Journal of Education and Health Promotion

Abstract BACKGROUND: Obesity has been identified as a serious global health concern whose prevalence
doubles almost every 10 years. Health education regarding physical activity and healthy diet imparted
to adolescents could prove to be fruitful in reducing obesity‑risk. Objectives of this study were to
evaluate the effect of health education intervention on knowledge, attitude, and practices (KAP)
regarding obesity‑risk reduction and to estimate the postinterventional change in body mass
index (BMI) and total body fat (%) among adolescent school children in South India.
MATERIALS AND METHODS: Stratified cluster randomized controlled trial was carried out among
398 students recruited at baseline including 206 and 192 participants in intervention and control
group respectively selected through simple random sampling from eligible government aided and
private schools to assess KAP regarding physical activity and diet using pretested and validated
questionnaire by making three school visits 6 months apart. Anthropometric measurements were
recorded in first and third visit only, while health education intervention was given in first visit to
intervention and third visit to control group after taking their responses on the questionnaire. Data
were entered and analyzed using SPSS version 15.
RESULTS: Overall dropout rate was 13.5% with dropout in intervention and control group being
12.6% and 14.5% respectively, making 180 participants in intervention and 164 in control group
available for analysis. Mean physical activity KAP score improved significantly from 16.19 ± 4.61
to 19.46 ± 10.07 in intervention group. Mean dietary KAP score also improved significantly from
21.38 ± 4.07 to 23.43 ± 4.53 in intervention group (p < 0.001). Mean BMI decreased significantly
within intervention group (p < 0.001) as compared to control group (p = 0.908). Based on cut‑off level
for total body fat (%) to categorize obesity‑risk among participants, statistically significant decline in
proportions from 26.1% to 13.3% was observed in intervention group (p < 0.001).
CONCLUSION: Results depicted better KAP in intervention group than control group in all the three
visits while it improved significantly within both groups. Hence, the health education was found to
be effective in improving the overall KAP regarding modifiable risk factors of obesity among the
study participants. Further studies to screen the adolescents for obesity‑risk and successive health
education sessions must be carried within schools in order to bring about change in knowledge,
attitude, and practices regarding obesity‑risk.

Abstract BACKGROUND: Healthy children are the foundation for a healthy and developing nation. Perceived
behavioral control (PBC), comprising control belief and perceived power, is a person’s perception of
the ease or difficulty of performing the behavior of interest. For facilitating regular physical activity and
regular healthy dietary practices among the adolescents, PBC is an important construct to develop
and implement appropriate interventions. The aim is to assess PBC to perform regular physical
activity and regular healthy dietary practices and measure their statistical relationship among the
school‑going adolescents in an urban area in West Bengal.
MATERIALS AND METHODS: A school‑based cross‑sectional study was conducted among 251
adolescents aged 12–16 years after taking consent and assent for participation in the study. Data
were collected with self‑administered questionnaire on sociodemographic variables and the two
domains of PBC, i.e., control beliefs and perceived power, related to regular physical activity and
regular healthy dietary practices. Each PBC total score was calculated by multiplying control belief
score and perceived power score for each respondent. Partial correlation coefficient was calculated
between regular healthy dietary practices and regular physical activity.
RESULTS: Among the total 251 responses analyzed, 34.7% and 27.5% students belonged to age
group 14 and 15, respectively. It was observed that the mean (± standard deviation) score of PBC
regarding regular healthy dietary practices was 100.7 (±27.7) and for regular physical activity was
106.0 (±21.4). The correlation between PBC of regular healthy dietary practices and regular physical
activity was 0.421 and was statistically significant.
CONCLUSION: In case PBC score over any behavior is higher, behavioral intention and ultimately
chances of performing that particular behavior increases. Designing appropriate school‑based health
promotion strategies can lead to healthier children fostering regular healthy dietary practices and
regular physical activity in their homes and communities.

Abstract BACKGROUND: Coronavirus disease (COVID‑19) and resulting restrictions have impacted 
populations’ lifestyles and posed a challenge regarding their behaviors, including physical 
activity (PA). This study aimed to evaluate PA patterns of university students during the COVID‑19 
outbreak. We also analyzed the association of participants’ characteristics, including their level of 
anxiety, under the pandemic conditions, with adherence to the world health organization (WHO) 
recommendations for PA.
MATERIALS AND METHODS: This cross‑sectional study comprised 717 Moroccan university 
students recruited during the COVID‑19 pandemic. The Global Physical Activity Questionnaire (GPAQ 
V.2) was used to evaluate PA. Data on sociodemographic characteristics and anxiety levels were 
also collected. Anxiety was assessed using State‑Trait Anxiety Inventory (STAI). Descriptive and 
inferential statistical analysis was carried out. The association between participants’ characteristics 
and PA was studied using regression models.
RESULTS: Of all participants, 33.2% did not achieve the recommended levels of PA. The daily 
median (25th–75th percentile) time spent in PA was 34.3 min (12.7–98.6), whereas the median time 
of sedentariness was 10 h per day (6–14). Multivariate analysis showed that female sex (OR = 0.63; 
95% CI: 0.44–0.90; P < 0.05) and high level of state anxiety (OR = 0.43; 95% CI: 0.20–0.92; P < 0.05) 
were negatively associated with the achievement of the WHO recommended PA.
CONCLUSION: The reported PA patterns of university students during the current outbreak should 
be taken into account and evoke the necessity of encouraging this population to adhere to the 
recommended PA levels. Targeting state anxiety related to the conditions we are facing may have 
a promising effect on the promotion of PA.

Abstract BACKGROUND: Health‑promoting behaviors can affect the psychological and physical consequences 
of hypertension. For the prevention and control of hypertension, lifestyle modification has been 
recommended. This study aimed to investigate the health‑promoting behaviors of patients with 
hypertensive heart disease in Iran and compare them with those of healthy people.
MATERIALS AND METHODS: This was a descriptive comparative study with cross‑sectional 
design. Participants were 141 patients with hypertensive heart disease (mean age = 39 ± 10.2 years) 
referred to the cardiac clinic of Madani Hospital in Khorramabad, Iran, and 141 healthy people 
selected from those referred to the hospital. The Persian version of the revised Health‑Promoting 
Lifestyle Profile‑II (HPLP‑II) was used to evaluate the health‑promoting behaviors of participants. 
After collecting data, they were analyzed in SPSS v. 22 software using descriptive statistics and 
statistical tests including independent t‑test and one‑way ANOVA.
RESULTS: The overall HPLP‑II score was 142.34 ± 30.48 in patients and 150.52 ± 37.07 in 
controls. The highest and lowest HPLP‑II dimension scores in both groups were related to health 
responsibility and stress management dimensions. There was a significant difference between 
groups only in dimensions of nutrition (P = 0.017) and physical activity (P = 0.016), and in the overall 
score (P = 0.044), whose scores were lower in patients compared to controls. The difference in 
HPLP‑II score of patients with different demographic characteristics (marital status, place of residence, 
gender, age, educational level, and occupation) was not statistically significant.
CONCLUSION: Patients with heart disease caused by high blood pressure in Iran have poorer diet 
and physical activity compared to healthy people. Educational interventions with a focus on the 
importance of dietary regime and exercise are recommended for them.

Abstract BACKGROUND: A large proportion of noncommunicable diseases (NCDs) can be prevented by
reducing unhealthy nutrition, inadequate physical activity, smoking, and alcohol consumption. The high
burden of NCDs underlines the need for a greater understanding of the causes of these risk factors.
This paper aims to identify factors affecting smoking, alcohol consumption, unhealthy nutrition, and
inadequate physical activity in current and future times.
MATERIALS AND METHODS: A scoping review was conducted in Iran University of Medical
Sciences, Tehran, Iran, in 2020 to identify factors affecting smoking, alcohol consumption, unhealthy
nutrition, and inadequate physical activity. The review was guided by the five‑step Arksey and O’Malley
model. A deductive qualitative content analysis was employed to identify the factors synthesized
through descriptive and narrative synthesis. The search was conducted in English without date
restrictions up to January 2020.
RESULTS: We identified 1437 studies through database search and other sources and finally included
72 studies in the review. The content analysis of the data led to the identification of 27 factors affecting
smoking, alcohol consumption, nutrition, and physical activity. The factors categorized into social,
technological, environmental, economic, political, and values factors.
CONCLUSION: Political and economic factors have a significant effect on all risk factors, and it is
necessary to take comprehensive measures to improve these factors. Technological factors have a
greater impact on healthy nutrition. Physical activity is more affected by environmental factors than
other risk factors. However, smoking and alcohol consumption are more influenced by social factors
and individual attitudes.

Abstract BACKGROUND: Considering the low level of physical activity in pregnant women in the COVID‑19
pandemic period, and on the other hand, the benefits of mobile application (mobile app) learning,
we decided to conduct a study to determine the impact of educational intervention based on mobile
app on physical activity in pregnant women.
MATERIALS AND METHODS: The present study was quasi‑experimental and examined 93 pregnant
women aged 16–20 weeks of gestation. Sampling was done on pregnant women participating in
the childbirth preparation classes in Isfahan. We used the validated and reliable questionnaire
including perceived benefits, perceived barriers, perceived enjoyment, perceived social support,
and Pregnancy Physical Activity Questionnaire. The intervention was based on mobile app, and the
content of the application contained 12 main domains such as description of physical activity and
benefits and barriers of exercise in the pregnancy, different types of proper pregnancy exercise,
planning for exercise, and different types of exercise. Finally, data were analyzed using SPSS20,
and the Chi‑square test, independent t‑test Paired t‑test were employed. The significance level was
considered to be <0.05.
RESULTS: The results showed that, after the intervention based on mobile app, the mean score
of perceived benefits and enjoyment were significantly higher than before the intervention in
the intervention group. Finally, total mean score of physical activity significantly increased in the
intervention group, while the change decreased in the control group.
CONCLUSION: The results indicated that the use of mobile app can be used to promote physical
activity in pregnant women. Therefore, it is recommended that mobile app education should apply
with face‑to‑face classes in health centers for physical activity in pregnant women in the pandemic
situation.

Abstract BACKGROUND: Physical activity and nutrition interventions are the most important ways to prevent
gestational diabetes. The purpose of the study was to determine the effect of healthy lifestyle
intervention to promote preventive behaviors of gestational diabetes in the rural woman of Shoush city.
MATERIALS AND METHODS: In an experimental study, 60 pregnant women were selected using
simple random sampling and allocate into intervention group (n = 30) and nutrition program. The
study was conducted from September to June 2018. The data were collected in baseline and 1 month
and 3 months of follow‑up phase and were analyzed using Chi‑square test, repeated‑measure test,
and generalized linear model (GLM). The α = 0.05 was considered as significance.
RESULTS: The mean age in the intervention and control group was 25.9 ± 5.6 and 27.2 ± 5.9,
respectively. The GLM test showed a significant increase in the physical activity level and the mean
of nutrition behaviors within the intervention group over time (P = 0.013). Further, based on the results
of repeated‑measure test, the mean of weekly MET‑minute was increased in the intervention group
in comparison to the control group at 1 month and 3 months of follow‑up (P < 0.001).
DISCUSSION AND CONCLUSION: The lifestyle interventions are appropriate programs to the
reduction of the risk of development of gestational diabetes in pregnant women.

Abstract BACKGROUND: Little is known about the inference that physical activity (PA) may have on academic
performance and learning styles of Latin American dental students.
MATERIALS AND METHODS: In this cross‑sectional study, an administrative dataset and a voluntary
university characterization provided information about PA and academic performance. Moreover, 218
dental students of the University of Antioquia in Colombia completed a structured questionnaire to
identify their learning styles. To analyze the information obtained a Pearson correlation, and logistic
and linear regression models were implemented.
RESULTS: A total of 131 (60%) students informed being physically active (PA group), and 87 (40%)
did not report PA (non‑PA group). The results showed a high‑grade point average (GPA) in the
PA group (P = 0.01). The PA group showed a preference for the theorist and pragmatist learning
styles with statistically significant differences between the groups (P = 0.004 and P < 0.0001,
respectively). It was also observed a statistically significant Pearson positive correlation between the
theorist style and higher GPA (r = 0.15; P = 0.04). The multivariate regression model showed that
PA protects against lower means of GPA (odds ratio = 0.3; 95% confidence interval [CI]: 0.09–0.7,
P = 0.01). Furthermore, the adjusted linear regression models also showed that PA protects against
lower means of the theorist (β= −0.15; 95% CI: −0.02 to − 0.002, P = 0.002) and pragmatist styles
(β= −0.18; 95% CI: −0.03 to − 0.006, P = 0.0006). Interestingly, men were statistically significant in
all multivariable models.
DISCUSSION: This study suggests that PA is associated with higher academic performance and
the theorist and pragmatist styles. Male students were also more physically active; therefore, it is
relevant to establish strategies to stimulate physical activities in dental students, especially in women,
including extracurricular activities.

Abstract BACKGROUND: Employees spend most of their time at work, and hence, it is important to pay
attention to health‑promoting behaviors. The purpose of the present study was to investigate the
status of health‑promoting behaviors of employees in the Medical University of Ilam‑Iran.
MATERIALS AND METHODS: This cross‑sectional, descriptive study has been conducted by
the participation of 208 employees, whom selected through the simple random sampling method.
In the present study, participants completed Walker’s Health Promoting Life Style Profile II in the
self‑report form. The gathered data were analyzed using software at the significant level of 0.05.
Data were analyzed by the independent samples t‑test, one‑way analysis of variance, and Pearson
correlation coefficients.
RESULTS: The highest correlation of health‑promoting behaviors was related to spiritual
growth (r = 0.785), stress management (r = 0.777), interpersonal relationships (r = 0.767), health
responsibility (r = 0.730), nutrition behaviors (r = 0.641), and physical activity (r = 0.611) were in
the next places (P < 0.001), respectively. Among sub‑scales, the highest correlation was observed
between spiritual growth and stress management (r = 0.676, P < 0.001) and the lowest correlation
between physical activity and interpersonal relationships (r = 0.253, P < 0.001).
CONCLUSIONS: The score of physical activity was lower compared to other dimensions of health
promoting behaviors. Therefore, it is necessary to make more effective interventional measures for
improving physical activity status.

Abstract BACKGROUND: Students must be made aware about the essentiality of optimum level of physical
activity and the fact that it is the key to good health and an important technique to prevent and control
a lot of noncommunicable diseases including depression and other related mental ill‑health.
MATERIALS AND METHODS: It was an institution‑based intervention study among 187 Madrasah
students of classes VII and VIII, conducted in five‑phase assessment of the training needs of
Madrasah students on different aspects of healthy lifestyle, development of a need‑based module
to be used by teachers to impart training of students through classroom setting, training of teachers
to use the module to train students, training of students by the trained teachers in classroom setting,
and evaluation of effectiveness of the training module.
RESULTS: The mean pretest knowledge score in study Madrasah was 2.64 ± 1.35 (Mean ± SD)
and post test score was 4.13 ± 0.88 (Mean ± SD). In paired t‑test, t‑value was 13.54 and P < 0.05
with effect size of 1.370 (Cohen’s d). Practice related to the mean score in pretest was 2.38 ± 1.08
and posttest score was 2.73 ± 1.03. In paired test, t‑value was 6.25 and P < 0.05 with effect size of
0.458 (Cohen’s d).
CONCLUSIONS: The study revealed the effectiveness of training by teachers using the module
developed by the researcher to address significant changes in lifestyle‑related issues.

Abstract BACKGROUND: Osteoporosis is one of the major problems associated with aging and is more
common among women than men. This study was designed to modify osteoporosis‑related behaviors
in female students based on the transtheoretical model (TTM).
MATERIALS AND METHODS: This quasi‑experimental study was conducted on female
secondary school students. The sample size was determined 100 by using Altman’s nomogram,
including 50 cases and 50 controls. Participants were completed the Demographic Information and
Osteoporosis‑Related Behavior Questionnaire based on TTM. Evaluation of the data showed that
each participant was at what stage of change in physical activity and preventive dietary behavior
of osteoporosis. The content of the training package was designed, and for the intervention group,
2‑h training sessions were held weekly by the instructor in accordance with the stage of change
for 2 months, and the booklet was provided with the appropriate contents of the stage of change.
Three months after the completion of training, the questionnaires were completed by intervention
and control groups. Statistical analysis was performed using SPSS 23 software.
RESULTS: Concerning the stages of change in physical activity and nutrition, a significant difference
was before and after the intervention in the intervention group (P < 0.001), while no significant
difference was observed in the control group. After the intervention, there was a significant difference
in the self‑efficacy and some subconstruct of processes of change, but there wasnot a significant
difference in the decisional balance.
CONCLUSION: Educational intervention based on TTM has been successful in achieving the goal of
modifying osteoporosis‑related behaviors in female students. The results of this study can be used
by health planners to plan and implement health promotion interventions that will undoubtedly help
reduce the burden of disease.

Abstract BACKGROUND: Health promotion of adolescents requires appropriate evidences of its determinants.
The aim of this study was to investigate predictors of self-rated health (SRH) among adolescents
in Qazvin, Iran.
MATERIALS AND METHODS: In this descriptive cross-sectional study, with a multistage sampling
method, we recruited 1740 adolescents aged 12–19 years from 53 schools in Qazvin, Iran (2018). We
used the Strengths and Difficulties Questionnaire and Adolescents’ Academic Stress Questionnaire
for data collection. The analysis was conducted using a multilevel logistic regression model. Gender,
educational period, and socioeconomic status were considered as confounders.
RESULTS: Almost 21% of the adolescents reported their SRH suboptimal. Suboptimal SRH was
higher in girls and older adolescents. Mental health disorders and academic stress had a positive
association with SRH. However, this association was negative for academic achievement and
physical activity. The interaction between mental health disorders and academic stress with SRH
had a significant association in a crud regression model.
CONCLUSION: Mental health, academic stress, academic achievement, and physical activity were
important predictors for SRH. Interventions that focus on promoting mental health, academic stress,
academic achievement, and physical activity such as physical activity for 1 h and each day for 3 days
per week can improve SRH in adolescents. Hence, policymakers should pay more attention to this
issue in health promotion programs of adolescents.

Abstract BACKGROUND: Medical students face a variety of challenges during their years of medical education
that can affect their quality of life (QOL). This study aimed to investigate the association of QOL
with physical activity (PA), depression, and demographic characteristics, as well as to determine its
predictors among medical students in different stages of education.
METHODS: A cross‑sectional descriptive‑correlational study was conducted on 186 medical students
of Tabriz University of Medical Sciences in different educational stages including basic sciences,
physiopathology, externship, and internship using stratified random sampling method. Data were
collected using demographic questionnaire, International PA Questionnaire, World Health Organization
QOL Questionnaire, and Beck depression inventory‑2. Data analysis was performed using SPSS/Ver 23
through descriptive and analytic statistics including one‑way analysis of variance, independent t‑test,
Pearson and Spearman correlation coefficient, and multivariate linear regression model.
RESULTS: There were significant differences in total score of QOL among students in different
stages (P < 0.05). There were indirect significant correlations between total score of QOL (β [confidence
interval 95%]:−0.85 [−1.11–−0.59]) and its all subdomains with Beck depression score but direct
significant correlations with total PA (P < 0.05) except for social relationship. Educational stage,
employment status, family income, inhabitant, moderate PA, and depression were the predictors of
QOL and altogether explained 63% of its variance.
CONCLUSIONS: To pay attention to the predictors of QOL, life among medical students seems
necessary for increasing their QOL to provide high‑quality care for people with disabilities as well
as for the whole community.

Abstract BACKGROUND: Ethnic minorities are underrepresented in health sciences programs in various
nations. Furthermore, there is no known research studying the occurrence of physical inactivity (PI)
and insufficient sleep (IS), and their effects on academic achievement (AA) in ethnic minority
students (EMS) in higher education.
OBJECTIVE: The objective of this study is to explore the occurrence of PI and IS, and their
independent and mixed effects on AA in EMS of a dental school.
MATERIALS AND METHODS: Thirty EMS and sixty non‑EMSs were matched (1:2) in this
case–control study. It was utilized as an administrative dataset that stores register related to the
students. Moreover, the grade point average was considered an indicator of AA. Logistic regressions
models were run, expressed in odds ratios, complemented by confidence intervals (CIs) of 95%.
RESULTS: A total of 73% and 60% EMS were PI and slept insufficiently, respectively. The groups
presented statistically significant differences (P < 0.0001) in physical activity, sleep, and AA, with
inferior values for EMS. All unadjusted models showed that PS, IS, and low AA were strongly
associated with EMS, demonstrating their independent effect. After controlling for PI and IS, the
multivariate model for AA and EMS increased odds by 6.5 times (95%CI: 1.8–23;), indicating
that EMS is strongly associated with low AA. Besides, PI and IS were also statistically significant
higher (<0.0001) in the model, demonstrating their mixed effect.
CONCLUSIONS: This study found a higher occurrence of PI and IS in EMS. Besides, independent
and mixed effects of these variables on low AA in EMS were very significant.

Abstract INTRODUCTION: The present study aims at designing and evaluating the effect of new educational
media‑based educational intervention on students’ stages of behavior change of physical activity.
SUBJECTS AND METHODS: In the present interventional study, 225 students of medical sciences
university were assigned into two experimental and one control groups using proportional stratified
random sampling, where web‑based and software‑based educational interventions were used. Data
were collected using International Physical Activity Questionnaire, Marcus’s stages of change scales,
and a self‑made questionnaire including constructs of barriers, benefits, and self‑efficacy. Evaluation
was conducted through pretest and posttest and immediate and 2 and 6 months of follow‑ups after
the intervention. Data were analyzed by SPSS software using descriptive statistics and Chi‑square,
Friedman, one‑way ANOVA, and ANOVA with repeated measure.
RESULTS: Based on the results, there was no significant difference between the experimental and
control groups before the intervention (P = 0.37); however, immediately and 2 and 6 months after
the intervention, there was a significant difference between the experimental and control groups
in terms of stages of change (P < 0.001). Furthermore, in the experimental group, the educational
intervention led to improvement of individuals in the stages of change of physical activity. At 6‑month
follow‑up, 75.4% of the software group and 60.6% of the web group achieved the maintenance stage.
CONCLUSION: The results suggest that designing intervention based on people’s level of preparation
for changing behavior and using new educational methods such as web and software were effective
on individuals’ progress in different stages of change of physical activity behavior and physical
activity rate.

Abstract BACKGROUND: Sedentary habits may increase the noncommunicable disease risk factors, and
few teens get enough physical activity. Therefore, the current study aimed to examine the effects
of a web‑based intervention on the promotion of physical activity among adolescents using the
transtheoretical model (TTM).
METHODS AND MATERIALS: A quasi‑experimental study was conducted on 278 high school students
who were randomly allocated into one of the three groups: two web‑based intervention groups. The
intervention groups 1 and 2 received education through web (www.salamat.family), but the second
group received educational strategies based on TTM. Five questionnaires were applied two times
before the intervention and 6 months after the intervention. And, in the control group, the data were
collected using stage of exercise behavior change questionnaire and the International Physical Activity
Questionnaire. Student’s t‑test and two‑way analysis of variance, and McNemar’s test were applied
to compare before and after the intervention. P < 0.05 was considered statistically significant.
RESULTS: The mean differences for TTM constructs related to exercise behaviors (processes of
change, self‑efficacy, and decisional balance) in intervention groups 1 and 2 were very higher than
the control group. Participants in intervention groups 1 and 2 who had low or moderate physical
activity before the intervention were placed in high physical activity after it.
CONCLUSION: According to the obtained results, education on PA based on website effective, but
if we use education based on TTM, it will be more useful on the behavior.

Abstract BACKGROUND: Sufficient physical activity (SPA) in children and adolescents has an important role
in health, growth, and development of persons. This study aimed to investigate the prevalence of
and inequality in physical activity (PA) in 12–15‑year‑old students in the West of Iran, 2018.
MATERIALS AND METHODS: In this cross‑sectional study, 1404 students from 14 schools of
Kermanshah city were included. Data on demographic and socioeconomic status (SES) of students
and their family, body mass index, moderate‑to‑vigorous PA of students were collected. Normalized
concentration index (NC) and decomposition analysis applied to measure inequality in SPA and the
contribution of affecting factors, respectively.
RESULTS: About 19% of the students had SPA. The proportion of SPA in boys was higher than
girls (38.98% vs. 9.84%). There was a significant deviation from equality line (NC = 0.31; 95%
confidence interval [CI]: 0.23, 0.38) and NC for boys and girls were 0.15 (95% CI: 0.04, 0.25) and
0.05  (95% CI: −0.07, 0.17). Sex of students and SES of households with 59.09% and 39.77%
contribution to the measured inequality in SPA were the highest positive contributors. Household
size (−2.60) had a negative contribution to inequality in SPA.
CONCLUSION: There was a significant pro‑rich socioeconomic inequality in SPA and sex, and SES
were the main contributors to the inequality in PA. Some interventions are needed to improve PA
among children and adolescents with a focus on girls and low‑SES groups to narrow the existing gaps.

Abstract BACKGROUND: Insufficient physical activity is a global health‑care problem and is considered an
independent risk factor for chronic diseases. The present research aimed to explore the effect of
an educational intervention based on the theory of planned behavior (TPB) and stages of change
on promoting women’s physical activity.
MATERIALS AND METHODS: This quasi‑experimental research was conducted on 68 women
who voluntarily visited the health‑care centers of Mashhad. They were selected by randomized
multistratified sampling method and were divided into two groups of intervention (n = 34) and control
(n = 34). The data collection tools included a demographic information questionnaire, a questionnaire
based on the TPB and stages of change, and the International Physical Activity Questionnaire. The
data were statistically analyzed by SPSS software version 16 using descriptive statistics (frequency,
percentage, mean, and standard deviation) and inferential statistics (paired t‑test, correlation
coefficient, and covariance). The significance level of P < 0.05 was considered in this study.
RESULTS: No statistically significant difference was found between the intervention and control groups
before the intervention in terms of the scores of the TPB constructs and physical activity (P > 0.05).
However, after the educational intervention, a significant difference was observed in the mean scores
of TPB constructs and physical activity (P < 0.05). In addition, no statistically significant difference
was found in the stages of change between the two groups after the intervention.
CONCLUSIONS: The results of this study pointed to the effectiveness of educational intervention
and the necessity to use educational interventions to help adopt preventive behaviors. Therefore,
the use of well‑established educational models rather than conventional methods is recommended.

Abstract BACKGROUND AND OBJECTIVES: Hypertension in pregnancy is one of the most important
unsolved problems in midwifery, and since it is the main cause of maternal death, preventive
intervention measures are essential to control this serious complication. This study aimed to determine
the effect of walking on gestational hypertension disorders in women prone to hypertension.
MATERIALS AND METHODS: This randomized clinical trial was conducted on 72 pregnant women
susceptible to gestational hypertension who were randomly (through a random number table)
assigned into two groups of 36. The pregnant women in the experimental group had walking program
for 20–30 min from weeks 14–34, four times a week. Data were analyzed, via independent t‑test,
Fisher’s exact test, and Chi‑square test.
RESULTS: The results indicated that in the experimental group, 2 cases with transient gestational
hypertension and 1 case of preeclampsia existed, and in the control group, 9 pregnant women
were with gestational hypertension and 4 pregnant women were with preeclampsia. Therefore, the
incidence of these two complications in the experimental group was significantly lower than the control
group (P < 0.05). Moreover, the mean systolic and diastolic blood pressures in the experimental
group were significantly lower than the control group (P < 0.05).
CONCLUSION: Based on the results, the moderate walking, as an easy physical activity, is
recommended for pregnant women susceptible to pregnancy hypertension.

Abstract BACKGROUND: Sympathetic overactivity mediates abnormal cardiovascular outcome that is affected
by stress, lack of physical activity (PA), and familial hypertension (HTN). It can be assessed by blood
pressure‑based sympathetic function tests.
OBJECTIVE: We studied sympathetic function tests in young nonathletic males in relation to measures
of obesity, PA, and familial HTN.
METHODOLOGY: We recruited 100 males (mean age: 19 years) and measured body mass
index (BMI) and body composition parameters by tetrapolar bioelectrical impedance such as total body
fat, visceral fat, subcutaneous fat, and skeletal muscle mass. Using instrument cardiac autonomic
neuropathy system of Recorders and Medicare System Company, India, blood pressures (supine,
standing, and post hand grip) were recorded and studied quantitatively and qualitatively.
RESULTS: Physically active and inactive individuals (n = 50 each) had comparable age, BMI,
measures of obesity, and sympathetic function tests. However, individuals with familial HTN (n = 37)
showed significantly higher obesity measures and blood pressures (supine: systolic blood
pressure [SBP] – 133 vs. 115 and diastolic blood pressure [DBP] – 79 vs. 76; standing: SBP – 136 vs.
122 and DBP – 80 vs. 76; post hand grip: SBP – 136 vs. 125 and DBP – 86 vs. 81). Qualitatively,
postural hypotension was seen in only two individuals, while worst grading was in post hand grip
test significantly and more so in physically inactive group (30%, 28%, and 42% vs. 16%, 20%, and
64%) and individuals with positive familial HTN (32%, 38%, and 30% vs. 17%, 13%, and 70%).
CONCLUSION: Familial HTN, but not physical inactivity, affects sympathetic functioning in nonathletic
young male medical personnel. It asks for other lifestyle modifications for better cardiovascular health
as primary prevention.

Abstract BACKGROUND: Regular physical activity during preconception period has beneficial effects
on the health of women during conception and the identification of factors associated with it is
an effective factor for improving the behavior. Therefore, the aim of this study is to evaluate the
relationship between the physical activity and health belief model (HBM) constructs (perceived
susceptibility/severity, barriers, and self‑efficacy) as intrapersonal factors among women undergoing
preconception care.
METHODS: In this cross‑sectional study, 110 women who were undergoing preconception care were
carried out. Moreover, health belief constructs and attitude toward physical activity were assessed
through the use of researcher‑made questionnaire. In addition, the duration of physical activity with
moderate/vigorous intensity was evaluated utilizing a long form of the International Physical Activity
Questionnaire.
RESULTS: The results showed that although there was a relationship between the all health belief
constructs and attitude toward physical activity and the duration of leisure physical activities carried
out during (P < 0.05), but using the linear regression test showed that only perceived barriers,
independent from other variables, had a significant inverse correlation with this type of activities
(β = −0.27, P = 0.02).
CONCLUSION: The findings of this study showed that among the constructs of theHBM, perceived
barriers are the most important predictor of physical activity in women during the preconception
period and emphasize the need to design possible means to promote physical activity to remove
barriers to effective physical activity.

Abstract BACKGROUND: The positive effects of physical activities during pregnancy are totally recognized
but due to lack of knowledge and negative aspect toward it, physical activities decrease throughout
the pregnancy period. To find the appropriate model to enhance physical activity during pregnancy,
the education that are focused on health belief constructs about physical activity during pregnancy,
were assessed.
MATERIALS AND METHODS: This was a semi‑experimental study conducted on 90 pregnant
women in their first trimester that were divided into two groups of control and intervention.
After assessing health belief model (HBM) constructs and measuring the duration of severe/
moderate‑intensity) physical activity through a questionnaire, participants were divided into
two groups of 45. The intervention group received education about physical activity based on
HBM and the control group received dental health education. In the second trimester again, the
constructs of HBM and the duration of physical activities were evaluated. Significant level was
set at P < 0.05.
RESULTS: Data analysis showed that level of perceived susceptibility/severity and perceived
benefits and also the level of appealing physical activity (P < 0.05), had a significant increase in
the intervention group after the education, but the mean of the severe/moderate‑intensity physical
activity with did not rise to 150 min/week.
CONCLUSION: Study results showed that education based on HBM could lead to an increase in
physical activity during pregnancy by increasing the level of health beliefs in pregnant women, but
this increase does not reach the adequate level.

Abstract INTRODUCTION: Nowadays with respect to the automation of the lifestyle, immobility statistics
in middle‑aged women has increased and they are at risk for complications of immobility. One of
the models used to identify factors associated with physical activity is Health Belief Model utilized
in different age and different cultural backgrounds and different results have been obtained from
those studies. The purpose of this study was to investigate the factors affecting on physical activity
in middle‑aged women using Health Belief Model.
MATERIALS AND METHODS: This descriptive‑correlation study was conducted on 224 middle‑aged
women referring to health centers in Isfahan. Health Belief Model structures including perceived
susceptibility and severity, perceived barriers and benefits, and self‑efficacy were measured
by questionnaire and physical activity was assessed using the international physical activity
questionnaire. Collected data were analyzed using descriptive statistics and Pearson correlation
coefficient test and regression analysis.
RESULTS: There wasn’t significant correlation between perceived susceptibility (P = 0.263, r = 0.075)
and perceived severity with physical activity duration (P = 0.127, r = 0.058) but there was positive
and weak correlation between physical activity duration with perceived benefits (P = 0.001 and
r = 0.26) and perceived self‑efficacy (P = 0.001, r = 0.54) and had weak and inverse correlation with
perceived barriers (P = 0.001, r = ‑0.25). Regression analysis also showed that from among all the
Health Belief Model structures just self‑efficacy structure has influenced on behavior independently
and other structures are affected by it.
CONCLUSION: The obtained results implied on a correlation between benefits, barriers and perceived
self‑efficacy with and moderate physical activity. Therefore it is necessary to develop appropriate
educational programs with emphasis on structures of Health Belief Model that has the maximum
impact on physical activity in middle‑aged women.

Abstract Introduction: Handicrafts seems to be one of the high‑risk jobs regarding work‑related
musculoskeletal disorders (WMSDs) which necessitate the implementation of different
corrective intervention like regular physical activities. This study aimed to investigate the
impact of physical activity on WMSDs among craftsmen. Methods: This cross‑sectional study
was an analytical – descriptive study carried out on 100 craftsmen working in Isfahan, Iran,
in 2013. The sampling method was census, and all workshops involved with this job were
included. Information on demographic parameters and physical activity was collected by
demographic forms. The data related to worker’s musculoskeletal discomforts were conducted
using Cornell Musculoskeletal Discomfort Questionnaire. The data were analyzed using
statistical tests including independent t‑test, Chi‑square, and ANOVA. The statistical analysis
was performed using SPSS 18. Results: The highest percentages of complaints related to
severe musculoskeletal discomfort were reported in right shoulder (%36), right wrist (%26),
neck (%25), and upper right arm (%24), respectively. A significant relationship was observed
between physical activity and musculoskeletal discomforts of left wrist (P = 0.012), lower
back (P = 0.016), and neck (P = 0.006). Discussion and Conclusion: Based on the study
results, it can be inferred that regular but not too heavy physical activity can have a positive
impact on decreasing the musculoskeletal discomforts.

Abstract Background: Physical activity generally declines during pregnancy, but activity barriers during
this period are not well understood. The objective was to determine physical activity and some
relative factors in referred pregnant women. Materials and Methods: This cross‑sectional
study was carried on 384 in referred pregnant women to Isfahan Health Care Centers and
Shahid Beheshti Hospital in second stage sampling method in 2013. Demographic/prenatal
characteristics, physical activity (36Q) and prenatal life quality questionnaire (26Q) were
completed by participants. The statistical analysis was performed with various statistical tests
such as the t‑test, one‑way ANOVA, individual correlation coefficient, and linear regression
using SPSS statistical software (version 16). Results: Based on the findings, 98.7% (n = 378)
of pregnant women had low physical activity. Also, there were a correlation among physical
activity and parity, age, gestational age (P ≤ 0.005). Conclusion: Since physical activity is
recommended for the most of pregnant women, it is imperative to promote physical activity
between pregnant women and some intervention suggestions.