Discussion
To our knowledge, this study is the first of its kind
in Australia, aimed to evaluate the effectiveness
of a mind, body and spiritually based health promotion program in increasing physical activity, as
well as improving mental and spiritual health in
women. Results suggest that the intervention was
effective in significantly increasing physical activity
levels as assessed by two different measures: total
walking duration; and total time spent in moderate and vigorous physical activity, compared to a
comparison group. The intervention group reported
increasing their walking time by an average of half
an hour per week, and increasing their time spent
in moderate and vigorous physical activity by 0.63 h
per week (these two increases share some overlap,
as the variables walking uphill and brisk walking
were included in both scores). The present findings
are consistent with the limited research available
in African—American samples in the US,
20,21
and
indicate the potential for church-based settings in
assisting women in the community to become more
active.
Positive effects of the intervention on men-tal health were also observed in the present
study. Symptoms of depression decreased significantly within the intervention group relative to the
control group. This is somewhat consistent with
the known benefits of physical activity, although
this finding may be an effect of improvements in
other health areas. Having increased social support,
encouragement and individual goal achievement
and counselling in the support group component
of the program may have contributed to improvements in mental health. The difference between
the intervention and comparison groups was some-what surprising considering the comparison group
were undertaking steps to more positive relationship building and were exposed to the same amount
of time in a support group as part of their program.
The experiential physical activity component of the
intervention combined with the holistic approach
may have contributed to the improvements in mental health among women in the intervention group.
The connection between spirituality, or religious
practices, and reduced risk of allcause mortality
has been well documented,
22—24
but a relation-ship between physical activity and spiritual health
has not been previously researched. In the present
study, spiritual health scores in the intervention
group significantly improved compared to the comparison group. This finding was unexpected as the
comparison group had a similar spiritual component
in their program. It may be that a program including
multiple aspects of health, mind, body and spirit
400 M. Jorna et al.
produces additional benefits to spiritual health,
beyond those of a spiritual component alone. It
is however difficult to separate program components and attribute the positive effects to any one
particular aspect of the program, as all occurred
simultaneously. Further research that assesses separate components of the program could help to
determine those aspects most important in promoting increased physical activity and improved mental
and spiritual health.
Ideally, effective physical activity intervention
studies could provide insights into the specific factors that mediate increases in physical activity
behaviour. Due to the small number of participants in the present study, we did not have the
power to conduct mediational analyses. However,
supplementary analyses investigating changes in
key cognitive and social factors hypothesised by
Social Cognitive Theory to be important (data not
shown) demonstrated that self-efficacy and perceived social support significantly improved, and
perceived personal barriers significantly decreased,
in the intervention group relative to the comparison group between pre- and post-intervention.
These findings, which corroborate those of previous research,
25
are consistent with the hypothesis
that self-efficacy, perceived barriers and social support are important mediators of changes in physical
activity among adults.
This program focused on self-selected women
volunteers, and hence caution should be exercised
in generalising these findings to the wider population. In addition, the longer-term maintenance
of these lifestyle behaviour changes has not yet
been determined. As the present study did not randomise participants into the intervention or com-parison groups, there may have been other impor-tant differences between groups (e.g. health status) that were not assessed and that confounded
the study findings, although statistical adjustments
were made for confounding by BMI. The study
was also limited by the small number of women.
All the measures in the present study were self-reported, and hence subject to response biases. A
more objective measure of physical activity (e.g.
pedometers or accelerometers) could be incorporated to complement the selfreported measures in
future research.
The present results suggest that a church-based
holistic health
DiscussionTo our knowledge, this study is the first of its kindin Australia, aimed to evaluate the effectivenessof a mind, body and spiritually based health promotion program in increasing physical activity, aswell as improving mental and spiritual health inwomen. Results suggest that the intervention waseffective in significantly increasing physical activitylevels as assessed by two different measures: totalwalking duration; and total time spent in moderate and vigorous physical activity, compared to acomparison group. The intervention group reportedincreasing their walking time by an average of halfan hour per week, and increasing their time spentin moderate and vigorous physical activity by 0.63 hper week (these two increases share some overlap,as the variables walking uphill and brisk walkingwere included in both scores). The present findingsare consistent with the limited research availablein African—American samples in the US,20,21andindicate the potential for church-based settings inassisting women in the community to become moreactive.Positive effects of the intervention on men-tal health were also observed in the presentstudy. Symptoms of depression decreased significantly within the intervention group relative to thecontrol group. This is somewhat consistent withthe known benefits of physical activity, althoughthis finding may be an effect of improvements inother health areas. Having increased social support,encouragement and individual goal achievementand counselling in the support group componentof the program may have contributed to improvements in mental health. The difference betweenthe intervention and comparison groups was some-what surprising considering the comparison groupwere undertaking steps to more positive relationship building and were exposed to the same amountof time in a support group as part of their program.The experiential physical activity component of theintervention combined with the holistic approachmay have contributed to the improvements in mental health among women in the intervention group.The connection between spirituality, or religiouspractices, and reduced risk of allcause mortalityhas been well documented,22—24but a relation-ship between physical activity and spiritual healthhas not been previously researched. In the presentstudy, spiritual health scores in the interventiongroup significantly improved compared to the comparison group. This finding was unexpected as thecomparison group had a similar spiritual componentin their program. It may be that a program includingmultiple aspects of health, mind, body and spirit400 M. Jorna et al.produces additional benefits to spiritual health,beyond those of a spiritual component alone. Itis however difficult to separate program components and attribute the positive effects to any oneparticular aspect of the program, as all occurredsimultaneously. Further research that assesses separate components of the program could help todetermine those aspects most important in promoting increased physical activity and improved mentaland spiritual health.Ideally, effective physical activity interventionstudies could provide insights into the specific factors that mediate increases in physical activitybehaviour. Due to the small number of participants in the present study, we did not have thepower to conduct mediational analyses. However,supplementary analyses investigating changes inkey cognitive and social factors hypothesised bySocial Cognitive Theory to be important (data notshown) demonstrated that self-efficacy and perceived social support significantly improved, andperceived personal barriers significantly decreased,in the intervention group relative to the comparison group between pre- and post-intervention.These findings, which corroborate those of previous research,25are consistent with the hypothesisthat self-efficacy, perceived barriers and social support are important mediators of changes in physicalactivity among adults.This program focused on self-selected womenvolunteers, and hence caution should be exercisedin generalising these findings to the wider population. In addition, the longer-term maintenanceof these lifestyle behaviour changes has not yetbeen determined. As the present study did not randomise participants into the intervention or com-parison groups, there may have been other impor-tant differences between groups (e.g. health status) that were not assessed and that confoundedthe study findings, although statistical adjustmentswere made for confounding by BMI. The studywas also limited by the small number of women.All the measures in the present study were self-reported, and hence subject to response biases. Amore objective measure of physical activity (e.g.pedometers or accelerometers) could be incorporated to complement the selfreported measures infuture research.The present results suggest that a church-basedholistic health
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