Promoting health

Introduction content

Research on adolescents

found regular physical exercise is associated with

lower levels of stress, anxiety, and lower levels of cortisol.

Experimental studies

also found exercise can

reduce symptoms of anxiety and depression

can lower baseline levels of cortisol and adrenaline.

indicates a reduction in ↓ stress and anxiety levels.

【
Cortisol is a hormone released in response to stress this
means that the person has less response to stress——> less
expose to stress 】
adrenaline is involved in the body's fight-or-flight response.
【 prepares the body to response to a perceived threat or
】
stressor ——> high level of adrenaline ——> more stress perceived

When these hormone levels are lower——> improved emotional

well-being, better stress management, and a more relaxed
state ——> lead to various health benefits: improved mood, better
sleep quality, and enhanced overall physical health.

Possible explanation:
The ‘cross-stressor adaption hypothesis’.

Body content
One possible explanation ——> cross-stressor adaptation hypothesis

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 Definition: adapting to cope with one stressor helps us to deal with
others.

Background:

When we undergo vigorous physical exercise——> putting our bodies

under physical stress

exercise = stressor.

This means our body reacts in the same way as a psychosocial stressor
like the TSST – heart rate, blood pressure and stress-hormones all rise.

——> exercise has resulted in our bodies adapting to the effects of stress
so we can cope better with other stressors.

Chovanec & Gropel 2020 Lab experiment

this study supports the The ‘cross-stressor adaption hypothesis’.

show exercise before a laboratory stressor (e.g. cold pressor stress test
【
(holding your hand in ice-water) or the TSST Trier Social Stress Test ) 】
reduces blood pressure when response to those tests.

To see if excericse influences perceived stress & stress responses.

Aim

- 60 Austrian College Students

- Randomly allocated to 1 to 3 conditions for 8 weeks
- Resistence training (weights training)
- Endurance training (high tempo aerobic dancing)
Methods
- No training
- 3 one hour training sessions a week
- Shown rapid images of snakes & spiders.

Results - Both training conditions had lowered perceived life stress, no

change in control
- Training groups
had faster recovery to stressor(being shown rapid images of snakes

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 and spiders).

Exercise can reduce stress and potentially improve stress regulation.

Conclusions
Not exercising could be a risk factor for stress.

- generalizability: the number of particpants and demographic

focued
-
Sample Size: While 60 participants is a reasonable size for
preliminary findings, larger studies would provide more robust data.
-
Demographic Limitations: The focus on Austrian college students
may limit the applicability of the results to other cultural or age
groups.

- 8-Week Program: The duration of 8 weeks is

sufficient to observe changes in physical fitness and psychological
outcomes.
Evaluation
- Three Sessions
per Week: This frequency is consistent with recommendations for
exercise to improve mental health, suggesting a commitment to
regular physical activity.
-
Random Allocation: Participants were randomly assigned to one of
three groups, which helps reduce selection bias and strengthens the
validity of the findings.
-
Training Conditions: The study included two active training groups
(resistance training and endurance training) and a control group with
no training, allowing for a comparison of different exercise
modalities.

Chovanec and Gropel 2020

The benefits of exercise programmes in promoting health (reduced

stress)

Exercise could help with stress regulation

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 Studies

Zschucke et al. 2014 Lab experiment

Test the effects of exercise on stress.

Aim

- Male university students from Berlin, Germany

-
20-30 years old, normal BMI (19-25)
- Aerobic condition 1 :
30 mins on a treadmill at challenging speed
Methods
- Placebo condition : light stretching
- MIST = maths problems on fMRI screen + harsh examiner &
treatment
- Cortisol from saliva sample

- Fitness levels were positively correlated with cortisol after

exercise (0.31) but negatively correlated with cortisol response
to MIST test.
Results
- Aerobic condition had higher activation in their hippocampus.(
hippocampus helps regulate the HPA axis)

- Results support the cross-stressor hypothesis; being fit and

Conclusions doing regular exercise reduces cortisol levels in response to
other stressors.

- Use of Cortisol Levels: Measuring cortisol levels from saliva

samples provides a physiological marker of stress response,
adding objective data to support the study's findings.
-
Controlled Conditions: By comparing an aerobic condition with
a placebo condition (light stretching) and using the MIST test to
induce stress, the study establishes controlled conditions to

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 assess the impact of exercise on stress response.

-
Sample Size and Generalizability: The study's reliance on a
specific group of male university students from Berlin,
Germany, may limit the generalizability of the findings to
broader populations.
-
Duration of Exercise: The duration of exercise (30 mins) may
not be sufficient to induce significant changes in stress levels
for all participants, potentially affecting the study outcomes.

- correlation doesn’t mean causation

Zschuke et al 2014

Doing exercise regardless of fitness levels can reduce decrease the stress
response to an acute stressor.

Higher activation in hippocampus suggest more HPA axis regulation

Effectiveness of health promotion programmes

background:

In the 1980’s The World Health Organization realized that promoting healthy
behaviours by focusing on the individual has limited effectiveness.

1986:
Health Promoting Schools (HPS)
The main feature of the HPS model that distin- guishes it from other health
promoting programmes in schools is that it addresses multiple aspects of health
and doesn’t just teach kids about health habits.
To obtain the status of a Health Promoting School, the school must adress health
promotion in six areas.

health promoting schools:

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 1. School policy

2. The school’s physical environment

3. The school’s social environment

4. Developing individual knowledge, skills, and competencies for healthy living.

5. School healthcare and promotion services

6. Community links and relationships

Creating “a school that implements a structured and systematic plan for the
health, well-being, and the development of social capital of all students,
teachers, and staff”.

Distinguishing feature:

“Hidden cirriculum”

“Whole of school approach”

Addressing the parts of the school that unintentionally contradict the health
promoting objectives. 解决学校无意中与促进健康目标相矛盾的部分。
How do we evaluate the effectiveness of the HPS Model?

Studies

Langford et al. 2014 - Cochrane Review

To asses whether the HPS framework is useful for improving
Aim students’ health, wellbeing and performance.

- Meta-analysis - 67 randomized studies

- Comparisons between HPS schools and non-HPS schools.
Methods - Focussed on a range of health problems; diet, exercise, mental
health, risk behaviours (drugs).

Results HPS approach beneficial to some health problems

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 - Reduction in BMI & increased physical activity
- Increased fruit and vegetable consumption
- Decreased smoking
- No evidence for antisocial behaviours & mental health

WHO’s HPS Model might be helpful for some health problems, but not
Conclusions others.

Diverse Health Focus: Focusing on a range of health issues including

diet, exercise, mental health, and risk behaviors (such as drug use)
allows for a comprehensive evaluation of the HPS framework's impact
on various aspects of students' health

Comprehensive Analysis: Conducting a meta-analysis of 67

randomized studies provides a broad overview of the effectiveness of
the Health Promoting Schools (HPS) framework in improving
students' health, wellbeing, and performance.

Heterogeneity of Studies: Meta-analyses can be affected by

variations in study designs, populations, and interventions across the
included studies. The heterogeneity in the 67 randomized studies
may impact the overall generalizability and reliability of the findings.

Meta-analysis limitations
1. Heterogeneity: Studies included in a meta-analysis may vary in terms
of study design, population characteristics, interventions, and outcome
measures. This heterogeneity can affect the overall results and may
limit the generalizability of the findings.

2. Publication Bias: Meta-analyses are susceptible to publication bias,

where studies with significant results are more likely to be published.
This can skew the overall effect size and lead to an overestimation of
the treatment effect.

3. Quality of Included Studies: The quality of studies included in a meta-

analysis can vary. Lower-quality studies may introduce bias and affect
the reliability of the overall conclusions.

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 4. Data Availability: Meta-analyses depend on the availability of published
data. If important data is missing or inaccessible, it can impact the
completeness and accuracy of the analysis.

5. Ecological Fallacy: Meta-analyses provide aggregated data, which may

lead to an ecological fallacy where conclusions are drawn at the group
level but may not apply to individuals within the group.

6. Confounding Variables: Meta-analyses may not always account for all

potential confounding variables that could influence the results across
studies. Failure to control for these variables can affect the accuracy of
the conclusions.

7. Causation vs. Association: While meta-analyses can identify

associations between variables, they cannot establish causation.
Correlation does not imply causation, and other factors may be
influencing the observed relationships.

8. Contextual Factors: Meta-analyses may not always consider contextual

factors that could influence the effectiveness of interventions across
different settings or populations. The applicability of findings in real-
world scenarios may vary.

9. Timeframe: Meta-analyses are based on existing studies up to a certain

point in time. New research may have been published after the meta-
analysis was conducted, potentially impacting the current
understanding of the topic.

Mindfulness is the process of bringing non-judg-mental attention to the

present moment through meditation techniques and awareness exercises. It
is a type of meta-cognition, which means thinking about your thinking. When
you are practicing mindfulness, the aim is to be aware of your thoughts in the

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 present moment. If you get distracted and your mind starts towander, you exert
cognitive effort to bring your thoughts back to the present. In many
mindfulness sessions, this involves focusing on your breathing.

• Because of the positive benefits seen in adults, intro-ducing mindfulness

training programmes in schools isbecoming a common health promotion
strategy. One example is the
Mindfulness in Schools Programme(MiSP) which has been developed to be
implemented in
schools. Numerous studies have been conducted to see if the MiSP is
effective.

Loon et al. 2020

Investigate how effective school-based interventions were for

Aim reducing adolescents psychological stress

- Meta-analysis on stress reducing programs (mindfulness, breathing,

Methods yoga, relaxation techniques, and teaching coping skills).

- Intervention programs have an overall moderate effect.

- Better results in programmes for a specific group rather than whole
Results school.
- Effects better for school stress rather then social stress.

“School-based intervention programmes targeting selected

Conclusions adolescents have the potential to reduce psycholigcal stress”.

Focus on School Stress: The observation that interventions were

more effective in reducing school-related stress compared to social
stress highlights the potential benefits of targeting stressors that are
directly related to the school environment.

Generalizability: The study's findings may not be universally

applicable to all adolescent populations, as the effectiveness of

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 interventions can vary across different cultural contexts, age groups,
and school settings.

Can you think of any limitations of implementing a mindfulness in schools

programme?

Resource Constraints: Implementing mindfulness programs in schools

may require significant resources in terms of funding, trained staff, and
time, which can be a limitation for schools with limited budgets or
personnel.

Acceptance and Adaptation: The acceptance of mindfulness programs by

students, teachers, and parents can vary. Resistance to new programs or a
lack of buy-in from key stakeholders can hinder successful
implementation.

Sustainability: Maintaining long-term sustainability of mindfulness

programs in schools may be challenging without ongoing support,
professional development for staff, and integration into the school
curriculum.

Minda

Past questions
2019:
Discuss one or more ethical considerations related to promoting health
2021:
Discuss one or more sociocultural factors in promoting health
2022:
Discuss the effectiveness of one or more health promotion programmes.

2023:
To what extent have one or more health promoting programmes been effective in

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 promoting health?
2024:
Discuss one or more studies related to health promotion.

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