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Tatiana Andreyeva and Roland Sturm

Background:

Physical activity has clear health benefits but there remains uncertainty about how it affects health care costs.

Objective:

To examine how physical activity is associated with changes in health expenditure for a national sample age 54 to 69 y, and estimate how this association varies across people with different chronic diseases and health behaviors.

Methods:

Data were from the Health and Retirement Study, a national longitudinal survey of late middle age Americans.

Results:

Correcting for baseline differences in active and inactive groups, physical activity was associated with reduced health care costs of about 7% over 2 y (or $483 annually).

Conclusions:

Regular physical activity in late middle age may lower health expenditure over time, and the effect is likely to be more pronounced for the obese, smokers, and individuals with some baseline health problems. While substantially large for the health care system, our estimates are much smaller than health-unadjusted comparisons or cross-sectional effects.

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Melissa N. Galea, Steven R. Bray and Kathleen A. Martin Ginis

This study aimed to identify barriers and facilitators associated with walking for exercise among people who experience intermittent claudication. Fifteen individuals (7 men and 8 women) participated in 3 focus groups that were tape-recorded and content analyzed. A social-cognitive framework was used to categorize barriers and facilitators as those related to the person, to the activity, or to the environment. Variables identified included those specific to intermittent claudication and those common among the general population. Barriers to walking included irregular or graded walking surfaces, uncertainty about the outcome of walking, ambiguity regarding pain, the need to take rest breaks, and the presence of leg pain. Facilitating factors included availability of a resting place, use of cognitive coping strategies, companionship support, and availability of a treadmill-walking program. Findings are interpreted in light of current research on exercise determinants and encourage prospective examinations of the predictive validity of these factors for walking.

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Matthew D. Bird and Brandonn S. Harris

Sport psychology professionals have increasingly utilized technology for providing performance enhancement and clinical services. Some uncertainty exists amongst professionals to the ethical nature of providing services using technology. The purpose of this study was to survey Certified Consultants of the Association for Applied Sport Psychology (AASP) on the frequency and perceived ethicality of their technology use for providing performance enhancement and clinical services. A secondary purpose was to investigate differences in perceived ethicality between consultants with professional licensure compared to unlicensed professionals. Results suggest overall technology use for service delivery by consultants is low. Technologies used to provide clinical services displayed significantly lower ethical ratings compared to their use for performance enhancement purposes. Differences between licensed consultants and those who are unlicensed emerged for the ethical perceptions of providing performance enhancement services via email, cell phone, and videoconferencing, as well as for clinical services provided via cell phone.

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Dan Goodley

What do disability labels give us and what do they steal from us? How possible is it to live our lives without categories when life is necessarily categorical? In this brief provocation, I want to explore the disability labels through recourse to three perspectives that have much to say about categorization, disability, and the human condition: the biopsychological, the biopolitical, and, what I term, an in-between-all politics. It is my view that disability categories intervene in the world in some complex and often contradictory ways. One way of living with contradictions is to work across disciplinary boundaries, thus situating ourselves across divides and embracing uncertainty and contradiction to enhance all our lives. I will conclude with some interdisciplinary thoughts for the field of adapted physical activity.

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Christoph Lienert, Claudine Sherrill and Bettye Myers

The purpose was to conduct a qualitative cross-cultural comparison of the concerns of physical educators in two countries about integration of children with and without disabilities. In-depth interviews were held with 30 regular elementary physical education teachers in Berlin (7 males, 9 females) and in the Dallas-Ft. Worth (DFW) area (2 males, 12 females), and observations were made of school settings. The Concerns-Based Adoption Model (CBAM) of Hall, Wallace, and Dossett (1973) guided the study. Data were analyzed by grounded theory procedures. Many concerns about integration were generalizable across cultures. In both countries, teachers reported concerns at only four of the seven stages of CBAM: personal, management, consequence, and collaboration. Most concerns focused on management. The major cultural difference was that DFW teachers reported more personal concerns (uncertainty about everyday demands and competence to meet these demands) than Berlin teachers. A dynamic systems model was proposed to guide future research.

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Calum Mattocks, Andy Ness, Sam Leary, Kate Tilling, Steven N. Blair, Julian Shield, Kevin Deere, Joanne Saunders, Joanne Kirkby, George Davey Smith, Jonathan Wells, Nicholas Wareham, John Reilly and Chris Riddoch

Background:

Objective methods can improve accuracy of physical activity measurement in field studies but uncertainties remain about their use.

Methods:

Children age 11 years from the Avon Longitudinal Study of Parents and Children (ALSPAC), were asked to wear a uni-axial accelerometer (MTI Actigraph) for 7 days.

Results:

Of 7159 children who attended for assessment, 5595 (78%) provided valid measures. The reliability coefficient for 3 days of recording was .7 and the power to detect a difference of 0.07 SDs (P ≤ .05) was > 90%. Measures tended to be higher on the first day of recording (17 counts/min; 95% CI, 10–24) and if children wore the monitor for fewer days, but these differences were small. The children who provided valid measures of activity were different from those who did not, but the differences were modest.

Conclusion:

Objective measures of physical activity can be incorporated into large longitudinal studies of children.

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Darren J. Burgess

Research describing load-monitoring techniques for team sport is plentiful. Much of this research is conducted retrospectively and typically involves recreational or semielite teams. Load-monitoring research conducted on professional team sports is largely observational. Challenges exist for the practitioner in implementing peer-reviewed research into the applied setting. These challenges include match scheduling, player adherence, manager/coach buy-in, sport traditions, and staff availability. External-load monitoring often attracts questions surrounding technology reliability and validity, while internal-load monitoring makes some assumptions about player adherence, as well as having some uncertainty around the impact these measures have on player performance This commentary outlines examples of load-monitoring research, discusses the issues associated with the application of this research in an elite team-sport setting, and suggests practical adjustments to the existing research where necessary.

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Fiona J. Moola, Moss E. Norman, LeAnne Petherick and Shaelyn Strachan

While interdisciplinary knowledge is critical to moving beyond categorical ways of knowing, this comes with its own set of pedagogical challenges. We contend that acknowledging existing knowledge hierarchies and epistemological differences, recognizing the ideological baggage that students’ bring to the classroom in terms of their understandings of health, embracing intellectual uncertainty, and encouraging learning-as-witnessing, are fundamental to fostering an interdisciplinary pedagogy that opens up a space for dialogue between psychology and sociology. We draw on the case of obesity and physical inactivity in the Canadian context as an exemplar of a kinesiology dilemma in which both psychology and sociology have important, albeit different, roles to play. We suggest that the anxiety provoked by such an approach is not only necessary but productive to forge an intellectual space where psychologists and sociologists may better hear one another.

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Martin Gérin-Lajoie, Carol L. Richards and Bradford J. McFadyen

This article introduces a novel, ecological, obstructed walking paradigm. Gait adaptations to circumvent obstacles undergoing uncertain displacements, and the effect of revealing the obstacle’s action beforehand, were investigated in young adults. The personal space (PS) maintained during walking was quantified for the first time under different environmental factors including auditory distractions. Obstacle movement and its uncertainty resulted in gait adjustments aimed at gaining time to assess the situation. Early gait adaptations and constant clearances around the obstacle suggest that anticipation and preplanning are involved in such navigational tasks. Participants systematically maintained an elliptical PS during circumvention, but they adjusted its size according to different environmental factors. There was a relationship between the size of PS and level of attention, which suggests that the regulation of PS is used to control locomotion. This novel paradigm has important implications for the assessment and training of locomotor ability within real world environments.

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Marj Moodie, Michelle M. Haby, Boyd Swinburn and Robert Carter

Background:

To assess from a societal perspective the cost-effectiveness of a school program to increase active transport in 10- to 11-year-old Australian children as an obesity prevention measure.

Methods:

The TravelSMART Schools Curriculum program was modeled nationally for 2001 in terms of its impact on Body Mass Index (BMI) and Disability-Adjusted Life Years (DALYs) measured against current practice. Cost offsets and DALY benefits were modeled until the eligible cohort reached age 100 or died. The intervention was qualitatively assessed against second stage filter criteria (‘equity,’ ‘strength of evidence,’ ‘acceptability to stakeholders,’ ‘feasibility of implementation,’ ‘sustainability,’ and ‘side-effects’) given their potential impact on funding decisions.

Results:

The modeled intervention reached 267,700 children and cost $AUD13.3M (95% uncertainty interval [UI] $6.9M; $22.8M) per year. It resulted in an incremental saving of 890 (95%UI −540; 2,900) BMI units, which translated to 95 (95% UI −40; 230) DALYs and a net cost per DALY saved of $AUD117,000 (95% UI dominated; $1.06M).

Conclusions:

The intervention was not cost-effective as an obesity prevention measure under base-run modeling assumptions. The attribution of some costs to nonobesity objectives would be justified given the program’s multiple benefits. Cost-effectiveness would be further improved by considering the wider school community impacts.