A PHYSICAL ACTIVITY INTERVENTION AIMED TO IMPROVE THE MOOD OF BOYS AGED 15-18 IN A HIGH SCHOOL - Essay Example

? A PHYSICAL ACTIVITY INTERVENTION AIMED TO IMPROVE THE MOOD OF BOYS AGED 15-18 IN A HIGH SCHOOL [Pick the [Type the company a010003a ABSTRACT The present report aims to present a physical activity based intervention plan to improve the mood of boys in the age group of 15-18 years. The intervention plan was tested on high school students of specified age group in Abu Dhabi (United Arab Emirates). The intervention is based on the potential benefits of physical activity on the mental health and mental wellbeing of individuals. Role of physical activity in the improvement of mental health and preventive measure for occurrence of mental sickness has been studied in all age groups. A large volume of academic literature is available in support of this hypothesis and several theories have been proposed to provide probable mechanisms for the same including biochemical, physiological and psychosocial theories. Based on this evidence intervention strategies have been devised that utilize the different models of behaviour change. The theory of planned behaviour is a widely applied model encompassing personal as well as interpersonal factors of behaviour change and has been utilized in the present intervention strategy. A PHYSICAL ACTIVITY INTERVENTION AIMED TO IMPROVE THE MOOD OF BOYS AGED 15-18 IN A HIGH SCHOOL INTRODUCTION If you want creative workers, give them enough time to play. John Cleese English actor & comedian Importance of physical activity “All work and no play makes Jack a dull boy”, goes an old proverb. The maxim increasingly finds support in scientific researches conducted over time. Physical activity is now accepted to promote physical health as well as mental well being (CDC, 2010). Regular physical activity and involvement in sports and games during early years has a positive impact on the physical strength and mental toughness of the adolescents and youth. Besides helping build strong bones and muscles; preventing problems of overweight and obesity; and controlling blood pressure and cholesterol levels; it helps the individual alleviate anxiety and stress and improve self esteem. It also builds up an active lifestyle that helps the individual continue the habit in later phases of life (US department of health and human services, 2008). A sedentary lifestyle on the other hand leads to twice the risk of development of coronary heart diseases and stroke, along with obesity and higher probabilities of diabetes and certain cancers. Further in recent years it has also been reported to aid in prevention and control of mental disorders (Fox, 1999). Association of Physical Activity to Mental Health During the recent years there has been increasing interest in the exploration of role of physical activity in promoting mental health. These researches are directed at investigating exercise as therapeutic measures for mental disorders and illnesses, means of coping with mental disturbances, improving quality of life of those suffering from mental illness, and as a preventive measure for the development of mental problems. Depression, low self esteem, stress and anxiety are frequently reported mental problems that stem from the demands of modern lifestyle and many individuals at some stage fail to cope with them (Fox et al; 2000). Impact of physical activity and its variables have been studied on each of these mental problems individually. On the basis of a meta-analysis of randomized controlled trials (RCTs), Craft & Landers (1998) have concluded that physical activity definitely lowers the risk of development of clinical depression, effective depression treatment is possible through aerobic and resistance exercise and these interventions have an efficacy equivalent to psychotherapy. Consistent and regular exercises have also shown to have moderate alleviating impact on anxiety and stress (Fox, 1999). Further perceptions of individuals’ physical self are also reported to improve as a consequence of physical activity, which has an overall impact on individual’s self esteem (Fox, 1999). Finally, evidences support that physical activity exhibits a moderate association with indices of subjective well being and improves the mood of the individual (Biddle, 2000). Thus researchers have consistently made an effort to understand the mechanisms underlying the role of physical activity in helping with mental illnesses and problems. Though the exact mechanism is not yet known several theories have been proposed for the same that can be categorized in to three categories: biochemical, physiological and psychosocial (Fox, 1999). The major biochemical impact of exercise is that it causes neurogenesis specifically in the hippocampus. Though the pathway is not known, it has been suggested that mild exercise cause an influx of calcium within the cells that activate transcriptions factors which in turn initiate Brain Derived Neurotrophic factors (BDNF). The BDNF promote neurogenesis (Mattson et al., 2004). High intensity physical exercises have also been shown to have an osteogenic effect (Rantalainen et al., 2009). Neurotransmitters such as serotonin, dopamine, nor-epinephrine are involved in the exercise physiology. The revised central fatigue hypothesis (Meeusen et al., 2006) proposes the role of serotonin to dopamine ratio along with release of catecholamines and noradrenaline in determining the mood during and after physical activity. Serotonin has been known to play an important role in treatment as well control of susceptibility to depression. Studies have also reported a positive correlation between serotonin levels and positive emotions or normal mood ranges (Young, 2007). The physiological basis of impact of physical activity on mental health is based on the observations that endorphins or endogenous morphine (mainly beta-endorphins) are released as a consequence of physical activity. These endorphins have been proposed to have an inhibitory effect on central nervous system, leading to a feeling of calmness and therefore improved feeling of mental well being post exercise. Another mechanism mediated y monoamines has also been proposed based on the fact that physical activity enhances the synaptic transmission of monoamines which has an antidepressive influence (Peluso & Andrade, 2005). The psycho-social impact of physical activity is mediated through its impact on distraction, self-efficacy and social interaction (Peluso & Andrade, 2005). Models of Behaviour Change Having established the role of physical activity in ensuring physical as well as mental well being, several questions emerge as to the development and maintenance of health related behaviour. The causal factors and nature of these behaviours determine the levels of diseases risk involved and hence are an important field of study. They also are important tools aiding the development of effective intervention strategies. However health behaviour is a complex and multidimensional issue hence it cannot be explained on the basis of any one of the behaviour change models (Glanz et al., 2002). The major theories can be categorized into three groups: those focusing on individual knowledge and attributes, emphasizing social or interpersonal factors and determined by environmental issues (Glanz & Stryker, 2010). Theory of Reasoned Action is based on the assumption that behaviour intention is the closest determinant of actual behaviour. The intensions are in turn dependent on individual attitude and subjective norms. A development of this theory is the theory of planned behaviour (TPB), which is based on idea of perceived behavioural control. Transtheoretical/Stages of Change Model considers the behaviour change as a multiple step process with individuals at different stages of readiness or self regulation need to be offered different programs appropriate for their stage (Glanz & Stryker, 2010). Health Action Process Approach is based on the assumption that the individual determines and weighs the two aspects of health behaviour, one whether it would be effective in achieving the goal, and two whether the individual would be able to pursue the behaviour i.e. self efficacy (Maes & Gebhard, 2000). Social learning/social cognitive theory (SCT) is based on the observation that people learn not only from their own experiences but also from the experiences of others around them. Thus SCT proposes that there are three determinants of behaviour. Individual self efficacy, precise personal goals, and the perceived benefits of particular behaviour must at least compensate the efforts taken in pursuing the behaviour change process (Glanz & Stryker, 2010). Theory of Planned Behaviour (TPB) The theory of planned behaviour is based on the assumption that a decision is based on analysis of available information, past experiences and after consideration of implications of the decision or subsequent action. Thus according to TPB, human behaviour is determined by three factors, one personal, second interpersonal and third dependent on self control (figure 1) (Ajzen, 2005). The personal factor encompasses individual’s perceptions; positive or negative regarding the behaviour. These perceptions are responsible for specific attitude of the individual towards the behaviour and are based on individual’s beliefs about his abilities and evaluation of the outcome of the behaviour (Rivis & Sheeran, 2003). The second factor is subjective norm and it includes individual’s perceptions of socially acceptable or unacceptable behaviour. Subjective norms include and are a product of both normative beliefs and individual’s readiness to act in accordance with them. Finally, the third factor that determines individual’s decision to pursue behaviour is his perception about himself, his self efficacy or his perception of his ability to perform the target behaviour (Ajzen, 2005). TPB is one of the most commonly used models of cognitive determinants of behaviour. It has been successfully utilized in many health behaviour studies and also has facilitated prediction of exercise related intentions and behaviour in several studies. The model has a few weaknesses such as higher stress on personal factors compared to subjective norms and neglect of prototype perception. However the model compared to other models of behaviour change such as theory of reasoned action is more comprehensive and accounts for both personal as well as social factors (Rivis & Sheeran, 2003). Figure 1: Theory of Planned Behaviour (Ajzen, 2005) AIMS AND OBJECTIVES The problems related to inactivity have been a major cause of concern among the children and adolescents due to lifestyle changes during the last three decades. A 2007 data indicates that the participation of high school students in at least 60 min of physical activity each day is below 17%, with a meagre 30% attending physical education daily (CDC, 2008). In view of the implications of lack of physical activity on the mental well being of adolescents and based on an understanding of the mechanism underlying the relationship between the two, the current research aims to present a rational intervention strategy. The intervention is based on the theory of planned behaviour and is able to accommodate the target population of 15-18 yr old boys besides being able to achieve the specific goal of their mental well being. In order to achieve this aim, the following objectives were pursued during the research: 1. An understanding of the interrelationship of physical activity and mental health. 2. A study of the probable mechanisms underlying the above relationship. 3. A study of the models of behaviour change. 4. A study of the available and recent literature exploring the various intervention strategies suitable for the purpose 5. Development of an intervention strategy based on the Theory of Planned Behaviour (TPB) model. 6. Assessment of the impact of the intervention on the basis of Subjective Exercise Experience Scale (SEES) REVIEW OF LITERATURE During the last decade several studies have been conducted successfully to provide substantial evidences for the positive impact of physical activity on mental well being of adolescents and young people. This section aims to present a review of some of these studies. 100 undergraduate university students were involved in a study conducted in UK. The physical activity data was gathered using Physical Activity Questionnaire (PAQ) and the levels of anxiety and depression were estimated using Hospital Anxiety and Depression Scale (HADS). The group could be classified in to three categories on the basis of levels of physical activity, with corresponding differences observed in their mental health. The study established that physical activity has a significant contribution in the mental well being of young students (Tyson et al., 2010). Another study was conducted on 19842 participants, both male and female; with self reported physical activity and General Health Questionnaire (GHQ) to assess mental health (Hamer & Steptoe, 2009). Lower risk psychological distress (GHQ score >4) was found to be associated with any form of daily physical activity. The study was able to establish an association between such varied forms of physical activities such as household chores, walking and sports; and psychological distress. The study reported that levels of physical activity as low as less than 20min per week had a positive impact on mental well being. A two year study to assess the impact of physical activity on mental health of 165 adolescents (14 yr old at baseline) was conducted by Centre for physical activity and nutrition research (Veitch et al., 2008). Physical activity measures were based on data collected using accelerometers and depression symptoms were assessed using the Centre for epidemiological studies depression scale for children (CES-CD). Though the levels of depression at 16 yrs were not found to be associated with physical activity levels, however a significant correlation was observed in depressive symptoms at 14 yrs and television watching time at 16 yrs. This could mean that depressive symptoms at early age lead to further withdrawal from social activities. A longitudinal study spanning the period from 2001-2004 was conducted in Oslo involving 2433 boys and girls in the age group of 15-16 yrs at baseline. The assessment of mental health at baseline and follow up was done using the impact supplement of Strengths and Difficulties questionnaire (SDQ). A logistic regression was done after accounting for interfering factors such as ethnicity, economic factors and smoking or drinking habits. The results revealed that individuals with higher level of continuous physical activity during the late teens showed less impairment due to mental health problems at follow up. The results are suggestive of possible preventive effect of physical activity on mental health problems (Sagatun et al., 2007). Brosnahan and colleagues (2004) conducted a study to estimate the correlation of physical activity to feelings of sadness and suicidal thoughts in a group of 1870 Hispanic and non Hispanic white adolescents (14-18 yrs) in Texas. The study was a cross sectional study design based on 2001 Youth behaviour risk survey. A logical regression analysis between the measures of independent variables of physical activity and dependent variables of mood revealed a negative correlation between the two. Thus the study provides evidence for the positive impact of physical activity on mental health of adolescents. Thus a rich body of evidence is available for the potential association of physical activity and mental health providing sufficient support to the belief that physical activity on one hand improves mental health and on the other hand lowers the risk for and even prevents the development of mental illnesses. However the studies are vague with reference to nature of physical activity. Most studies include solely walking or exercise as physical activity, with the exact nature of the latter unspecified. Playing, cycling or simply active living are ignored. Some studies do mention that physical activity should be according to preferences of individuals (Whitelaw, 2008); however this issue itself is contradictory. Further the term mental health is vaguely defined in most researches. In fact mental health is an umbrella term that has been differently used to encompass mental wellbeing as well as mental health, rather than in terms of specific mental health terms conceptualized and understood today. Besides this, researches involving precise quantitative data along with ‘dose response’ studies are rare and further efforts are required in this direction. Qualitative aspects of the association of physical activity and mental health also need a detailed and scientific study for developments of concepts and comprehension of mechanisms underlying the association of the various aspects of the two. Intervention Strategy Participants The proposed intervention strategy involved a group of 50 boys (15-18 yrs), students of applied Technology High School of Abu Dhabi (Unite Arab Emirates). The participants were in self reported state of good health and were ensured to have no medical contraindication on the basis of approval letters obtained from their physicians. Procedure The procedure involved physical activity regime followed by filling up of questionnaires. The physical activity regime involved separate sessions of aerobic exercises involving brisk walking, both preceded and followed by a warming up session. The details of the procedure are provided in the appendix. Measures The primary dependent variable was considered to be mood and therefore the assessment of mental health was based on the participants response to “how they are feeling” immediately after the exercises. To assess this; the subjective Exercise Experience Scale (SEES) (McAuley & Courneya, 1994) was administered to the participants. SEES is a subjective three factor assessment of psychological responses to exercise as stimulant. The three factors include psychological health, psychological distress and subjective indicators of fatigue. In accordance the current intervention plan used the following three subscales: 1) Psychological well-being (great, positive, Strong, terrific); 2) Psychological distress (awful, crummy, discouraged, miserable); and 3) Fatigue (drained, exhausted, fatigued, and tired). The SEES has been found to be reliable and valid technique for the assessment of impact of exercise on both young adults and middle age adults. It is a comprehensive and valid assessment technique, which can form the basis of further analysis. Besides this, heart rate measures were also obtained. CONCLUSION Higher levels of physical activity have been correlated increased levels of self esteem, a positive attitude, mental strength and lower the risk of mental illnesses. Thus the study emphasizes the importance of physical activity not only as a means to improve physical fitness, but also as preventive measure for mental illnesses. Adolescents learn social skills, develop mental toughness and build an active life style that helps them cope with the stresses of present life as well as prepare them to deal with the demands of future life. The efficacy of physical activity in improving mental health is a subject of further and exhaustive study to enable development of intervention strategies based on sports, exercises and physical activity for adolescents. REFERENCES 1 Ajzen, I. (2005). Attitudes, personality and behaviour. Berkshire: Open University Press. 2 Biddle, S. J. (2000). Emotion, mood and physical activity. In S. J. Biddle, K. R. Fox, & S. H. Boutcher, Physical activity and psychological well being (p. 63). London: Routledge. 3 Brosnahan, J., Steffen, L. M., Lytle, L., Patterson, J., & Boostrom, A. (2004). The relation between physicala ctivity and mental helath among hispanic and non hispanic white adolescents. Arch Pediatr adolesc med , 818-23. 4 CDC. (2008, June 6). 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APPENDIX Intervention Plan The exercises were completed in small groups with each group comprising of five boys. The participants wore a heart rate monitor (FT7; Polar Inc). The aerobic sessions conducted for 30 minutes, four days a week for 12 weeks, included a session of brisk walking. The intensity of walk was selected to be 60-70% of their age predicted maximal heart rate. The exercise protocol with reference to mode, duration and intensity) was in accordance to American College of Sports Medicine’s (ACSM) guidelines. The session was preceded and followed by a 5min warm up session. Guidance was provided to the participants on manner of treadmill walk prior to the exercise. After the exercise or during the quite rest period, the participants were directed to the desk and where they were asked to sit and fill up the questionnaire. Read More