Health, Nutrition & Exercise Science Doctoral Work

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The Association Between Workplace Lactation Accommodations and Corporate Lactation Programs and Breastfeeding Duration in Working Women
(North Dakota State University, 2017) Hilliard, Elizabeth
Breastfeeding support has increased over the past 2 decades, especially in the workplace. The Patient Protection and Affordable Care Act of 2010 provided several protections for working, breastfeeding women. Prior to the passage of this legislation, the North Dakota State Legislature amended SB 2344 to create an Infant Friendly business designation available to any business or organization in the state providing specified lactation accommodations for their employees. While this amendment has been in effect since 2009, and the first cohort of businesses was designated in 2011, there has been no evaluation of this designation to determine effectiveness. The purpose of this research is to examine the difference in breastfeeding continuation rates between women working for Infant Friendly and non-designated businesses, and to identify how intention, self-efficacy, and other worksite factors influence breastfeeding duration. An 85 item online questionnaire was developed and distributed using various sampling methods to working women across the state of North Dakota. T-tests, Analysis of Variance, and forward step-wise regression were used to analyze results. While there was no statistically significant difference in breastfeeding duration between designated and non - designated businesses, there was a 3-month difference in duration between continually designated businesses and those letting their designation lapse. Participants disagreed that breastfeeding education was available from their employers. With regard to intention, women who intended to exclusively breastfeed did so with a four month longer duration than those with other feeding intentions, although the results were not statistically significant. Women who perceived only minor challenges with combining breastfeeding and working, and those with greater self-efficacy for breastfeeding had longer breastfeeding durations as well. While the designation is a starting point for worksite breastfeeding support, it could be more comprehensive. Adding a policy promotion and breastfeeding education component to the designation may improve awareness and use of accommodations, making the designation more impactful. These additions may also aid in increasing breastfeeding intention and self-efficacy among working women, and decrease the perception of barriers.
Associations between Physical Activity and Quality of Life: Implications for Primary Care
(North Dakota State University, 2018) Meyer, Stefanie Marie
It is increasingly well-known that chronic diseases are placing a burden on the United States, including the healthcare system. Considering chronic disease risk and quality of life (QOL) measures, improving lifestyle behaviors such as physical activity (PA) should be further explored. In particular, using a place-based approach such as the healthcare system to improve lifestyle behaviors is a strategy to explore. Lifestyle Medicine (LM) is an approach that uses behavior as therapy to treat conditions and is suggested as an approach for primary care. The purpose of study 1 was to explore potential differences in QOL of patients who were referred to LM and are categorized into one of three groups 1) did not engaged in LM 2) engaged in up to two sessions of LM 3) engaged in three or more sessions of LM. The purpose of study 2 was to explore the relationship among provider QOL, PA level, and referral practices to LM. Participants completed demographic and lifestyle referral practices questionnaire, RAND-36 item health questionnaire, and Physical Activity Vital Sign questions. Results from study 1 include no significant differences between LM groups, QOL, and PA. Additionally, a significant difference was found for patient general health QOL score for those who met PA guidelines (M = 68.16, SD = 23.346) versus those who did not meet PA guidelines (M = 54.67, SD = 16.23); t (48) = 2.41, p = .02. Results for study 2 include no significant differences between provider PA minutes and LM referral as well as provider general health QOL and LM referral. A significant difference was found for provider general health QOL score for those who met PA guidelines (M = 85.833, SD = 10.68) versus those who did not meet PA guidelines (M = 67, SD = 9.08); t (9) = 3.109, p = .013. This dissertation will further inform the healthcare community (health system and health professionals) about the importance of PA to overall QOL for patients and providers. Moving from sick care to preventive care using LM approaches must be further explored and studied for both improved health outcomes and financial sustainability.
Best Practices for Strengthening Physical Activity Policies at Childcare
(North Dakota State University, 2017) Strang, Michelle
The sharp increase in childhood obesity in recent years has been dramatic and continues to negatively impact children and their families. Low levels of physical activity (PA) during the preschool years is likely a contributing factor. Considering that most children in the U.S. attend some type of childcare, this is an ideal venue for implementing policies that shape children’s activity and sedentary (SED) patterns. The purpose of this dissertation was twofold. The first study compared levels of moderate-to-vigorous PA (MVPA) and SED in children attending licensed childcare centers with a PA-policy with those attending centers without a PA policy. The second study identified correlates (child-level, teacher-level, and classroom-level) of children’s MVPA and SED at childcare. Preschoolers (191), lead teachers (23), and center directors (12) from 12 licensed childcare centers (6 intervention/6 comparison) participated in the study. Children wore accelerometers during childcare for 3 days in the spring (April/May) of 2016. For the first study, separate mixed-model ANCOVAs were utilized to examine group differences in MVPA and SED, with gender entered as a covariate and classroom as a random factor. Levels of MVPA (6.74 min/h vs. 5.62 min/h, p = 0.06) and SED (29.97 min/h vs. 31.30 min/h, p = 0.32) were not significantly different between intervention and comparison groups, Findings from study one suggest the implementing a PA policy may not improving children’s PA behaviors, although compliance to policy guidelines was low. For study two, accelerometry data were utilized to examine potential correlates (measured by surveys completed by parents, teachers, and directors) of children’s PA and SED. Correlation and mixed-model regression analyses were conducted to examine associations between 18 potential correlates across multiple domains (demographic, anthropometric, social, and environmental), accounting for gender and clustering of activity within classrooms. Results from study two indicate that gender (boys) (p < .01), time spent outdoors (p < .05) and the amount of play equipment available (p < .05) were positively associated with MVPA, and gender (boys) (p < .01), and time spent outdoors (p < .05) were negatively associated with SED.
Changes in Physical Activity and Quality of Life of Cancer Survivors Participating in a Group Exercise Program
(North Dakota State University, 2017) Greterman, Sarah
Although cancer survival rates are improving, cancer treatment is often associated with adverse biopsychosocial symptoms, including increased risk of anxiety, depression, and social isolation, and reduced physical fitness and quality of life (QOL) (Courneya, 2003; Howlader, et al., 2012; Rajotte, et al., 2012). Since the early 1990’s, interest in the potential benefits of participation in exercise on the well-being of cancer survivors has been growing (Pinto & Floyd, 2007). Although physical activity (PA) has shown to improve physical functioning and QOL many adverse biopsychosocial effects often impact one’s ability to engage in regular PA, and challenges overall well-being. (Knobf, Musanti, & Dorward, 2007). To overcome some of these barriers, the LIVESTRONG® Foundation partnered with numerous YMCA’s establishing a structured 12-week post-treatment group exercise program for cancer survivors. The purpose of this study was to evaluate changes in PA and QOL among cancer survivors participating in a LIVESTRONG® at the YMCA group-exercise program. Subjects (N=47) participating in a program in Fargo, North Dakota, between July 2011 and August 2014, were grouped into cohorts based on their monthly start date. PA was monitored using the SenseWear armband activity monitor and QOL was assessed using the FACT-G. Both PA and QOL were evaluated at three different time points: end of week 1, week 6, and week 12. Overall, results indicated participants engaged in more than 4 hours of PA each day, with more than 40 minutes of moderate-vigorous PA per day. Furthermore, significant declines in sedentary activity were observed from week 1 to week 6 and week 6 to week 12, based on wear time. In addition, participants started the program with relatively high QOL. All areas of QOL improved, with the most significant improvements correlated with physical well-being. Although it was difficult to determine exact cause and effect relationships relative to participation in the LIVESTRONG® at the YMCA group exercise program, the fact that participants met the minimum ACSM PA recommendations at each time point, expressed a significant decline in sedentary activity, and displayed improvements in QOL is promising.
Effects of Nutrition Education and Fruit and Vegetable Consumption on Knowledge of Antioxidants and Biomarkers of Inflammation and Chronic Disease
(North Dakota State University, 2012) Wagner, Meredith Grace
Obesity rates have reached epidemic proportions contributing to the majority of Americans experiencing a state of chronic inflammation. Associations between inflammation, oxidative stress, and increased disease risk contribute to detrimental consequences of obesity. Regulation of inflammation and oxidative stress is possible via antioxidants consumed through a diet adequate in fruits and vegetables but consumption among adults is poor. Previous studies have assessed the impact of fruit, vegetable, and antioxidant consumption on oxidative stress and inflammation among healthy individuals. However, no studies have examined effects of education and fruit and vegetable consumption on markers of oxidative stress, inflammation, and other chronic disease biomarkers in a single study of overweight and obese adults. The purposes of this study were to examine effects of nutrition education and fruit and vegetable consumption on: interest and knowledge related to antioxidants; consumption patterns; weight, body mass index (BMI), body composition, blood lipids, and blood glucose; and biomarkers of oxidative stress and inflammation. Fifty-four adults (19 men/35 women; age 44.7±12.1 y; BMI 33.2±7.7 kg/m2 were randomly assigned to one of three intervention groups. The control group received no intervention, the education group attended weekly nutrition lessons, and the fruit and vegetable group attended weekly nutrition lessons and received one serving of fruits and two servings of vegetables per day for 10 weeks. Fruit and vegetable-related knowledge, attitudes, and behaviors were assessed using questionnaires. Fruit, vegetable, and antioxidant consumption was assessed using semi-quantitative food frequency questionnaires and three-day food records and anthropometric measurements and fasting blood draws were conducted. Results indicated improvements in fruit and vegetable-related knowledge, attitudes, and behaviors and increased consumption of antioxidant-rich fruits and vegetables following nutrition education. Associations existed between increased fruit and vegetable consumption and improvements in LDL cholesterol. However, minimal associations between changes in consumption of fruits, vegetables, and antioxidants and biomarkers of inflammation and oxidative stress were indicated. In order to be effective, nutrition intervention programs need to thoroughly address participants' fruit and vegetable-related knowledge and attitudes, provide exposure to fruits and vegetables, and promote adequate consumption of antioxidant-rich fruits and vegetables while concurrently emphasizing management of overall energy intake.
Effects of Sit-Stand Desks in a College Class
(North Dakota State University, 2016) Frost, Jeremy
This disquisition examined the effects of sit-stand desks in a college classroom over the course of a semester and was split into two studies. Paper 1 determined the pattern of sit-stand desk usage over the course of a semester, the relationship to movement outside of class, and likeability of the sit-stand desks. Paper 2 determined the effect of using adjustable-height (sit-stand) desks in a college class on attention (AT), stress (ST), musculoskeletal discomfort (MD), anxiety (AN), and academic performance. Participants (total n=18; control=6) were recruited from two sections of the same course at a public university in Minnesota. Individual daily standing time for the intervention group ranged from 0-100% of daily attendance time and the daily group average ranged from 2.1-38.4%. Weekly standing was lower (p<.05) in week 8 than week 5, 9, 11, 13, and 15. There was no difference in standing percentage between Wednesdays and Fridays. A third of all standing bouts were less than 0.3 min and two-thirds were less than 2 min in length. Perception Questionnaire answers were positive for using the desk and their effect on ability to work in class. The amount of daily moderate-to-vigorous physical activity (MVPA) did not differ between groups or between time points (week 7 vs. 14). All participants completed visual analogue scales (VAS) to measure AT, ST, MD, and AN from week 3-15, and took exams at week 4, 6, 8, 10, 12, 14, and 15. The main findings indicated lower MD scores for the intervention group, higher week 6 than week 11 scores for AN and ST, and more variability in AT and ST scores. Exam scores were not different between groups. There was no difference in direct observation of attention (OAT) between groups (total n=15; control=6) at week 9, 12, or 13. The results indicate the sit-stand desks were utilized at low levels, and for short durations, for most participants, but perceptions of desk use remained positive. In addition, sit-stand desks were associated with lower MD scores and weekly fluctuations in AT, ST, and AN. Future interventions should attempt to minimize the variability in desk use.
External Ankle Supports Alter Kinematics and Kinetics during Drop-Jump Landing and Forward-Jump Landing Tasks
(North Dakota State University, 2014) Okamatsu, Hidefusa
This research project was designed to understand the influence of excessively restricting ankle range of motion (ROM) on knee injuries, especially non-contact anterior cruciate ligament (ACL) tear. Participating in physical activity without injuries is important to maintain physically active life style and well-being. To prevent ankle injuries, external ankle supports (EAS) are widely used in sport settings by limiting frontal plane ankle ROM; however, the EAS also restricts sagittal plane ankle ROM that could increase the risk of non-contact ACL injury by intensifying the medial knee displacement (MKD) and ground reaction force (GRF). In this research, the effects of external ankle supports (EAS) on landing mechanics were investigated among 19 physically active college-aged females. Two research manuscripts report the results of this research project. The first manuscript investigated the effect of EAS on landing kinematics and kinetics during a drop-jump landing task. The results demonstrated the use of EAS altered the ankle displacement, total MKD, and vertical GRF; however, no relationship was observed between isokinetic plantar flexor strength and landing mechanics. The second manuscript compared the effect of EAS on landing kinematics and kinetics between drop-jump landing and forward-jump landing tasks. The result exhibited the use of EAS similarly affect ankle displacement, knee displacement, peak MKD in drop-jump landing and forward-jump landing tasks. However, the landing tasks affected the posterior GRF differently, and the EAS altered vertical GRF differently in the two landing tasks. Overall, excessively restricted ankle ROM changed the landing kinematics and kinetics, especially MKD and GRF during landing tasks. Our findings indicate that healthcare professionals should use EAS with care because the overly limited ankle ROM could increase the risk of non-contact knee injuries by increased MKD and GRF. Future research should include an examination of the effect of EAS on the magnitude of ACL strain, an assessment of the strength of the other muscles, an evaluation of the muscular activation during a landing task. These studies help understand the landing techniques and strength training to reduce the risk of non-contact ACL tear among physically active population.
Interval Training Methods to Increase Performance Markers and Load Carriage in Tactical Professionals
(North Dakota State University, 2019) Dicks, Nathan D.
Load carriage is an inherent part of the military and other tactical occupations (e.g., law enforcement, firefighters). Variation in load carriage ranges from 7-60 kg and can increase energy expenditure as well as lead to higher injury risk. Various novel training methods such as low-intensity interval training (LIT) in combination with blood flow restriction (BFR) as well as high-intensity interval training (HIT) aim at enhancing critical velocity (CV), aerobic fitness, and load carriage performance. Two investigations identified the feasibility of LIT with BFR and the use of HIT to increase performance and load carriage. Methods: Twelve male participants (21.8 +/- 1.5 yrs) underwent LIT with (BFR-LOAD) and without BFR (LOAD) loaded with 15% of their body mass to compare the acute metabolic and perceptual responses. Next, twenty adult participants (male = 15, female = 5) (age = 21.8 +/- 1.5 yrs) completed 4-weeks of HIT (2 d⋅wk-1) to compare aerobic fitness and load carriage task performance. Results: Metabolic responses (VO2) were elevated 7% during BFR-LOAD (p = .001) compared with BFR familiarization and LOAD Condition. There were significant increases with CV (p = .005) and velocity at VO2max (vVO2max) (p = .037), but there was no statistical difference between the groups. There were load carriage performance improvements for the 3200 m task (p < .001) with a decrease of 9.8% in completion times. Conclusion: There was an increased metabolic response during the BFR-LOAD condition. Thus, there is a potential for BFR to limit the use of load carriage for individuals engaging in rehabilitation and reconditioning programs due to injury. Furthermore, four weeks of 2 d⋅wk-1 HIT was appropriate to see improvements in with aerobic measures of CV and vVO2max as well as improvements in the load carriage task performances. LIT and HIT methods warrant continued research to increase aerobic fitness and load carriage performance.
An Investigation of Physical Activity and Cardiorespiratory Fitness in Career Firefighters
(North Dakota State University, 2018) Barry, Allison Michelle
Firefighters are responsible for protecting citizens as well as the infrastructure of cities across the United States. In order to safely protect and perform on-duty tasks, firefighters must be capable of performing physiologically demanding skills. Emerging evidence has led to heightened concern for firefighters’ increased obesity levels and decreased physical activity (PA). Formal exercise and PA research specific to firefighters is lacking. More specifically, there is a lack of literature using accelerometers to objectively measure PA. There is more evidence, however, to demonstrate firefighters have a high prevalence of obesity surpassing the general population. Not only are firefighters overweight and inactive, but also they are not aerobically fit to adequately perform their job-specific tasks. Purpose: To examine the relationship of PA and obesity to cardiorespiratory fitness (CRF). Methods: Firefighters (n=29) wore an accelerometer for eight consecutive on- and off-duty days. The accelerometer was worn on the right hip and tracked sedentary activity, light physical activity (LPA), moderate physical activity (MPA), vigorous physical activity (VPA), and moderate-to-vigorous physical activity (MPVA). Additionally, each participant completed a stage-graded exercise test with submaximal square-wave verification bout to determine maximal oxygen uptake (VO2max). A stepwise linear regression model was conducted using physical activity intensity, body mass index (BMI), and waist circumference (WC) as predictor variables for CRF. Results: According to the World Health Organization BMI categorization, none were normal weight, 20 were overweight, and 9 were obese. Firefighters spent roughly 61% of their waking hours in sedentary activity, 35.4% in LPA, and only 3.6% in MVPA. The two linear regression models were used to investigate whether PA intensity, step count, physical activity rating scale, BMI, or WC were more predictive of VO2max. VPA was predictive of VO2max (F(1,27) = 7.89, R2 = 0.23, p <0.01). Additionally, when BMI and WC were added, only WC was predictive of VO2max (F(1,27) = 11.76, R2 = 0.30, p<0.01). Conclusion: It is imperative fire departments emphasize the importance of cultivating an environment where improved health and wellness is essential for firefighters to adequately perform their physiologically demanding tasks.
Life Skills at a Tribal College: Effects of a Culturally Relevant Educational Intervention on College Retention & Self-efficacy for Healthy Choices among American Indian Tribal College Students
(North Dakota State University, 2016) Keith, Jill Fabricius
American Indians and Alaskan Natives (AIAN) have the lowest rates of college retention and graduation in the U.S. Additionally, AIAN face health disparities including higher rates of obesity/overweight and Type 2 diabetes. The study purpose was to explore the effects of a culturally relevant life skills curriculum delivered in a family-style environment on self-efficacy, healthy choices, and college retention in tribal college students over four separate semesters. A non-experimental cohort design using mixed methods (quantitative and qualitative) was utilized for the study. Participants in the study (full study completion, n=9; initial participants, n=26) were purposively sampled newly enrolled, academically under-prepared tribal college students. Participant demographics included various tribal affiliations, ages, and number of dependents. Research instruments included pre- and post-questionnaires and pre- and post-telephone interviews. General self-efficacy did not increase significantly, nutrition knowledge increased but not significantly, and nutrition attitudes and beliefs were not different between pre- and post-intervention. Dietary analysis reflected improved intake of healthy choices, however none of the participants met dietary recommendations for any food group. Eating behaviors such as eating in front of the TV decreased. Retention of students within-semester was lower among participants than overall students at the tribal college. However, semester-to-semester retention rates of Life Skills at a Tribal College participants who completed the course were significantly higher than those participants who did not complete the course and significantly higher than overall semester-to-semester retention rates at the tribal college. Qualitative analysis revealed a variety of barriers and strategies for making healthy food choices. Addressing self-efficacy and perception of capabilities regarding making healthy food choices can help AIAN students feel more capable of success and impact the quality of their diet. However, challenges remain to college retention and improving dietary intake to meet recommendations.
The Relationship Between Exercise and Mental Health in College Students
(North Dakota State University, 2013) Demers, Nikki Richelle
The purpose of this study was to evaluate the influence of an exercise program on aspects of wellness in college students. The study explored changes in physical fitness and on self-reports of anxiety and depression symptoms before and after participating in a six-week exercise program at a Midwestern university. The study participants consisted of 53 undergraduate students from activity courses, and 25 undergraduate students from a lecture course. The Burns' Anxiety Inventory, Burns' Depression Inventory, and the Attitudes Towards Exercise Inventory were used for assessment. Quantifiable measures of physical fitness were assessed using anthropometric measures for weight and body composition, and the Rockport walking test was used as a measure of cardiovascular fitness. Results indicated significant differences existed between pre- and post-scores for the treatment group that participated in the six-week exercise program in categories of anxiety, depression, attitudes/beliefs that exercise can improve mental health, and maximal oxygen uptake (VO2 max) scores which indicate cardiorespiratory fitness. Non-significant differences were found between pre and post data in the measures of attitudes in the stages of change, body composition and Body Mass Index for the treatment group. In the control group, a significant difference was noted in VO2 max, but no differences were found in all other categories of anxiety, depression, attitudes towards exercise, body fat, and Body Mass Index. Results from this study indicate that an exercise prescription may be used as a tool to alleviate symptoms of depression and anxiety in college students. Additional studies may confirm significance in reducing anxiety and depression symptoms or seeing changes in body composition while adhering to a regular exercise program.

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