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- Supervised Exercise Patterns among Diabetic and Non-diabetic Portuguese AdultsPublication . Esteves, Dulce; Gouveia, Ana; Rodrigues, Ricardo; Pinheiro, Paulo; Brás, Rui; O'Hara, Kelly; Duarte, PauloBackground. Physical activity (PA) is a keystone of diabetes management, but although self-exercise is beneficial, supervised exercise (SE), adapted to individual characteristics, and is more effective. Objectives. The main research goal is to compare SE patterns among diabetic and non-diabetic Portuguese adults. Methods. A total of 484 participants (85 diabetics, 399 non-diabetics), aged 41-90 years old (mean=58.9; SD=11.9) were interviewed. PA level was assessed using short form of the International Physical Activity Questionnaire. Attendance in different SE programs was evaluated across three kinds of PA programs providers: gym/health-clubs; swimming pools and other club/ sports facilities. Itens like Barriers to Exercise; Intention to participate; Importance of the structure and PA information sources were also evaluated. Independent t-tests were used to examine the difference between the group means, and Levene’s test was used to check the homokedasticity of the groups’ variances. Results. PA level of diabetics (32% low; 25% moderate; 44% high) and non-diabetics (29% low; 33% moderate; 39% high) display no differences. 90% of diabetics do not attend SE. The main barrier for diabetics’ non-participation is the perception that the exercise is not adequate to their health. Doctors are the preferred information source for diabetics and they rely less on information provided by the Internet, with may impair on-line campaigns. Conclusion. Promoting exercise in diabetics should shift the focus from "promoting physical activity" to "promoting SE".
- Breast Skin Temperature Evaluation in Lactating and Non-lactating Women by Thermography: An Exploratory StudyPublication . Gouveia, Ana; Pires, Luís Carlos Carvalho; Garcia, Nuno; Barbosa, Ana; Jesus, Ana; Pombo, Nuno; Soares, Marta; Oliveira, J. Martinez deDuring pregnancy and lactation, woman breasts feel changes like blood flow increasement, associated with a higher breast temperature. We performed an exploratory study of the breast skin temperature of lactating and non-lactating women based on thermography, with a qualitative analysis of the temperature patterns and a quantitative evaluation of the differences. Frontal breast thermograms of four non-lactating young women and four women with well-established lactation were acquired and analyzed. Qualitative analysis of the images obtained show some evidence of the existence of a characteristic skin temperature pattern for lactating women. Quantitative differences between thermograms were also noticed, especially when considering dispersion metrics: lactating women present higher breast skin temperature gradients and amplitudes. Results obtained, especially based on central tendency metrics, should be interpreted with caution because some of the acquisition conditions for non-lactating women may lead to some bias on the results. Further investigation will be performed to quantify breast skin temperature gradient and be able to classify images based in the breast skin temperature pattern.
- Medical image registration by neural networks: a regression-based registration approachPublication . Gouveia, Ana Isabel Antunes Dias Rodrigues; Freire, Luís Manuel Carvalho; Almeida, Pedro Domingues de; Queiroz, João António de Sampaio RodriguesThis thesis focuses on the development and evaluation of a registration-by-regression approach for the 3D/2D registration of coronary Computed Tomography Angiography (CTA) and X-ray angiography. This regression-based method relates image features of 2D projection images to the transformation parameters of the 3D image by a nonlinear regression. It treats registration as a regression problem, as an alternative for the traditional iterative approach that often comes with high computational costs and limited capture range. First we presented a survey of the methods with a regression-based registration approach for medical applications, as well as a summary of their main characteristics (Chapter 2). Second, we studied the registration methodology, addressing the input features and the choice of regression model (Chapter 3 and Chapter 4). For that purpose, we evaluated different options using simulated X-ray images generated from coronary artery tree models derived from 3D CTA scans. We also compared the registration-by-regression results with a method based on iterative optimization. Different image features of 2D projections and seven regression techniques were considered. The regression approach for simulated X-rays was shown to be slightly less accurate, but much more robust than the method based on an iterative optimization approach. Neural Networks obtained accurate results and showed to be robust to large initial misalignment. Third, we evaluated the registration-by-regression method using clinical data, integrating the 3D preoperative CTA of the coronary arteries with intraoperative 2D X-ray angiography images (Chapter 5). For the evaluation of the image registration, a gold standard registration was established using an exhaustive search followed by a multi-observer visual scoring procedure. The influence of preprocessing options for the simulated images and the real X-rays was studied. Several image features were also compared. The coronary registration–by-regression results were not satisfactory, resembling manual initialization accuracy. Therefore, the proposed method for this concrete problem and in its current configuration is not sufficiently accurate to be used in the clinical practice. The framework developed enables us to better understand the dependency of the proposed method on the differences between simulated and real images. The main difficulty lies in the substantial differences in appearance between the images used for training (simulated X-rays from 3D coronary models) and the actual images obtained during the intervention (real X-ray angiography). We suggest alternative solutions and recommend to evaluate the registration-by-regression approach in other applications where training data is available that has similar appearance to the eventual test data.
- Physical activity level as a booster of entrepreneurial intention: a social innovation approachPublication . Rodrigues, Ricardo; Marques, Carla; Esteves, Dulce; Brás, Rui; Santos, Gina; Gouveia, Ana; Duarte, Paulo; Pinheiro, Paulo; O'Hara, Kelly; Marques, VanessaThis study aims to investigate if engaging in physical activity (PA) and gender influences people’s entrepreneurial intention (EI). A survey for measuring EI and PA was developed and administered to the general population. The data were collected with a questionnaire distributed across all continental Portuguese regions. A two-way analysis of variance was used to test the influence of PA level and gender in EI. The results highlight that PA and gender have an impact on EI. This study’s main practical implication is that evidence was found that people need to be involved in more PA, especially in high PA level, because the results show that there is an association with increased levels of EI. This paper contributes to filling a gap in the literature by identifying the importance of PA for the increase of EI. This relationship may be a consequence of skills promoted by the practice of PA and also the development of some personal psychological and cognitive characteristics such as autonomy, risk tolerance, and leadership. The main implication resulting from this study is that it is essential to develop and booster PA into society, namely through PA programmes in organisations, not only for improving persons’ health condition but also as a social benefit, that can promote social innovation and entrepreneurship.
- Physical activity patterns and perceptions among portuguese type 2 diabetic and non-diabeticPublication . Esteves, Dulce; Gouveia, Ana; Rodrigues, Ricardo; Pinheiro, Paulo; Brás, Rui; O'Hara, Kelly; Duarte, PauloBackground. The increasing prevalence and incidence of type 2 Diabetes has turned it into a worldwide epidemic. Although Physical Activity (PA) may play an essential role in the prevention and management of this disease, sedentary lifestyles continue to increase among diabetics. Besides, there is evidence to believe that diabetics and non-diabetics show different patterns of PA behavior, perceptions and information seeking. Objectives. This study aims to analyze diabetics and non-diabetics differences regarding (1) PA patterns (level, barriers, goals/expectations and preferred activities); (2) PA-related information sources and (3) evidenced perception on the need and importance of PA. Methods. Using data from 485 Portuguese subjects aged between 41 and 90 years old, differences between diabetics (n=85) and non-diabetics (n=400) were analyzed with Pearson’s chi-square and independent t-test. Results. The study concludes that 32% of diabetics that are physically inactive. Their attitude toward PA is not much different from non-diabetics. Nevertheless, the importance given to the time available and the schedules of activities as well as exercising with friends were more relevant for diabetics. Diabetics considered that the exercise is not safe for their health condition and present lower expectation towards exercise. Regarding information seeking behavior about PA, diabetics use as leading information source doctors and less online information. Conclusion. Diabetics and non-diabetics give different importance to PA. Results establish a foundation for the development of effective tailored communication strategies to promote PA among the diabetics.
- Physical activity level and perceptions about exercise in patients with OsteoporosisPublication . Esteves, Dulce; Pinheiro, Paulo; Brás, Rui; Gouveia Rodrigues, Ricardo; Gouveia, Ana; O'Hara, Kelly; Duarte, PauloOsteoporosis is a major health concern around the world. Physical activity (PA) is an essential preventive and therapeutic approaches for osteoporosis. This investigation aims to evaluate PA level and of perceptions about exercise of osteoporosis patients, regarding (1) importance of exercise on osteoporosis condition (IE); (2) balance between exercise benefits and risks (B/R); (3) importance of participation in exercise programs (IP); (4) major risks (R); (5) major benefits (B). PA level of 73 postmenopausal Portuguese women (mean=74.3, SD=8.7 years) with diagnosed osteoporosis (T-score < - 2.5 by DXA) was assessed by IPAQ. A complementary questionnaire was designed to evaluate perceptions about exercise. Descriptive statistics were used to analyse data. IPAQ analysis reported 21.9% high; 35.6% moderate and 42.5% low PA. 35.6% of patients consider that exercise has no impact in preventing osteoporosis evolution and 19.2% refers that it is only partially important. 63.0% considers that exercise has more disadvantages than benefits. About IP, 65.8% of women found daily activities more adequate then exercise programs. Main disadvantages reported (R) were risk of fall (87.7%) risk of bone injury (83.6%); risk of vertebral fractures (63.0%) and risk of increase pain (52.1%). Main benefits found were related to calcium fixation (83.6%); lower body weight (78.1%); increase bone density (69.9%); and increase muscular tonus (61.6%). Results suggest that the adherence to an active lifestyle is dependent on the capacity to change perceptions of osteoporosis patients about exercise. Exercise is medicine if patients acknowledge that exercise brings greater benefits than risks.
- Physical activity and supervised exercise among hypertensives and normotensives: status and barriersPublication . Esteves, Dulce; Duarte, Paulo; Pinheiro, Paulo; Brás, Rui; Rodrigues, Ricardo; Gouveia, Ana; O'Hara, KellyPurpose Physical activity (PA) is considered central to hypertension prevention and management. The main purpose of this article is to compare supervised exercise (SE) patterns among hypertensive and normotensive Portuguese adults. Methods A total of 966 participants aged between 15 and 90 years old (mean 41.9; SD 19.5) were surveyed face-to-face in public places across Portugal. Participants were considered hypertensives (n=144) if they have systolic and diastolic blood pressure higher than 160 and 90 mmHg or report taking antihypertensive medication. PA was assessed using the International Physical Activity Questionnaire (IPAQ). Descriptive statistics, Chi-square test for associations and t test for independent samples were used to analyze data. Results Hypertensive individuals show a higher prevalence of sedentary lifestyle than normotensive (31% vs 20%). About 40% of hypertensive patients have a high level of physical activity. Several signifcant diferences were found between hypertensives and normotensives regarding the causes for non-participation, information sources and motivation to participate. For infrastructures, only the quality of the equipment (p=0.032), innovative activities (p=0.027), and the opportunity to socialize (p=0.000) are capable of diferentiating the two groups. Conclusions This study shows the prevalence of sedentary behavior among the hypertensive population. Hypertensives and normotensive behavior reveal diferent patterns on the barriers, sources of information, and perception regarding the structures. Service providers seem incapable to make hypertensives aware of the risks associated with PA and the benefts associated with SE. More information is needed to make hypertensives aware of the benefts of SE programs.
- Evaluation of Risks and Benefits of Physical Activity: Fighting a Societal BurdenPublication . Brás, Rui; Esteves, Dulce; Rodrigues, Ricardo; Duarte, Paulo; Gouveia, Ana; O'Hara, Kelly; Pinheiro, PauloPhysical Activity (PA) is considered a coadjutant factor in the control of hypertension, helping to control this societal burden. This study investigates the factors that may influence the adoption of PA recommendations by hypertensive individuals by comparing physical activity patterns among hypertensives and normotensives and the importance placed on PA by both groups. Data from 966 Portuguese participants aged between 18 to 90 years old, representing hypertensives (n=144) and normotensives (n=822) were collected using a face-to-face questionnaire. The results show significant differences between the two groups in terms of causes of non-participation and dropping out, preferred PA activities, perceived knowledge, and information-seeking behaviour. The main barriers to exercise reported by hypertensives were the perception that PA is not adequate or even dangerous to their health. Doctors must be considered a key factor in promoting exercise. When compared to normotensives, hypertensives feel that PA information available is not appropriate (p=.0006). Hypertensives consider that existing programmes will not meet their needs and do not like traditional fitness classes, such as those in gyms. The fear of risks associated with exercise seems to be a significant barrier that impairs PA participation.
- Effect of the Internet and online social media on awareness of ACSM physical activity recommendationsPublication . Esteves, Dulce; Pinheiro, Paulo; Brás, Rui; Rodrigues, Ricardo Gouveia; Gouveia, Ana; O'Hara, Kelly; Duarte, PauloIntervention strategies to increase physical activity (PA) that can reach many people in a cost-effective manner are desired. Web-based interventions have shown promising results, but little investigation focus the effect of use Internet Sites and online social media as information sources on PA knowledge. This investigation aims to evaluate the effect of seeking for PA information on Internet Sites and online social media on awareness of ACSM PA recommendations for health promotion, among college students. The study included a randomly recruited sample of 658 college students (32.1% males; 67.9% females), aged 20.8, SD 2.9 years. A survey was designed to evaluate the use different PA information sources and the awareness of ACSM PA recommendations. 63.2% of respondents were not accurately knowledgeable of the ACSM PA recommendations. Interviewed use Internet Sites (55.8%) and online social media (29.1%) to seek for PA information. Looking for PA information online presents a negative influence on awareness of ACSM recommendations (P= .003 for Internet Sites and P= .022 for online social media).Despite efforts to promote PA and widespread knowledge on ACSM recommendations, about two thirds of interviewed students can not accurately identify adequate PA characteristics for health improvement. The use of new information technologies as PA information source seems to lead to lower level of knowledge, what could be related with poor quality of PA information on web.
- Segmentation of Portuguese customers’ expectations from fitness programsPublication . Rodrigues, Ricardo; Pinheiro, Paulo; Gouveia, Ana; Brás, Rui; O'Hara, Kelly; Duarte, Paulo; Esteves, DulceExpectations towards fitness exercises are the major factor in customer satisfaction in the service sector in question. The purpose of this study is to present a segmentation framework for fitness customers, based on their individual expectations. The survey was designed and validated to evaluate individual expectations towards exercises. The study included a randomly recruited sample of 723 subjects (53% males; 47% females; 42.1±19.7 years). Factor analysis and cluster analysis with Ward’s cluster method with squared Euclidean distance were used to analyse the data obtained. Four components were extracted (performance, enjoyment, beauty and health) explaining 68.7% of the total variance and three distinct segments were found: Exercise Lovers (n=312), Disinterested (n=161) and Beauty Seekers (n=250). All the factors identified have a significant contribution to differentiate the clusters, the first and third clusters being most similar. The segmentation framework obtained based on customer expectations allows better understanding of customers’ profiles, thus helping the fitness industry develop services more suitable for each type of customers. A follow-up study was conducted 5 years later and the results concur with the initial study.