Journal of Education and Health Promotion

Abstract Osteoporosis is a systemic skeletal disease that is associated with negative physical and psychosocial
consequences, so understanding the effective strategies that can be used in the prevention of
osteoporosis is especially important. The aim of this study was to integrative review the published
interventional of nonpharmacological studies regarding the prevention and treatment of osteoporosis
among menopausal women. In this systematic review, databases such as PubMed, PsycInfo, Web
of Science (ISI), Scopus, ScienceDirect, EmBase, Cochrane library, Google scholar, and Iranian
databases, such as Scientific Information Database and Magiran, were searched. The latest search
was performed between “November 2020 and December 2020” separately by two researchers and
then double‑checked by them. The quality of the included studies was assessed using the Jadad
score calculation tool. Twenty eight randomized controlled trials and quasi‑experimental studies were
included in this current study. The quality assessment indicated that 19 studies had acceptable (good)
methodological quality and also 9 studies had weak methodological quality. The main results of this
study were classified in three main categories such as exercise or physical activity training (n = 15),
educational sessions (n = 11), and other interventions (n = 2). The results of most included studies
showed that nonpharmacological strategies such as physical activity and educational interventions
are considered as the appropriate actions to prevention of osteoporosis among menopausal women
so implementing these strategies can be a good alternative for women with contraindication of
hormone therapy or therapeutic treatment.

Abstract BACKGROUND: Social distancing policy during the COVID‑19 pandemic may affect physical activity
levels. This study aimed to compare physical activity levels before and during the pandemic and to
explore physical activity correlates among Indonesian young adults.
MATERIALS AND METHODS: This longitudinal study was conducted before the pandemic (n = 141)
in September 2019 and was followed by an online follow‑up survey during the pandemic
(79% response rate) in September 2020. Physical activity was measured using the global physical
activity questionnaire and was classified into “sufficient” and “insufficient.” The potential correlates
of physical activity were constructs from social‑cognitive theory and health belief model. Those were
measured using a validated questionnaire in the follow‑up survey. Physical activity levels before and
during pandemics were compared using the Wilcoxon signed‑rank test. Simple logistic regressions
were used to assess the relationships between each potential correlate and physical activity status
during the pandemic.
RESULTS: Physical activity levels decreased significantly during the pandemic, mostly in the
work‑related domain. Participants with favorable physical activity‑related constructs were more likely
to be physically active. The odds ratio ranged from 3.41 (95% confidence interval [CI] = 1.15–10.11)
in participants with higher self‑efficacy to 4.50 (95% CI = 1.44–14.06) in those with higher outcome
expectations of physical activity.
CONCLUSION: A significant decline in physical activity during the COVID‑19 pandemic among
Indonesian young adults was confirmed. The application of behavioral change theories for explaining
physical activity status during the pandemic in this population is also supported. It is recommended
to incorporate these constructs to develop physical activity interventions in this target population.

Abstract BACKGROUND: Taking exercise in health sector is one of the important steps to implement the
disaster risk management programs, especially preparedness phase. The present study aimed to
identify indexes and factors affecting successful evaluation of disasters preparedness exercises in
hot wash stage.
MATERIALS AND METHODS: This study was a qualitative content analysis. Data were collected
by purposeful sampling through in‑depth and semi‑structured individual interviews with 25 health
professionals in the field of disasters. The data were analyzed using directed content analysis method
by which the initial codes were extracted after transcribing the recorded interviews and immersing
them in the data analysis. The initial codes were reviewed, classified, and subdivided into several
stages to determine the main classes.
RESULTS: The data analysis resulted in the production of 24 initial codes, 5 subcategories, 2 main
categories of “evaluation and exercise debriefing” and “modification of programs and promotion of
exercise operational functions” under the original theme of “exercise immediate feedback.”
CONCLUSION: This study can be considered a suitable standard guide for health care organizations
to evaluate successfully disasters exercises in hot wash stage, maintain and promote their
preparedness, and properly respond to disasters.

Abstract Obesity is a commonly encountered health‑care problem that is an independent risk factor for chronic
metabolic complications. Primary care physicians are the first point of contact in the management
of obesity. Weight management is a step‑wise intensification of interventions that initiates with
lifestyle modification. Dietary and physical activity advices are integral components of all weight
loss consultations and should ideally be imparted by a dietician or a nutritionist. In case of their
nonavailability, the onus for lifestyle counseling rests with the physician. The prescription for a
low‑calorie diet coupled with increased physical activity might seem simple, but the success lies in
compliance and sustainability of this advice. Compliance can be enhanced through patient‑specific
diet and activity plans along with corrections in eating and activity behavior. Barriers in patient’s
environment must also be addressed to achieve sustainable weight loss. This review covers practical
insights in standard lifestyle management techniques, which can help the physicians to set better
weight loss goals, adapt to patient specific lifestyle counseling, and apply strategies to enhance
compliance for sustained weight loss.

Abstract INTRODUCTION: Many women refuse to exercise during pregnancy due to lack of awareness and
not receiving training. The aim of this study was to investigate and compare the effect of group and
telemedicine education on exercise during pregnancy by using the health belief model (HBM).
MATERIALS AND METHODS: This quasi-experimental study was carried out in 2019 in Zahedan,
and a total of 135 pregnant women participated in it. Samples were randomly assigned to the following
three groups: group training (n = 45), telemedicine (n = 45), and control (n = 45). Group training was
presented in three sessions, and the telemedicine group received the educational content through
mobile applications. The samples completed the HBM questionnaire before and 6 weeks after the
intervention. In addition, within 6 weeks after the intervention, they completed the exercise activity
schedule. SPSS software Ver. 16 (IBM Corp, Armonk, NY, USA) was used for analysis, and data
were analyzed by ANOVA, Tukey’s post-hoc test, Kruskal–Wallis test, and Mann–Whitney test.
RESULTS: After intervention, the scores of HBM constructs and exercise levels in group training,
telemedicine group, and control group, respectively, were as follows: perceived susceptibility
25.91 ± 3.24, 25.51 ± 1.97, and 22.55 ± 3.78; perceived severity 27.48 ± 2.27, 25.13 ± 2.29, and
22.51  ±  3.88; perceived benefits 27.28  ±  2.97, 25.68  ±  3, and 22.8  ±  3.05; perceived barriers
10.69 ± 2.69, 10.66 ± 3.19, and 14.17 ± 3.14; cues to action 24.71 ± 4.35, 23.9 ± 2.48, and
22.84  ±  3.02; self-efficacy 26.17  ±  3.05, 25.2  ±  2.82, and 22.51  ±  3.38; and exercise levels
70.99 ± 20.43, 56.51 ± 21.99, and 37.62 ± 29.66. Group training and telemedicine led to significant
improvement in all HBM constructs and exercise levels (P < 0.05, P < 0.0001, and P = 0.003,
respectively). Group training provided more improvement than telemedicine in the scores of perceived
severity (P < 0.0001), perceived benefits (P = 0.001), cues to action (P = 0.02), and mean exercise
time (P = 0.001).
CONCLUSION: The results of this study showed that the HBM is a proper model for exercise
education in pregnant women. It is recommended to use HBM as a group training and telehealth in
promoting the rate of exercise in pregnant women.

Abstract BACKGROUND: Inadequate lifestyle practices among individuals with diabetes may influence
the progression of diabetes and its complications. The aim of this study was to assess the lifestyle
practices among individuals with diabetes in Sudan.
METHODOLOGY: This was a descriptive, cross‑sectional, health facility‑based study conducted in
3 diabetes centers treating individuals with diabetes. The data were collected using a standardized
pretested metabolic questionnaire about lifestyle and were analyzed by performing descriptive and
inferential statistics through SPSS program version 23.
RESULTS: A total of 528 patients with diabetes answered the questionnaire. There were 52.1% of
female participants and 72.9% of urban residents. 23.9% were obese, regular exercise was reported
by 27.7%, and no exercise by 17%. There was a statistically significant association between
lifestyle practices and gender (P < 0.001), age (P < 0.001), educational level (P = 0.002), marital
status (P < 0.001), duration of diabetes (P < 0.001), hypertension (P < 0.001), high‑density
lipoprotein (P < 0.001), low‑density lipoprotein (P < 0.001), and HbA1c level (P < 0.001). Logistic
regression analysis showed male gender and education were significantly associated with lifestyle
changes. Men were more likely to engage in favorable lifestyle practices than women (P < 0.001),
while those with no formal education were less likely to engage in healthy lifestyle (P < 0.001).
CONCLUSIONS: Health authorities in Sudan will need to put more efforts into education for promoting
self‑awareness and good lifestyle practices in the population with diabetes.

Abstract BACKGROUND: Eighty percent of women during their reproductive age experience some
symptoms attributed to premenstrual phase of the menstrual cycle. Premenstrual syndrome (PMS)
is characterized by emotional, behavioral, and physical symptoms that occur during late luteal phase
of menstrual cycle and are relieved after the onset of menstruation. Aerobic exercise and yoga are
one of the ways to reduce these symptoms. The aim of this study was to compare the effects of
aerobic exercise and yoga on PMS.
MATERIALS AND METHODS: A total of 72 participants of PMS, referred for physiotherapy
treatment (mean age 28 years), were enrolled and allocated into two groups (Group A and B) by simple
computerized randomization. Patients in Group A received aerobic exercise and in Group B received
yoga movements for 40 min, 3 times a week for 1 month. The pain intensity (Visual Analog Scale)
and PMS Scale were measured before, at the end of 15 days, and 1 month of treatment program.
RESULTS: Data were analyzed by paired t‑test, unpaired t‑test, and one‑way ANOVA; and the
results showed that both aerobic exercise and yoga movements significantly reduced pain intensity
and PMS symptoms. Significant reduction in PMS symptoms was found in patients treated with
yoga compared to aerobic exercise; however, no significant difference was found in pain intensity
between these two groups (P > 0.05).
CONCLUSION: It is concluded that both aerobic exercise and yoga movements are effective in
treating PMS; however, yoga is more effective in relieving the symptoms of PMS than aerobic exercise.

Abstract BACKGROUND: Noncommunicable diseases (NCDs) are the leading causes of mortality worldwide.
Environmental factors play an important role in development of risk factors. Hence, the study was
done to assess the neighborhood environmental factors related to NCDs in urban area.
METHODOLOGY: This community‑based cross‑sectional study was carried out among three selected
wards of urban Puducherry. All shops/establishments related to the risk of NCDs within the study
area were study units. Information regarding tobacco, alcohol, diet, and physical activity‑related
establishments was assessed using pretested semi‑structured pro forma. Shops/establishments were
labeled either as “favorable” (prevents the risk of NCDs) or “unfavorable” (increases the risk of NCDs).
RESULTS: Among 655 establishments, 372 (56.8%) belonged to favorable and 283 (43.2%)
to unfavorable category, respectively. Tobacco‑related establishments amount to 15.1% (95%
confidence interval: 12.6–18.1) of the total establishments. Among these tobacco establishments,
almost one‑third were selling tobacco to minor and located within 100 m of school. Fruits and vegetable
markets contributed to 21.8% of the total establishments. About 22% of the establishments were
fast‑food outlets. Public health sports facilities were only 6.8% of the total establishments.
CONCLUSION: The current study reported almost equal distribution of favorable and unfavorable
establishments. However, among unfavorable establishments, tobacco establishments raised
concern as one‑third of those were selling tobacco to minors. Healthy diet and physical activity related
establishments were also found to be less. Hence, corrective measures are to be implemented which
will reduce the burden of behavioral risk factors.

Abstract BACKGROUND: Obesity and inactivity have led to an increasing number of individuals with sexual
dysfunctions (43% of women; 31% of men). Small bouts of exercise can drastically improve sexual
functioning. Thus, the present study is designed to examine the effects of physical fitness and
self‑concept on sexual functioning.
MATERIALS AND METHODS: Fitness assessments and questionnaires were administered to 133
participants between the ages of 18 and 50 years. Physical fitness was assessed through body
composition, cardiovascular endurance, muscular strength, and muscular endurance. Self‑concept
was presented as a total self‑concept score and as six individual concepts of self. Sexual
function was presented as both an aggregate score and five separate constructs of sexual
functioning – fantasy/cognition, arousal, orgasm, behavior/experience, and drive/desire.
RESULTS: The results indicated that sexual behavior/experience was predicted by body fat
percentage. In men, fantasy was related to total self‑concept; sexual behavior/experience was related
to likeability. In women, arousal was predicted by cardiovascular endurance. Total self‑concept was
related to both orgasm and sex drive/desire. Power and muscular strength were significantly related
to number of sexual partners in women but not men.
CONCLUSIONS: The present study adds to the growing body of evidence indicating a positive
relationship between physical fitness and sexual health. Individuals with sexual dysfunctions,
particularly women, who are not persuaded by the currently publicized benefits of physical activity,
may be inclined to exercise to improve sexual functioning.

Abstract OBJECTIVE: Exercise evaluation is one of the most important steps and sometimes neglected in
designing and taking exercises, in this stage of exercise, it systematically identifying, gathering, and
interpreting related information to indicate how an exercise has fulfilled its objectives. The present
study aimed to assess the most important evaluation techniques applied in evaluating health exercises
for emergencies and disasters.
METHODS: This was meta-evaluation study through a systematic review. In this research, we
searched papers based on specific and relevant keywords in research databases including ISI web
of science, PubMed, Scopus, Science Direct, Ovid, ProQuest, Wiley, Google Scholar, and Persian
database such as ISC and SID. The search keywords and strategies are followed; “simulation,”
“practice,” “drill,” “exercise,” “instrument,” “tool,” “questionnaire,” “ measurement,” “checklist,” “scale,”
“test,” “inventory,” “battery,” “evaluation,” “assessment,” “appraisal,” “emergency,” “disaster,” “cricise,”
“hazard,” “catastrophe,: “hospital”, “prehospital,” “health centers,” “treatment centers,” were used in
combination with Boolean operators OR and AND.
RESULTS: The research findings indicate that there are different techniques and methods for data
collection to evaluate performance exercises of health centers and affiliated organizations in disasters
and emergencies including debriefing inventories, self‑report, questionnaire, interview, observation,
shooting video, and photographing, electronic equipment which can be individually or collectively
used depending on exercise objectives or purposes.
CONCLUSION: Taking exercise in the health sector is one of the important steps in preparation and
implementation of disaster risk management programs. This study can be thus utilized to improve
preparedness of different sectors of health system according to the latest available evaluation
techniques and methods for better implementation of disaster exercise evaluation stages.

Abstract Introduction: Today, many jobs are associated with the inactivity or sedentary lifestyle.
Employees’ health will be affected by their depriving of the benefits of physical activity (PA).
Therefore, the present study was undertaken to determine the PA among employee
women in Isfahan University of Medical Sciences based on the transtheoretical model.
Materials and Methods: This is a cross‑sectional study has been performed in Isfahan
University of Medical Sciences employee women (2013). A convenience sample of 100
women was selected. Data were collected by validated and reliable questionnaire in three
parts (demographics information, PA scale, and TTM constructs). Data were analyzed by SPSS
SPSS (version 16.0; SPSS, IBM, Inc, Chicago, IL, USA) and descriptive and analytical statistics
such as ANOVA and independent t‑test were used. A two‑tailed P < 0.05 was considered
statistically significant. Results: The mean of PA was 21.17 ± 27.30 min in a day. Weekly
heavy, moderate, and light exercise mean was 0.72 ± 1.81, 0.89 ± 1.87 and 0.57 ± 1.57 days,
respectively. In this study, 26% of women were in contemplation, 22% in contemplation, 20%
in preparation, 13% in action, and 19% in the maintenance stage. Furthermore, there were
significant differences between consciousness raising, dramatic relief, counter‑conditioning,
stimulus control, helping relationships, reinforcement management, and self‑liberation with
stages of change constructs. Conclusion: Because of a significant relationship between
cognitive and behavioral processes and PA in this group, designing and implementing an
educational program based on the transtheoretical model may be useful in promoting PA of
a female employee.

Abstract Background: The physical activity in teaching faculties is an important aspect to maintain
good health. This not only prevents the various non - communicable diseases but also has
role in secondary prevention of diseases. It is also proven that the growing epidemic of
obesity mostly in children is linked to recent decline in physical activity levels both in home,
school and working places. Social class is thought to have a bearing on physical activity. On
basis of this, the survey was done to assess the physical activity levels in higher social class
population i.e. on teaching faculty of Melaka Manipal Medical College, Manipal, Karnataka,
India. Materials and Methods: Questionnaire study was implemented in 2010 as the design of
this research without any manual intervention. No experiment was conducted in the research.
Questions were specific and related to the physical activities in home and also in working
environment. Results: The study found that in medical college the lifestyle is restricted mostly
to sedentary and moderate work. Most of faculties were using bike and cars to reach there
working place and also we found the physical activities in the form of exercise and sports activity
were lacking. Discussion: In addition to the importance of a physical activity professional’s
potential influence on others as a model, engaging in a physically active lifestyle is very
important for personal reasons. Achieving and maintaining a health-enhancing level of physical
fitness is one of the basic standards for good teaching and maintaining good health. Physical
activity in professionals leads to both personal health benefits, and improve job satisfaction.
Conclusion: Infrastructure improvements such as sports activity in colleges among faculties,
combined with regular exercise provide additional physical activity that would help reduce
obesity and non-communicable diseases.