Effects of Physical Activity on Adolescent Well-Being

Running head: ADOLESCENT WELLNESS & PHYS. EX.
The Effects of Physical Activity on Adolescent Well-being
Julia Christian, OTS & Lisa Slade, OTS
The Sage Colleges
School of Health Sciences
April 14th
2016

ADOLESCENT WELLNESS & PHYS. EX. 2
A Master’s Thesis for OTH-670: Research Seminar II
Presented to the Faculty of the Department of Occupational Therapy
The Sage Colleges
School of Health Sciences
In Partial Fulfillment of the Requirements for the
Degree of Master of Science in Occupational Therapy
Julia Christian, OTS & Lisa Slade, OTS
_________________________
Brittney Muir, PHD
Research Advisor
_________________________
Theresa Hand, OTD, OTR/L, CHT
Program Director, Occupational Therapy

Statement of Original Work:
I represent to The Sage Colleges that this dissertation and abstract (title listed above) is
the original work of the author and does not infringe on the copyright or other rights of
others.
____________________________ _______________
Julia Christian Date of Signature
____________________________ _______________
Lisa Slade Date of Signature

Permission for The Sage Colleges to release work:
I hereby give permission to The Sage Colleges to use my work (title listed above) in
the following ways:
■ Place in the Sage College Libraries electronic collection and make publically
available for electronic viewing by Sage-affiliated patrons as well as all general
public online viewers (i.e. “open access”).
■ Place in the Sage College Libraries electronic collection and share
electronically for InterLibrary Loan purposes.
■ Keep in the departmental program office to show to other students, faculty
or outside individuals, such as accreditors or licensing agencies, as an
example of student work.

Abstract
The lack in physical activity of adolescents in the United States is a highlighted
concern for youth today. The benefits of physical activity are endless and with child
obesity rates rising the need for programs to promote preventive health is imperative. It
is the role of occupational therapist in community settings to promote healthy living and
provide ample opportunities for individuals to engage in activities that enhance overall
wellness. The purpose of this study was to develop the association of physical activity to
universal wellness of adolescents, while exploring the opportunities and barriers (cost,
limited opportunities, time spent doing other things, transportation, fear of failure) of
physical activity on adolescent’s occupations (academics, socialization, eating habits, and
sleep) in the Capital Region of New York State. A mixed method cross-sectional paper
survey was distributed to 9-12th graders from Ichabod Crane High School and Catholic
Central High School. Adolescent’s physical activity score showed positive relationships
with decrease stress and academic success. Motivating factors to engage in physical
activity included parent engagement and friendship. The top barrier preventing
adolescents from engaging in physical activity was limited time due to homework. In
order for occupational therapist to push for community preventative health programs,
these barriers and motivating factors that contribute to physical activity need to be
addressed to find the best-fit program for this population.
Suggested Keywords: physical activity, adolescents, physical wellness, mental wellness,
occupational therapy

Table of Contents
Introduction ..............................................................................................................................7
Literature Review....................................................................................................................8
Trends of Physical Activity in Adolescents in US....................................................................8
The Impact of Physical Activity on the Wellness of Adolescents.......................................9
The coping self & essential self...............................................................................................................11
The creative self: thinking, emotions, control, positive humor, work...................................14
The physical self: physical activity, nutrition & sleep...................................................................17
The social self: friendships.......................................................................................................................19
Environmental Factors that Relate to Physical Activity....................................................21
The Need for Occupational Therapy in Adolescents Populations..................................22
Purpose..............................................................................................................................................22
Theoretical Perspective ...............................................................................................................23
Definition of Terms........................................................................................................................23
Methods ................................................................................................................................... 23
Design.................................................................................................................................................23
Research Questions .......................................................................................................................24
Ethical Procedures.........................................................................................................................24
Setting ................................................................................................................................................24
Participants......................................................................................................................................25
Data Collection ................................................................................................................................25
Data Analysis ...................................................................................................................................26
Results...................................................................................................................................... 27
Representation of PAQS ...............................................................................................................27
Impact of Wellness Questions on PAQS ..................................................................................28
Relationships of PAQS and Wellness Across Gender and School ...................................28
Barriers to Physical Activity.......................................................................................................30
Discussion ............................................................................................................................... 31
References............................................................................................................................... 36
Appendix.................................................................................................................................. 44

Introduction
A highlighted concern for youth in United States today is the lack of physical
activity in their daily lives. Physical activity is described by the Center for Disease
Control & Prevention (CDC) as participating in 60 minutes of activity that increases
one’s heart rate (2014). Throughout the United States 15.2 % of adolescents have
reported not participating in physical activity of any kind on at least one day out of the
seven day week span (CDC, 2014). Physical activity is imperative during adolescence
because this population is at risk for developing co-morbid diseases and mental illnesses
during adolescence that can follow them into adulthood (Southern, Loftin, Suskind,
Udall, Blecker, 1999). Interventions typically don’t occur until after problems develop,
leading to a decline in overall wellness. The Affordable Care Act has pushed many
health care professions into creating preventative care programs on a community basis
(Persch, Lamb, Metzler, & Fristad, 2015). Recently published literature within the field
of occupational therapy has looked at the understudied population of adolescents and has
pointed out a need for preventive care of this high-risk population, specifically in mental
and physical health (Arbesman, Bazyk, & Nochajski, 2013; Persch et al., 2015). Inquiry
into the types of physical activity (cardiovascular exercise, stretching, and strength
training) that adolescents engage in and its effects on wellness would help provide a
foundation for occupational therapists to learn more about this understudied population.
Providing interventions to adolescents as a preventative approach to this massive
epidemic could cut healthcare costs and provide longevity to adolescent’s life into
adulthood (Sothern, Loftin, Suskind, Udall, & Blecker, 1999).

Literature Review
The discussion of adolescents and the impact of physical activity on their wellness
has been a topic of great interest within American society today. Physical activity has
become a missing piece for youth wellness programs (Rachele, Cuddihy, Washington, &
McPhail, 2014). This literature review looks at physical activity on adolescent wellness,
and describes the universal term of wellness. The following also addresses the
connections to the role of occupational therapy with health and wellness and health
management within the adolescent population, an under researched population in
occupational therapy literature (Whitney & Hilton, 2013).
Trends of Physical Activity in Adolescents in US
A sedentary lifestyle, as explained by Lumsdon & Mitchell (1999) has become
the recent trend amongst adolescents in the U.S., due to the changing demands on their
occupational roles (as cited in Ziviani, Scott, & Wadley, 2004). An obesity epidemic has
affected children and adolescents of the twenty first century due to these sedentary
lifestyles (Iannotti & Wang, 2013). It was found that on an average school day 32.5% of
students are engaging in watching television or playing video/ computer games (41.5%)
for three hours (CDC, 2014). A solution to the problematic trend has been the increase in
youth physical activity programs across the nation, “as the preventative focus of
contemporary health care moves to target younger age groups” (Rachele et al., 2014,
p.282). According to the American Medical Association the prevalence of obesity in the
U.S. is high, with one third of adults and 17% of children obese, however the number of
obese people in U.S. has leveled off since 2003 (Ogden, Carroll, Kit, & Flegal, 2014).
Current trends have been identified in the typical adolescent lifestyle that show factors

that can result in obesity with the most common factor reported being a lack in physical
activity (Iannotti & Wang, 2013). Physical activity is just one factor of a total of five
factors, including creative self, the coping self, the social self, the essential self of
wellness, that all overlap each other and affect one another in a positive way (Myers &
Sweeney, 2008).
The Impact of Physical Activity on the Wellness of Adolescents
Wellness is a holistic and multidimensional term that can be identified by many
definitions and models. There is limited evidence of a gold-standard definition of
wellness (Rachele et al, 2014). Within the discipline of occupational therapy wellness is
defined as
“… a context for living, a state of being, a place from which to come as
individuals commit themselves to improve life for all humanity….As a context for
living, wellness is not limited to getting something more for oneself; rather, it
becomes the possibility that one’s life, health, and well-being contributes to the
health and well-being of others” (Johnson, 1985, p.130).
Measuring wellness is a dynamic process and is an essential part when evaluating clients
with in the field of occupational therapy. A model used in therapeutic disciplines to
describe wellness is the Indivisible Self-Model of Wellness (IS-Wel), which describes
five descriptors of “self” that pertain to wellness. These factors include the creative self,
the coping self, the social self, the essential self, and lastly the physical self (Rachele et
al., 2014). Although this model is not used within the field of occupational therapy, it has
been used in multiple studies over the past 15 years as well as in counseling evaluations
and interventions across professions within the mental health field (Myers & Sweeney,

2008). Each of the factors within this model has its own characteristics that are
associated with it. The creative self deals with thinking, emotions, control, work, and
positive humor (Rachele et al., 2014). The coping self includes leisure, stress worth, self
management, and realistic beliefs while the social self holds one's relationships like love
and friendship. A person's essential self holds true to who they are spiritually and
culturally, along with self-care. Lastly, the physical self is described as the dimensions of
exercise and nutrition in which one engages (Rachele et al., 2014).
“Occupational Therapy Scope of Practice” (2014) identifies all factors of a
person’s wellness at any stage of life from birth to death. The role of occupational
therapy has been addressed within populations that have limitations related to their
occupational performance across many settings. However, a recent American
Occupational Therapy Association position paper promoted the idea of prevention of
disease and disability (AOTA, 2001). Lifestyle redesign programs are a prevention idea
that occupational therapists have developed, which act as a preventive measure to at risk
populations like the elderly. These programs address the physical and mental diseases
that affect wellness of the geriatric population (Jackson, Carlson, Mandel, Zemkw &
Clark, 1998). Gondoli (1999, p.231) describes adolescence as a “phase of life with great
potential for wellness” in which occupational therapists can assist in promoting.
However, studies addressing the adolescent population are overlooked within
occupational therapy research (Whitney & Hilton, 2013; Scaletti, 1999). The current
literature indicates that wellness is strongly associated with physical activity specifically
for adolescents in coping with stress (Brown & Siegal, 1988; Calfas, & Taylor, 1994;
Norris, Carroll, & Cochrane, 1992), increased self-esteem (Altintas & Asci, 2008; Calfas,

& Taylor, 1994), decreased risk taking behaviors (Delisle, Werch, Wong, Bian, &
Weiler, 2010; Audrain-McGovern, Rodriguez & Moss, 2003; Rehm & Shield, 2013),
increased social interaction (Peterson, Lawman, Wilson, Fairchild, & Van Horn, 2013;
Ullrich & Smith, 2008; Smith, 2003), academia (Wi-Young So, 2012; Van Dijk, De
Groot, Savelberg, Van Acker, & Kirschner, 2014), sleep (Brand, Gerber, Beck,
Hatzinger, Puhse, & Holsboer-Trachsler, 2009; Singh, Clements, & Fiatarone, 1997) and
eating habits (Brooks, Smeeton, Chester, Spencer, Klemera, 2014). All of these are
aspects of wellness that are looked at in the “Occupational Therapy Practice Framework”
(2014).
The coping self & essential self.
The wellness component embodies the idea that the body, mind, spirit, emotions
and environment are interdependent, and that health is a state of balance (Johnson, 1986).
The occupational therapy profession was founded on such belief that if one is ill it is due
to an imbalance of one or more of these factors (Johnson, 1986). Two big components to
a person’s coping self is self-worth and their ability to cope with stress. These are vital
factors to look at as an occupational therapist because they can provide indicators for
unhealthy lifestyles (Norris, Carroll, & Cochrane, 1991; Hilyer, Wilson, Dillon, & Caro,
1982; Merikangas, He, Burstein, Swanson, Avenevoli, Cui, Benjet, Georgiades, &
Swendsen, 2010). Stress can come from many areas within an adolescent's life. It could
be the result of increased expectations of independence, taking on additional roles within
the family, major life events, and or traumatic life events like losing a parent. As
children become adolescents they begin to experience more of these stressors in their
lives, and if they are unable to cope with this stress it could lead to possible onset of

illness (Brown, 1991). Finding outlets to alleviate stress is imperative during this age.
One possible outlet is through high physical activity. The findings of two studies showed
evidence that adolescents and college students with low levels of physical activity
actually had more onset of illness throughout the year during periods of stress, than those
with higher levels of physical activity (Brown & Siegel, 1988; Brown, 1991). Physical
activity can also decrease depressive/anxiety symptoms (Motl, Birnbaum, Kubik, &
Dishman, 2004).
Those who are unable to cope with stress are more likely to suffer from
psychiatric disorders like depression/anxiety than those with better coping skills. The
incidence of depression and anxiety in U.S. adolescents was reported through research,
with 31.9% of adolescent meeting the criteria for anxiety disorder and 11.7% for major
depressive disorder (Merikangas et al., 2010). This prevalence in child psychiatric
epidemiology has caused an influx of research for treatment (Merikangas et al., 2010).
Treatment programs that include physical activity have demonstrated significant
improvements in mental well-being within communities (Malcolm, Evans-Lacko, Little,
Henderson, & Thornicroft, 2013), psychiatric clinics (Craft & Landers, 1998), schools
(Norris, Douglas, Cochrane, 1991), and juvenile facilities (Hilyer, Wilson, Dillon, Caro,
Jenkins, Spencer, Meadows & Booker, 1982), all of which are areas that occupational
therapists find themselves working in (Occupational Therapy Scope of Practice, 2014).
The types of physical activity used in community interventions included elements of
gardening, gym class, and walking groups (Malcolm et al., 2013). Common intervention
programs that have been implemented suggest that 10 minutes of flexibility exercises, a
strength development program and a cardio portion significantly decrease stress/anxiety

and depression (Hilyer et al., 1982). The intensity of the exercise is also important as
high intensity exercise significantly decreased stress/anxiety in adolescents compared to
moderate exercise and flexibility exercise (Norris, Douglas, Cochrane, 1991).
Interventions like this show the positive effects physical activity can have on mental
health.
In relation to wellness and the essential self of adolescents, there are consistent
findings in research for variables of self-esteem and self-concept in comparison with
physical activity (Altintaş & Aşçi, 2008). Physical activity level in relation to self-
esteem was looked at within multiple dimensions of sport competence, body
attractiveness, physical condition, physical strength, and physical self-worth.
Adolescents who engage in high physical activity showed higher physical self-esteem
specifically with sport competence and physical condition from their less active
counterparts (Altintaş & Aşçi, 2008).
Gender is another important component to essential self; which has been
identified to have a direct effect on adolescent engagement in physical activity (Altintas
& Asci, 2008; F. Brooks, 2007). Throughout the years our society and cultural
expectations have gender stereotyped boys and girls. Boys are typically expected to
engage in sports that demand more physical expenditure than girls’ sports. American
culture has typically expected women to be more on the conservative side. Many
adolescent girls are not encouraged to join a “masculine” sport that will make them look
and act less feminine. Instead they are encouraged to join supports such as gymnastics or
volleyball that can be aesthetically pleasing. In American society there are less women
role model athletes for adolescent girls than there are for boys (Altintas & Asci, 2008).

Physical activity can decrease by 75% when girls enter their adolescent years.
Many of the activities that they engaged in as a youth have diminished. The lack of
physical exercise or activity is linked to obesity. Adolescent girls in physical education
class are interacting with adolescent boys who are competitive and dominate the activity.
Adolescent girls would rather stand by and watch the boys play than be criticized by their
male peers. Girls have opted for less competitive sports that do not take place in public
spaces and the physical activities that girls are choosing to participate in are more
sedentary. Types of physical activities that girls are choosing to participate in are a part
of their leisure pursuits (Brooks, F., 2007).
The creative self: thinking, emotions, control, positive humor, work.
The creative self is based on the notion that what one thinks affects their emotions
as well as their body. The complexity of one's creative self is based on thinking,
emotions, control, positive humor, and work (Myers & Sweeny, 2008). Control is the
ability to perceive one's own influence on events in one's own life, which is the main
concept behind risk-taking behaviors (Myers & Sweeney, 2008). Adolescence is a time
of trial and error, where risk-taking behaviors like alcohol consumption, cigarette and
drug use become more evident and habitual in their lives. The CDC reports that in 2013,
34.9% of adolescence had consumed alcohol and 23.4% had used marijuana, 30 days
prior to taking the survey. If adolescents lack the ability to control these behaviors and
engage further it can lead to detrimental health effects like cancer, heart, lung, liver and
kidney diseases (Rehm & Shield, 2013), which will limit their abilities to engage in daily
life occupations.

Adolescents who engaged in higher levels of vigorous physical activity (VPA)
had a significant decrease in the amount and frequency of marijuana that was consumed,
compared those who engaged into low levels of physical activity (Delisle, Werch, Wong,
Bian & Weiler, 2010). Cigarette smoking had similar findings for frequency and amount
of cigarette smoking, for adolescents who engaged at high levels of VPA compared to
lower levels of physical activity (Delisle et al., 2010; Audrain-McGovern, Rodriguez &
Moss, 2003; Pyle, McQuivey, Brassington & Steiner, 2003). The odds of those
adolescents who progressed to smoking actually decreased by 50% after physical activity
was implemented (Audrain-McGovern, Rodriguez & Moss, 2003). Thus physical
activity protects adolescents from becoming continuous smokers.
Competitive sports clubs provide a certain motivation and work ethic for
adolescents to work hard on and off the field. Academically they strive to excel in the
classroom and have high future expectations towards work and happiness as well as
within their sport (Gisladottir, Matthiasdottir, & Kristjansdottir, 2013). There is a
growing body of research that looks at physical activity in schools (Rasberry, Lee, Robin,
Laris, Russell, Coyle, & Nihiser, 2011). This is because of the constant changes in
academic curriculum (Rasberry et al., 2011), which has resulted in schools not meeting
the standard time of 60 minutes of moderate to vigorous exercise on most days of the
week during physical education class (Rachele et al., 2014). Simons-Morton, Taylor,
Snider, et al., (1994) “revealed that physical education specialists provided students with
only 3 min of moderate to vigorous physical activity per physical education class; that is
less than 10% of class time” (as cited in Sallis, McKenzie, Alcaraz, Kolody, Faucette, &

Hovell, 1997, p.1328). In some cases, even when physical education was provided, many
children and adolescents wouldn't participate.
Most of the literature within this domain applied to elementary school students
and less to high school students (Sallis, 1997; Randall, 2003). In regard to occupational
therapy there has been an increase in studies over the past four years of children and
youth, due to the substantial proportion of occupational therapy practitioners, 26.9 %,
working with children and youth in schools and in early intervention. There is an
increasing trend of intervention studies within the area of children and youth, however, a
review of 11 articles looking at occupational intervention and effectiveness showed only
two intervention studies that looked at adolescence (Whitney & Hilton, 2013). Outside
of the domain of occupational therapy, there is still limited research on adolescents. The
data that is available is mainly self-reported and shows a positive correlation between
vigorous physical activity and academic performance in Korean males (So, 2012). The
complexity of the association between physical activity and academic achievement
involves many factors like academic year, physical activity, volume and intensity, and
school grade all have an effect (Van Dijk, De Groot, Savelberg, Van Acker, & Kirschner,
2014). Significantly, this research found that total physical activity was positively
associated with executive functioning, which was found to correlate with academic
achievement (Van Dijk et al., 2014). There has been no data that suggests negative
effects of physical activity on academia and those school districts that incorporate a type
of physical activity intervention within the curriculum are only benefiting their students
(Rasberry, 2011).

The physical self: physical activity, nutrition & sleep.
Physical activity in adolescents has increased over time, with reports of engaging
in more physical activity in 2009-2010 than in 2001-2002 (Iannotti & Wang, 2013). TV
shows like The Biggest Loser and recent Nike fit apps have tried to push and motivate
Americans into finding their physical self. The main concepts behind the physical self
are habits of exercise and nutrition, according to Myers & Sweeny(2008). The benefits
exercise and nutrition have on the physical self are beneficial especially to those
adolescents with physical disabilities (Persch et al., 2015). Children that spend time in
wheelchairs engage in weight-bearing activities such as the standing experience, which
has a positive effect on digestive health, cardiopulmonary health, and bone density
(Chad, Bailey, McKay, Zello, & Snyder, 1999). An example of an intervention is the
Fitkids program, which has been implemented to provide children and adolescents with
chronic diseases with one hour of health-related fitness, two times a week for three
months, and then one hour per week during months four through six. The program shows
significant improvements in the adolescents’ aerobic fitness, anaerobic fitness, muscle
strength, and walking capacity over time (Kotte, de Groot, Winkler, Huijgen & Takken,
2014).
The benefits of physical activity are not limited to just those who are impaired.
All groups of adolescents can benefit from physical activity because it is an effective way
to fight against chronic diseases such as coronary heart disease, high blood pressure,
colon cancer, diabetes mellitus, and obesity (Delisle, Werch, Wong, Bian, & Weiler,
2010). Another seen benefit of physical activity includes increased bone growth and

increased amounts of growth hormone, which are vital during adolescent growth (Field,
2012).
As with physical activity, nutrition also is a key aspect to wellness that has
noticeable obesogenic behaviors in adolescents today. Over the past two decades
research has shown that fewer and fewer adolescents take time to eat breakfast, and have
increased their caloric intake by consuming soft drinks, fruit drinks, and eating unhealthy
snacks (Iannotti & Wang, 2013). Obesity has been associated with these poor eating
habits along with low levels of physical activity and high levels of sedentary behavior
(Iannotti & Wang, 2013). Healthy eating habits have been observed in adolescents who
engaged in physical activity for at least 60 minutes per day. These adolescents have
shown higher rates of consuming breakfast on the weekdays and weekends, consumed
more fruits and vegetables, and had lower BMI (Iannotti & Wang, 2013). Literature
shows that adolescents who engaged in high physical activity eat breakfast more
regularly than adolescents who engaged in medium to low physical activity (Brooks et
al., 2014). Eating habits of those adolescents who engaged in high physical activity ate
fruit and vegetables at least twice a week as compared to those adolescents who engaged
in medium and low physical (Brooks et al, 2014).
Adolescents engaged in high physical activity also watched less TV and ate fewer
sweets and drank fewer sweetened beverages (Iannotti & Wang, 2013). Obesogenic
behaviors that were found included maximized consumption of energy-dense snacks and
sweetened beverages along with consuming breakfast less than five times per week
(Iannotti & Wang, 2013). Occupational therapists must look at these habits and find
solutions into improving nutrition (Persch et al, 2015), because by engaging in these

obesogenic behaviors, adolescents lead themselves down a pathway of mental and
physical problems, of which can carry over into adulthood (Iannott & Wang, 2013).
Although sleep habits are not mentioned in the wellness model described by
Myers & Sweeny (2008), it is vital aspect of overall wellness, especially in adolescents.
It is also an essential aspect of a person that is looked at in the “Occupational Therapy
Practice Framework” (2014). The National Institute of Health (NIH) has identified
adolescents and young adults (ages 12-25) as a population at high risk for “problem
sleepiness” (National Sleep Foundation, 2000, p.2). Survey data shows that “26 % of
students report sleeping 6.5 hours or less each school night” (National Sleep foundation,
2000, p.2). Favorable sleep patterns were found in those adolescents who engaged in
high exercise levels (Brand, Gerber, Beck, Hatzinger, Pushe, & Holsboer-Trachsler,
2010). The results showed that for mood, sleep quality, and restoring sleep, athletes had
higher scores than the control group. Favorable sleep patterns of “shortened sleep onset
latency, a smaller number of awakenings after sleep onset were observed in the athlete”
along with “higher concentration during the day, and lower tiredness during the day”
(Brand et al., 2010, p.136). Occupational therapists can educate adolescents on the
importance of sleep and make suggestions in regard to environment and participation in
physical activity to encourage favorable sleep patterns (Persch et al, 2015).
The social self: friendships.
Friendships are a vital part to overall wellness because they provide emotional,
material, or informational support when needed, but they also shape and influence
behavior of an individual (Myers & Sweeney, 2008). “The Theory of Planned Behavior
(TPB) proposes that the social environment influences individual behavior via

perceptions of norms, and that these norms (as well as attitudes and perceptions of
behavioral control) subsequently predict intentions and behavior” (de La Haye, Robins,
Mohr, & Wilson, 2011, p.719). Adolescents look to their peers for self-assurance and
compare themselves to each other throughout their daily life. When they see their peers
joining in sporting activities, they themselves can be influenced to engage as well.
Research has shown a link with the idea that friends are a reflection of a person,
suggesting that obesity is contagious. Meaning if a person's friends take part in unhealthy
lifestyle choices, that person will also (de la Haye et al., 2011). Adolescents gravitate
towards peers that have the same level of physical activity, meaning that adolescents who
engage in physical activity look for active peer to associate himself or herself with (de la
Haye et al. 2011).
One’s network of friends can have a direct impact on the beliefs and attitudes
about physical activity (de la Haye et al., 2011). The correlations between cognitive
variables and subsequent physical activity behavior with in adolescents network of
friends was strong, the biggest effect was on attitudes and intentions toward exercise.
Adolescents were seen joining social groups that had similar beliefs and attitudes towards
physical activity (de la Haye et al., 2011). It was determined that youth physical activity
had direct correlation with physical activity of family members and best friends, however
best friends were seen as making the biggest impact on physical activity (Ullrich-French,
2009).
Although family members were not seen as making the biggest impact on
physical activity there has been some significant research done on family significance in
physical activity of adolescents (Brooks, 2014; Peterson et al., 2013). Both boys’ and

girls’ physical activity and vigorous exercise levels were significantly linked to
engagement in sport with family members (Brooks, 2014). Parental social support and
encouragement are significant external motivating factors for adolescents because they
supported the intrinsic motivation for adolescents to engage in physical activity
(Quarema, Palmeira, Martins, Minderico & Sardinha, 2014). Parents can encourage their
child to play sports or take the initiative to take walks or go for runs. Those parents that
engage in physical activity themselves can promote the same physically active lifestyle
for their children.
Environmental Factors that Relate to Physical Activity
A major environmental factor that needs to be addressed in adolescent’s
participation in physical activity is geographic location. Those adolescents who live in
remote rural areas might find fewer resources to engage in physical activity than those
adolescents who live in cities or suburbs that have gyms and community centers available
(Zheng, 2015). One’s geographic location can be a valid implication for possible social
economic status (SES), which can also be a factor that contributes to adolescent’s ability
to engage in physical activity (Zheng, 2015). Those adolescents who come from higher
economic backgrounds reported engaging in higher participation of physical activity,
which inevitably increases their overall wellness (Gisladottir et al., 2013). A notable
observation made was that adolescents who live in rural areas also reported having low
socio-economic status (SES), thus limited resources to afford gym memberships or fees
for extracurricular sports outside of school as compared to urban adolescents with higher
SES (Zheng, 2015). The environment is a vital aspect that is constantly looked at within

the field of occupational therapy. It can limit a persons ability to fulfill their overall
wellness self.
The Need for Occupational Therapy in Adolescents Populations
Occupational therapists, along with the rest of the health care disciplines, were put
to the test when the Patient Protection and Affordable Care Act (ACA) of 2010 was
passed. The challenge of the Triple Aim, a three factor framework of which the ACA is
based upon (Persch et al., 2015), pushed occupational therapy professionals to achieve
quality, efficiency, and cost-effectiveness within the healthcare system (Berwick, Nolan
& Whittington, 2008). This law has recognized the importance of preventive care
through community-based health care and school based health centers. It has been
proven that adolescence is an understudied population within the occupational therapy
discipline (Whitney & Hilton, 2013). Adolescence need for preventive care is great, due
to the constant threat of obesity and sedentary behavior surrounding them. With the use
of physical activity and its positive effects on overall wellness, occupational therapists
can provide opportunities for adolescents to engage in healthy habits throughout multiple
settings.
Purpose
The purpose of this study was to develop the association of physical activity and
the universal wellness of adolescents in the Capital Region of New York State. Our aim
is to explore the opportunities of physical activity and its overall effect on adolescent’s
occupation, based on the Model of Human Occupation. It is expected to see that those
adolescents who do engage in physical activity have an overall healthier well-being.
Outcomes of this study might include; those adolescents who engage in physical activity

will succeed in the classroom, are able to cope with stress, have healthier sleeping and
eating habits, and have a higher self-esteem. It is also likely to see these adolescents have
increased engagement in socialization with peers and less risky behaviors.
Theoretical Perspective
A common model used in occupational therapy is the Model of Human
Occupation (MOHO). The focus of this model is on “the person and how the
environment contributes to one’s source of motivation, patterns of behaviors, and
performance” (Cole & Turfano, 2008, p. 95). This model allows for the opportunity to
explore what motivates adolescents to engage in healthy habits that lead to overall
wellness. MOHO also looks at the environment and the effects it has on a person's
occupational performance. Adolescent’s performance of healthy living can easily be
correlated with the environment in which they live in.
Definition of Terms
Universal Wellness: integrity of the body, mind, spirit and emotions and is available in
the presence or absence of disease or disability (Johnson, 1987).
Physical Activity: any body of movement that requires energy expenditure, according to
the World Health Organization.
Occupation: an essential part of human nature that is manifested by active participation
in self-maintenance, work, leisure, play, and rest (Evans, 1987)
Methods
Design
A mixed method cross-sectional paper survey was used for this study. The survey
packet (parent consent, child assent, and survey) was handed out in an envelope during

homeroom to adolescents. The students took the survey packet home and filled out all
necessary information if they chose to participate. The students then returned the survey
packet to the locked box in the main office. Lisa Slade and Julia Christian, Occupational
Therapy Students at Sage College, secondary advisors to this study, checked the box
weekly and picked up any of the returned surveys.
Research Questions
Central Question: Is there an association of physical activity and the universal wellness of
adolescents?
1. How does physical activity affect socialization with peers?
2. What impact does physical activity have on adolescent self esteem & stress?
3. What effect does physical activity have on adolescent’s academics?
4. What motivates adolescents to engage in physical activity?
5. What limits adolescent’s ability to engage in physical activity?
6. How do environmental affect adolescents engagement in physical activity?
Ethical Procedures
The study was reviewed and approved by the IRB, along with certificate of
completion of the National Institute of Health (NIH). Parent consent forms were sent
with the survey packet. Parent’s consent was given for the researchers to use and analyze
the data. Child assent was also given for the researchers to use the data collected. This
survey was voluntary and anonymous.
Setting
Catholic Central High School & Ichabod Crane High School students were
surveyed at the schools.

Participants
9-12th graders, male and female, age ranging from 13-18 from n= 618 (Ichabod
Crane High School) and n= 323 (Catholic Central High School). The selection process
for this population was random and optional for those who wished to participate. From
the total n=941 available adolescents, n=34 choose to participate in the study. Two of
these participants did not have parental consent and so their surveys were not used. The
total participants involved n=32 was separated by demographic of school in Table 1.
Data Collection
The data collected from the locked boxes at Catholic Central High School and
Ichabod Crane High School identifies adolescent’s physical activity level within the last
seven days. The survey is a modified version of the Physical Activity Questionnaire-
Adolescents (PAQ-A) with an added wellness component (Appendix A). The PAQ-A is
a self-reported measure that is low cost, time efficient, reliable and valid assessment for
large-scale studies. It provides a physical activity score for adolescents that will be used
to compare their universal wellness. The researchers developed the universal wellness
questions to this survey. The surveys were distributed to the schools and were asked to
have their students complete the survey and drop it in the locked box in the main office. It

was made clear that taking this survey was optional. The surveys were picked up from
the lock boxes at the school. They were placed in a binder where the use of a master
code sheet allowed for organized knowledge of consent given by parent and child. The
code sheet was kept separate from the surveys to allow for the participants to remain
anonymous.
Data Analysis
All data was entered into a three tab excel spreadsheet. The first tab collected all
the scores that correspond to the physical activity score, while the second tab collected all
the scores that correspond to the wellness score, and the third tab had all the qualitative
data. The quantitative data was examined using into SPSS statistical analysis software.
Descriptive statistics such as gender, school and grade level were run to analyze the
major trends in demographic information. Regression analysis was computed between
PAQs and wellness questions 9 (sleep), 10 (stress), 11 (risk taking), 13 (friendship), 17
(healthy eating behaviors), 18 (unhealthy eating behaviors), 19 (academic success), 20
(grades), 21 (concentration), 22 (self-esteem), 23 (self-esteem), 24 (self-esteem). A
second regression analysis was done on PAQS and questions 9 (sleep), 10 (stress), 11
(risk taking behaviors), 13 (friendship), 20 (grades) and other variables such as school,
parent engagement, and gender. Other regression analysis tests were done on 13
(friendship), 22 (self-esteem), and 23 (self-esteem), which was then followed by a
regression analysis of 22 (self-esteem) and 23 (self-esteem) on question 13 (friendship).
The variables of school and gender split the data accordingly, and a 2-tailed
Pearson’s correlation were ran with each of the following variables: 9 (sleep), 10 (stress),
11 (risk taking), parent engagement, 13 (friendship), 17 (healthy eating behaviors), 18

(unhealthy eating behaviors), 19 (academic success), 20 (grades), 21 (concentration), 22
(self-esteem), 23 (self-esteem), 24 (self-esteem) in comparison to PAQS in order to look
for if any one variable shows a relationship to adolescent PAQS. Averages of PAQS
scores were identified and turned in percentages to show the PAQS of the adolescents.
Answers to question 16 (prevention to physical activity) were placed on a separate
Excel sheet and divided up into 9 components of prevention. A tally was taken on how
many adolescents responded to each component, allowing researchers to identify
significant areas of prevention to physical activity. A second Excel sheet collected the
open-ended questions to risk taking behaviors, motivation to engage in physical activity,
and barriers to engage in physical activity. The answers to these questions will be
considered in the discussion.
Results
Representation of PAQS
A representation of percentage of PAQS across the data is depicted in Figure 1,
showing that 47% of adolescents had a PAQS between 3-3.99 out of 6, while only 3% of
adolescents had a PAQS between 4-4.99, and 0 % of the participants score a PAQS of 5-
6.

Impact of Wellness Questions on PAQS
Linear regression analysis was performed to show how the questions regarding
wellness impacted PAQS. When all wellness questions; 9 (sleep), 10 (stress), 11 (risk
taking), 13 (friendship), 17 (healthy eating behaviors), 18 (unhealthy eating behaviors),
19 (academic success), 20 (grades), 21 (concentration), 22 (self-esteem), 23 (self-
esteem), 24 (self-esteem) were included in the regression, PAQS was not predicted, F
(12)=1.475, p=.217. However when certain wellness questions 9 (sleep), 10 (stress), 11
(risk taking), 13 (friendship), 20 (grades) were the only questions looked at against PAQS
with inclusion of other variables such as school, parent engagement, and gender, a
variance of 54.7% was identified and a significant relationship was shown, F(8)=3.469,
p=.009. A second regression analysis was done on the wellness data to see what
questions adolescents identified as wellness. The results suggests that questions 13
(friendship), 22 (self-esteem), and 23 (self-esteem) show the most significance to
adolescent wellness, F(3)=3.004, p=.047, and that 24% of these questions explain the
variance of PAQS. Question 13 (friendship), showed the most significance in predicting
PAQS out of the three questions that adolescents identified as wellness with a p=.019.
Out of the 3 questions regarding friendship and self esteem, self esteem was identified as
essential to friendship with a variance of 31.5%, F(2)=6.660, p=.004.
Relationships of PAQS and Wellness Across Gender and School
A Pearson correlation was performed to show a PAQS relationship against
questions 10 (stress), parent engagement, 13 (friendship), and 19 (academic success),
using different variables including gender and school to split the data. Stress, question
10, was looked at with and without gender (Figure 2). All adolescents showed a

significance (p<.05) of PAQS and stress, however a weak correlation (R= .372) was
found (Figure 2A). Females showed a significant relationship between PAQS and stress
(p<.01) with a moderate correlation (R=.509) compared to their male counterparts, whose
data showed no significant relationship (p>.05)(Figure 2B).
The two schools; Catholic Central High School (CCHS) and Ichabod Crane
Central High School (ICCHS) were compared by looking at PAQS to parent engagement
(Figure 3A), academic success (Figure 3B), and friendship (Figure 3C). Parent
engagement and PAQS showed a significant moderate correlation (p<.01, R=.556) in
CCHS adolescents. Academic success showed a significant strong negative relationship
(p<. 05,R=.654) to PAQS at ICCHS. Friendships relationship to adolescents PAQS
showed a strong positive correlation at ICCHS (p<.001, R=.889).

Barriers to Physical Activity
Adolescent prevention to engaging in physical activity had 9 components that
represented common barriers (Figure 4). Of the adolescents that responded (N=23),
N=17 responded with homework being the top reason to not engaging in physical
activity. The bottom response with N=2 adolescents identified being to scared to try out
for a sport and gyms being to expensive as reasons they don’t engage in physical activity.

Discussion
This mixed method cross-sectional paper survey investigation identified
adolescent physical activity level and showed an association between physical activity
and aspects of wellness within occupations does exist. Specifically what was seen by the
results was a relationship between physical activity and friendships, which corresponded
to adolescent self-esteem. Adolescents of this study identified wellness as friendship and

self-esteem. These aspects were linked with increased physical activity within the
adolescent population.
Descriptive factors that were examined were gender, schools, and grade level.
Findings from this investigation provided insight to many of the researcher questions.
The most significant finding was that in the past 7 days those adolescents with higher
physical activity scores also had higher engagement with friends while doing physical
activity at ICCHS. Unexpectedly, we found a negative association between academics
success and PAQ score with ICCHS students. Looking at the findings for CCHS it
showed there was no relationship between a higher PAQ score and adolescents having
academic success. However, there was a strong association between PAQS and parent
engagement for students at CCHS. Gender was also a factor in the investigation; it
showed that girls who had a higher PAQ score were less stressed. Surprisingly there was
not an association between PAQ scores for males in relation to stress.
The researchers found that less than half of the adolescents surveyed at CCHS
and ICCHS, scored a physical activity rating of 3-3.99 in the past seven days, which is
considered moderate engagement in physical activity. The investigation into physical
activity barriers was most affected by adolescents not having enough time to be
physically active due to homework. The second leading cause of decreased physical
activity was that adolescents are spending their leisurely time watching TV and playing
video games.
The open-ended results of the investigation have added to the literature supporting
the belief that physical activity is beneficial to adolescents. Physical activity does not
only prevent chronic diseases in adolescents but has a positive relationship on certain

aspects of well-being such as friendships contributed to self-esteem (de la Haye et al.,
2011), academics (Van Dijk et al., 2014; Gisladottir, Matthiasdottir, & Kristjansdottir,
2013), and parent involvement (Brooks, 2004). One aspect of our investigation that was
different than the literature was academic success. Our survey determined that a higher
PAQ score did not result in higher academic success at ICCHS. The lack of academic
success at ICCHS may have been the result of fewer survey participants than compared to
CCHS. The researchers believe that this was not a proper representation of overall
academic success with physical activity scores with ICCHS students.
An open-ended question regarding risk-taking behaviors was addressed in survey,
due to present literature that found adolescents who engaged in higher risk taking
behaviors were less physically active (Delisle, Werch, Wong, Bian & Weiler, 2010).
From our investigation we could not link a positive relationship between more physical
activity and less risk taking behaviors because of the lack in responses. Those who
responded identified that alcohol, marijuana, cigarettes, and poor eating habits during
times of stress contributed to risk taking behaviors. These risk taking behaviors did not
affect their physical activity level.
Adolescents reported that their physical activity level was affected by
environmental factors such as geographic location. The literature supports that location
is a barrier for adolescents who want to engage in physical activity (Zheng, 2015).
Adolescents in our study and in comparing research identify living too far away and
having limited to no transportation as barriers to participating in physical activity, such as
fitness centers. Occupational therapists could occupy this space by developing a home
exercise programs to complete when adolescents are unable to exercise within their

community. With schools that provide a late bus option, an occupational therapist could
offer after school physical activities with adolescents in a weight room or gymnasium.
Adolescents who do not have transportation could benefit from an occupational therapist
commuting to their community, and providing physical activities at a local park. This
would give adolescents who cannot participate in physical activities at school the
opportunity to do so within their community with friends.
Lastly, we found that motivation was a factor that positively relates to physical
activity level. Parents, friends, family, and future goals such as getting into a desired
school were all external motivators for engaging in physical activity. Internal motivating
factors that were described include: wanting to be physically fit, looking good, and
relieving stress. Occupational therapists are educated on the Model of Human
Occupations, which looks at a person’s motivation. Occupational therapists can work
with adolescents to find out what physical activity motivates them and set up a schedule
to implement this into their daily activities.
There are important study limitations in this investigation. The information
reported by adolescents was self reported questionnaire. Adolescents could have reported
a skewed perception of their physical activity, resulting in untruthful results. Second, the
students had a limited time to fill the survey out and get it back to the school, therefore
shortage of time could have been a factor. Future research is important within this
population, specifically in the occupational therapy discipline. Areas of wellness should
be thoroughly researched include the affects of physical activity on nutrition, sleep, and
risk taking behaviors. Socio-economic status and the disadvantages of adolescents living
in a low-economic community should be further investigated as well. Currently,

occupational therapists rarely work with the adolescent population. The inclusion of
occupational therapist in adolescent lives could improve overall wellness for this high-
risk population.

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Appendix
Physical Activity Questionnaire
This survey will help identify what physical activity you engage in and how it may or
may not affect your academics, self-esteem, stress level, social engagement and sleep.
This is not a test and is voluntary and confidential. You may skip and not answer any
question that gives you feelings of discomfort or distress. Please do your best to answer
correctly and best to your knowledge.
General Questions:
School: ______ Gender: M____ F____
Age: _____ Grade: _____
Physical Activity Questions:
These questions are based on your level of physical activity from the last 7 days.
Definition of Physical Activity: any bodily movement that requires energy expenditure.
1. Physical activity in your spare time: Have you done any of the following activities in
the past 7 days (last week)? If yes, how many times? (Mark only one circle per row.)
No 1-2 3-4 5-6 7 times or more
Skipping __ __ __ __ __
Rowing/canoeing __ __ __ __ __
In-line skating __ __ __ __ __
Tag __ __ __ __ __
Walking for exercise __ __ __ __ __
Bicycling __ __ __ __ __
Jogging or running __ __ __ __ __
Aerobics __ __ __ __ __
Swimming __ __ __ __ __
Baseball, softball __ __ __ __ __
Dance __ __ __ __ __
Football __ __ __ __ __
Badminton __ __ __ __ __
Skateboarding __ __ __ __ __
Soccer __ __ __ __ __
Street hockey __ __ __ __ __
Volleyball __ __ __ __ __
Floor hockey __ __ __ __ __
Basketball __ __ __ __ __
Ice skating __ __ __ __ __
Cross-country skiing __ __ __ __ __
Ice hockey __ __ __ __ __
Other:
_______________ __ __ __ __ __
_______________ __ __ __ __ __

2. In the last 7 days, during your physical education (PE) classes, how often were you
very active (playing hard, running, jumping, throwing)? (Check one only.)
I don’t do PE __
Hardly ever __
Sometimes __
Quite often __
Always __
3. In the last 7 days, what did you normally do at lunch (besides eating lunch)? (Check
one only.)
Sat down (talking, reading, doing schoolwork) __
Stood around or walked around __
Ran or played a little bit __
Ran around and played quite a bit __
Ran and played hard most of the time __
4. In the last 7 days, on how many days right after school, did you do sports, dance, or
play games in which you were very active? (Check one only.)
None __
1 time last week __
2 or 3 times last week __
4 times last week __
More than 6 times last week __
5. In the last 7 days, on how many evenings did you do sports, dance, or play games in
which you were very active? (Check one only.)
None __
1 time last week __
6. On the last weekend, how many times did you do sports, dance, or play games in
which you were very active? (Check one only.)
None __
1 time __
2-3 times __
4-5 times __
6 or more times __

7. Which one of the following describes you best for the last 7 days? Read all five
statements before deciding on the one answer that describes you.
All or most of my free time was spent doing things that involve little physical effort__
I sometimes (1-2 times last week) did physical things in my free time __
I often (3-4 times last week) did physical things in my free time __
I quite often (5-6 times last week) did physical things in my free time __
I very often (7 or more times last week) did physical things in my free time __
Do not need to fill out. For office use only. PAQS _____/8
8. Mark how often you did physical activity (like playing sports, games, doing dance, or
any other physical activity) for each day last week.
None Little bit Medium Often Very
Monday ____ ____ ____ ____ ____
Tuesday ____ ____ ____ ____ ____
Wednesday ____ ____ ____ ____ ____
Thursday ____ ____ ____ ____ ____
Friday ____ ____ ____ ____ ____
Saturday ____ ____ ____ ____ ____
Sunday ____ ____ ____ ____ ____
9. In the last 7 days, did you sleep more than 8 hours?
Always __
Very Often __
Sometimes __
Rarely __
Never __
10. In the last 7 days, how many times have you used physical activity as an outlet to
decrease your stress level?
None __
1 time last week __

11. In the last 7 days, have you engage in any risk taking behaviors such as, alcohol,
drugs, stealing, violence towards others(people or animals), as an outlet to decrease your
stress level?
None __
1 time last week __
12. Please describe what risk taking behaviors you engage in if any?
13. In the past 7 days how frequently did you engage with friends while doing physical
activity?
Always __
Very Often __
Sometimes __
Rarely __
Never __
14. Did your parents within the past 7 days encourage you to engage in physical activity?
Always __
Very Often __
Sometimes __
Rarely __
Never __
15. Were you sick last week?
Yes____ No____
If yes, did this prevent you from engaging in physical activity last week?
Yes _____ No_____
16. What things prevent you from doing physical activities besides sickness/disability?
Check all that apply.
Limited options of interested physical activities at my school ___
No transportation ___
Too expensive__
No gyms around me __
Scared to try out for sports___
Fear of failure__
Limited time due to job___
Limited time due to homework___

Netflix, Hulu & TV watching, video games___
17. After exercising I normally tend to eat healthier foods like veggies, fruit, whole
grains, and protein?
Always __
Very Often __
Sometimes __
Rarely __
Never __
18. If I don’t exercise I normally tend to eat foods that are high in sugar and saturated fats
like, cookies, candy, chicken tenders, and fries?
Always __
Very Often __
Sometimes __
Rarely __
Never __
19. Do you feel like you academically succeed in the classroom?
Always __
Very Often __
Sometimes __
Rarely __
Never __
20. What grades do you earn in your classes?
A __
A-B __
B __
B-C __
C __
C-D __
F __
21. Do you struggle concentrating in class?
Always __
Very Often __
Sometimes __
Rarely __
Never __
22. I feel failure in life…
Always __
Very Often __
Sometimes __

Rarely __
Never __
23. When I look in the mirror I am usually unhappy with how I look…
Always __
Very Often __
Sometimes __
Rarely __
Never __
24. I tend to be quiet even when I feel strongly about something…
Always __
Very Often __
Sometimes __
Rarely __
Never __
25. For those who do engage in physical exercise daily what motivates you to do so? If
you don’t engage in daily physical activity please leave this question blank and proceed
to question 22.
26. For those that don’t engage in physical exercise please explain why?

Effects of Physical Activity on Adolescent Well-Being

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