilot program and noted the preliminary approval by the hospital administration. An invitation was extended to a l l staff for a meeting with the Fitness Committee to discuss the proposed pilot program.  This meeting, held  in December, 1978, concluded:a)  the minimum number of times per week for employee participation in the program i s three,  b)  department directors may consider scheduling flexible working hours on an individual basis to facilitate participation i n the program, and  c)  work must be up-to-date before the employee attends.  The program was to be assessed for i t s effectiveness and usefulness in the hospital at the end of a twelve week t r i a l period. In January, 1979, Action B.C. appointed the investigator as the fitness coordinator for the P.A.D.H. Employee Fitness Program. The investigator met with the Fitness Committee and was informed of the developments involved with the program thus far. A committment of two days a week of employment :time was established for the investigator to help coordinate the program.  36 The investigator and committee initiated an awareness campaign to publicize the implementation  of the program.  Various responsibilities  were delegated to the members of the committee and the campaign included a poster and pamphlet program, a special "get f i t " issue of the hospital newsletter and a Peace Arch Fitness Promotion Day. A schedule and description of classes was drafted by the investigator and submitted to the committee for inclusion i n the hospital newsletter.  The investigator also provided a small group of  employees with a Fitness Leaders Training Program.  This program  provided the group with some' of the theoretical and practical background necessary to lead a fitness class. A program proposal identifying the design, objectives and the research component was submitted to the administration for final approval prior to theriftpl'^en£a£ibh'.:'o"£':"tha "program (Appendix 1 ) .  LIFESTYLE AND FITNESS ASSESSMENT Action B.C.'s Health Promotion Program was used for the . l i f estylefand^f'itness assessment and included the JHealth Hazard. _„._,.-•: Appraisal, three day nutrition evaluation and functional fitness tests. The Tennessee Self Concept Scale (T.S.C.S.) was also included. One week prior to the assessment, f i f t y employees received the H.H.A., nutrition evaluation worksheets and the T.S.C.S. testing booklet and answer sheet for self administration. The results from the H.H.A. and the nutrition evaluation were used i n conjunction with the results from  37  the fitness assessment to provide lifestyle counselling and prescriptive exercise suggestions (American College of Sports Medicine Position Statement, 1978).  The results of the T.S.C.S. were not revealed to  the employees. Counselling was conducted on a one to one basis and employees were advised as to the specific programs open to them for the duration of the pilot period. A l l employees received the same counselling information during the session and were encouraged to adhere to the prescribed exercise suggestions.  Individual needs regarding exercise  were also discussed at this time. Participants received progress cards which were collected monthly. Due to the number of varying shifts within the hospital, collection of these cards on a weekly or bi-weekly basis was not considered feasible. Participants were encouraged to keep up-to-date and accurate records. Perusal of the progress cards revealed accurate record-keeping by a majority of the participants.  These cards monitored personal progress  and provided the primary assessment of adherence to the prescribed exercise suggestions. The functional physical fitness assessment included cardiovascular, bbodyccomposition  and f l e x i b i l i t y measures. An electronic,  computerized bicycle ergometer, the Dynavit, was used to assess cardiovascular fitness. Kuntzelman's (1975) method for determination of percent body fat was utilized.  Harpenden skinfold calipers were used and the locations  of tissue measurements were the triceps and the suprailiac.  38 The f l e x i b i l i t y measures included the s i t and reach, back extension and shoulder extension tests.  The test methodology and  normative tables are contained i n the Action B.C. Functional Fitness Appraisal Test Manual (Sinclair^-and Rhodes, 1977). The  Physical Activity Readiness Questionnaire (PAR-Q) was used  for pre-test screening.  The PAR-Q was developed as a f i r s t level  screening device prior to conducting non-medical monitored exercise tests (Chisholm et a l . , 1975). The post-program lifestyle and fitness assessment was conducted one week after the ~cessation of the program. r  TESTS The Dynavit Test for Cardiovascular Fitness The Dynavit computerized  bicycle ergometer was designed to  c l i n i c a l standards for both exercise , tolerance testing and exercise training (Dynavit, 1978). The  Dynavit ECG amplifier accepts inputs from chest electrodes  or from a plethsysmograph type pulse-sensor.  ECG signal processing  detects the blood wave at the finger tip when finger-type sensors are used.  The ECG circuit i s free from exercise induced artifacts. The  computer accepts signals from the'-'ECG; amplifier and determines heart rate using a crystal controlled time base to period average 25 beats with beat-by-beat updating.  This technique provides a highly accurate  digital display plus easy recognition of an increasing, decreasing or steady state heart rate (Dynavit, 1978).  The keyboard is used to enter each subject's age, weight and sex which are used in calculating output data. by keyboard selection and includes:  Data output i s displayed  elapsed time of exercise, heart  rate, cumulative caloric costs, workload, age, weight, target rate maximum^ exercise time and intensity cumulative_units  (Dynavit, 1978).  Based upon measured performance and heart rate, the computer calculates a vscore>of an individual's aerobic capacity auto-corrected for age, weight and sex differences.  The projected index is compatible  with the table of Cardiorespiratory Fitness Classification as published by the American Heart Association i n Exercise Testing and Training of ' Apparently Healthy Individuals:  A Handbook for Physicians (1972)  (Dynavit, 1978). The Meditronic model used in this study also provides data output (calculations and projections) of oxygen uptake at 170 BPM (Dynavit, 1978).  The predicted oxygen consumption score at PWC 170  was used in this study.  Hockey (1979) has defined this score as  "a prediction of what the oxygen consumption for the subject would be i f he were to work at a task which would elevate his heart rate to 170 beats per minute".  The score i s expressed in ml/kg/min and was  computed when the subjects reached a steady state for three minutes in the target heart range.  The target heart rate range i s calculated  and displayed by the ergometer.  It i s based principally on a percentage  of the predicted maximal heart rate with the percentage varying between 70 and 80 percent depending on the age (Hockey, 1979).  In a report of a study using both the Dynavit and Monark bicycle ergometers, Edington (1979) concluded: " . . . i t appears clear from the data in this study the results of treadmill testing and bicycle ergometer testing are i n agreement . 11  Hockey (1979) states that, .maximal pxygertfiiptake values -may be predicted quite accurately using the Dynavit and has concluded: "...the Dynavit Bicycle ergometer may very adequately be used for administration of a stress test to evaluate cardiovascular efficiency".  Tennessee Self Concept Scale The Tennessee Self Concept Scale i s a self administered test comprised of 100 self descriptive statements which the subject uses to portray a picture of herself.  The T.S.C.S. was designed for ages  12-68 years, i s standardized and has published norms. The scale has a retest r e l i a b i l i t y of .88 (Fitts, 1956) and has been cross-validated with several other measures of self concept (Black, 1976).  The T.S.C.S.  gives a total positive or "P" score that indicates overall level of self esteem (Fitts, 1970).  The "P" score was used in this study.  As well, the Counselling Form used i n this study was designed for use by administrators who are unsophisticated in psychometrics analysis. Black (1976) made an exhaustive search to determine the instrument which could best measure self concept. the T.S.C.S.:  He concluded that  1.  Examines the many facets of self concept; i t i s a multivariable instrument.  2.  Yields scores that identify the contribution of facets of self concept to the total self concept.  3.  Is based on a substantial body of knowledge derived from several years of research and over 400 studies in which i t was utilized.  4.  Has been reviewed favorably by several psychologists and personality measurement specialists.  A number of researchers\has studied the relationship between physical fitness and self concept.  Christian (1969) correlated five  indices of physical fitness with T.S.C.S. measures of self concept and found that muscular endurance, the cardiovascular index and the overall fitness index were significantly and positively correlated with the physical self score on the T.S.C.S. Similar results have been reported by Smith (1970), Neale (1969) and Hillison (1969). Albinson  (1974) found that physically active college males tended to  have better self concept. Johnson (1968) studied the changes i n self concepts during a physical development program and concluded: "...the presence of notable changes in self concept strongly suggests that an individualized physical development program can be of significant value i n the total functioning".  42  Darden (1972) has stated: " . . . i t i s generally agreed that there i s a relationship between an individual's physique and his personality. This relationship i s primarily indirect; a person's body image affects his self concept which in turn influences the development of his total personality". Fitts (1956) has concluded that "considerable evidence exists to indicate that people's concepts of self do change as a result of significant  experiences".  The Health Hazard Appraisal The H.H.A. allows computation of a subject's "physiological" or "appraised" age based on risk factors derived from a relatively short and simple questionnaire which the individual has answered (Taunton, 1978). A computer program rates the subject's potential risk for the top 12 causes of death for that particular age and sex.  The print-out shows how  the specific risk factors can be reduced by following certain lifestyle modifications.  Compliance with these modifications results in a decrease  in the "appraised" age, thus moving towards a recommended "achievable" age.  Examples of lifestyle modification include regular exercise,  reduction of alcohol and smoking and the use of a seatbelt (Taunton, 1978). The five main causes of death in Canada include (Lalonde, 1974): 1.  Motor Vehicle Accidents  2.  Ischaemic Heart Disease  3.  A l l Other Accidents  4.  Respiratory Diseases and Lung Cancer  5.  Suicide  Lalonde (1974) has stated: "...It w i l l be noted that selfimposed risks and the environment are the principal or important underlying factors in each of the five major causes of death between age one and age seventy, and one can only conclude that, unless the environment i s changed and the self-imposed risks are reduced, the death rates w i l l not be significantly improved". Self-imposed risks that can lead to various causes of mortality include cigarette smoking, over-eating, high fat intake, lack of exercise and  lack of relief from work and other pressures.  The H.H.A. was originally designed as a tool to help private medical practitioners counsel patients about ways to improve their health but in recent years has been used in the business community as a motivational tool to reduce employees' risks (Employee Health and Fitness, 1980). Ladou(1979) has suggested that the H.H.A. can be a useful tool to change behaviour.  His four year follow-up of. one employee  group showed a net risk reduction of 2.38 years per person.  His most  recent study looked at the risk reduction of 26 examinees, and the results were consistent with an earlier study that showed a 1.4 year net risk age reduction for a one year follow-up on 107 employees (Employee Health and Fitness, 1980). The net risk.lfeduction i n the "appraised" age was used in this study as the way to determine compliance with the recommended l i f e style modifications. Specific risk factors were not analyzed due to  44  the large age range of the sample where the lifestyle risks can vary greatly from person to person. The H.H.A.'s used i n this study were obtained from and processed by the Division of Health Systems, Health Sciences Centre, University of British Columbia.  Action B.C. Nutrition Evaluation The nutrition evaluation was used i n this study primarily to assess the activity levels of the subjects over a three day period. The computer print-out provides an averaged caloric expenditure for the three days reported by the subject. To complete the physical activity data on the evaluation form, the subjects were instructed to accurately l i s t the number of hours spent i n each activity category. The categories included: 1.  Sleeping, resting.  2.  Sitting (at home, in car, on bus), eating meals, watching T.V., standing s t i l l , most office work.  3.  Moving quickly, walking, or brisk sports activity, working with hands, using physical effort for work or play.  4.  Performing a physical activity that uses a high degree of effort - running, playing hard, swimming, dancing, skating, cycling.  The computer print-out also identifies excesses or deficiencies in the diet and was used during the counselling session to provide the subjects with nutritional counselling and recommendations.  45  EMPLOYEE FITNESS PROGRAM The Employee Fitness Program consisted of: a)  a lifestyle and fitness assessment;  b)  an exercise f a c i l i t y within the hospital and various exercise opportunities including exercise classes;  c)  a weekly education and motivation program.  The schedule of fitness classes offered various programs to accommodate the fitness levels of the employees and the number of varying shifts within the hospital. The exercise classes stressed the main components of physical fitness namely, cardiovascular capacity, f l e x i b i l i t y and muscular strength and endurance, and were designed according to current principles of exercise.  A "Start F i t Lunch Break"  was offered during the noon hours and stressed mainly f l e x i b i l i t y and range of motion exercises. included.  A short cardiovascular segment was also  This program was designed primarily to acquaint the beginner  with the proper approach to exercise and to offer a refereshing midrrday break.  The more vigorous "Keep F i t " classes were offered after work  and were designed primarily as an aerobic workout. muscular endurance exercises were also included. a vigorous Exercise to Music format.  Flexibility and  These classes offered  Classes were conducted on Mondays,  Tuesdays and Thursdays (Appendix 3 ) . A l l classes were conducted in the P.A.D.H. Exercise Room with the exception of a jogging program which took place on several routes  46  surrounding the hospital. An "Aerobic Circuit" was housed within the exercise room to facilitate activity when no classes were offered. The education and motivation program was available weekly and consisted of films, lectures and workshops (Appendix 4).  This program  was instruction oriented and geared towards general health promotion. It stressed the importance of physical activity, stress reduction, smoking cessation and the general enhancement of health.  This component  was designed after a similar program conducted at the Canada Life Assurance  Company i n Toronto (Peepre, 1978) and utilized a number of  health promotion workshops offered by Action B.C. Such a component i s considered an integral part of a "complete" fitness program i n that i t not only motivates individuals to continue exercising, but i t also enhances their knowledge of the role exercise plays in relation to general good health (Peepre, 1978).  This program offered a supportive  role in order to maintain interest i n a regular physical activity routine. A l l classes were conducted in the Exercise Room during lunch hours on Wednesdays and Fridays. An Employee Fitness Bulletin Board and a Health and Fitness Library were located i n the Exercise Room. As well, a pamphlet display was located i n the cafeteria. Educational handouts were available at some of the education classes.  Communication for the  program was facilitated through the hospital newsletter, the bulletin board and a Fitness Memo Board i n the hospital cafeteria (Appendix 5). The investigator was available to the employees for personal consultation twice a week.  47  EXPERIMENTAL DESIGN The study used a 3lXL2jf actorial design with repeated measures on the second factor for Hypotheses 1 and 2. The independent variables were the treatment factor with three levels (Group 1, Group 2, Group 3) and the time factor with two levels (Pre, Post).  The experimental  design employed for Hypothesis 3 was a 2 X 2 factorial design with repeated measures on the last factor.  In this case, the independent  variables were the treatment factor with two levels (High vs. Low Adherence groups) and the time factor with two levels (Pre, Post). Eight dependent variables were measured: predicted oxygen uptake, sit and reach, shoulder extension, back extension, percent body fat, caloric expenditure, "appraised" age and self concept.  DATA ANALYSIS The U.B.C. BMDP2V repeated measures ANOVA program (Halm, 1977) was performed to ascertain any differences that occurred in functional physical fitness, "appraised" age, T.S.C.S. and caloric expenditure over the course of the program and between the groups. The Chi-square test of independence (U.B.C. SPSS, 1978) was used to ascertain any differences in the adherence rate between the three groups.  48  Chapter 4 RESULTS AND DISCUSSION Fifty subjects volunteered to take part in the employee fitness pilot program at Peace Arch District Hospital, White Rock, B.C.  They  were divided into three nearly equal groups; a l l completed a lifestyle and fitness assessment and were requested to improve their fitness by participating in a regular exercise routine and improving pertinent health habits.  Group 1 also had available to i t and was encouraged to  participate in (a) a fitness and lifestyle educational program and (b) an on-site exercise program.  Group 2 also had available to i t and  was encouraged to participate in the exercise program.  Group 3 also  had available to i t and was encouraged to participate in the educational program. At the end of the pilot period, twelve subjects were unable to take part in the retest due to illness, vacation, pregnancy, change of job or loss of interest.  These subjects were eliminated from the  study. The relationships between the selected component combinations of the program and adherence were assessed from data from an amended sample of thirty-eight subjects.  Basic descriptive data for the  subjects are summarized in Table 1. equal numbers and mean ages.  The three groups were of nearly  49  Table 1 Subject Data  Age (years) G r O U p  'x  n  S.D.  1  12  34.8  10.6  2  13  36.2  10.2  3  13  35.1  12.3  The different combinations of motivational and practical components were introduced into the work place with the intention of determining: a)  i f the total program would improve -the physical activity • levels, physical fitness, self concept and lifestyle risk factors of the employees (Hypothesis 1 of this study).  b)  i f the group with a l l o f the motivational and practical 1  1  "components in i t s program showed (i) a higher.rate  1  .  of adherence to a regular exercise routine, (ii) a greater improvement in the variables used in the study, than the two groups with lesser numbers of components in their program (Hypothesis 2 of this study). c)  i f there was any relationship between high arid low adherence to the employee fitness program and the amount of change over the course of the study in the measured variables (Hypothesis 3 of the study).  Results of the Employee Fitness Pilot Program The following results deal with a basic theme underlying this investigation which i s to study the effects of a twelve week employee fitness pilot program on the physical fitness, physical activity, lifestyle risk factors and self concept of the employee sample. The means and associated standard deviations for the eight dependent variables for the three separate groups are given in Table 2. Table 2 Observed Cell Means for Groups 1, 2 and 3  Dependent Variable  Group 2  Group 1 Pre (S.D.)  Post (S.D.)  Pre (S.D.)  Post (S.D.)  Group 3 Pre (S.D.)  Post (S.D.)  Pred. MVOo (ml/kg/min)  26.4 (3.7)  26.6 (3.2)  26.1 (4.7)  27.5 (4.6)  25.8 (4.7)  27.1 (4..7)  Sit/Reach (cm)  32.7 (5.5)  32.8 (7.2)  37.2 (4.5)  39.4 (3.5)  33.6 (8.3)  33.4 (7.2)  Shoulder Ext. (cm)  20.5 (8.2)  22.9 (9.1)  16.0 (6.4)  19.5 (7.1)  20.4 (12.9)  22.5 (13.6)  Back Ext. (cm)  34.9 (8.8)  38.3 (9.8)  29.8 (9.8)  32.4 (11.7)  Body Fat (%)  24.1 (6.8)  23.1 (4.9)  23.2 (4.6)  22.2 (4.2)  34.8 (11.4)  34.5 (11.2)  34.5 (11.2)  34.5 (11.5)  "Appraised" Age (yrs) Cal. Exp. (kcals) T.S.C.S.* *(n=21)  26.4 28.9 (10.8) . (12.4) 25.3 (4.9)  25.0 (5.0)  35.1 35.1 (15.2)' (14.4)  2110.8 2334.8 2203.5 2247.8 2329.7 2341.3 (338.9) (187.0) (256.9) (250.3) (386.3) (402.7) 348.7 (31.9)  374.3 (26.9)  356.4 (17.7)  360.0 (28.5)  320.2 (29.1)  320.2 (42.0)  The marginal means i.e. the means averaged over the three groups, and the F values'obtained from the ANOVA. tables are indicated i n Table .3. For examination of the complete ANOVA tables see Appendix  Figures 1  through 8 give graphic representations of the data from Table 3. Table 3 Marginal Means and F Values  xl  Marginal x2  Hypothesis Mean Square  F Value .8.42*  MV0 (pred.)  26.1  27.1  17.09  S &R  34.5  35.2  9.16  S. Ext.  19.0  21.6  134.92  6.95*  B. Ext.  30.3  33.1  153.09  6.49*  % B.F.  24.2  23.4  10.11  4.24*  "App." Age  34.8  34.7  0.23  0.25  2217.4  2307.3  165374.09  345.2  355.3  934.40  2  kcals T.S.C.S.(n=21)  2.84  6.21* 3.82  *Significant at .05  Table 3 shows significant F values for five of the eight dependent variables.  The predicted maximum oxygen uptake, shoulder  and back extension, percent body fat and caloric expenditure showed improvement over the twelve week period.  Pre x = 26.1 S.D. •= 4.4  Post x = 27 4 S.D.  Pre  Post  40-35 30 25 20 15 10 -  Figure 1.  Predicted Oxygen Uptake  Pre x = 34.5 S.D. = 6.3  Post x = 35 S.D. = J5  50 45 40 35 30 25 20  Post  Pre Figure 2.  Sit and Reach  53 Pre x S.D.  = 19.0 = 9.2  Post S.D.  x  21.6 9.9  35  co  30  •H  25  4-1  20  cn C d)  w M CD T) rH O  C/3  15 10 5 JL Pre F i g u r e 3.  Post Shoulder E x t e n s i o n  Pre x = S.D. =  30.3 9.8  Post x = S.D. =  50 h 45 S o  40  c  35  o  •H  cn C  QJ 4J  X  w  a  corn  30 25 20 15  Post  Pre F i g u r e 4.  Back E x t e n s i o n  33.1  11.3  Pre x = 24.2 S.D. = 5.2  Post x = 23.4 S.D. = 4.7  35 r30  t! co  2 5  £  2 0  o w  «  1 5  10  t Post  Pre Figure 5.  % Body Fat  Pre x = 34.8 S.D. = 12.6  Post x = 34.7 S.D. = 12.4  Pre  Post  50 h co CO w  o  H  J  -  40 35  13 CD CO •H •ctj U  P.  30 25 20  X Figure 6.  "Appraised" Age  Pre x = 2217.4 S.D. = 327.3  Post x S.D.  Pre  Post  2307.3 280.0  2 4000 I  i-i  3500  ±1 3000 <» 2500 2000 f 1500 f 1000 f  Figure 7. Caloric Expenditure  Pre  Post  Figure 8. Tennessee Self Concept Score  56 The f i r s t hypothesis dealt with four categories of the dependent variables: a)  Caloric expenditure was estimated to assesstthe physical activity of the subjects.  b)  Physical fitness was assessed using five variables: predicted maximum oxygen uptake, percent body fat, s i t and reach, back extension and shoulder extension.  c)  The Tennessee Self Concept Scale was used to measure changes in self concept over the pilot period. Only twenty-one subjects returned both completed self evaluation questionnaires so that results can only be attributed to just over half the sample (55.2%).  d)  The Health Hazard Appraisal yielded an "appraised" age which determined lifestyle risk factors.  Results:  ;  The Selected Program Components and Adherence  The Chi-square test of independence was used to ascertain any differences in the adherence rate between the three groups. obtained from the Chi-square are presented in Table 4.  The results  The tables of  data from the Analysis of Variance employed to discern significant changes in the groups (G X T interaction) over the' pilot period, are contained in Appendix{7. S :  57  Table 4 Chi-square Test of Ind. (Crosstabulation of Groups by Adherence)  Adherence Group  Count Row Pet Col Pet Tot Pet  High  Low  Row Total  1  2  1  4 33.3 36.4 10.5  8 66.7 29.6 21.1  12 31.6  2  5 38.5 45.5 13.2  8 61.5 29.6 21.1  13 34.2  3  2 15.4 18.2 5.3  11 84.6 40.7 28.9  13 34.2  11 28.9  27 71.1  38 100.0  Column Total  Raw Chi-square = 1.84702 with 2 Degrees of Freedom Significance = 0.3971  Hypothesis!.21.hasttwo-parts. Part A indicated that the employees in Group 1 would demonstrate a higher rate of adherence to a regular exercise routine when compared with employees i n Groups 2 and 3. Part B of the hypothesis proposed a significantly greater change i n the dependent variables for those employees i n Group 1 compared with those in Groups 2 and 3. This was related to expectations of a higher rate of adherence.  58 The Chi-square table shows that high adherence to a regular exercise routine was maintained by 33.3% of the subjects in Group 1, 38.5% in Group 2 and 15.4% in Group 3.  Eleven of the thirty-eight employees  (28.9%) were classified as high adherence participants.  Of the high  adherence participants, 36.4%, 45.5% and 18.2% came from Groups 1, 2 and 3 respectively.  The raw Chi-square value of 1.84702 (2df) indicates  that no significant difference existed between the groups in adherence. Thus Part A of Hypothesis 2 was not supported by the data. Part B of Hypothesis 2 required testing by Analysis of Variance design for comparing the three single group improvements inter alia. The groups-by-tests interaction (G X T) was used to determine the existence, i f any, of significant differences between group improvements in the dependent variables over the period of the study.  The G X T  interactions obtained indicate that only one variable (Sit and Reach) showed a significant difference between groups in the amount of improvement made (Table 5). Table 5 ANOVA Table for Sit and Reach  Source:.'..,. Groups (G) Tests (T) G X T  Surn^of Squares'.-df iMean Square u'.:E  Prob. F Exceeded  458.83  2  229.41  3.04  0.06  9.16  1  9.16  2.84  0.101  21.51  2  10.75  3.33  0.047  A graphic representation (Figure 9) of the data for the s i t and reach variable from Table 2 indicates that the groups did not a l l change similarly from the pre to post tests.  Groups 1 and 3 virtually  stayed the same, while Group 2 showed an increase in performance of 2.2 cm.  The hypothesis, however, proposed a significantly greater  change in the dependent variables for those employees in Group 1 compared with those in Groups 2 and 3.  Part B of the Hypothesis 2  then, i s not supported by the data.  Results:  High vs. Low Adherence Participants  The third hypothesis of this study dealt with the relationship between adherence (high or low) and the amount of change in the measured dependent variables from the pre :to post tests. The means and associated standard deviations for the High vs. Low Adherence participants are presented in Table 7. 17 give graphic representations of these data.  Figures 10 through  The tables of results  of the Analyses of Variance used to analyse differences in the way the two groups changed (G X T interaction) over the pilot period, are contained in Appendix 8. v ,Due to the unequal number of subjects in the high adherence (n=ll) and low adherence (n=27) groups, caution i s necessary in the interpretation of the F-arid p.values obtained and shown in the ANOVA tables.  It has been shown (Box, 1954) that minimal "bias" occurs with  unequal n i f c e l l variances are equal.  However, for five of the  Group 1 Group 2 Group 3 41.0 40.0. .39.4 39.. 0. 38.0  S u •H rH •H  3  CD  37.0  37.2>  36.0 35.0 34. a  33.6—.  _J3.4  33.0  —32.8  32.r 32.0.  Post  Pre Figure',9 . V  Sit and Reach (cm).  61 dependent variables, namely the s i t and reach, shoulder extension, "appraised" age, caloric expenditure and T.S.C.S., there were large differences among the c e l l variances.  These variables, therefore, are  not considered appropriate for statistical analysis. The investigator, however, w i l l note any trends that occurred for these variables which are pertinent to the hypothesis discussed in this section. The Chi-square table presented in Table 4 indicates that eleven of the thirty-eight employees, or 28.9%, were classified as high adherence participants.  The remaining twenty-seven employees (7111%)  were considered low adherence participants. Testing Hypothesis 3 calls for an examination of the ANOVA results considered appropriate for statistical analyses due to minimal "bias".  The groups by tests interaction (G X T) was analysed in the  ANOVA tables for predicted maximum oxygen uptake, back extension and percent body fat. The G X T interactions for these three variables show significant F values.  The observed c e l l means (Table 6) indicate  the greatest improvements for the high adherence participants.  These  are displayed graphically in Figures 10, _ 1;3 and 14. The c e l l means (Table 6) for the five variables deemed inappropriate for statistical analyses indicate a greater change from the pre to post test for the high adherence participants in each case. noted in Figures 11, 12, 15', 16, and 17'.  This trend can be  40 t3 •H  High Adherence Group Low Adherence Group  j= 35 60  rH  e  * '  CNI  30 25  o  20 0)  U  15  FM  10  Pre Figure 10.  55 •-  Post P r e d i c t e d Oxygen Uptake  High Adherence Group Low Adherence Group  50 •• 45 •• e  ^—' o O CO CO  40 •• 35 ••  38.1  36. Z33.6 -  34.1  30 •-  C  cd 25 ••  4-1  •H C/l  20 ••  i Post  Pre Figure 11.  S i t and Reach  63 High Adherence Group = Low Adherence Group =  I  10 '.5 1  1  Pre Figure 12.  Post Shoulder Extension  High Adherence Group Low Adherence Group  Pre Figure 13'.  Post Back Extension  35 r-  High Adherence Group Low Adherence Group  30 25 20  .23.8 22.6  24.7 23. a  15 10 -U  Post  Pre Figure 14.  % Body Fat  High Adherence Group Low Adherence Group  37.5,  — 36. a  33.7  —- 33.8  Post  Pre Figure 15.  "Appraised" Age  65  High Adherence Group Low Adherence Group 4000 3500  w  3 3000. •H  1  2500.  w  2000  o  2353 2288  2230 2184  L  g 2500 u  1000.  Pre  Post  Figure 16". Caloric Expenditure  380.  High Adherence Group Low Adherence Group  370 360. 350  350.8-  00  6 34Q CO  H  336.1  330. 320 310  Pre  Post  Figure 17j. Tennessee Self Concept Score  66 Table 6 Observed Cell Means For High vs. Low Adherence Participants  High Adherence Dependent'. Variable  Pre (S.D.)  Post (S.D.)  Low Adherence Pre (S.D.)  Post (S.D.)  IPred. MVO2  (ml/kg/min)  27.2 (4.4)  29.6 (4.1)  25.6 (4.3)  26.0 (3.7)  Sit/Reach (cm)  36.7 (5.3)  38.1 (4.7)  33.6 (6.8)  34.1 (7.2)  Shoulder Extension (cm)  16.8 (5.0)  20.9 (7.9)  19.8 (10.9)  21.9 (11.1)  Back Extension (cm)  28.1 (9.1)  34.4 (10.2)  vr.3i.:.i (10.6)  32.5 (12.5)  Body Fat (%)  24.7 (6.6)  22.6 (4.7)  23.9 (4.9)  23.8 (4.8)  37.5 (10.3)  36.9 (9.2)  33.7 (13.2)  33.'8 (13,2)  2184.5 (287.3)  2353.6 (210.0)  2230.7 (356.6)  2288.4 (321.0)  336.1 (29.5)  354.9 (39.2)  350.8 (27.7)  "Appraised" Age (years) Caloric Expenditure (kcals) T.S.C.S.* *(n=21)  (n-= 8)  355.5 . (36.6)  (n = 13)  Based on the above results and having regard for the problems associated with some of the statistical analyses i t seems reasonable to propose that Hypothesis 3 as stated i n Chapter 1 should be accepted with reservations. -  67  Discussion of the Employee Fitness Pilot Program Results A major assumption of this study was that an employee fitness program would result in a significant increase in the physical activity and physical fitness of the participants thereby increasing their self concept and decreasing lifestyle risk factors.  Hypothesis 1  was upheld, but not uniformly on a l l levels. Analysis of the data indicates statistically significant changes in both the levels of physical activity and physical fitness of the employees.  These results are in agreement with regard to the direction  but not to the extent of improvements noted in other studies of this type and duration (Yuhasz 1977, 1978).  Perhaps this can be explained  by the higher attendance of the participants at the lunch hour exercise classes which were designed primarily as a mid-day exercise break.  The  more vigorous aerobic program offered after work was not as well attended.  A number of other researchers have reported improvements in  functional physical fitness parameters in a variety of employee fitness programs (Peepre, 1978; Fogle, 1975; Koerner, 1973; Garson, 1977; Yarvote, 1974; Heinzelman, 1974; Durbeck, 1972). The groups showed no numerical change in the mean "appraised" age and the change in the self concept mean score was not statistically significant. The T.S.C.S. results agree with those published by Williams (1973) who found that the involvement of subjects in a program of physical education,ffitness and s k i l l acquisition had no significant effect on self concept.  However, a number of researchers has found notable changes  in self concept over the course of physical development programs.  68  Self concept i s made-tup of many areas.  These areas include  physical ability, mental ability, social relations, attractive appearance, work habits and social values, with each area differing in importance or reward value from the others (Black, 1976)., Perhaps the reward value of increased; physical activity and fitness was not sufficient for the subjects i n this study to significantly increase the ?.mean..self concept.  It would appear that although an attempt was  made to relate changes i n physical fitness to self concept, this was not accomplished during the twelve week period for the twenty-one employees who responded to the questionnaire. The relatively poor return of the T.S.C.S. questionnaires would also seem to indicate that this instrument i s unsuitable for this particular sample and experimental design.  Although confidentiality was assured, a number of  subjects refused to comply with the request to f i l l in the pertinent questionnaire forms. The Health Hazard Appraisals showed the mean "actual" age for the subjects was 35.3 years compared to the "appraised" age of 34.8 years and 34.7 years for the pre and post tests respectively. The "appraised" ages i n both cases indicate a mean net risk reduction of .5 and .6 years.  The H.H.A. was used i n this study to;.'.advocate  certain lifestyle changes to the employees i n order to improve the length and quality of l i f e .  The i n i t i a l H.H.A. score indicated a small  degree of reduction of lifestyle risk factors.  Perhaps this i s  related to the occupational nature of the sample, i.e. health care professionals and support staff.  Nevertheless, examination of the  69  pretest H.H.A. data reveals that a mean net risk reduction (the "achievable" age) of 2.4 years was possible had the employees complied fully with the recommended modifications of their lifestyle.  Table 7 Health Hazard Appraisal (Pretest Mean Ages) Actual Age 35.3  Appraised 34.8  Age  Achievable  Age  32.9  The information presented in Table 7 shows that the subjects did not fully comply with the recommended lifestyle modifications during the pilot period.  Discussion of the Program Components and Adherence Results These results pertain to the main problem investigated in this study i.e. to determine which of several selected combinations of components within an employee fitness program could positively affect female hospital workers rate of adherence to a regular physical activity routine.  To recapitulate, the specific program components studied were:  a)  a lifestyle and fitness assessment and retest (Groups 1, 2 3)  b)  an on-site exercise f a c i l i t y with scheduled exercise classes (Groups 1 and 2)  c)  an education and motivation program (Groups 1 and 3).  70  Thus, the different combinations of motivational and practical factors were introduced into the workplace with the intention of determining (a) i f the maximal stimulus program (Group 1) was indeed better than any lesser combinations i n producing a higher rate of adherence to the employee fitness program and (b) i f the maximal stimulus program produced the highest improvements i n the measured dependent dariables.  Essentially, Group 1 had the advantage of a "total" program  compared to Group 2 with the "exercise" program and Group 3 with the "education" program. Based on this review of pertinent literature and professional experience with a variety of employee fitness programs, the investigator believed that i t was necessary to include a l l three program components when implementing an employee fitness program i n order to obtain a higher rate of adherence by the program participants.  This "maximal  :  stimulus" approach would obtain a higher rate of adherence than i f there were fewer modes of stimulus provided.  Peepre (1978) has reported  that a highly integrated fitness and health promotion program should combine fitness and lifestyle awareness components i n order to stimulate high participation rates.  It was, therefore, hypothesized  that employees in Group 1 would achieve a higher rate of adherence to a regular exercise routine with greater changes i n the dependent variables than Groups 2 and 3. The results, however, indicate that this effect was not achieved in this study.  The results from the Chi-square test of independence  indicate no significant difference between the groups.  71  In this study, the highest percentage of high adherence participants belonged to Group 2, the "exercise" program, with 38.5%  of  the participants demonstrating a high level of adherence to a regular exercise routine i.e. participating three or more times a week.  This  was followed by Group 1 participants (33.3%), who had the "advantage" of the "total" or maximal stimulus program.  Only 15.4%  of the Group 3  participants demonstrated high adherence participation. The groups by tests interactions of the ANOVA's used in this study were employed in statistically validating the hypothesized adherence differences between the groups.  As could be expected, perusal  of the adherence data shows that Group 1 participants did not demonstrate a significantly greater change in the: measured dependent variables when compared with Groups 2 and 3. Although the majority of participants cited the professional quality of the programs offered, a high number of subjects reported to the investigator that time constraints, both at work and at home, resulted in a lower participation rate that they i n i t i a l l y expected. This appears to have been the main factor which resulted in the relatively low percentage of high adherence participants in a l l three groups. Thirty of the final thirty-eight subjects were married and the majority of these subjects had families.  Essentially, these employees were engaged  both as hospital workers and homemakers. Accordingly, many of the participants expressed to the investigator that they had no time to attend the various classes offered after work, or to work out on their own at home.  72  During the pilot program budget cuts by the B.C. Ministry of Health resulted i n cutbacks and layoffs i n hospitals throughout the province. Many of the employees i n the Peace Arch program felt that increased workloads and responsibilities did not allow them enough time to participate i n the exercise classes offered during the work day. Although the original plan of the pilot program did allow the various department directors to schedule flexible working hours on an individual basis to facilitate participation i n the classes, many of the employees felt that the situation was not conducive to taking the extra time off and thus, did not take advantage of the situation. Perhaps the main factor which detracted from the total effect of a l l three program components on the adherence rate of Group 1 participants was the time committment to the "total" program. Many of the Group 1 "low adherers" indicated to the investigator that they did not have :  enough "time" to participate in a regular exercise routine at least three times a week. Many of these employees believed that the "total" program interfered too much with their daily work routine and were unwilling to make the necessary adjustments to their daily schedules. This concurs with results published by Wanzel and Danielson (1977) who found that the necessary rearrangement of a participant's daily schedule to accommodate exercise sessions was a major reason for withdrawal from a company fitness program.  Respondents to their research  questionnaire Indicated that the availability of exercise classes during office hours would have been a suitable alternative to their  73  after-hours exercise periods and would have kept them in the program. 78% of their respondents felt that this type of scheduling would not have decreased their normal office productivity.  The investigators  recommended that employers should investigate the possibility of adjusting individual work schedules to incorporate the workout periods of interested employees thus reducing the strain of fitness participation on an employee's daily schedule. The results from this study indicate that such a strategy seems necessary to positvely influence the adherence rate of the Peace Arch Hospital employees to regular exercise.  The classes were'.held during  the lunch breaks and after work which can be considered "non-job" hours. Although paramount importance was placed on the factors which influence exercise program adherence when the program was designed, i t seems likely that the availability of exercise and education classes with established time off normal working hours could greatly influence program participation by the employees-in a l l three groups and increase the rate of adherence to a regular exercise routine.  Discussion of High vs. Low Adherence Results Hypothesis 3 stated that high adherence participants in a l l three groups would show a significantly greater change in the measured dependent variables when compared with the low adherence participants. The majority of the low adherence participants were involved in a regular physical activity routine one or less times per week. Due to large differences among the cell variances in five of the eight dependent variables, these were considered inappropriate for statistical analyses.  74  The three variables that were analysed revealed significant differences between high and low adherence participants with respect to improvement over the pilot period i.e. the high adherence participants improved significantly more than the low adherence participants. The five dependent variables inappropriate for the statistical analyses also revealed this trend, thus permitting an acceptance of Hypothesis 3 with reservations.  The decision to accept Hypothesis 3 with reservations  is consistent with studies on employee fitness programs reviewed in Chapter 2.  These studies have reported a positive and consistent  relationship between program effects and program adherence (Heinzelman and Durbeck, 1970; Yarvote et a l . , 1974; Fogle and Verdesca, 1975; Yuhasz, 1977, 1978; Koerner, 1973; Peepre, 1979). The high adherence participants (those who were involved in a regular physical activity program at least three times a week) accounted for approximately 30% of the sample.  This figure i s approximately  similar to at least two other studies of employee fitness programs (Heinzelman, 1970; Fogle, 1975) where high adherence participation by 35% of their respective samples were reported. High adherence figures from other programs vary from 11% 1974)  (Yarvote,  to 78% (Yuhasz, 1978) of the participants. A number of these  programs, however, have considered high adherence or regular attendance based on a participation rate of at least twice a week. Based on the existing evidence concerning the effect of difference exercise prescriptions on healthy adults, the American College of Sports Medicine (1978) has recommended the frequency of training to be 3 to 5 days per week.  Chapter 5 SUMMARY AND CONCLUSIONS Summary Stimulating participants' to a high level of adherence to supervised or unsupervised exercise routines has been a major problem for many employee fitness programs in North America.  A number of  factors which influence the initiation of and adherence to exercise programs by adults has been reported.  Much of the data available on  factors important for adherence to exercise programs has been obtained from asking participants or dropouts about program characteristics that influence their participation and not from controlled trials where selected program characteristics are systematically varied and their effects evaluated. The purpose of this investigation was to determine i f several selected components i n combination, within an employee fitness program, could positively affect female hospital workers' rate of adherence to a regular physical activity routine.  The specific program components  studied were: a)  a lifestyle and fitness assessment and retest  b)  an on-site exercise f a c i l i t y with scheduled exercise classes  c)  an education and motivation program.  75  0  76 The subjects were randomly assigned to one of three groups. Each group participated in a lifestyle and fitness assessment but was otherwise distinguished as follows:  Group 1 was assigned to the exercise  f a c i l i t y , exercise classes and the. education and motivation program. Group 2 was assigned to the exercise f a c i l i t y and exercise classes. Group 3 was assigned to the education and motivation program. An attempt was made to determine i f the maximal stimulus program available to Group 1 resulted in (i) a superior rate of adherence to a regular exercise routine and ( i i ) a greater improvement in the dependent variables, compared with Groups 2 and 3. Two additional hypotheses were examined in the study.  The f i r s t  hypothesis dealt with a basic theme underlying the investigation: to study the effects of the employee fitness pilot program on the physical fitness, physical activity, lifestyle risk factors and self concept of the employee sample. The third hypothesis examined/ the relationship between adherence (high or low) and the amount of change in the measured dependent variables from the pre to post tests. The Employee Fitness Program was conducted over a twelve week period and the subjects were pretested and posttested for: 1.  physical activity asaevaluated Nutrition Evaluation.  by the three day Action B.C.  77 2.  physical fitness as evaluated by the Dynavit bicycle ergometer (Dynavit, 1978), f l e x i b i l i t y (Sinclair and Rhodes, 1977) and percent body fat (Kuntzelman, 1975).  3.  self .concept as evaluated by the Tennessee Self Concept Scale (Fitts, 1956)..  4.  lifestyle risk factors as evaluated by the Health Hazard Appraisal (Hsu and Milson, 1977).  An analysis of variance program was used to ascertain any differences that occurred in the measured dependent variables over the course of the program and between the groups.  The Chi-square test  of independence was used to ascertain any differences in the adherence rate between the groups.  Complete data was obtained for 38 subjects:  12 in Group 1 and 13 in both Groups 2 and 3.  These were remaining after  12 subjects were dropped for non-compliance with the requirement for completing the retest due to a variety of reasons. 3X2  The study used a  factorial design with repeated measures on the second factor  for Hypotheses 1 and 2.  The independent variables were the treatment  factor with three levels (Group 1., Group 2, Group 3) and the time factor with two levels (Pre, Post). The ..experimental design employed for Hypothesis 3 was a 2<X 2 factorial design with repeated measures on the last factor.  In this case, the independent variables were the  treatment factor with two levels (High vs. Low Adherence groups) and the time factor with two levels (Pre, Post). Eight dependent variables  78 were measured:  predicted oxygen uptake, s i t and reach, shoulder  extension, back extension, percent body fat, caloric expenditure, "appraised" age and self concept.  Results A basic theme underlying this investigation was that of studying the effects of the twelve week employee fitness pilot program on the physical fitness, physical activity, lifestyle risk factors and self concept of the employees. Statistical analyses of the data indicated the following results regarding Hypothesis 1: a)  a significant increase in the caloric expenditure (p = .017) measured to assess the physical activity of the subjects  b)  a significant increase in the oxygen uptake (p = .006) measured to assess physical fitness  c)  a significant increase in shoulder extension (p = .012) and back extension (p = .015) measured to assess physical fitness  d)  a significant decrease in percent body fat (p = .047) measured to assess physical fitness.  Positive changes not considered significant were found in the s i t and reach (p = .101) and the Tennessee Self Concept scores (p = .066). The decrease in the "appraised" age was not considered significant (p = .617). Thus, the results support the hypothesized improvements dealing with physical activity levels and physical fitness.  The  hypothesized improvements dealing with lifestyle risk factors and self concept, however, were not substantiated.  79 Hypothesis 2, the main problem of the investigation, dealt with the relationship between the combinations of selected program components and adherence. An attempt was made to show the total effect of an educational program together with the availability of a fitness f a c i l i t y and exercise opportunities on the adherence rate of an employee fitness program.  The Chi-square test of independence revealed no significant  difference among the three groups in adherence (p = .03971).  The G X T  interactions contained in the ANOVA's validated the Chi-square results by showing no significant differences among the groups for the hypothesized improvements in the dependent variables. Hypothesis 3 of the investigation was concerned with the relationship between adherence (high or low) and the amount of change in the measured dependent variables from the pre to post tests.  Employees  were categorized as either high adherence participants (n = 11) or low adherence participants (n = 27), based on data in self reported progress charts.  Unfortunately, due to the unequal numbers in the groups  and the large differences between c e l l variances, five of the dependent variables (sit and reach, shoulder extension, "appraised" age, caloric expenditure and Tennessee Self Concept score) were considered for statistical analyses.  inappropriate  For the remaining three variables analysed,  there existed a significant relationship between adherence and the amount of improvement i.e. the high adherence participants showed a significant improvement over the low adherence participants.  The G X T  interactions calculated in the ANOVA's revealed significant F values  80 for the (a) predicted oxygen uptake (p =  .003), (b) back extension  (p = .037) and (c) percent body fat (p = .006).  This trend was also  noted i n the five variables that were inappropriate for statistical analyses.  Conclusions Within the limitations and delimitations of the sample population, experimental procedures used and statistical analyses performed, the following conclusions appear justified: 1.  As a group, the participants i n the employee fitness program showed a significant increase i n their daily physical activity and a significant improvement i n their physical fitness.  2.  As a group, the participants i n the employee fitness program did not significantly decrease lifestyle risk factors.  3.  As a group, the participants in the employee fitness program did not show a significant increase i n their self concept.  4.  There were no significant differences between the three groups in adherence rates, thus indicating that for one group, the combination of three components designed to stimulate a high level of adherence succeeded no better i n doing this than the combinations of two components for the other two groups.  5.  There were no significant differences between the three groups in hypothesized improvements i n the dependent variables.  6.  High adherence participants demonstrated significantly greater changes i n three of the measured dependent variables when compared to low adherence participants. This trend was also noticed i n the five variables inappropriate for statistical analyses.  Stimulating high adherence to an employee fitness program i n hospitals or similar work environments, where employees are often subjected to stressful situations and strenuous routines;, seems to offer particular d i f f i c u l t i e s when participation i s required during the employee's free time.  A study similar to  this should be done with paid .release•"time". f_or~exef cise.,and. lifestyle educational sessions in order to determine the effects on adherence rates, physical activity, fitness improvements, lifestyle modifications •'ands.elf c6nceptr.2..- ; . v  Investigators undertaking research related to adherence to exercise programs should use a standard reference value for "high" and "low" adherence.  This should bring coherence to  comparisons of studies of this kind, which i s always desirable for scientific reasons.  The American College of Sports Medicine  (1978) standards regarding frequency, intensity and duration of exercise appear to be reasonable guidelines for this purpose. A further study to examine the effects of the specific program components used i n this study to determine their effectiveness in the initiation and maintenance of regular physical activity routines would seem worth doing.  The various combinations of  components i n this study made i t d i f f i c u l t to assess the effectiveness of any particular component.  To improve this study, the various combinations of program components could be tested at different hospitals.  This would  hopefully result i n a more controlled study with a larger number of subjects per group.  This procedure was unfortunately  beyond the scope of the present study. As absenteeism i s an important human resource problem faced by employers, i t would seem worthwhile to compare absentee records with attendance records to a company sponsored employee fitness program i n subsequent studies.  83  84  Albinson, J.G. 1974. Lifestyles^of Physically Active and Physically Inactive College Males. International Journal of Sport Psychology, Vol. 5(2): 93-101. American College of Sports Medicine. 1978. The Recommended Quantity and Quality of Exercise for Developing and Maintaining Fitness in Healthy Adults. Medicine and Science in Sports, Vol. 13, No. 3. American Heart Association. 1972. Apparently Healthy Individuals: York.  Exercise Testing and Training of A Handbook for Physicians. New  Banister, E.W. 1978. Human Performance in Business and Symposium Proceedings, Vancouver, British Columbia.  Industry.  Bjurstrom, L.A., and N.G. Alexiou. 1978. A Program of Heart Disease Intervention for Public Employees. Journal of Occupational Medicine, 8: 521-531. Black, B.M. 1976. The Relationship of Self Concept to Physical S k i l l and Athletic Participation. Doctoral Dissertation, Springfield College, University of Oregon Microfiche. Box, G.E.P. 1954.'.."iSome: Iheorums on Quadratic Forms Applied in the Study of Analysis of Variance Problems: II. Effects of Inequality of Variance and Correlation Between Errors in the Two Way Classification. Annals of Mathematical Statistics, 25, 484-498. Brown, P. 1979. Marketing Fitness. Newsletter, Vol. 1 (1).  Employee Health and Fitness  Chisholm, D.M., Collis, M.L. and L.L. Kulak. 1975. Physical Activity Readiness. British Columbia Medical Journal, Vol. 17, No. 11. Christian, Q. 1969. Relationship Between Physical Fitness and Self Concept. Doctoral Dissertation, East Texas State University. Colacino, D. 1979. The Organization, the Administration and the Qualifications in Obtaining the Total Health Management Program. Paper presented at the American Association of Fitness Directors in Business and Industry Annual Conference, Colorado Springs, Colorado. ;  Collingwood, T. 1978. An Educational Approach to Fitness. Paper presented at the American Association of Fitness Directors in Business and Industry Annual Conference, Atlanta, Georgia. Collis, M.L. Ottawa.  1977.  Employee Fitness.  Health and Welfare Canada,  85  Cox, M. 1978. Potential Effects of an Employee Fitness and Lifestyle Program. Paper presented at the Canadian Conference on Employee Recreation and Fitness. Darden, E. 1972. A Comparison of Body Image and Self Concept Variables Among Various Groups. Doctoral Dissertation, Florida State University. Durbeck, D.C. 1972. The National Aeronautics and Space Administration U.S. Public Health Service Health Evaluation and Enforcement Program. American Journal of Cardiology, 30: 788-789. Dynavit of America. 1978. Dynavit Computerized Bicycle Ergometer Exercise Data. Keiper U.S.A. Inc., Battle Creek, Michigan. Edington, D.W. 1979. Performance Evaluation of 40-55 Year Old Men on the Bicycle Ergometer. Unpublished paper, The University of Michigan, Ann Arbor. Employee Health and Fitness. 1980. Special Report: Health Hazard Appraisal in the Workplace. Employee Health and Fitness, Vol. 2(2). Everett, M.D. 1979. Strategies for Increasing Employees! Level of Exercise and Physical Fitness. Journal of Occupational Medicine, Vol. 21, No. 7. Faulkner, R.A. and G.W. Stewart. 1977. Exercise Management Recruitment and Retention Project. Employee Fitness Program, Occupational Health Service, B.C. Ministry of Health, Victoria, B.C. Fitts, W.H. 1956. Manual for the Tennessee Self Concept Scale. Nashville: Counsellor Recordings and Tests. Fogle, R.K. and A.S. Verdescai 1975. The Cardiovascular Conditioning Effects of a Supervised Exercise Program. Journal of Occupational Medicine, Vol. 17, 4: 240-246. Foss, P.M. 1979. Factors Related to Urban Adult Female Participation in Physical Activity Programs. Paper presented at the American Association of Fitness Directors in Business and Industry Annual Conference, Colorado Springs, Colorado. Garson, R.D. 1977. Pilot Project on Metropolitan Life Fitness Program. Unpublished paper.  86  Halm, J. 1977. U.B.C. BMD P2V. Computing Centre.  University of British Columbia  Hardin, D. 1978. The Effect of Managerial Implementation of Prescriptive Exercise on the Physical Fitness of Employees. Paper presented at the American Association of Fitness Directors in Business and Industry Annual Conference, Atlanta, Georgia. Haskell, W.L. 1978. The Physical Activity Component of Health Promotion Programs in Occupational Settings. Paper prepared for the Office of Health Information and Health Promotion, Department of Health, Education and Welfare, U.S.A. Heinzelman, F. and R. Bagley. 1970. Response to Physical Activity Programs and Their Effects oh Health Behaviour. Public Health Reports, Vol. 85, 10: 905-911. and D. Durbeck. 1970. Personal Benefits of Health Evaluation and Enhancement Program. Paper presented at the NASA Annual Conference of Clinic Directors, Health Officials and Medical Program Advisors, Cambridge, Mass., U.S.A. 1974. Psycho-social Implications of Physical Activity. Paper presented at the Canadian Conference on Employee Fitness, Ottawa, Canada. Hillison, D.R. 1969. The Effects of Physical Conditioning on Affective Attitudes Toward the Self, the Body,•.•and Physical Fitness. Doctoral Dissertation, Ohio State University. Hsu, D.H.S. and J.H. Milsum. 1977. Redressing the inbalance between acute and preventive medical care. B.C. Medical Journal, 19(12): 450-453. Hockey, R.V. 1979. Prediction of Maximal Oxygen Consumption From a Standardized Task Using the Computerized Dynavit Bicycle Ergometer. Paper presented at the American Association of Fitness Directors in Business and Industry Annual Conference, Colorado Springs, Colorado. Johnson, W.R. 1968. Changes in Self Concept During a Physical Development Program. Research Quarterly, 39: 560-565. Kavanagh, T. 1974. Physical Fitness and General Health. Proceedings of The National Conference on Employee Physical Fitness. Fitness and Amateur Sport Branch, Ottawa, Canada.  87 Keelor, R.O. 1976. Testimony to the Council on Wage and Price Stability Hearings on Health Care Costs. Chicago, 111., U.S.A. Kita, S. 1978. U.B.C. S.P.S.S. University of British Columbia Computing Centre. Koerner, D.R. 1973. Cardiovascular Benefits from an Industrial Physical Fitness Program. Journal of Occupational Medicine, Vol. 15, 9: 700-707. Kraus, H. and W. Raab.  1961. Hypokinetic Disease.  Kuntzelman, C. 1975. Activetics.  New York:  Springfield, U.S.A.  Peter H. Wyden Publisher.  Ladou, J., J.N. Sherwood and L. Hughes. 1979. Health Hazard Appraisal Counselling - Continuing Evaluation. Western Journal of Medicine, 130: 280-285. Lalonde, M. 1974. A New Perspective on the Health of Canadians a Working,Document. Information Canada, Ottawa, Ontario. Megali, W. 1978. Employee Fitness Programs: Philanthropic Venture on Shrewd Investment. The Labour Gazette, May: 174-178. Neale, D.C. and R.J. Sonstroem. 1969. Fitness, Self Esteem, Attitudes Towards Physical Activity. Research Quarterly, 47: 743-749. Oldridge, N..B. . 1979. Noncompliance in Cardiac Exercise Rehabilitation. The Physician and Sportsmedicine, Vol. 7, 5: 94-103. Peepre, M. 1979. Employee Fitness and Lifestyle Project. Fitness and Amateur Sport Branch, Ottawa, Canada. Pfeiffer, G.J. 1977. Physical Fitness and Behavioural Attitudes in Industry. Unpublished Manuscript. Phelan, F.J. 1973. An Investigation into the Relationship Between Self Concept and Selected Physical Fitness Attributes in Boys and Girls. Unpublished Master's Thesis, University of Wyoming. Pravosudov, V. 1976. The Effect of Physical Exercise on Health and Economic Efficiency. Mimeograph: Iesgaft State Institute of Physical Culture, Leningrad. Raab, W. and S.B. Gilman. 1964. Insurance Sponsored Preventative Cardiac. Reconditioning Centers in West Germany. American Journal of Cardiology, 13: 670-673.  88  Recreation Canada. 1974. Proceedings of The National Conference on Employee Physical Fitness. Fitness and Amateur Sport Branch, Ottawa, Canada. Reid, E.L. and R.W. Morgan. 1979. Exercise Prescription: A Clinical Trial. American Journal of Public Health, Vol. 69, No. 6: 591-595. Roth, J. 1978. Vol. 2.  Keeping the Work Force F i t . Industrial Management,  Shephard, R.J. 1969. Endurance Fitness. Press, Toronto, Canada.  University of Toronto  Sinclair, G.D. and E.C. Rhodes. 1977. Functional Fitness Appraisal Test Manual. Action B.C., Vancouver, Canada. Smith, L. 1970. Personality and Performance Research": News, Theories and Directions Required. Quest, Winter Issue. Taunton, J.E. 1978. Health Problems of the Executive. Paper presented at the Human Performance in Business and Industry Symposium, Vancouver, Canada. Wanzel, R.S. and R.R. Danielson. 1977. Improve Adherence to Your Fitness Program. Recreation Management, July: 16-19. 1977. Improve Adherence to Your Fitness Program. Part 2, Recreation Management, August: 38-41. 1977. Improve Adherence to Your Fitness Program. Part 3, Recreation Management, September: 34-37. Williams, D.D. 1973. Instruction Stressing Physical Fitness Compared with Instruction Stressing S k i l l Acquisition upon Self Concept in Caucasian and Negro Students. Completed Research and Health Physical Education and Recreation. Yarvote, P.M., T.J. McDonagh, M.E. Goldman and J. Zuckerman. 1974. Organization and Evaluation of a Physical Fitness Program in Industry. Journal of Occupational Medicine, Vol. 15: 589-598.  APPENDICES  89  APPENDIX 1 P.A.D.H. EMPLOYEE FITNESS PROGRAM PROPOSAL  90  PEACE ARCH HOSPITAL EMPLOYEE HEALTH AND FITNESS PROGRAM' PROPOSAL/:,  February 1979  92 INDEX  1.  INTRODUCTION  2. OBJECTIVES OF THE PROGRAM 3. PROGRAM DESIGN 4. RESEARCH COMPONENT 5. PROGRAM RECOMMENDATIONS AND EXPANSION 6. REFERENCES 7. APPENDIX  93  1.  INTRODUCTION Action B.C. believes that physical fitness and improved health  habits can make an important contribution to the overall function of the employee in the work setting.  With the growing interest i n  preventive medicine, exercise programs have become increasingly important.  Exercise i s practical, inexpensive and can prove effective  against various health problems including lower back pain and coronary heart disease. Results claimed by companies who have programs'available", to employees include: a)  Improved employee health - reduced incidence of cardiovascular illness and death among employees - reduced absenteeism  b)  Improved morale  c)  Improved productivity  d)  A decrease i n the financial burden of replacing top level 1 2 personnel who have incurred some sort of hypokinetic illness '  Heart disease alone represents thousands of lost working years to the Canadian employer.  The cost of compensation to employers showed  a national increase of 72% i n the ten year period between 1965 and 1974 . 3  A recently completed report i n Ontario titled "The Relationship between Physical Fitness and the Cost of Health Care", concluded:  94  a)  People with higher levels of physical fitness tend to have lower Ontario Health Insurance Plan (O.H.I.P.) medical claims  b)  An estimated reduction of $31 million in O.HVI.P. medical claims could be expected i f a l l adults age 20-69 years were of at least average level of physical fitness  c)  People with higher levels of physical fitness tend to have reduced incidence of coronary heart disease^  Physicians and public health authorities stress prevention more than ever before. As health costs mount, prevention proves to be the only affordable course of action.  The lifestyle of an  individual has been defined as "the aggregation of decisions by individuals which affect their health and over which they more or less have control"^.  Lifestyle changes which could improve the health  and quality of l i f e for most Canadians include: - proper exercise - sound nutrition - reduced weight - reduced alcohol and tobacco consumption  The Peace Arch Hospital Employee Health and Fitness Program w i l l offer the opportunity for lifestyle enhancement to employees interested in a positive change of lifestyle based on individual testing and counselling.  95  2.  OBJECTIVES OF THE PROGRAM ; The main objective i s to promote a healthier and more positive  lifestyle of the employees at Peace Arch Hospital.  A reduction in  lifestyle risk factors associated with today's sedentary society is also expected. These objectives are hoped to be met by providing the employees with a comprehensive schedule of physical fitness classes and educational films and lectures. The research component of the program will attempt to determine modifications of lifestyle as reflected by the following measured criteria: - physical fitness - lifestyle analysis - nutrition evaluation - psycho-social attitudes  3. . PROGRAM DESIGN The program design w i l l consist of two major components: a)  the fitness classes, and  b)  the motivation and education program.  The schedule of fitness classes w i l l be flexible to accommodate the fitness levels of the employees and the number of varying shifts within the hospital.  The employees will be encouraged  96  to use the hospital exercise room at their convenience.  The fitness  classes w i l l stress the three main components of physical fitness: a)  Cardiovascular Fitness  b)  Muscular Endurance  c)  Flexibility  The fitness schedule w i l l be drawn up according to the principles of exercise as well as the employee's current fitness levels so that attendance at a fitness class w i l l prove to be enjoyable and somewhat challenging. A group of individuals from within the hospital ranks w i l l lead the fitness classes.  A fitness leader's training program was  completed by a l l the group leaders and provided them with some of the theoretical information and practical background necessary to produce an effective fitness experience. The motivation and education program w i l l include an ongoing"'; schedule of films and guest speakers dealing with topics on positive health developments and lifestyle changes. available in the near future.  This schedule w i l l be  The purpose of this program i s to  acquaint the group with the benefits of physical activity and lifestyle modification.  It i s hoped that this educational component w i l l  enhance the adherence rates of the employees to the program. Pamphlets, booklets and texts on physical fitness, nutrition, smoking cessation etc., w i l l be available to the hospital staff through the Employee Health and: Eitness.'jLibr.ary ' (Appendix!. 1) .  97  4.  RESEARCH COMPONENT Prior to the implementation of the program, Action B.C. staff  will administer a functional physical fitness assessment (Appendix 2 ) , a lifestyle analysis (Appendix 3 ) , and a nutritional evaluation (Appendix 4 ) , to each participant i n the program.  Certain inventories  w i l l be chosen and administered to ascertain specific psycho-social attitudes relevant to the program.  These inventories, when selected,  w i l l attempt to ascertain attitudes towards physical activity, job satisfaction and self image. The research design i s s t i l l under consideration, however information w i l l be available i n the near future specifying details of the design.  At the time of the testing session, exercise  recommendations w i l l be administered on an individual basis i n accordance with the needs, ability, and interests of each employee. Further counselling will be based on the interpretation of the l i f e style risk inventory and the nutrition evaluation. At the end of twelve weeks, post tests w i l l be administered to determine any changes i n fitness levels, lifestyle risk factors and psycho-social attitudes. •' * •  5.  ,•"•.  ~f~' ~ .'?-^"v.'".-.'/ 7  •  PROGRAM RECOMMENDATIONS AND EXPANSION Based on the data from the research component, recommendations  concerning program modifications w i l l be made.  If the i n i t i a l  ; >  program proves successful, expansion w i l l occur according to the demands and interests of the employees of Peace Arch Hospital. This task w i l l primarily be the responsibility of the Peace Arch Hospital Fitness Committee and the Fitness Leaders.  A fitness  consultant from Action B.C. w i l l be available to the hospital on request basis as a resource person.  APPENDIX 2 LIFESTYLE AND FITNESS ASSESSMENT MATERIALS  99  100  ACTION B.C. LIFESTYLE & FITNESS ASSESSMENT Action B.C.'s introduction to.Lifestyle Modification and Fitness Assessment program begins with a motivational film.  After the film,  a general discussion about alternative lifestyles are introduced. An explanation followed by demonstration of physical assessment techniques are presented and possible follow-up activities were outlined. Upon confirmation of date, time and schedule of participating individuals, Action B.C. provides the following services: 1.  Health Hazard Appraisal  The computerized printout provides personal information. The analysis compares risks imposed upon a person's lifestyle and how they compare to others their own age and sex. More positively, i t provides recommendations for desirable lifestyles and healthy living habits. The interpretation of the program i s provided by a specially trained counsellor. 2.  Nutrition Evaluation  This analysis i s also computerized and i t ' s results are linked with the Lifestyle Analysis. This part of the program considers the individual's energy requirements and energy expenditures for each day recorded. We recommend a three day analysis. The personalized printout breaks down the food and drink consumed.for three days into: caloric intake, amount from each food group, percentage of fat, carbohydrate and protein consumed, vitamin and mineral intake and i t w i l l offer requirements for the individual based on his/her age and sex. A specially trained counsellor interprets the results. 3.  Fitness Assessment  Action B.C.'s specially designed assessment evaluates an individual's body composition, f l e x i b i l i t y and cardiorespiratory fitness level.  101  a.  Body Composition  The body composition test measures an individual's percentage of body fat. Using fat calipers, skin fold measurements are taken to get the results. b.  Flexibility  Flexibility tests measure an individual's ability to move the joints through a normal range of motion. Three areas are focused on: hip,shoulder and back. c.  Cardiorespiratory Assessment  A capacity, exercise health.  fitness specialist can determine an individual's endurance physical work capacity (P.W.C.), caloric expenditures during and recommended exercise load for maintaining a good state of The Dynavit bicycle ergometer i s used for this assessment.  102  ACTION B.C. LIFESTYLE AND FITNESS ASSESSMENT PROGRAM APPOINTMENT SCHEDULE Included with this appointment sheet i s a PAR-Q questionnaire. The PAR-Q i s a screening technique used to identify the individuals f  who should consult a physician before participating in a cardiorespiratory test such as the one done by Action B.C. on the bicycle.  Please be certain every person who i s to participate  reads the questionnaire.'  We have included the PAR-Q to assist you  in determining the individuals who should not have a cardiorespiratory test.  In this way we can avoid disappointing anyone  on the day of the test.  Below you w i l l find a l i s t of the do's  and don'ts for your group to follow prior to the testing procedure. DO'S AND DON'TS 1.  Do wear loose clothes (separating at the waist - some participants may wish to wear a T-shirt for the test).  2.  Do avoid smoking for one hour before the test.  3.  Do avoid eating a big meal or drinking coffee, tea or alcohol two hours before the test.  4.  Do not exercise on the day of your test.  5.  Don't worry. A fitness test can be fun! Our staff i s there to answer any questions and to help whenever necessary.  103  INSTRUCTIONS 1. Please make sure you f i l l out the following forms: a) b) c) d)  Health Hazard Appraisal 3-Day Nutrition Analysis Tennessee Self-Concept Questionnaire Peace Arch Hospital Fitness Program Questionnaire  2. READ THE INSTRUCTIONS before f i l l i n g out the forms. This i s particularly essential when recording information on the health hazard appraisal and the nutrition analysis. The computer cannot analyse forms which are f i l l e d out incorrectly. Make haste slowly! 3. Please;-bring- allccompletedfforms. with -you':to zthe if itness assessment. 4. The Peace Arch Fitness Program Questionnaire and the Tennessee self-concept scale are necessary tools for the research component of the physical fitness program. A l l results w i l l be confidential and general conclusions only w i l l be drawn from the data. Please make a special effort to f i l l out these forms. 5. Please be on time for your appointment. loose clothing and running shoes.  If possible, wear  6. Avoid smoking for one hour before the test and avoid eating a big meal, drinking coffee, tea or alcohol for two hours before the test. 7. Don't exercise on the day of your test. 8. Relax - As many of you found out twelve weeks ago, a fitness test can be fun!  APPENDIX 3 EMPLOYEE FITNESS PROGRAM SCHEDULE AND FITNESS LEADERS SCHEDULE  *0  104  105  P.A.D.H. EMPLOYEE FITNESS PROGRAM CLASS SCHEDULE March 12 to June 1, 1979  Wednesday"  Thursday  Monday.  Tuesday  11:30  Start F i t (Session 1)  Start F i t (Session 1)  Start F i t (Session 1)  12:00  Start F i t (Session 2)  Start F i t (Session 2)  Start F i t (Session 2)  1:30  Free  Free  Free  2:00  Exercise  Exercise  Exercise  2:30  Time  Time  Time  1:00  3:00 3:30 4:00 4:30  Keep F i t  Keep F i t  Keep F i t  and  and  and  Walk-Jog 5:00  Walk-Jog  Walk-Jog  Friday  106  FITNESS LEADERS* SCHEDULE April 1979 1.  Start F i t Lunch Break 11:30 - 12:00  Julie  12:00 - 12:30  Bette  12:30 - 1:00  Ruth  11:30 - 12:00  Bette  12:00 - 12:30  Valerie  12:30 - 1:00  Al  11:30 - 12:00  Jeanette  12:00 - 12:30  Julie  12:30 - 1:00  Al  Monday:  4:15 - 4:55  Jacquie  Tuesday:  4:15 - 4:55  Jacquie  Thursday:  4:15 - 4:55  Jacquie  Monday:  4:15 - 4:55  John  Tuesday:  4:15 - 4:55  John  Thursday  4:15 - 4:55  John and/or Jeanette  Monday:  Tuesday:  Thursday:  Keep F i t  Walk/Jog Program  APPENDIX 4 LIFESTYLE EDUCATION AND MOTIVATION PROGRAM  107  108 LIFESTYLE EDUCATION PROGRAM SCHEDULE MARCH 1.  FILM:  "THE GOOD. LIFE" (sound-color) ...  A PARTICIPATION FILM which humorously points out that today's good l i f e i s not necessarily a healthy l i f e .  Increased physical  activity i s emphasized (attendance: 30 persons).  2.  FILM:  "IT HAPPENED TO ME" (sound-color)  This filmr.is...designed'_ toi.-provoke action by the audience so that i t :  w i l l A) accept responsibility for health maintenance, B) change living habits to reduce risk of cardiovascular disease and C) to help others to do likewise (attendance: 17 persons).  3.  FILM:  "HEART ATTACK? COUNTERATTACK:" (sound-color)  A MOTIVATIONAL FILM presented by Dr. T. Kavanagh, Medical Director of the Toronto Rehabilitation Centre. supervised fitness program-  It shows the medically  that i s held at the Centre for Cardiac  Patients, and also gives new confidence that the risk of heart disease can be avoided by an active lifestyle (attendance: 22 persons).  109  APRIL 1.  FILM:  "PHYSICAL FITNESS - THE NEW PERSPECTIVE" (sound-color)  This light hearted animated film takes a serious look at the effects of urban lifestyle on physical fitness.  A rural family, displaced  from their farm by the advance of mechanization, move to the city where their physical condition visibly deteriorates.  The positive  aspects of being physically f i t are emphasized and many simple ways to increase everyday activity are introduced (attendance: 1.12 persons).  2.  FILM:  "WEIGHT CONTROL: JUST A STEP AWAY" (sound-color)  This film demonstrates the value of activity i n weight reduction and control (attendance: 30 persons).  3.  WORKSHOP: "PREVENTION OF RUNNING INJURIES" This workshop focused on the biomechanical principles behind running and jogging, preventive measures to avoid injury and the characteri s t i c s of a good jogging shoe (attendance: 6 persons). SPEAKER: Mike MapLeod, Action B.C. Fitness Consultant  4.  FILM:  "COPING WITH LIFE ON THE RUN" (sound-color)  An extremely motivational film which discusses the physical, psychological and emotional rewards of physical activity through running.  This film i s narrated by Dr. George Sheehan, one of the  leading proponents of exercise and preventive medicine in the U.S. (attendance: 24 persons).  110  MAY 1.  FILM:  "STRESS" (sound-color)  This program examines the concepts of stress in conjunction with a variety of people and lifestyles.  Based on the findings of  Dr. Hans Selye, i t i s explained that a certain degree of stress i s both necessary and desirable for physical and mental wellbeing.  However, i f stress i s prolonged, illness can result,  "stress with distress" i s emphasized (attendance:  2.  13 persons).  WORKSHOP: "RELAXATION TRAINING" This workshop focused on learning the relaxation response as a method of stress and tension reduction. The participants were guided through a process designed to reduce the level of nervous stimuli from tense skeletal muscles to the brain and in so doing, quietenc.'the.;total ;self(attendance: 10 persons). l  SPEAKER: Dr. Hugh Venables, Action B.C., Technical Director  3.  WORKSHOP: "BODY AWARENESS AND RELAXATION" This workshop examined then"Feldenkrais Method" of body awareness and i t s incorporation into relaxation achievement (attendance: 12 persons). SPEAKER: Dr. S. Brown, Dept. of Physical Education, U.B.C.  r  Ill  4.  FILM/WORKSHOP: "IS IT WORTH YOUR LIFE" (sound-color) A film which documents the harmful effects of smoking on the human body.  A smoking cessation consultant was also available for those  interested i n quitting the smoking habit (attendance: 7 persons). CONSULTANT: Marie Tracey, Action B.C., Smoking Cessation Program  APPENDIX 5 BIBLIOGRAPHY OF HEALTH EDUCATION LITERATURE AND "FITNESS MEMOS"  112  113  EMPLOYEE HEALTH AND FITNESS LIBRARY BOOKS  AUTHORS  1.  The New Aerobics  K.H. Cooper M.D.  2.  The Aerobics Way  K.H. Cooper M.D.  3. Activetics  C.T. Kuntzelman Ph.D.  4. Jogging - A Physical Fitness Program for a l l Ages  W.J. Bowerman  5.  T. Ko s t rubal a"'. M.D.  The. Joy*.of Running  6. The Complete Book of Running  J.F. Fixx  7. Women's Running  J. Ullyot M.D.  8. The Complete Diet Guide  Editors of Runner's World Magazine  9. Beginner's Running Guide  Hal Higdon  10. Encyclopedia of Athletic Injuries  G. Sheehan M.D.  PAMPHLETS AND BOOKLETS 1.  Health and Fitness.  P.O. Astrand.(Recreation Canada)  2.  Heart Attack, How to Reduce Your Risk.  3.  Physical Activity and Your Heart.  4. Participate, Do It Your Way. 5.  (B.C. Heart Foundation)  (B.C. Heart Foundation)  (Participaction)  Family Fitness. (Fleischmann's)  6. Your Heart:  What Smoking May Do.  (B.C. Heart Foundation)  7. Recipes for Fat Controlled, Low Cholesterol Meals. Foundation)  (B.C. Heart  114  8.  Cigarettes and Your Health.  9.  Your Choice - Nutrition in Pregnancy.  10. Food and Your Heart. 11. The Joy of Eating: of Canada)  (B.C. Health Dept.)  (Health and Welfare Canada)  A Guide to Better Nutrition.  12. Walking and Hiking.  (Mutual Life  (Sun Life of Canada)  13. Rowing and Paddling. 14. The Fitness Wheel.  (B.C. Ministry of Health)  (Sun Life of Canada) (Canadian Heart Foundation)  15. A Sane Look at Cancer.  (Canadian Cancer Society)  16. The Pap Test - "It only takes Minutes to be Sure". Cancer Society) 17. Breast Cancer.  (Canadian  (Canadian Cancer Society)  18. When a Woman Smokes.  (Canadian Cancer Society)  19. Cancer Facts for Men.  (Canadian Cancer Society)  20. Exploding the Myths About Weight Control. 21. Prescription for Fitness.  (B.C. Medical Association)  22. Good Eating to Guard Your Heart.  (B.C. Ministry of Health)  23. Tensions - and How to Master Them. 24. Overweight - A Problem for Millions. 25. Women and Smoking.  (Action B.C.)  (B.C. Heart Foundation) (B.C. Heart Foundation)  (B.C. Heart Foundation)  FITNESS MEMO - 1 To:  Peace Arch Hospital Employees  From: Mike MacLeod, Action B.C. Fitness Consultant  I w i l l be available for personal consultation next week on: Tuesday (March 27th), 11:00 a.m. - 5:30 p.m. Friday (March 30th), 111:00 a.m. - 1:30 p.m.  Feel free to drop by the Peace Arch Exercise Room (Basement of E.C.U. II) during these times to discuss your ideas, problems or questions on physical fitness, nutrition, exercise recommendations, lifestyle modification, etc.  Also, take a few minutes to browse  through the "Health and Fitness Library" which i s housed i n the Exercise Room. It contains some excellent literature!  116  FITNESS MEMO - 2 To:  Hospital Employees  From: Mike MacLeod, Action B.C. Fitness Consultant  I w i l l be available for personal consultation on: Tuesday (April 3rd), 11:30 a.m. - 5:30 p.m. Friday (April 6th),  11:00 a.m. - 2:00 p.m.  There have been a lot of questions directed to me about running injuries, how to start on a jogging program, the proper type of jogging shoes and the biomechanics of jogging.  On Tuesday I w i l l  be prepared to discuss these questions on an impromptu basis with those interested.  I w i l l also have a number of jogging shoes on  hand so as to provide a "Jogging Shoe" c l i n i c . Feel free to drop by the Exercise Room (Bottom of E.C.U.II) at your convenience with your, questions about jogging! •  Next Friday (April 6th), the film, "Physical Fitness - A New Perspective" w i l l be run every half hour from 11:30 a.m. - 1:00 p.m.  This film  is very informative, so grab your lunch and bring a friend down to the Exercise Room! Check the monthly In-Service calendar for future films and workshops to be held weekly on either Wednesdays o_r Fridays. This "Lifestyle Education" program deals with various aspects of physical fitness, nutrition, stress reduction and lifestyle risk factors.  117  FITNESS MEMO - 2 (cont'd) For  those employees who were"not i n i t i a l l y tested for physical fitness  and lifestyle risk factors, please feel free to take part in any of the fitness classes or lifestyle education sessions.  The Peace  Arch Hospital fitness program i s open to a l l employees.  If you desire  a personal exercise program drop by and see me at your convenience!  For  those who were i n i t i a l l y tested, a new month has arrived so  remember to drop off your monthly progress card to Jacquie or Ruth and pick up. a new one.  Your cooperation regarding this matter i s  really appreciated as i t assists me with my personal research!  Remember that the Peace Arch Hospital Employee Fitness Program i s 'working for you' so take advantage of the program i f you have not already done so!  "The body i s the temple of the soul, And to reach harmony of body, mind and Spirit, the body must be physically f i t " Aristotle  118  FITNESS MEMO - 3 To:  Peace Arch Hospital Employees  From: Mike MacLeod, Action B.C. Fitness Consultant  I will be available for personal consultation next week on: Tuesday (April 10th), 1:30 p.m. - 5:30 p.m.  From 11:30 a.m. - 1:00 p.m. I will hold a workshop on the biomechanics of jogging and the prevention of jogging injuries. the characteristics of a good jogging shoe.  I w i l l also discuss  For those on a jogging  program or those who are interested in getting started, this workshop w i l l provide valuable information!  The "Awareness Through Movement" workshop originally scheduled for April 11th has been cancelled and rescheduled for May 16th.  An "Aerobic Circuit" has been set up in the exercise room and i s available to a l l employees to use at their convenience.  There are ten  stations, each station consisting of a different exercise.  The station  charts provide instructions and diagramatic representations of the exercises.  The exercises are designed to increase cardiorespiratory  fitness, f l e x i b i l i t y , and muscular endurance. Music to "Work-out By" i s available in Ruth Kendall's office.  The aerobic circuit i s a fun way  to exercise, so come on down to the exercise room and give i t a try!  119  s  FITNESS MEMO - 4 To:  Peace Arch Hospital Employees  From: Mike MacLeod, Action B.C. Fitness Consultant  On Friday, April 20th, 11:30.a.m. to 1:30 p.m., the exceptional film "Coping with Life on the Run" w i l l be shown every half hour.  This  film, part of the "Lifestyle Education" series, i s narrated by Dr. George Sheehan, one of the leading proponents of exercise and preventive medicine in the U.S. Due-to the high quality and extremely interesting subject matter of this film, I urge you to bring your lunch and a friend down to the Exercise Room for one of the half hour sessions.  It could change your lifeI  120  FITNESS MEMO - 5 To:  Peace Arch District Hospital  From: Mike MacLeod, Action B.C. Fitness Consultant  The Vancouver International Marathon w i l l be held on Sunday, May 6th starting at 0730.  The organizers of this spectacular event have  requested volunteers to help out with the "aid" stations. If you are interested in helping out, a volunteers meeting w i l l be held on Tuesday April 24th at 1930 hours at Robson Square in downtown Vancouver. Any doctors, nurses or physios who are interested in helping out in the medical tents are asked to contact Clyde Smith at 689-7301.  This  26.2 mile race is a fantastic display of physical fitness and endurance. I encourage everybody to get into Vancouver on May 6th and cheer those runners on!  Who knows, one of these days you might be there!  On Friday, April 27th the film "Stress" w i l l »be shown every half hour from 11:30 avm.  to 1:00 p.m.  This film examines the concepts of stress  in conjunction with a variety of people and lifestyles.  I will be available for private consultation on: Tuesday, .(April 24th), 11:30 a.m.  - 3:30  p.m.  FITNESS MEMO - 5 (cont'd) Remember - Keep those monthly progress cards up to date!  Those who  have not handed in the March progress cards are asked to get them in and pick up the April cards.  Better late than never!  "Man was made to work and play" Dr. George Sheehan  "An athlete i s someone who makes the most of their genetic endowment by training in the environment" Dr. George Sheehan  WE CAN ALL BE ATHLETES!  .:: APPENDIX -6INDIVIDUAL RAW SCORES  122  123 INDIVIDUAL RAW SCORES PRETEST DATA  *;•. Subject No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38  . -• v. /- Age,. (yrs)  G ? r  w  44 26 24 35 35 51 29 31 27 55 39 22 59 29. 44 46 35 20 34 30 32 47 36 28 31 53 51 49 25 28 20 31 32 31 25 55 24 33  v  °  Predicted' Percent „„_ - - • ,^ . Body (ml/kg/min) Fat T  U p  ',.  1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3  25.0 22.8 27.0 22.8 30.0 26.8 29.8 22.0 29.8 28.0 20.8 31.8 31.8 20.8 27.0 23.8 25.8 20.8 29.8 28.0 20.0 27.8 21.8 25.8 35.8 25.8 26.0 31.8 17.8 32.0 22.8 32.8 26.8 25.8 24. 8n 27.8 24.8 17.8  23.5 30.0 25.5 27.0 15.0 33.0 17.5 22.0 19.0 16.5 37.0 23.0 21.0 20.0 26.0 22.0 20.0 27.0 20.0 14.5 29.5 25.0 26.5 30.0 19.5 35.0 20.5 22.0 23.0 30.0 21.3 26.8 24.0 21.3 20.0 29.3 23.2 32.1  _ , Sit and Reach  22.0 35.5 35.0 25.0 32.0 39.0 37.5 38.0 31.0 36.0 35.0 26.5 44.2 41.0 41.0 37.0 34.0 37.0 35.0 34.0 37.4 40.5 26.0 39.0 37.3 23.0 25.0 41.0 33.0 37.4 35.5 28.0 30.0 48.5 41.0 28.1 43.4 22.5  124  INDIVIDUAL RAW SCORES PRETEST.DATA (continued)  No.  Back Extension (cm)  1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38  32.0 38.0 37.1 41.5 41.1 24.5 36.5 52.1 25.5 25.0 24.4 41.0 25.5 37.0 35.7 29.3 21.0 34.2 23.8 41.0 30.8 19.5 10.0 33.7 46.5 23.0 23.8 24.2 31.5 15.0 23.0 23.5 27.5 28.6 56.5 12.0 34.0 21.0  Sulibject  Shoulder Extension (cm) 15.0 .18.0 37.6 24.5 23.3 16.5 21.5 30.0 14.0 10.4 10.0 • 25.5 21.0 19.5 18.9 11.1 12.5 24.3 19.7 13.0 26.0 04.5 08.1 11.5 18.0 09.0 13.0 10.0 19.5 23.5 34.7 21.6 10.0 18.0 30.0 09.4 53.9 13.2  T.S.C.S.  328 322 294 . 341 363 360 379 380 349 378 333 355 347 341 378 347  347 356 305 300 293  \_  Appraised Age (yrs) 48 23 25 40 33 51 27 30 28 55 37 21 58 27 45 44 33 12 33 27 32 43 34 29 31 57 . 55 47 24 26 12 31 30 35 23 60 21 35  kcals 1967 2740 2417 1707 1793 1843 1777 2391 1913 2178 2537 2066 1572 2605 2147 2025 2306 2097 2264 2116 2262 2356 2525 2313 2057 2532 1956 2941 2636 2025 2793 2369 2333 2192 2255 2732 1766 1756  INDIVIDUAL RAW SCORES POSTTEST DATA  Subject ''No'?'"  Age (yrs)  1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38  44 26 24 35 35 51 ,29 31 27 55 39 22 59 29 44 46 35 20 34 30 32 47 36 28 31 53 51 49 25 28 20 31 32 31 25 55 24 33  Group i  i  •;  '" ;  I  I I  2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3  Percent Body Fat  Sit and Reach (cm)  25.0 ; ,21.8 .'•  23.5 30.0 25.3' 27.0 16.5 .28.0; ;i7.o. 22.0 19.0 18.0 30.0 21.0 21.0 23.4 23.2 19.0 19.0 23.5 20.0 15.0 24.0 27.0,1 26.5 30.0 17.5 35.0 24.0 21.0 22.2 29.5 21.3 26.4 20.5 21.4 19.0 29.3 23.0 32.0  22.0 38.5 35.0 25.2 28.541.5 37.5 45.0 32.0 29.5 35.0 24.0 44.0 41.0 42.5 41.0 40.0 36.5 37.2 41.0 38.5 41.0 30.0 39.0 40.0 23.0 28.0 39.0 33.0 37.4 35.5 28.1 30.5 45.5 41.3 29.1 41.0 22.5  2  • i .' i '• i "J 1 " • i > l l  Predicted MV0 (ml/kg/min)  27.6  22.8 30.0 '28 .'8; 29.8 25.8' 30.8 27.8 21.8 27.8 31.8 21.8 29.8 24.8 27.8 23.8 30.8 30.8 24.8 25.8 21.8 25.8 37.8 25.8 26.0 28.8 21.8 32.0 22.8 32.8 29.8 31.8 25.8 31.8 24.8 17.8  126  INDIVIDUAL RAW SCORES POSTTEST DATA (continued) Sub'ect ^  Back Extension (cm)  1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24' 25 26 27 28 29 30 31 32 33 34 35 36 37 38  32.0 38.0 37.3 41.3 23.0 34.2 48.0 52.0 37.3 25.0 35.6 55.6 25.5 40.0 33.0 33.4 36.0 44.0 25.0 41.0 38.3 12.0 10.0 33.7 49.9 23.0 23.0 21.0 34.0 24.0 23.2 23.5 34.4 28.6 56.5 13.0 51.4 21.0  Shoulder Extension (cm) 15.0 18.0 37.6 24.5 37.0 16.5 28.8 27.0 16.8 10.0 14.7 29.2 21.2 21.3 29.0 19.1 12.5 16.0 21.0 13.0 19.5 09.6 27.0 11.5 33.2 09.0 31.0 10.0 19.5 20.0 34.5 21.0 10.0 28.7 31.3 09.2 55.6 13.0  T.S.C.S.  Appraised Age (yrs) 46 23 25:  397 337 362 358 363 416 387 384 • /."  370 378 293 357 365 340 372 381  343 379 290 315 274  40 33 50 27 30 28 56 35 21 58 26 46: v.. 44 33 11 33 27 33 43 34 29 31 57, 55 47 21 27 12 31 30 35 26 55 23 37  kcals 2255 2740 2403 1987 2243 2332 2448 2391 2147 2349 2245 2478 1572 2374 2374 2226 2306 2138 2604 2373 2536 2198 2137 2211 2173 2532 2052 3012 2213 2467 2793 2369 2571 2012 2308 2713 1628 1767  APPENDIX 7 ANOVA TABLES FOR DEPENDENT VARIABLES (GROUPS 1, 2 AND 3)  127  128  ANOVA TABLE FOR PRED. MVO Source  Sum of Squares  df  Mean Square  F  Prob. F Exceeded  Groups (G)  1.68  2  0.84  0.02  0.976  Tests (T)  17.09  1  17.09  8.42  0.006  5.08  2  2.54  1.25  0.298  G XT  ANOVA TABLE FOR SIT AND REACH Mean Square  F  2  229.41  3.04  0.06  9.16  1  9.16  2.84  0.101  21.51  2  10.75  3.33  0.047  Source  Sum of Squares  Groups (G)  458.83  Tests (T) G XT  df  Prob. F Exceeded  ANOVA TABLE FOR SHOULDER EXTENSION Mean Square  Prob. F Exceeded  Sum of Squares  Groups (G)  251.73  2  125.86  0.7  0.502  Tests (T)  134.91  1  134.91  6.95  0.012  7.45  2  3.72  0.19  0.826  G XT  df  F  Source  ANOVA TABLE FOR BACK EXTENSION F  2  498.14  2.44  0.102  153.09  1  • 153.09  6.49  0.015  2.73  2  1.36  0.06  0.943  Sum of Squares  Groups (G)  996.28  Tests (T) G XT  Prob., F Exceeded  Mean Square  Source  df  129  ANOVA TABLE FOR % BODY FAT Source  Sum of Squares  df  Mean Square  F  Prob. F Exceeded  Groups (G)  77.92  2  38.96  0.78  0.464  Tests (T)  10.11  .1  10.11  4.24  0.047  1.78  2  0.89  0.37  0.69  G XT  ANOVA TABLE FOR APPRAISED AGE (H.H.A.) Source  Sum of Squares  df  Mean Square  F  Prob. F.Exceeded  :.. 2^54  0.01  0.992  Groups (G)  5.09  2  Tests (T)  . 0.23  1  0.23  0.25  0.617  0.45  2  0.22  0.25  0.782  G XT  ANOVA TABLE FOR CALORIC EXPENDITURE Source  Sum of Squares  df  Groups (G)  211692.43  2  105846 -.211 0.62  0.544  Tests (T)  165374.06  1  165374.06  6.21  0.017  G XT  161331.84  2  80665.92  3.03  0.061  Mean Square  F  Prob. F Exceeded  ANOVA TABLE FOR TENNESSEE SELF CONCEPT SCORES Source  Sum of Squares  Groups (G)  11945.90  2  934.40 1285.50  Tests (T) G XT  df  Mean Square  F  Prob. F Exceeded  5972.95  4.21  0.031  1  934.40  3.82  0.066  2  642.75  2.63  0.099  V  APPENDIX 8.' ANOVA TABLES FOR DEPENDENT VARIABLES (HIGH AND LOW ADHERENCE GROUPS)  130  ANOVA TABLE FOR PRED. MV0  2  Source  Sum of Squares  df Mean Square  F  Prob. F Exceeded  Groups (G)  103.70  1  103.70  3.32  0.076  Tests (T)  30.54  1  30.54  18.38  <0.001  G X T  16.26  1  16.26  9.79  0.003  ANOVA TABLE FOR SIT AND REACH Source  Sum of Squares  Groups (G)  193.74  1  193.74  2.40  0.13  Tests (T)  12.77  1  12.77  3.50  0.069  3.30  1  3.30  0.91  0.347  G XT  df Mean Square  F  Prob. F Exceeded  ANOVA TABLE FOR SHOULDER EXTENSION Source  Sum of Squares  Groups (G)  65.37  1  65.37  0.36  0.55  Tests (T)  150.64  1  150.64  8.08  0.007  16.35  1  16.35  0.88  0.355  G X T  df Mean Square  F  Prob. F Exceeded  ANOVA TABLE FOR BACK EXTENSION Source Groups (G) Tests (T) G X T  Sum of Squares  df Mean Square  F  Prob. F Exceeded  5.01  1  5.01  0.02  0.882  233.34  1  233.34  11.45  0.001  94.87  1  94.87 .  4.65 ,  0.037  132  1  ANOVA TABLE FOR % BODY FAT Source  Sum of Squares  df  Mean Square  F  Prob. F Exceeded  Groups (G)  0.69  1  0.69  0.01  0.907  Tests (T)  20.58  1  20.58  10.67  0.002  G XT  15.84  1  15.84  8.21  0.006  ANOVA TABLE FOR APPRAISED AGE (H.H.A.) Mean Square  F  1  185.09  0.61  0.44  0.86  1  0.86  1.00  0.324  1.49  1  1.49  1.73  0.197  Source  Sum of Squares  Groups (G)  185.09  Tests (T) G XT  df  Prob. F Exceeded  ANOVA TABLE FOR CALORIC EXPENDITURE Source  Sum of Squares  Groups (G)  1415.75  1  200940.03 48517.92  Tests (T) G XT  df  F  Prob. F Exceeded  1415.75  0.01  0.928  1  200940.03  6.92  0.012  1  .^48517.92  1.67  0.204  Mean Square  ANOVA TABLE FOR TENNESSEE SELF CONCEPT SCORE Mean Square  F  1  586.08  0.30  0.589 .  1360.77  1  1360.77  4.97  0.038  489.34  1  489.34  1.79  0.196  Source  Sum of Squares  Groups (G)  586.08  Tests (T) G XT  df  Prob. F Exceeded  

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