-4 .- .- unci- as L f «In. 0/ r ;-<. in». "E ' Inga! nib-“Vat I 4-... fl 0 e .4, . .. uvz‘-.e.4-- _ 'L-clJI‘a fag-3,391.3 4: v.11! -‘m‘w O O .afifl-Hg ‘Ff"-& 'llj Hui uni' This is to certify that the dissertation entitled THE EFFECT OF A WELL-DEFINED ADULT WELLNESS PROGRAM ON LIFESTYLE AND SELF CONCEPT presented by Ralph John Honderd has been accepted towards fulfillment of the requirements for PHD degree in EDUCATIONAL ADMINISTRATION m Mango“, Major professor Date 10/: /// 25* M30 is an Affirmative Action/Equal Opportunity Institution 0-12771 IIIIIIIIIIIIIIIIIIIIIIIIIIIIII 3 1293 \OOOL6‘ 674 MSU RETURNING MATERIALS: Place in book drop to “3111111155 remove this checkout from ”- your record. FIN____E__S ml] be charged if book 15 returned after the date stamped below. E90 r ...... ("1‘ IV 7‘ ‘1. 1 - 1'1 01 111110520111 THE EFFECT OF A WELL-DEFINED ADULT WELLNESS PROGRAM ON LIFESTYLE AND SELF CONCEPT By Ralph John Honderd A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY College of Education Department of Educational Administration 1985 ABSTRACT THE EFFECT OF A WELL-DEFINED ADULT WELLNESS PROGRAM 0N LIFESTYLE AND SELF CONCEPT By Ralph John Honderd The purpose of this study was to investigate the changes that take place in lifestyle and self concept of adults, following the implementation of a well- defined wellness program. To help accomplish this purpose, two instruments were used to measure the changes that took place. The Lifestyle Assessment Questionnaire was used to measure lifestyle changes in exercise, nutrition, stress management, and the spiritual dimension. The Tennessee Self Concept Scale was used to measure changes in self concept. These instruments were used prior to the program and at the conclusion of the eight-week wellness program. A post- posttest of the Lifestyle Assessment Questionnaire was also given to the experimental group six months following the completion of the program. A total of ninety male and female adults were involved in this program. One-half of the group (#5) were randomly assigned as the control group. Of the original ninety subjects, complete data was collected on eighty subjects. Based on the results of the data it was found that significant lifestyle changes in exercise and nutrition took place in the subjects involved in this wellness program. No significant changes, however, took place in the lifestyle components stress management and the spiritual dimension. Data collected six months following the completion of the program showed a regression in the mean score of the exercise component. Although this regression in mean exercise scores was statistically significant at the .05 level, the mean score for exercise six months following the completion of the program was still higher than the pre-program exercise means. The lifestyle component nutrition did not show any regression of mean score following a six-month time period. Implications of these findings and suggestions for future research are also addressed. ACKNOWLEDGMENTS I would like to acknowledge the efforts of a number of people who provided me with encouragement and support in the writing of my dissertation. Dr. Melvin Buschman, my advisor and friend who has encouraged me to be persistent in all tasks that I undertake. Dr. Buschman's ability to help me keep things in perspective was of tremendous help to me. Dr. RN]. Webster, a member of my doctoral committee, who was also my advisor during my masters program. Dr. Webster was very instrumental in the development of my philosophy of teaching. Dr. Joe Levine, a member of my doctoral committee, and teacher who challenged me to become more flexible in my world and life views. Dr. Levine challenged me to look at issues and problems from many sides and to reflect on these things before jumping to conclusions. Dr. Kenneth Harding, my dissertation chairman, who spent many hours helping me develop my dissertation. Dr. Harding's encouragement and positive attitude helped me persevere during the writing of my dissertation. Dr. Al Reynolds, my statistics consultant and colleague, who helped me select the appropriate statistical methods to analyze the data. Diane Vander Pol, my typist, who did everything possible to help me meet my deadlines. Diane also helped make this dissertation possible by being one of the subjects involved in my study. Carol Honderd, my wife, who encouraged me to pursue my doctoral degree. Her understanding and encouragement were very instrumental in giving me the self-confidence i needed to complete my degree requirements. ii TABLE OF CONTENTS CHAPTER PAGE I. INTRODUCTION.0.000....OOOOOOOOOOOOOOOOOOO0.00...00.0.0.0... 1 Statement ofthe Problem....................................... Purpose of the Study.... Research Hypotheses Statistical Hypotheses Delimitations.................................................. Limitations.................................................... DefinitionofTerms PrxedureOOOOOOOOOOOOOOOOOOOOOOOOOOO0.0IOOOIOOOOOOOOOOOOOOOOOO overView Ofthe StUdy 0......OOOOOIOOOOIOOOOOOOOOIOOOOOOOOOOOOOO owoovwmuuc p—p- y.- II. REVIEW OF THELITERATURE.00....0.0.0.0.0...OOOOOOOOOOOOOOO LiICSty1eoooooooooocoo00000000000000000000.0000.000000000one...12 ExerCiseO...OOOOIOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO15 NuuitionOIOOCO.I...I...IO...OOOOOOOOOOOOOOOOOOOOOOI.COO...19 Stress 0.000000IOIOOOOOOOOOOOOOOI0.00.0.0...OOOOOOOIIIOOOOO 22 Spiritual DimenSionOOOOOOOO0..OOOOOOOOOOOOOOOOOOOOOO00...... 2“ SelfConcept . 27 Exercise.................................................. 28 Nutrition 30 Spiritual OOOOOOOOCOOOOOOOOOOIOOOOOOOOOOOOOOOOOOOOOIOOOOOOOO 3“ In. DESIGNOFTHESTUDYOOOCOOOOOOOOOO00.0.0...OOOOOOOOOOOOOCCOO 35 Hypotheses 35 Instruments 36 SourceoftheData............................................. 38 StudyGroups.................................................. 41 SumrnarYOOOOOOOOOO00.0.0...0.0000IOOOOOOOOOOOOOOOOOOOO00...... #2 Iv. ANALYSISOFTHEDATAOOOOIIOOOOOOOOOOOOOOOOOOOOOOOOO00...... #3 Characteristicsofthe StudySample #3 StatisticalDataonLifestyle..................................... M Statistical Data of Lifestyle (Collected six months following completionofwellnessprogram) #8 StatisticalDataonSelfConcept 51 sumerOOOOOOOO0..IO...OIOO00......IOOOOOOOOOOOOOO...00...... 56 iii V. SUMMARY, FINDINGS, AND RECOMMENDATIONS . . . . . . . . . . . . . . . . Interpretationand Conclusions................................... RefleCtions...O...0.0.0.0000....0.0....OOOOOOOOOOOOOOOOOOIOOOOO RecommendationSOOOOOOOO...0....0.0...OOOOOIOOOOOODOOOOOOOOOOO APPENDICES.OOOOOOOOOOIOOOOIOO0.0.0.0...O00......OOOOOOOOOOOOOOOOOOO Appendix A Appendix B Appendix C Appendix D Appendix E Appendix F Promotional Material............................... Reply Letter to Participants......................... Post-posttest Contact Letter Concerning the Lifestyle Assessment Questionnaire................... Health History and Status Form Informed Consent Letter............................ Study Instruments.................................. REFERENCES0.0...OOIOOOOOOOOOOOOO0.0.000000000000000000000000...... iv 57 61 67 70 72 72 7‘! 75 76 79 81 93 LIST OF TABLES TABLE PAGE U -P o GROUPS AND NUMBER OF SUBJECTSO......OOOOOOOOOOOOOOOOOOOO a” GROUPS AND NUMBER OF SUBJECTS FOR POST-POSTTEST SUBJECTSIOOCCOOCOOOOOOCOOOOOOOOOOO0.0... 4” ANALYSIS OF COVARIANCE—EXERCISE. . . . . . . . . . . . . . . . . . . . . . . . . #6 ANALYSIS OF COVARIANCE—-STRESS MANAGEMENT . . . . . . . . . . . . . 47 ANALYSIS OF COVARIANCE—NUTRITION ....................... '17 ANALYSIS OF COVARIANCE—SPIRITUAL DIMENSION . . . . . . . . . . . . . #8 REPEATED MEASURE ANALYSIS—EXERCISE. . . . . . . . . . . . . . . . . . . . . #9 REPEATED MEASURE ANALYSIS—STRESS MANAGEMENT . . . . . . . . . 50 REPEATED MEASURE ANALYSIS—NUTRITION . . . . . . . . . . . . . . . . . . . 5O REPEATED MEASURE ANALY SIS-SPIRITUAL DIMENSION . . . . . . . . . 51 ANALYSIS OF COVARIANCE—TOTAL POSITIVE SCORES. . . . . . . . . . . 52 ANALYSIS OF COVARIANCE—PHYSICAL SELF . . . . . . . . . . . . . . . . . . . 53 ANALYSIS OF COVARIANCE—MORAL-ETHICAL SELF. . . . . . . . . . . . . 53 ANALYSIS OF COVARIANCE—PERSONAL SELF. . . . . . . . . . . . . . . . . . . 5'! ANALYSIS OF COVARIANCE—FAMILY SELF . . . . . . . . . . . . . . . . . . . . . 55 ANALYSISOF COVARIANCE—SOCIAL SELF...................... 56 CHAPTER I INTRODUCTION Government statistics predict that after the year 2000, if present trends remain constant, the national annual expenditure for health care in the United States will pass the one trillion dollar mark.l If this great expenditure of money had resulted in a corresponding rise in the health of the American people, this expenditure might be justified. The results, however, have not shown any great improvement. Life expectancy tables show that the life expectancy in 1900 for a 35 year-old male was 63. In 1970 the life expectancy only increased to 67 and in 1980 to 68.2 Increased quality of life in terms of health for the typical American is also suspect. Infectious diseases have been curtailed or eliminated but diseases associated with obesity, diet, stress, and lad< of exercise have taken their place. In the past we only thought of health when we had a health problem. We went to the doctor and expected that doctor to "heal" us. John Naisbitt in his book Megatre'nds states very concisely the view many people have regarding health care. We allowed ourselves to act as passive bystanders handing over to the medical establishment not only the responsibilities it could handle, healing traumatic wounds and grave illnesses, but also the responsibility that in reality belonged only to ourselves, the responsibility for our health and well-being. We revered doctors as our societies' high priests and denigrated our own instincts. And in response, the medical establishment sought to live up to our misplaced expectations. Placing all their trust in the modernovoodoo of drugs and surgej'y, they practiced their priesthood and we believed. During the last nine to ten years there has been an interest in what people can do for themselves in terms of health care. Many people are attempting to take more responsibility for their health but the problem of knowing how to proceed in this area of self-help is compounded by much misinformation. In the area of nutrition, a new book comes out about once a week. Fad diet books are notorious best sellers. In the area of exercise, books promise increased health benefits if a person follows their exercise program for five minutes a day. Stress management seminars are available in all parts of the country with great claims about their results. A logical place for these concerned people to obtain the health information for which they are searching is from physicians. The physician's image of a provider of health services has been tarnished (Naisbitt, p. 137‘); but most people still do have a high level of confidence in physicians. The problem, however, of gaining this health information from physicians is two-fold. First, although most physicians have a good understanding of how the body functions and how to treat illnesses and disease, most physicians have had no training, although some have been involved in self-directed learning projects, in the area of prevention. In the past, medical schools have not included courses in the area of nutrition, stress management, or physiology of exercise. There seems to be an increase in this type of training in some medical schools but the majority seem to be changing very slowly. Also, physicians seem to be much more excited about trying to diagnose an illness or disease and elicit a cure than about trying to educate people on how to prevent the illness or disease. The results of an operation or treatment of an illness are much easier to evaluate than an attempt to evaluate the effectiveness of a prevention program. The second reason most physicians would not be a good source of obtaining the type of information for which people are seard'iing is that it would be too expensive. If a patient is sick and the doctor tells the patient what the problem is, what the patient is to do, and prescribes a medication, the patient expects to pay the doctor a relatively high fee for this service. If the advice and medication help, the patient feels it was worth the expense. On the other hand, doctors would be hard-pressed to charge the same fee per unit of time spent with a patient for advice about lifestyle and how that influences a person's health. An interesting model in regard to health care is that of the ancient Chinese. The Chinese physician would receive pay from a patient as long as the patient was healthy. Whenever the patient became ill, the payment to the physician would stop. A comparable model would give a tremendous incentive for physicians to practice preventive medicine. This model, however, does not appear to be an option at this time. At the present time there is a real interest among many people to take more responsibility for their own health. Wellness programs are very popular and are attracting large numbers of people. The promoters of these wellness programs claim that if people will participate in their programs changes in lifestyle and self concept will result that will improve their quality and quantity of life. STATEMENT OF THE PROBLEM Although the promoters of wellness programs claim their programs will change a person's lifestyle and self concept there has been no empirical evidence to prove these claims. Several writers (Fixx, 19775; Morgan, 19786; Kostrubala, 19767) have written about the psychological changes that occur as a result of exercise and several doctoral dissertations have researched the relationship between exercise and self concept. However, the basic claims of wellness programs concerning lifestyle and self concept changes have not been substantiated by research. The claims of the promoters of wellness programs regarding lifestyle changes and improved self concept seem to be rational claims but the questions remain: I. What effect does a well-defined wellness program have on the lifestyle of an individual? 2. If a well-defined wellness program does have an effect on the lifestyle of an individual, is this effect temporary? 3. What effect does a well-defined wellness program have on the self concept of an individual? PURPOSE OF THE STUDY The physiological effects of exercise have been researched and are well- documented. The psychological effects of exercise are starting to be addressed but little research has been conducted which substantiates the claims that wellness programs change an individual's lifestyle and self concept. The primary purpose of this study is to investigate the changes that take place in lifestyle and self concept following the implementation of a well-defined wellness program. RESEARCH HYPOTHESES The following research hypotheses reflect the expected results of this study. 1. It is expected that those subjects involved in a well-defined wellness program will have more positive lifestyle changes that a similar group of controls not involved in such a program. 2. it is e1q>ected that those subjects involved in a well-defined wellness program will maintain their positive lifestyle changes for at least a six- month period. 3. It is expected that those subjects involved in a well-defined wellness program will have a more positive increase in self concept than a similar group of controls that has not been involved in such a program. STATISTICAL HYPOTHESES The following hypotheses, in null form, were tested at the .05 level of significance. H: no difference will exist in the lifestyle of adults who participate in a well- defined adult wellness program and those who do not, in the following areas: 1.1 exercise 1.2 stress management 1.3 nutrition 1.11 spiritual dimension H: no difference in lifestyle will exist between the results of the experimental group immediately after completing a well-defined adult wellness program and six months following the program, in the following arcas: 2.1 exercise 2.2 stress management 2.3 nutrition 2.1: spiritual dimension H: no difference will exist in self concept of adults who participate in a well- defined adult wellness program and those who do not participate. DELIMITATIONS The study population was confined to people in the Grand Rapids, Michigan area, who were high school graduates and were between the ages of 21 and 65. The study occurred over a period of eight weeks from February 1985 to April 1985. Participation was voluntary and was limited to those adults who had no medical restrictions that would preclude moderate exercise. LIMITATIONS l. The built-in bias of a volunteer group. This group may, therefore, differ from a random sample of people in the Grand Rapids, Michigan area. 2. Various levels of previous exposure to exercise and positive lifestyle concepts. 3. Reliability of self assessment: the ability of individuals to accurately assess their self concept and lifestyle. DEFINITION OF'TERMS WELLNESS: a positive approach to living where the individual becomes aware of and makes choices toward a more successful existence. LIFESTYLE: a particular style of living which each of us chooses, even though we do not often think about it. Lifestyle has different components, four of which will be addressed in this study: exercise, nutrition, stress management, and the spiritual dimension. NUTRITION: the ability to choose foods that are consistent with the dietary goals as reported by the Senate Select Committee on Nutrition and Human Needs. STRESS MANAGEMENT: the ability to be able to recognize stress in one's life and to be able to manage this stress. SPIRITUAL DIMENSION: to seek meaning and purpose in human existence. SELF CONCEPT: the total picture that one has of himself/herself and of the value which one places on himself/herself as a person, as measured by the Tennessee Self Concept Scale. PROCEDURE Two testing instruments were used to test the hypotheses that have been proposed. The Lifestyle Assessment Questionnaire (LAQ), developed by Dr. Bill Hettler and associates at the University of Wisconsin-Stevens Point, was used to assess lifestyle changes. This instrument is in its third edition and has been used by over 200,000 persons. The other instrument that was used was the Tennessee Self Concept Scale (TSCS) which has been used since 1965 to test for self concept. The experimental and control group, 45 in each group, were given these two instruments at the start of the study and again after the experimental group had completed the eight-week program. The LAQ was also given to the experimental group six months after completion of the eight-week wellness program. Due to the fact that all programs that are called wellness programs do not include exactly the same components, this study has attempted to construct a program that includes the major components that all wellness programs include. This has resulted in this study being very specific when it refers to what has been called a well-defined adult wellness program. This study would have become too fragmented and cumbersome if it had attempted to include every component that every wellness program has. From talking to wellness program directors, no wellness programs were found that did not include exercise, nutrition, and stress management, and most include the spiritual dimension. The experimental group was involved in an exercise session three times a week for eight weeks, each session lasting approximately forty-five minutes. Each person was given an exercise prescription based upon the results of a 10 sub-maximal stress test. Walking, jogging, or swimming were the forms of exercise used. Lectures concerning exercise, nutrition, stress, and the spiritual dimension were conducted for the experimental group. These sessions met one hour a week for eight weeks. OVERVIEW OF THE STUDY This study consists of five chapters, a selected bibliography, and appendices. Chapter I has included the introduction, statement of the problem, purpose of the study, research hypotheses, statistical hypotheses, delimitations, limitations, definition of terms, and procedure. Chapter 11 contains a review of the literature related to the topic. Chapter 111 describes and explains the methods and procedures of the study. This chapter includes the population, sample, instruments used, and the collection and treatment of the data. Chapter IV is an analysis of data collected from the use of the instruments. Chapter V presents the summary, findings, and recommendations of the study. CHAPTER 11 REVIEW OF THE LITERATURE An examination of the literature did not uncover any studies which specifically covered the topic chosen by this investigator. Studies, however, which addressed specific components of this investigator's study were found and have been reported. To effectively assess the existing literature as it pertains to this study this chapter is divided as follows: 1. Lifestyle: the effect on health 8.. Exercise b. Nutrition c. Stress d. The Spiritual Dimension 2. Self concept and its relationship to the following: a. Exercise b. Nutrition c. Stress d. The Spiritual Dimension The review of the literature is intended to provide evidence to support each of the individual components as they relate to the two major divisions: lifestyle and self concept. ll 12 LIFESTYLE The Center for Disease Control in Atlanta, Georgia, is a clearinghouse for information regarding diseases. This center has reported that the majority of premature deaths, disabilities, and low quality lives suffered by the majority of our population are not the result of infectious diseases but rather the result of chronic diseases.8 These diseases are the result of choice, or self-inflicted diseases, and could be called lifestyle diseases. Lifestyle is responsible for up to 54% of deaths caused by heart disease, 37% of deaths caused by all types of cancer, 50% of deaths due to strokes, and 6096 of all suicides. The center points out the important role lifestyle plays in the prevention of disease. The center claims that the next great improvement in the nation's health will come from lifestyle changes and not from the research lab. Supportive evidence for this importance of lifestyle is reported in a study conducted by the Human Population Laboratory of the California State Department of Health Services which studied the population (about 7,000 subjects) of Alameda County housing units.9 This study which was conducted by Belloc and Breslow found a positive association between seven health practices and good physical health. The favorable health practices that were identified in this study were: I) never smoked, 2) average weight status, 3) low alcohol consumption, ’4) regular physical activity, 5) seven to eight hours of sleep per night, 6) eating breakfast almost every day, and 7) not snacking between meals. In this study each factor was shown to independently affect health status. 13 Nine years later (1971!), using longitudinal data from the Alameda County group, a study was conducted that showed that those who engaged in more of the positive health practices listed in the previous study had lower death rates.10 A second nine-year study11 found that not eating breakfast and snacking between meals did not have a significant effect on physical health status. This study, however, did find that the first five favorable health practices, identified by Belloc and Breslow, were associated with better health status. A third follow- up study12 based on nine-year mortality data confirmed that the first five favorable health practices were associated with lower mortality rates. The significance of the original Alameda County Study and subsequent studies is that attention was drawn to the importance of a person's lifestyle practices and their impact on health. A national survey conducted by Pacific Mutual Life Insurance Company called "Health Maintenance"13 attempted to assess the importance adults attached to lifestyle. This study used three separate samples: a national cross section of 1,517 adults; a cross section of 176 corporations which they obtained from the Fortune listing of 1,250 companies; and a cross section of 35 labor unions from a list of the largest labor unions. If was found that more than 90% of the adults 18 years and older who responded believed that if they changed their lifestyles, their health would improve more than anything traditional medicine could do for them. Fifty-one percent said that they were more concerned about prevention practices today than they were five years ago. Almost half (42%) believed more emphasis should be given to preventive medicine and less to curative medicine. 11 In contrast to the American lifestyle is the lifestyle of the Abkhansion peasants who live in the rural farming communities of Russia.” They are among the healthiest and longest living people on earth. The apparent key to their health is their lifestyle which is simple and close to nature. These people are very physically active throughout their entire lives, their diet is simple yet more nutritious than the "average" American diet, and they have a more relaxed way of living. In response to the favorable relationship between lifestyle and health the people who promote wellness programs claim that their programs are addressing issues of lifestyle changes. If these claims are valid the impact on health by wellness programs could be tremendous. A search of the literature, however, has not resulted in finding any studies that have been conducted to determine if wellness programs do result in lifestyle and self concept changes. The study that came the closest to implementing and evaluating a wellness program was conducted by the Institute for Aerobic Research, located in Dallas, Texas. The results of this study were published in the February (198‘!) issue of the Ameri'Can‘ Journal of Public Health.” This program involved 117 teachers in the Dallas, Texas, school district. The results of the study indicated that the health knowledge of the teachers increased as did their physical fitness and self concept scores. The study, however, did not determine if there was a change in lifestyle that took place. Although no research was found that specifically addressed the effect of a wellness program on lifestyle, studies were located which addressed individual 15 components of a wellness program on health. Pertinent literature as it is related to these components will follow. Exercise In the last 50 years our society has become more and more mechanized and an individual's requirement for physical exertion has diminiShed greatly. Leisure time for most people has increased greatly during the last 10 to 15 years. Many people are exercising more and the exercise "business" is a multibillion- dollar industry.16 Kaplan and associates found that people feel that regular exercise makes them feel better and results in their becoming more healthy.” Scientific evidence, however, to support the benefits of regular exercise has only become available over the last 50 years. A landmark study which explored the relationship of activity to good health was undertaken in 1949 by Morris and associates.18 This study revealed that of the 31,000 men conductors and drivers of the London transit system studied, the conductors had less coronary heart disease than the drivers. Also, the coronary heart disease that the conductors did manifest was not as severe and occurred at a later age than the heart disease of the drivers. The study went on the explain that the reasons for this difference might be any of the following: a. There may have been a difference in the constitution and early experiences of conductors and drivers. 16 b. Mental strain may be more severe for the drivers than the conductors. c. The greater physical activity of the conductors (double-decker vehicles) is a cause of the lower incidence and mortality in the conductors. Morris, however, goes on to state that This last proposition . . . that physical effort in the conductors' work may be a protective factor, safeguarding them in middle age from some of the worst manifestations of coronary heart disease suffered by less active workers . . . attracts us most because it offers special opportunity for study. The results of a study of postal workers in Britain during the same time period (1949-50) also suggested that the total incidence of coronary heart disease was lower in the postmen than in those employees that were less active. "Again, therefore, as with the transport workers, the early mortality of the physically active group is substantially less than that of the physically inactive."20 The San Francisco longshoreman study by Paffenbarger and associates21 also studied the relationship between activity on the job and coronary heart disease (CHD). After a preliminary examination in 1951 the San Francisco longshoremen were followed for 22 years to evaluate their work activity and the death rate from CHD. The study revealed that the cargohandlers who loaded and unloaded the ships had much lower risk of sudden death from CHD than did the foremen and clerks who were more sedentary in their jobs. 17 Similar results were found between farmers and inactive townsmen;22 railroad track workers and sedentary clerks.23 Because the American people are not as physically active on the job as they were in the past, research that studies the relationship of leisure-time activity to health have been investigated. A long range, ten-year health study of Harvard alumni by Paffenbarger and associates was reported in the Journal of the AmerICan Medical Associationzu which studied 16,936 Harvard alumni who entered college from 1916 to 1950. From the results of the study it appears that exercise benefits are independent of other life-style components, such as smoking, obesity, high blood pressure, and family health history, when it comes to CHD. Alumni who exercised so that at least 2,000 kcal/week were expended had much less CHD than did sedentary alumni. Even ex-varsity athletes who became sedentary were at high risk while those students who were inactive during their college days and became physically active after college were at low risk. This study showed that an inverse relationship exists between exercise and cardiovascular and respiratory mortality. In a ill—year follow-up of 1,909 men and 2,311 women from Framingham who were initially free of CHD, Kannel and Sorlie found that a high level of physical activity in men was a factor in overall death rate and in particular CHD mortality.25 The same results were not different in the women studied but the study did cite that the Framingham population was generally sedentary and it was difficult to form distinct high and low energy output groups. Although physical inactivity was not the most powerful characteristic affecting CHD the investigators recommended that persons should plan their day to include more l8 vigorous exercise habits. These observations were supported by Dawber who analyzed the data in a different way.26 Magnus and associates studied leisure-time activities in four residential areas of central Holland from 19704971.” The leisure-time activities included walking, cycling, gardening. Interviews were conducted with lI73 persons who experienced a heart attack. Interviews were also conducted with 975 persons who had no history of cardiovascular disease and who were randomly selected from the population of Zeist. The physical activity of these Stbjects was classified as habitual, more that 8 months per year; seasonal, it to 8 months per year; or occasional, less than 11 months per year. Hours of activity a week of participation were also tabulated. The investigators found a negative association between CHD events and habitual physical activity. In this study the intensity of activity did not seem to be a factor. Death within '1 weeks of a heart attack was highest in those subjects who only occasionally participated in the activities cited, walking, cycling, and gardening. The findings of this study suggest that leisure-time exercise should be year-round to protect a person from cardiovascular disease. This study also suggests that the effect of these leisure-time exercises may be lost if this activity is interrupted for several months or a year. The last study which will be reported and which seems to give support for exercise as an important component of health was a study reported by Salonen and associates on a longitudinal study of physical exercise and the risk of fatal and nonfatal cardiovascular disease and stroke among 7,666 men and women ages 30- 39 in two counties of eastern Finland.28 A 7-year follow-up in 1978 found that if a person was very inactive at work there was an increased risk of acute myocardial infarction, cerebral stroke, and death due to any disease. Risks were 19 further reduced if the subjects were high in physical activity both at work and at leisure. Nutrition The role nutrition plays in the health of an individual has been a source of controversy for years. During the past few years, however, there has been much empirical research which strongly indicates that nutrition plays an extremely important role in health. The role nutrition plays in coronary heart disease has received much study. The Seven Countries Study by Keys29 is a study which appears to show a relationship between diet and CHD. The data collected paid great attention to adequate sample size, the use of standardized measurements, analysis of blood lipids and of food eaten. This study found a large difference between populations of countries relative to the consumption of saturated and monosaturated fat. In Japan where there is an extremely low total fat intake the incidence of death from CHD was very low. On the other hand Eastern Finland where fat intake is very high (highest in countries studied), the number of deaths from CHD was the highest. The rest of the countries seemed to be on a continuum in relationship to total fat intake. The Ni-Hon-Sun Study30 shows what happens when Japanese, who had a low fat intake and low CHD rate in Japan, migrate to Hawaii and California. As the Japanese who migrated to Hawaii and California became more "westernized" in relation to diet, their incidence of CHD went up. An important aspect of this 20 study is that genetic factors associated with CHD seem to be controlled. Comparative data from other studies in Framingham, Honolulu, and Puerto Rico also point out a similar relationship.31 Blood cholesterol levels seem to be strongly associated with the incidence of CHD in all parts of the world. A study called the Pooling Project32 provides epidemiological evidence from the United States and other populations that have a high CHD incidence that high personal levels of cholesterol relate to CHD. In all eight United States studies involved in the pooling project it was reported that there is a greater risk for CHD as the level of cholesterol goes up. The Seven Countries Study mentioned earlier also shows a continuous relationship between cholesterol level and CHD risk. A specific study concerning diet and cholesterol was conducted by Sonja L. Connor and William E. Connor.” A double blind study was designed to determine if eggs (which are high in cholesterol) would raise the cholesterol level of normal volunteers. An egg product which contained two egg yolks or an identical placebo product (free of cholesterol) was given to the volunteers. These products were randomly fed to the volunteers for '1 weeks each. The Stbjects were asked to continue their normal diets in addition to the egg and placebo products. The investigators reported that, "The results clearly showed that only the egg products produced an elevated plasma cholesterol concentration compared with baseline values and also compared with the placebo product!” The investigators claim that a high intake of cholesterol leads to deposits of cholesterol in the tissues into which it is transported (blood vessels also) and this results in arteriosclerosis. 21 Nutrition and cancer is an area where much controversy exists. The role of diet and its relationship to cancer does seem to be supported by research which compares cancer incidence among populations living in the same country. In the North-Central states (Michigan, Wisconsin, and Minnesota) there is a cluster of stomach cancer cases. Many of the people living in this region are direct descendants of Scandinavian, German, or Russian ancestry. These people have a common eating pattern which includes highly spiced and smoked foods.35 The diets of Seventh Day Adventists and Mormons contain less fats, meats , tea, coffee, and alcohol than the rest of the population; and their cancer rate is about one-third to one-half less than the rest of the American population.35 Studies which compare the incidence of cancer with other countries also tend to show a relationship between cancer and diet. Japanese with low rates of breast cancer, in comparison to Americans, consume less dietary fat and cholesterol from meat and dairy products.36 Cancer of the colon also seems to be associated with diet. Countries with low-colon cancer rates consume less dietary fat and cholesterol. 37 Stomach cancer rates are among the highest in the world in Japan. Those individuals in Japan with the highest risk of developing stomach cancer are those that use highly salted foods. Although there are investigators38 who claim the relationship of nutrition to cancer is shaky at best, the National Research Council published a report in 1982, Diet‘,‘Nutrition, and Cancer, that concluded that most common cancers potentially are preventable and cancer relates more to diet than to genetic influences.39 This report advised Americans to eat less fats, avoid excess alcohol consumption, and include more whole-grain cereal products, certain vegetables and fruits in their daily diets. 22 During the past year (1981!) the American Cancer Society has also offered explicit advice about diet and cancer. These recommendations are in accord with those from the NRC/NAS but they also stress the importance of avoiding obesity. Stress During recent years an increasing amount of data from stress-related experiments, clinical, pathological, and epidemiologic research has provided strong evidence in favor of a causal relationship between stress and disease. ('0 accountants were studied to see In a study by Friedman and associates, if periods of high stress such as urgent tax deadlines would be associated with undesirable physiological changes. For this study #0 male accountants, ages 28 to 56, were bled biweekly for serum cholesterol and monthly for blood clotting time. Records were also kept of exercise, diet, weight, workload, and any other circumstances which might be a factor. The researchers found that each subject's serum cholesterol was highest during severe occupational stress and lowest when the stress level was lowest. Blood clotting time was also the highest at the time of greatest times of stress and it was normal during periods of low stress. The researchers claimed that these changes were not the result of any changes in weight, exercise, or diet. A study by Grundy and Griffin“1 also showed the relationship between stress and serum cholesterol levels. In the study two groups of male freshman medical students were studied. One group of 50 was studied during the winter term and another group of 47 was studied during the spring term. During the two 23 periods of examinations the mean cholesterol levels were significantly raised: 16.5 percent for the winter exam period; and 11 percent for the spring exam period. Additional evidence of the relationship between stress and disease is presented in the studies of cardiologists Friedman and Rosenman."2 Friedman and Rosenman found that men who were excessively competitive, had a continual sense of time urgency, accompanied by the feeling of always having to meet deadlines had a much higher rate of CHD. These researchers applied the label Type A to these individuals. A comprehensive review of studies of Type A individuals by Sparacend"3 seems to verify the relationship between these stress related traits and coronary heart disease. The relationship between cancer and stress is controversial and research in this area has been and is presently being carried out. A study by Riley“ of the Fred Hutchinson Research Center in Seattle, Washington, involved subjecting eiqaerimental mice to a variety of stresses. Riley demonstrated that mammary-tumor incidence in offspring could be increased up to 90 per cent under stress. Riley suggests that moderate chronic or intermittent stress may increase the risk of cancer in mice. He feels that this increase in cancer is a result of a depressed immunological or tumor surveillance system because of the stress imposed. Although it is always difficult to generalize from animal to human research, the implications of Riley's study are significant. Solomon has focused on the concept of the importance of immunological system as a key factor in the onset of cancer and humans."5 He feels that resistance to cancer appears to be immunological in nature and that stress does seem to depress the immune system. 2‘! Holmes and Rahe“6 studied the relationship of stress and health/illness in a more general way. They argued that if stress resulted in illness and disease, then people who experience a great deal of stress should be 111 more than people reporting only a little stress. They conducted more than 5,000 interviews over a 20 year period to try and link stressful major life-events with illness. They then gave #3 critical events numerical ranking from 0 to 100. They found that people who scored 150-199 on the scale showed a 37 percent chance of those stressful events leading to illness or disease the following year; those scoring 200-299, a 51 percent chance; and those scoring over 300, a 79 percent chance. Many other researchers have since supported these findings‘w'J‘9 Spiritual Dimension The relationship between religious and spiritual beliefs and health has been aligned from the beginning of history. Some type of god or spiritual force has been used to explain lightning, thunder, fire, and disease. Illness, even today, in some cultures is seen as a result of evil spirits; and the medicine man or witch doctor combines medicine, faith, and religion in rituals and healing practices. This influence of the spiritual dimension on health is not just limited to underdeveloped societies. Religion, in Eastern cultures, often plays a major role in the establishment of social mores. Pilgrims go to the shrine at Lourdes where they believe miraculous cures take place. Other groups of people located in the United States, such as the Jehovah's Witnesses, Christian Scientists, and the followers of Oral Roberts believe that faith is much more effective in healing than traditional medicine. 25 Many theories of health include the spiritual dimension as an important 50 was the person who coined the term ”high level wellness." ingredient. Dunn High level wellness to Dunn is an integrated method of functioning which requires the individual to maintain a continuum of balance within the environment where he is functioning. Dunn claims that the environment in which a person lives dramatically influences a person's health. Many factors exist in the environment including the spiritual dimension. According to Dunn these factors all influence the level of health of an individual. Hoyman51 also views health as a dynamic process. His theory is called the Ecologic Model of Health. The dimensions that comprise this model include the mental, spiritual, social, and physical. Hoyman feels that these components are affected by a variety of external and internal variables. The level of health a person has is determined by the interplay of these variables. Sorochan52 refers to the concept of "orthobiosis" which means "the right style of living." He feels that this term encompasses all the components that influence well-being. He speaks of a feeling of a spiritual awareness of a purpose in life. Sorochan then defines in greater depth those attributes that characterize an individual's health. These attributes include an emotional, social, spiritual, cultural, and physical dimension to health. Lafferty53 approaches health with a plan a person could use to influence his or her health in a positive manner. The positive health choices he mentions include the areas of the physical, intellectual, emotional, social, and spiritual. Under the heading of the spiritual component, suggestions such as setting aside some time each day for meditation, thought, and/or prayer, become involved in a 26 value-oriented, spiritual, or religious discussion, and attend a spiritual or religious meeting, were listed. Tillich” speaks of a spiritual nature of health. He feels that the healing power of faith is the force that helps man create a more fully integrated and meaningful life. Spiritual faith to Tillich means that we are searching for some deeper meaning to life than mere existence or survival. He feels that healthy people seek to transform and transcend themselves through spiritual aspiration and faith. Tillich hopes that this will bridge the gulf between just existing and the ideal. In order to stay healthy he claims that a person needs something for which and by which to live. Dr. Herbert Benson, a cardiologist, who is head of behavioral medicine at Boston's Beth Israel Hospital, believes that the spiritual dimension is an important component to attaining and maintaining health. His 1975 best seller, The Relaxation Response”, reviewed his research on the health benefits of meditation. In his latest book, Beyond the Relaxation Response 56, he explores the power of faith combined with meditation. Dr. Benson makes it very clear that there is no particular faith that is more advantageous. He has traveled to many parts of the world and observed many different "faith factors" which have been associated with a healing capacity. Dr. Benson claims that modern medicine can only deal with 25 per cent of what physicians encounter and the other 75 per cent relates to self-limited illness interactions between the mind and body. His view is that meditation combined with a person's faith can play a major role in alleviating the other 75 per cent. Dr. Norman Vincent Peale is a noted theologian who stresses the importance of the spiritual dimension in health. In his book, The Power of ~—.-~o--- 27 Positive Thinking”, the power of the spiritual dimension in a person's health is a recurring theme. In his chapter on "How to Use Faith in Hcaling," Dr. Peale states There is a growing emphasis in present-day religious practice which is designed to help people find healing from the slcknesses of mind, heart, soul, and body. This is a return to the original practice of Christianity. Only in recent times have we tended to overlook the fact that for centuries religion carried on healing activities. The very word "pastor" derives from a word meaning "the cure of souls.” In modern times, however, man made the false assumption that it is impossible to harmonize the teaching of the Bible with what is called "science" and so the healing emphasis of religion was abandoned almost entirely to materialistic science. Today, however, the close association of religigg and health is increasingly recognized (p. 146). On the very next page Dr. Peale states ”A sensible and effective pattern for health and happiness is to utilize the skills and methods of medical science to the fullest possible extent and at the same time apply the wisdom, the experience, and the techniques of spiritual sciences" (p. m)’9 SELF CONCEPT The relationship of self concept and wellness could not be found in a search of the literature. There are studies, however, that have been conducted which address some of the different components of this study. This review of the literature will report on exercise, nutrition, stress, and the spiritual dimension as they relate to self concept. 28 Exercise The concept of the relationship between mind and body is not a new 61 phenomenon. Plato speaks of the relationship in The Republic.60 Morgan wrote that recognized authorities in the field of psychiatry support the mind/body relationship. Greist,62 in his work with depressed patients, claims that the more deconditioned these depressed patients are, the less normal their psychological test scores tend to be. As these deconditioned people improve their physical fitness level, their psychological scores tend to change in a positive manner. The literature that specifically studies the relationship between self concept and exercise is contradictory. Crocitto studied the relationship of jogging to self concept and meaningful existence.63 The sample consisted of 125 members of the professional staff of the Arlington Public Schools during the 1980- 81 school year. Of the 125 members studies, 67 were joggers and 58 were non- joggers. The members of both groups were given the Tennessee Self Concept Scale (TSCS) and Purpose in Life Test (PIL). The findings of this study showed no difference between joggers and non-joggers in self concept and meaningful existence. Smith“ studied 20 people who exercise regularly and 20 people who did not exercise regularly. These subjects were matched for age, height, weight, and educational background. These subjects were then divided into four groups: group A was 10 regularly exercising females; group B was 10 non-exercising females; group C was 10 regularly exercising males; and group D was 10 non-exercising males. All subjects received the Tennessee Self Concept Scale (TSCS) and the Silhouette Photographic Selection Process (SPSP). The results for self concept 29 showed no differences between people who exercise regularly and people who do not exercise regularly. These studies seem to indicate that there is no relationship between exercise and self concept. There are, however, studies which indicate that there is a relationship between exercise and self concept. Rhodes“ studied seventeen joggers from the Planned Vigor grow of the Duke University Preventive Approach to Cardiology Program (DUPAC) and 40 non-joggers who volunteered from the Center for the Study of Aging and Human Development Program. The jogging group met three times a week for 10 weeks. The workout lasted for 45 minutes and the subjects exercised at 70-80 per cent of their predicted maximum heart rate. The results as they relate to self concept showed that the jogging group achieved an increase in self concept. Coulngwood“ studied 50 male rehabilitation clients from a large rehabilitation facility. These men were between the age of 18 and 26 and were matched in terms of behavioral and emotional difficulties and the need for an exercise program. The Bills Index of Adjustment and Values (IAV) was given to both groups (pre-post) to measure self concept. The results for self concept as measured by this instrument showed that the exercise group demonstrated a greater positive change than did the control group. Hilyer and Mitche1167 studied college students in regard to self concept and exercise. An added dimension of counseling was also included in this study, which involved 120 subjects from a pool of 262 students who registered for a basic physical education class. This sample included 77 males and 43 females. All 120 students were randomly assigned to one of three grows: control; running only; and running with counseling. Both running groups met three times a week for one 30 hour. The running and counseling group met one extra hour a week to talk about exercise and any problems they might have regarding exercise. All students were pretested with the Tennessee Self Concept Scale (TSCS). Those students with scores above the mean were designated as the high self concept grow. The duration of the study was 10 weeks. To test for changes in self concept the TSCS was again administered. The results revealed that the greatest change in self concept took place among students who were in the running groups and had exhibited low self concept. The low self concept counseling Slbjects had the greatest changes in overall self concept. This study did not show an improvement in the self concept of those in the high self concept running group. 1119213192. The literature that addresses the relationship between nutrition and self concept seems to be limited to studies concerning obesity and self concept. Most of these studies have explored this relationship with adolescents. A few studies were located which studied the relationship between obesity and self concept in adult females; but no studies were found which addressed this relationship in adult males. Wadden and associates68 studied the relationship between obesity and self concept of children in grades 3-8. Subjects included 105 obese (20% over ideal weight) and 105 normal weight (15% ideal weight) children. The Peers- Harris Children's Self Concept Scale was used to evaluate self concept. The results showed the mean scores of the obese groups were lower (55.0 to 58.1) than the normal weight group but the difference was not statistically significant 31 (p .07). The authors did speculate, however, that differences in self concept between obese and normal weight persons may increase with age. A study by Savrin69 seems to address the speculation of the authors in the previous paragraph. In Savrin's study a group of obese diildren, ranging in age from 9 to 14, was compared to a group of normal weight children. The results of the study found that the obese children tended to have higher self concept scores than the normal weight children for ages 9 to 10. The self concept scores of obese children, however, declined at ages 11 to 12. 70 examined the role that weight reduction appears to Stoner and Fiorello have on the self concept of overweight adolescent females. The swjects were 12 female girls, ages 15 to 18, who were 20 or more pounds over ideal weight. The subjects were randomly assigned to a control and experimental grow. The Tennessee Self Concept Scale was the instrument used to measure self concept. The experimental grow met 60 minutes one day a week for 16 weeks. Personal grooming skills, social skills, and information on how to lose weight were emphasized at these sessions. The experimental grow was not placed on a rigid diet but information about which foods to avoid and how to change eating habits was given. The results of the program show that the experimental group did lose weight (mean loss of 12.5 pounds) and the control group did not. The results of the Tennessee Self Concept Scale showed a difference on the sub-scores for physical self and personal self between the control and experimental groups. No difference, however, was found for overall self concept. In discussing the results of the study the authors explained that when the program ended, all subjects in the experimental grow were still overweight, even though weight loss had 32 occurred. They felt that this factor might account for the fact that the total self concept of the experimental grow was not different from the control grow. Rankin7l studied the relationship between self concept and the reduction of body fat in obese females. Rankin examined the effectiveness of three different weight reduction programs on enhancing self concept. This study consisted of 83 obese females between the ages of 20 and 40 were involved in this study. These 83 women were randomly assigned to four groups (one group was a control). The Tennessee Self Concept Scale was the instrument used to assess self concept. The results showed that two of the three treatment groups showed an increase in total self concept. The other treatment grow showed an increase in some sub-scores but not all. Helfman72 also studied the effect of different weight reduction treatments on the self concept of overweight women. The study involved 30 overweight and 30 normal weight women ages 25 to 45. When the self concept of the two grows was measured before the different treatments were initiated the self concept of the normal women was higher. The results after the program was completed did not show any difference between the three treatment grows in relationship to self concept. Stress The literature that addresses the relationship between stress and self concept is not clear and concise. A study by Sullivan73 studied the effects of stress on the self concept of secondary school counselors in Massachusetts. Of the 1,075 counselors listed in 33 the 1982 Massachusetts School Counselors Association Directory, 560 counselors (52%) responded. The results of this study found that personality factors, Type A and Type B personality, seem to be more important in coping with stress than a person's self concept. McEntee" studied 82 senior student nurses enrolled in acute-care clinical courses. These students were growed according to level of life stresses and randomly assigned to four groups. The experimental groups (2) received the sequential self-contained, audio-cassette Rankin-McEntee Stress Management Training Program (SMTP). One tape per week for six weeks was given to the experimental grows. Although the results of the study did not show any differences between the experimental and control groups in regard to self concept after the six-week experiment, analysis of the data did reveal that those students with multiple role demands uniformly had low self concept scores. Hobfall and Walfisch75 studied the relationship of self concept and social support to psychological distress among patients suspected of having cancer. Sixty-eight israeli women (who were later found to have benign tumors) were interviewed immediately before undergoing biopsy surgery and three months after the surgery. The results of this study found that self concept is of value in coping with the stress of undergoing surgery. Women with stronger self concepts were found to experience much less discomfort in the areas of state anxiety and state depression. Peaan and associates76 were involved in a longitudinal study to attempt to determine how life events, chronic life strains, self concept, coping, and social supports are related to form a process of stress. Interviews with 2,300 adults between the ages of 18 and 65 were conducted in 1972-73. This sample was 34 representative of the U.S. census-defined urbanized area of Chicago. The second interview was conducted four years later in 1976-77. Of the original 2,300 adults interviewed, data was collected on 1,106. The authors took involuntary job disrwtions and showed how they adversely affected role strains. It was found that these role strains have a tendency to lower self concept. The authors show statistically that the erosion of self concept leaves a person especially vulnerable to experiencing symptoms of stress. The loss of self concept is seen as being of pivotal importance in the process of stress. Sam A search of the literature did not uncover any empirical data concerning self concept and the spiritual dimension. A visit to bookstores did result in the location of a few books of a religious nature that did address the role of religion in the formation of the "self." These books, however, relied on isolated personal observations and furthermore did not address the specific topic of self concept. CHAPTER III DESIGN OF THE STUDY This study was designed to assess the changes that result in lifestyle and self concept in adult men and women following the implementation of a well- defined wellness program. HY POTHESES The study was undertaken with the expectation that the following hypotheses would be substantiated. 1. It is expected that those subjects involved in a well- defined wellness program will have more positive lifestyle changes than a similar group of controls. 2. it is expected that those swjects involved in a well- defined wellness program will maintain their positive lifestyle changes for at least a six-month period. 35 36 3. It is expected that those subjects involved in a well- defined wellness program will have a positive increase in self concept whereas a similar group of controls will not. INSTRUMENTS Lifestyle Assessment Questionnaire (LAO) The Lifestyle Assessment Questionnaire was designed by Dr. Bill Hettler and associates from the University of Wisconsin-Stevens Point. This Lifestyle Assessment Questionnaire has been used by more than 200,000 people from business and industry, schools and colleges, hospitals and clinics, YMCAs and community health agencies throughout the United States and Canada. It was formulated in 1976 and is now in its third edition. The Lifestyle Assessment Questionnaire is organized into four sections: 1) Wellness Inventory, 2) Topics for Personal Growth, 3) Risk of Death, and 4) Alert Section: Medical/Behavioral/Emotional. This study incorporated the wellness inventory section to assess the components of wellness that comprised the study. The reliability coefficients for the individual components are as follows: Exercise .77 Nutrition .74 Stress Management .79 Spiritual .77 37 Instructions to the wellness inventory section inform the subjects that "this section will help determine the current level of wellness that you are experiencing." The five possible responses are: A. Almost always this is true (90% or more of the time) B. Very frequently this is true (approximately 75% of the time) C. Frequently this is true (approximately 50% of the time) D. Occasionally this is true (approximately 25% of the time) E. Almost never is this true (less than 10% of the time) The components of wellness selected from the Wellness Inventory section of the LAQ take about 15 to 20 minutes to complete. Tennessee Self Concept Scale (TSCS) The TSCS (developed by William H. Fitts in 1965) consists of 100 self- descriptive statements to which the individual responds and which portray his own picture of himself. This instrument can be used with slbjects 12 years and older who have at least a sixth grade reading level. The TSCS is applicable to subjects representing the entire range of psychological adjustments—from well-adjusted to psychotic. The TSCS is available in two forms, a Counseling Form and a Clinical and Research Form. The 100 items are the same for each form. The only difference between the forms is the profile system and the scoring. The Counseling Form has fewer variables and scores and requires less sophistication in psychometrics and psychopathology by the person analyzing the data. (The Counseling Form is the form used in this study). 38 The 100 self-descriptive statements were derived from other self- concept measures and from self-descriptions of patients and non-patients. These items were then classified on the basis of what they themselves were saying; and a two-dimensional, 3 X 5 scheme evolved. The one-dimension (horizontal rows) reports three sub-scores which represent an internal frame of reference. These three measures are Identity (how the person sees himself), Self-Satisfaction (how the person accepts himself), and Behavior (how the person acts). The second dimension (vertical rows) report five sub-scores representing five aspects of self considered as a more external reference frame. These measures are Physical Self (how the person views his body), Moral-Ethical Self (how the person views his moral worth), Personal Self (how the person views his personal worth), Family Self (how the person feels in terms of adequacy, worth, and value as a family member), and Social Self (how the person sees his adequacy and worth in his social interactions with other people in general). The reliability coefficients for the three internal reference sub-scores and the five external reference sub-scores range from .80 to .91. The reliability coefficient for the Total Positive Scale is .92. Instructions to the TSCS inform the subjects to respond to a five-point endorsement scale which runs from "Completely False" to "Completely True." The TSCS can be completed in 10 to 20 minutes and is self-administered. SOURCE OF THE DATA People from the Grand Rapids, Michigan, area served as subjects in the study. Brochures and fliers were distributed to individuals, businesses, and were 39 posted in shopping malls. These brochures and fliers (see appendix A) outlined the wellness program offered and explained that the participants would be part of a statistical study. Of the 105 people who expressed interest, ninety persons were able to meet all the stipulations outlined in the brochure and were accepted into the program. Subjects included 46 adult men and 44 women between the ages of 23 and 64. Although the individuals' lifestyles varied, almost all led sedentary lives and were relatively unfit as measured by a sub—maximal, multistage exercise test on a stationary bicycle administered before the start of the exercise sessions. The 90 subjects were randomly assigned to one of two groups. The experimental grow of 24 males and 21 females participated in an eight-week wellness program that began in February (1984). The other group of 22 males and 23 females served as the control group during this eight-week time period. All subjects from both groups came to an organization meeting held one week prior to the start of the wellness program. At this meeting the program was explained and the two testing instruments, the Lifestyle Assessment Questionnaire and the Tennessee Self Concept Scale, were administered. The experimental group was then involved in the eight-week wellness program. This program consisted of exercise sessions and lectures. The exercise session options included walking/running, swimming, and aerobic dance. The slbjects could choose from one or any combination of the exercise options offered. They were encouraged to exercise a minimum of three times a week. The level of intensity that would be appropriate for each individual was determined by the results of the exercise test taken. The subjects were asked 40 to sign an attendance sheet at each exercise session they attended. Approximately 90 per cent of the subjects participated in at least three exercise sessions a week. About 8 per cent averaged two sessions a week and only one person averaged one time a week. Lecture sessions, which focused on exercise, nutrition, stress, and the spiritual dimension were held each week for the eight weeks. The same lecture was given Monday and Tuesday evenings from 7:00 p.m. to 8:00 p.m. to encourage attendance at these sessions. Subjects were again asked to sign an attendance sheet at each lecture session. Attendance at the lecture sessions was as follows: 75 per cent attended every lecture session, 15 per cent missed one lecture session, 5 per cent missed two, and 5 per cent missed more than two. At the conclusion of the eight-week session, all slbjects from both groups were again assembled at the same time and the posttest for the two evaluation instruments was given. The group that served as the control group for the first eight-week session then participated in a similar eight-week training program. This inducement to the control group, to be able to become involved in a second eight- week wellness program, served as an incentive to consent to be one of the control group for the first eight-week session. The fact that the cost to the subjects was much less than comparable wellness programs offered in the Grand Rapids area ($65 compared to 5180-190) helped recruit subjects for this study. Six months following the completion of the session in which the experimental group had participated, the Lifestyle Assessment Questionnaire was mailed to all those subjects who were part of the experimental group. The post- 41 posttest results were analyzed to attempt to determine if changes in lifestyle which occurred during the eight-week wellness program were temporary or were at least present following a six-month period. STUDY GROUPS Selecting a design appropriate to the needs of the study resulted in the selection of the pretest-posttest control-group with random assignment design. Group Pre test Treatment PoSttest Post-posttest One yes Participation in yes yes wellness program Two yes no treatment yes no This design allowed for control of the eight threats to internal validity identified by Campbell and Stanley." These internal validity factors are history, maturation, testing, instrumentation, regression selection, mortality, and interaction effect. Groups one and two were pretested on the Lifestyle Assessment Questionnaire and the Tennessee Self Concept Scale. Group one was involved in an eight-week wellness program, while group two served as controls. Groups one and two were posttested on the Lifestyle Assessment Questionnaire and the Tennessee Self Concept Scale. Group one received a post-posttest on the Lifestyle Assessment Questionnaire six months following the treatment session. 42 SUMMARY This chapter includes information concerning the hypotheses, the instruments used, and the source of the data. The hypotheses were explained as expected outcomes of the well-defined wellness program in which the subjects were involved. The two instruments which were used, The Lifestyle Assessment Questionnaire and the Tennessee Self Concept Scale, were explained to show the appropriateness of their use in this study. The source of data section gave information regarding the demographics of the subjects and information concerning the program in which the subjects were involved. CHAPTER IV ANALYSIS OF THE DATA The results of this study were based on data collected from 80 adult men and women who lived in the Grand Rapids, Michigan, area. To present the data collected, this chapter will be divided into three parts. Part one presents summary data on the subjects involved in this study. Part two contains statistical data concerning the effect of a well-defined wellness program on four components of lifestyle. Part three contains statistical data concerning the effect of a well- defined wellness program on self concept. CHARACTERISTICS OF THE STUDY SAMPLE The primary purpose of this study was to evaluate the effect of a well- defined adult wellness program on four components of lifestyle and on self concept. To accomplish this purpose subjects were recruited to participate in this study. To best control for initial equivalence between groups, the subjects were randomly assigned to either an experimental or control grow. Table 1 contains a breakdown of the groups. This study involved data from 80 adults; 41 men and 39 women. Initially 90 adults, 46 men and 44 women, entered this study. Most of the attrition was due to data collection limitations. 43 14 Table l Grows and Number of Subjects Group _N_ Experimental Males = 21 Females = _l_9_ 40 Control Males = 20 Females = 20 N = '40 TOTAL = 80 Table 2 Groups and Number of Subjects (for Post-Posttest Subjects) Group _N_ Experimental Males = 17 Females = 15 = 37 STATISTICAL DATA ON LIFESTYLE Test of Significance Analysis of covariance was used to test hypothesis number 1. This hypothesis, stated in null form, addressed the effect of a well-defined wellness program on lifestyle. 45 H: No difference will exist in the lifestyle of adults who participate in a well-defined adult wellness program and those who do not, in the following areas: 1.1 exercise 1.2 stress management 1.3 nutrition 1.4 spiritual dimension Analysis of variance for repeated measures was used to test hypothesis number 2. This hypothesis, stated in null form, addressed the effect of a six- month time period on the results of the posttest taken immediately following the treatment period. H: no difference in lifestyle will exist between the results of the experimental grow immediately after completing a well-defined adult wellness program and six months following the program, in the following areas: 2.1 exercise 2.2 stress management 2.3 nutrition 2.4 spiritual dimension Table 3 contains a breakdown of the data concerning the lifestyle component exercise. This table shows that the pre-post means of the control group dropped somewhat (37.650 pre — 35.525 post). The pre-post means of the experimental grow, however, did change (31.300 pre — 49.225 post, p<.001). 46 Table 3 Analysis of Covariance Exercise Mean SD. If: p_ Pretest Experimental 31.300 6.035 Pretest Control 37.650 10.521 Posttest Experimental 49.225 5.659 40.528 .001 Posttest Control 35.525 8.003 * The above F score represents the comparison of the two groups on the posttest. Table 4 shows the data concerning the lifestyle component stress management. The pre-post means of the control group did not change (84.025 pre -- 83.150 post). Even though the pre-post means of the experimental group changes (86.650 pre — 91.300 post) the change was not different (p<.470) at the level used in this study (p (.05). 47 Table 4 Analysis of Covariance Stress Management Mean S.D. E: p_ Pre test Experimental 86.650 10. 986 Pretest Control 84.025 11.676 Posttest Experimental 91.300 10.420 46. 924 .470 Posttest Control 83.150 13. 880 * The above F score represents the comparison of the two groups on the posttest. Table 5 presents the data concerning the lifestyle component nutrition. The pre-post means of the control grow stayed about the same (47.700 pre - 46.400 post) but the pre-post of the experimental group did change (47.150 - 53.800, p<.001). Table 5 Analysis of Covariance Nutrition Mean S.D. if: p_ Pretest Experimental 47.150 6.811 Pretest Control 47.700 8.905 Posttest Experimental 53.800 6.556 12.229 .001 Posttest Control 46.400 9.891 * The above F score represents the comparison of the two groups on the posttest. 48 Table 6 presents the data for the lifestyle component spiritual dimension. The means of the pre-post for both grows are very similar (61.800 pre - 60.850 post control and 60.700 pre — 61.875 post experimental). There was no difference between the posttest means of the two groups (p (.223). Table 6 Analysis of covariance Spiritual Dimension Mean S.D. if: p Pretest Experimental 60.700 7.238 Pretest Control 61.800 7.230 Posttest Experimental 61.875 7.436 1.509 .223 Posttest Control 60. 850 10.416 * The above F score represents the comparison of the two groups on the posttest. STATISTICAL DATA ON LIFESTYLE (Collected six months following completion of wellness program) Test of Significance Repeated measure analysis was used to test hypothesis number 2. This hypothesis, stated in null form, compared the data obtained immediately following 49 the completion of the wellness program with data obtained six months following the wellness program. H: no difference in lifestyle will exist between the results of the experimental grow immediately after completing a well-defined adult wellness program and six months following the program, in the following areas: 2.1 exercise 2.2 stress management 2.3 nutrition 2.4 spiritual dimension Table 7 presents the data concerning the lifestyle component exercise. The post-posttest mean of the experimental group changed from the mean of the posttest of the experimental group (50.2188 posttest -- 45.0938 post-posttest, p (.001). Table 7 Repeated Measure Analysis Exercise Mean S.D. I g Posttest Emerimental 50.2188 5.416 6.47 .001 Post-posttest Experimental 45.0938 5.195 50 Table 8 shows the data concerning the lifestyle component stress management. The posttest and post-posttest means of the experimental group did not change (91.3838 posttest - 88.5625 post-posttest, p<.121). Table 8 Repeated Measure Analysis Stress Management Mean S.D. I p Posttest Experimental 91.3438 10.697 1.60 .121 Post-posttest Experimental 88.5625 10.009 Table 9 contains a breakdown of the data concerning the lifestyle component nutrition. This table shows that the posttest and the post-posttest means did not change (54.2188 posttest - 54.2813 post-posttest, p (.902). Table 9 Repeated Measure Analysis Nutrition Mean S.D. I E Posttest Experimental 54.2188 6.786 -.12 .902 Post-posttest Experimental 54.2813 6.527 Table 10 presents the data for the lifestyle component spiritual dimension. The means of the posttest and post-posttest did change (62.1875 posttest -- 60.5000 post-posttest, p. <.049). 51 Table 10 Repeated Measure Analysis Spiritual Dimension Mean S.D. l E Posttest Experimental 62.1875 7.280 2.05 .049 Post-posttest Experimental 60.5000 7.767 STATISTICAL DATA ON SELF CONCEPT Test of Significance Analysis of covariance was used to test hypothesis number 3. The hypothesis, stated in null form, addressed the effect of a well-defined wellness program on self concept. H: no difference will exist in self concept of adults who participate in a well-defined adult wellness program and those who do not participate. The Tennessee Self Concept Scale was the instrument used in this study to evaluate self concept. The Total Positive Score (considered by the author of the test to be the single most important score) was the score used to determine self concept. Due to the fact that the five sub-scores (physical self, moral-ethical self, personal self, family self, and social self) might give additional information concerning specific factors of self concept, they were also included in this section. 52 Table 11 contains a breakdown of the data concerning the Total Positive Scores of the Tennessee Self Concept Scale. The mean scores for the control group on the pretest and the posttest were very similar. The pre-post mean scores for the experimental grow, however, were different (352.000 pre -- 367.075 post, p<.001). Table 11 Analysis of covariance Total Positive Scores Mean S.D. f: p Pretest Experimental 352.000 25.487 Pretest Control 346. 500 26.803 Posttest Experimental 367.075 32.108 13.160 .001 Posttest Control 344.975 33.360 * The above F score represents the comparison of the two groups on the posttest. Table 12 shows the relationship between the experimental and control grows concerning the Physical Self of the Tennessee Self Concept Sale. This table shows that the pre-post means of the control group dropped (64.575 pre - 63.800 post); but there was a change in the pre-post means of the experimental group (66.925 pre -72.250 post, p (.001). 53 Table 12 Analysis of covariance Physical Self Mean S.D. if: p Pretest Experimental 66.925 6.715 Pretest Control 64.575 6.850 Posttest Experimental 72.250 5.982 30.123 .001 Posttest Control 63.800 9.370 * The above F score represents the comparison of the two groups on the posttest. Table 13 presents the data for the Moral-Ethical Self of the Tennessee Self Concept Scale. The pre-post means of both grows changed very little and the difference between the posttest means of the two groups (p<.100) was not significant at the p<.05 level used in this study. Table 13 Analysis of covariance Moral-Ethical Self Mean S.D. E: p Pretest Emerimental 75.050 7.400 Pretest Control 74.625 6.690 Posttest Experimental 76.175 7.150 2.774 .100 Posttest Control 74.075 9.300 * The above F score represents the comparison of the two groups on the posttest. 54 Table 14 presents the data for the Personal Self of the Tennessee Self Concept Scale. The pre-post means of the control group did not change (65.825 pre - 65.625 post); but the pre-post means of the experimental group did change (pre 67.825 _ 69.650, p (.018). Table 14 Analysis of covariance Personal Self Mean S.D. E: p_ Pretest Experimental 67.285 6.664 Pretest Control 65.825 7.578 Posttest Experimental 69.650 6.435 5.793 .018 Posttest Control 65.625 7.520 * The above F score represents the comparison of the two groups on the posttest. Table 15 presents the data for the Family Self of the Tennessee Self Concept Scale. As found in the other tables which addressed data concerning the Tennessee Self Concept Scale the pre-post means of the control group did not change (73.425 pre - 73.475 post). The pre-post means of the experimental grow, however, did change (72.225 pre - 74.950 post, p<.014). 55 Table 15 Analysis of covariance Family Self Mean S.D. E: p Pretest Experimental 72.255 5.811 Pretest Control 73.425 6.105 Posttest Experimental 74. 950 6.664 6.292 .014 Posttest Control 73.475 7.521 * The above F score represents the comparison of the two groups on the posttest. Table 16 presents the data for the Social Self of the Tennessee Self Concept Scale. The pre-post means of the control grow were very similar (67.325 pre - 67.625 post). The pre-post means of the experimental group, however, did change (69.675 pre — 72.000, p<.016). 56 Table 16 Analysis of covariance Social Self Mean S.D. E: p Pretest Experimental 69.675 8.288 Pretest Control 67.325 7.590 Posttest Experimental 72.000 7.616 6.009 .016 Posttest Control 67.625 7.692 * The above F score represents the comparison of the two groups on the posttest. SUMMARY The results of the Tennessee Self Concept Scale data that was presented will be briefly summarized. Table 2 presented data for the single most important score computed on this test. This is the data on which total self concept will be determined. The data presented in Table 2 did show a difference (p<.001) between the control group and the experimental group on the posttest means. Tables 3 through 7 reported five sit-scores of self concept. The only sub-score that did not change at the level used in the study (p (05) in regard to the posttest means between the control and experimental groups, was the Moral-Ethical Self. The other four sub-scores, Physical Self, Family Self, Personal Self, and Social Self, did change at the level of significance used in this study. CHAPTER V SUMMARY, FINDINGS, AND RECOMMENDATIONS In the last five years the number of wellness programs has increased dramatically. One reason that wellness programs have proliferated is due to the concern people have for their health. The media has helped fuel this concern by reporting the importance of preventing illness rather than relying on being cured of disease after becoming afflicted. A person's lifestyle has been increasingly implicated in many diseases that afflict people today. Directors of wellness programs claim to address this issue of lifestyle and they also claim that people who participate in their programs have a tendency to feel better about themselves. Although these claims appear to be logical, no empirical data exist which support these claims. The primary purpose of this study was to investigate the changes that take place in lifestyle and self concept following the implementation of a well- defined wellness program. As stated in Chapter 1, three questions were considered pertinent: 1. What effect does a well-defined wellness program have on the lifestyle of an individual? 57 58 2. if a well-defined wellness program does have an effect on the lifestyle of an individual, is this effect temporary? 3. What effect does a well-defined wellness program have on the self concept of an individual? To assess the changes in lifestyle and self concept that might take place following the implementation of a well-defined wellness program, two instruments were used. The Lifestyle Assessment Questionnaire was used to assess lifestyle; and the Tennessee Self Concept Scale was used to assess self concept. The wellness program used in this study was considered to be a well- defined wellness program. The term, well-defined, was used because all programs that are called wellness programs do not include the same components. This study attempted to construct a wellness program that included the major components that all wellness programs include. From researching existing wellness programs, all programs included the components exercise, nutrition, and stress management. Most programs also included the spiritual dimension. Therefore, the well-defined wellness program implemented in this study included exercise, nutrition, stress management, and the spiritual dimension. The well-defined wellness program that was implemented in this study consisted of eight weeks of exercise and lectures. The exercise options consisted of walking/running, swimming, and aerobic dance. The subjects could choose one of the exercise options or use any combination of options but they were encouraged to exercise a minimum of three times a week. Lecture sessions 59 concerning exercise, nutrition, stress management, and the spiritual dimension were held one hour each week for eight weeks. Subjects who were enrolled in this program were adult men and women between the ages of 21 and 65, who resided in the Grand Rapids, Midiigan, area. Most of the subjects were relatively unfit as measured by the fitness test administered at the start of the program. The research design selected for this study was the pretest-posttest control-group with random assignment. This design allowed for control for the eight threats to internal validity (history, maturation, testing, instrumentation, regression selection, mortality, and the interaction effects). This study involved 90 subjects with 45 being randomly assigned to the experimental group and 45 being assigned to the control group. Both groups received the two testing instruments (Lifestyle Assessment Questionnaire, and the Tennessee Self Concept Scale) one week prior to the implementation of the program. At the completion of the eight-week program both grows again completed the testing instruments. Six months following the completion of the program the experimental group again took the Lifestyle Assessment Questionnaire. Due mainly to test attrition, data from forty experimental and forty controls was available for analysis. Based on the data collected and analyzed, the following statements for the subjects involved in this study can be made. 1. Participation in a well-defined wellness program changed the two lifestyle components, exercise and nutrition. Two lifestyle components, stress management and the spiritual dimension, were not 60 changed by participation in a well-defined wellness program. 2. Of the two lifestyle components (exercise and nutrition) that changed during the well-defined wellness program, the nutrition component did not change following a six-month time period. 3. Participation in a well-defined wellness program does positively affect a person's self concept. A word of caution must be used in generalizing the results of the data collected and reported in this study. The limitations of the study, as stated in Chapter 1, should be kept in mind. These limitations are: 1. The built-in bias of a volunteer grow. This grow may, therefore, differ from a random sample of people in the Grand Rapids, Michigan, area. 2. Various levels of previous exposure to exercise and positive lifestyle concept. 3. Reliability of self-assessment: the ability of individuals to accurately assess their own self concept and lifestyle. 61 INTERPRETATION AND CONCLUSIONS A discussion of the instruments used in this study and the results of the data collected from these instruments will be undertaken. Lifestyle Assessment Questionnaire The Lifestyle Assessment Questionnaire is organized into four sections: 1) Wellness Inventory; 2) Topics for Personal Growth; 3) Risk of Death; and 4) Alert Section: Medical/Behavioral] Emotional. This study used the Wellness Inventory section to assess the four components of lifestyle addressed. To obtain a score for each component the sum of the scores for each section were tabulated. The possible responses and points given are: A—Almost always this is true (90% of the time) = 5 points; B—Very frequently this is true (approximately 75% of the time) = 4 points; C—Frequently this is true (approximately 50% of the time) = 3 points; D-Occasionally this is true (approximately 25% of the time) = 2 points; E—Almost never is this true (less that 10% of the time) = 1 point. The pretest data for the experimental group and the control grow were very similar except for the exercise component. The mean score on the pretest for this component for the experimental grow was approximately 6 points lower than for the control group (31.300 for the experimental group to 37.650 for the control group). The posttest data for the experimental group was different from the control grow for the exercise and nutrition components. Therefore, Hypotheses 1.1 and 1.3, which addressed the exercise and nutrition components respectively, 62 were rejected. The posttest data for Hypotheses 1.2 (stress management) and 1.4 (spiritual) were not different and were accepted. The changes that resulted in the exercise and nutrition components might be explained by the fact that changes In both of these components are easy to recognize. When a person, especially an unfit person, exercises regularly over an eight-week period of time, the physiologial changes that occur are very easily recognized. The person's capacity to do more physical exercise increases during this time and this is easily recognizable. Muscle tone improves and this is also usually recognizable. A weight loss might occur and this is a factor which is easily documented. Changes involving nutrition are also very easily observable. When information is supplied which seems to help a person lead a more healthy life and the changes proposed are not too radial, many people, especially those people sufficiently interested in their health to become a participant in a wellness program, will change their lifestyle in regard to nutrition. Although the component of stress management did not seem to change between the control group and the experimental group, there did seem to be a trend. The mean score for the experimental group increased by over four points (86.650 pretest to 91.300 posttest) and the mean score for the control group decreased by more than three points (86.650 pretest to 83.150 posttest). One reason why the stress management component did not change might be due to the small emphasis placed on this component in this study. Two one-hour lectures were devoted to this component. Intervention techniques were explained but little time was spent in practicing these techniques. Another reason for no change might be due to the relatively short time of the wellness program (stress management was introduced during the fifth and sixth week). Eight weeks might 63 not be enough time to elicit changes in an area where the results are not as easily recognizable and concrete as exercise and nutrition. It also appears that the spiritual dimension component was not sufficiently stressed in the program. Only one hour was specifially devoted to this component. As with stress management, changes in this component probably take a longer time frame to elicit change. The post-posttest data of the experimental grow was different from the posttest data from the lifestyle component exercise. Therefore, Hypothesis 2.1, which stated that no difference in lifestyle will exist between the results of the experimental group immediately after completing a well-defined adult wellness program and six months following the program in the area of exercise, was rejected. Although the change in the exercise component following a six-month time period was different, the mean of the post-posttest data for exercise was still different when compared to the exercise pretest (31.300 pretest -- 45.0928 post-posttest, p (.001). This data seems to suggest that, although the persons involved in the program did regress somewhat from the mean scores they attained immediately following the program (49.255 - 45.0938), this regression did not approach the pretest mean (31.300). The post-posttest data of the experimental group was not different from the posttest data of the nutrition component. Therefore, Hypothesis 2.3, which addressed the lifestyle component nutrition, was accepted. The data from the post-posttest for nutrition seems to indiate that the gains the experimental grow made during the program were more than temporary gains. The similarly of the means between the posttest and the post-posttest data (53.800 posttest — 54.2813 64 post-posttest) does not even seem to indicate a trend toward a regression in the area after a six-months time period. Due to the fact that the lifestyle components, stress management and spiritual dimension did not change in Hypothesis number 1, it is irrelevant that Hypotheses 2.2 and 2.4 were accepted. Tennessee Self Concept Sale The Tennessee Self Concept Sale consists of 100 self-descriptive statements which provide a multi-dimensional description of the self. A grouping of these statements resulted in a two-dimensional, 3 x 5 scheme. The one dimension (horizontal rows) reports represent an internal frame of reference. These three measures are Identity (how the person sees himself), Self-Satisfaction (how the person accepts himself), and Behavior (how the person acts). The second dimension (vertial rows) report five sub-scores representing five aspects of self considered as a more external reference frame. These measures are Physical Self (how the person views his body), Moral-Ethial Self (how the person views his moral worth), Personal Self (how the person views his personal worth), Family Self (how the person feels in terms of adequacy, worth, and value as a family member), and Social Self (how the person sees his adequacy and worth in his social interactions with other people in general). The Total Positive Score (P), considered by the author of the Tennessee Self Concept Sale to be the single most important score, an be obtained by adding up the scores of the five vertical rows. The Total Positive Score (P) was used in this study to determine self concept. The five sub-scores which represent 65 Physial Self, Moral-Ethial Self, Personal Self, Family Self, and Social Self were analyzed to attempt to determine which specific aspects of the self were affected in this study. The pretest data for the control and experimental groups for the Total Positive Score (P) were not different (experimental 352.000 to 346.500 control). The posttest for the control and experimental groups, however, was significantly different (experimental 367.075 to 344.975 control, p<.001). This statistially significant difference (p<.001) resulted in the rejection of Hypothesis 3 which states that: no difference will exist in self concept of adults who participate in a well-defined adult wellness program and those who do not participate. Analysis of the five sub-scores revealed that the only sub-score which did not change between the control and experimental groups was the Moral-Ethical Self (posttest experimental 76.175 to posttest control 74.075, p<.100). The other four sub-scores, Physial Self (p<.001), Personal Self (p <.010), Family Self (p (.014), and Social Self (p (.016), did change. The changes that took place in four of the five sub-scores do seem to be logial changes if one analyzes the meaning given to each of these areas by the author of the Tennessee Self Concept Sale. Dr. Fitts describes Physial Self as the individual presenting his view of his body: his health, physial appearance, skills, and sexuality. A program which involved people in physical exercise and emphasized their role in well-being could be expected to result in a change in how a person views himself. Personal Self reflects the individual's sense of personal worth. Many studies have shown that exercise helps a person psychologially (Griest and Koslubala for example, as mentioned in Chapter II). The exercise portion of the wellness program might be part of the explanation for the 66 significant positive change in the Personal Self. Family Self reflects a person's feeling of adequacy, worth, and value as a family member. It is possible that as a person feels better about his or her Physical Self, which might have been brought about by a heightened awareness of his or her own body and increased physial vitality, the Family Self could be positively affected. Social Self reflects the person's sense of adequacy and worth in relation to his interactions with other people. The fact that the program in which these people were involved was a group venture might help to explain the positive change in this area. The exercise sessions were structured so that social interaction took place. People were encouraged to get to know all the people in the group. The walking/ruming, and aerobic exercise sessions did include much social interaction among the participants. The sub-score which did not change, Moral-Ethial Self, presents an interesting phenomenon. The Moral-Ethial Self reflects the moral worth of a person, the relationship to God, the feelings of what type of person one is (good or bad) and the satisfaction a person has with his or her religion or lack of religion. An interesting relationship might exist between this sub-area of self concept data and the spiritual dimension data from the Lifestyle section of this study. Both areas seem to deal with the same general subject. The fact that both areas did not change might show a weakness in this wellness program in regard to this area. The time devoted to this area, as stated previously, was minimal; and in order for this area to be changed, greater emphasis might have to be given throughout the wellness program. A general review of the data on self concept identified a phenomenon which was difficult to rationally explain. The Total Positive Scores for the 67 control group actually went down over the eight-week period (pretest 346.500-- posttest 344.975). Although the shift was not statistially different, it was thought that if any change took place it would be in a positive manner. The reason for this expected positive shift had to do with the time of year. The program originated in February (mid-winter) and concluded the first of April. After the drudgeries of winter it might be expected that springtime might elicit an increase in the Total Positive Score. Investigation as to how the negative trend might be explained uncovered the fact that springtime is not a time of the year that is regarded by psychologists as a high point psychologially for many people. In fact, statistics on suicide77 reveal that April and May are the months when most suicides occur. Further support to the argument that spring is not such a glorious time of the year is given by T.S. Eliot. In his poem "The Wasteland"78 Eliot calls April the "cruelest month." REFLECTIONS At this point of the dissertation this investigator would like to reflect on some issues that go beyond the design of this study. One factor which surprised this investigator and other persons involved in working with adults was the attendance of the swjects at the lecture and exercise sessions. This investigator feels that the positive results of the study were due in large part to the fact that the swjects stayed involved in all facets of the program from start to finish. Some reasons that might have contributed to this high attendance rate follow: 68 1. The subjects were introduced to each other and they were encouraged to get to know ead'i other better. Exercise sessions were structured so that communication between subjects was convenient. 2. The instructor knew everybody's name and made it a point to communicate with each individual every session. 3. The lectures were structured but input by the subjects was encouraged. 4. Role was taken at each lecture and exercise session and if a person missed a session the instructor would make a point of contacting such persons and letting them know they were missed. This investigator feels that the above reasons contributed to a building of a camaraderie among the subjects and should be incorporated into any wellness program. This feeling of devotion to the grow was exemplified one morning when the city of Grand Rapids was virtually shut down by a snowstorm. Of the 20 subjects who regularly exercised at 7:00 a.m., 14 were present that morning. The subjects who did not show up were those who lived at least eight miles from the exercise facility. This fact, however, did not allow them to esape the good- natured kidding from those who were present at this exercise session. The feedback from some of the subjects involved in this program has convinced this investigator of the importance of making people aware of what they an do to enhance their well-being. A lawyer who was involved in this 69 program has lost 30 pounds and has reached his ideal body weight. This lawyer claims that his energy level has increased dramatially and that he feels very much more positively about himself. A professor from Calvin College, where the program was conducted, lost 20 pounds and was pleased by that but he was most impressed by the release of tensions that exercise brought about. He related that he used to become very tense from teaching but when he exercised for 30 to 45 minutes in the morning before his classes he was much more relaxed in class. This professor's daughter, who was a member of one of the investigator's classes, related that her father used to come home from teaching with headaches almost every day. Since her father has been involved in this program, she has noticed that he is more relaxed and does not seem to be bothered by headaches. Another positive contribution a wellness program like this one has is the uncovering of potentially dangerous health problems. Three people who had wanted to become involved in the program were found to have medial problems of which they were not aware. By uncovering these problems and having these people referred to the proper medial authorities, serious health consequences were most likely avoided. One major weakness of this program was the fact that no organized plan was established to continue the exercise sessions on a regular basis once the program was completed. The feedback that this investigator received from some of the swjects was that they would have liked to continue meeting as a grow to continue their exercise program. The persons involved in the aerobic dance exercise sessions asked if a class could be held in the fall so they could continue to be involved in an exercise program they enjoyed. Of the 25 subjects who participated in aerobic dance during the study, 20 are currently involved in the 70 aerobic dance class they requested. This investigator feels strongly that provisions should be made so that those people who are involved in a wellness program have an opportunity to continue to experience the group dynamics which seem to help motivate them to continue to be active. The reader an so doubt sense that this investigator feels that wellness programs have the potential to do a tremendous amount of good for the adults who avail themselves of this service. This investigator feels, however, that the type of program conducted for this study could have a greater impact on the health of individuals if it involved people at a much younger age. This basic program, with a few modifiations, could be conducted at the elementary school level. RECOMMENDATIONS As a result of this study, the following recommendations for further study are made: 1. Study the effect of a wellness program on lifestyle and self concept when the program continues for a longer time span. A longer program (10-12 weeks) might produce different results, especially in regard to the lifestyle components of stress management and the spiritual dimension. 2. Study the effect of support groups who continue to meet after the formal wellness program is completed. 71 Conduct a longitudinal study on the effects of a wellness program. This study evaluated the lifestyle changes that remained six months following the completion of a wellness program. Follow-up data gathered one and two years later could give a more clear picture of the permanency of changes that took place following a wellness program. Study the effects of a wellness program on senior citizens (62 and older). As our population becomes older, positive changes in the lifestyle and self concept of these senior citizens (if they occur) could be a very positive contribution to society. Study the effect of introducing the lifestyle components of stress management and the spiritual dimension earlier in the wellness program. It would be interesting to determine if more emphasis placed on these components would result in a significant change. Study the effect of introducing this type of wellness program at the elementary level. APPENDICES APPENDIX A Promotional Material 72 WELLNESS PROGRAM The Calvin College Adult and Continuing Eduation Program, in cooperation with Life Wellness (a division of Human Resources Association) will be offering two eight-week health promotion programs in early 1985. One eight- week program will begin the week of February 3 and end March 29. The other eight-week program will begin the week of April 7 and end May 31. COMPONENTS'OF THE PROGRAM A sub-maximal, multi-stage exercise test on a stationary bicycle (performance 2000 exercise computer) to predict fitness level. This test will also be given at the completion of the program to determine any changes in fitness level. Exercise prescription based on exercise test. Blood analysis: The Cardio-screen Profile performed on the asymptomatic person can facilitate the diagnosis of coronary heart disease risk. Body composition: a skinfold aliper is used to determine body composition. This test will be given at the start of the program and also after the completion of program. Health History. Exercise sessions: The participants may choose the exercise program they would like to become involved in from the following: -- Swimming or walking/jogging on Monday/Wednesday/Friday from 7-8:00 a.m. or 12:30-1:30 p.m. - Aerobic dance on Tuesday and Thursday from 12:30-1: 30 p.m. (men and women) A minimum of three workouts a week should be the goal. Any combination of the above workouts is possible. Lecture/Discussions Sessions: The participants may choose to come either Monday or Tuesday night for informational sessions in the areas of exercise, diet and nutrition, stress management and the spiritual dimension (eight sessions). (continued) 73 COST OF PROGRAM Due to the fact that we plan to evaluate this program and the participants would be involved in this evaluation the cost will be $65.00 instead of 2140.00. When this program is offered in the Fall of 1985 the cost will be between 140.00—$150.00. The only "extra" that will be asked of those participants who agree to be part of this evaluation are the following: 1. Be randomly assigned to either of the eight-week programs (for statistial purposes). If your schedule does not allow you to be randomly assigned to either eight-week program you could specify which session you could participate in and if your name happens to be assigned to the "right" session you will be notified. 2. Take two written instruments (multiple choice) before the program begins and also after the program is completed. The pretest will be given at the organizational meeting that is part of the regular program and will take about one-half hour to complete. 3. Sign a consent from which will allow us to use the data collected in an evaluation of the program. A coding system will be used so that the confidentiality of the data will be assured. APPLICATION NAME ' ' “ BIRTHDATE BUS. PHONE HOME ADDRESS ‘ HOME PHONE Night you could attend weekly lecture/discussion session: Monday Tuesday Either Type of activity you would like to participate in. Walking/jo ging (M-W-F, 7-8 or 12:30—1:30) Swimming M-W-F, 7-8 or 12:30 -1:30) Aerobic Dance (Tu-Th, 12:30-1: 30) I would be able to participate in either session. I would only be able to participate in the first session (Feb. 3 - March 29) lwould only be able to participate in the second session (April 7 - May 31) Send application to: Ralph Honderd Physical Eduation Department Calvin College Grand Rapids, MI 49506 Enrollment is limited! Appliations will be processed as they arrive! APPENDIX B Reply Letter to Participants 74 Dear Wellness Participant: This letter is your confirmation that you have been selected from the appliations received to participate in the wellness program offered by the Adult and Continuing Eduation Program of Calvin College. We are excited about the program and are looking forward to your participation in the program. Due to the random assignment of participants for statistial purposes of the study to be conducted, you have been assigned to the following session: First session -- Feb. 4 to March 29 Second session - April 8 to May 31 if this assignment does not allow you to participate, please all Ralph Honderd at 957-6020 as soon as possible so that somebody from the waiting list may be substituted for you. All participants, from both sessions, must attend gn_e_ on the organizational meetings that will be held. In order to give you some options, the following dates are when this organizational meeting will be held: Monday, Jan. 21 from 7-8 p.m. -— Room C-301 College Center Tuesday, Jan. 22 from 7-8 p.m. - Room C-301 College Center Thursday, Jan. 24 from 7-8 p.m. -- Room C-301 College Center At these times the program will be explained. If you an not attend gr_3_e_ of these meetings please all Ralph Honderd at 957-6020 so special arrangements may be made. Payment for those involved in either session should be made at the organizational meeting that you attend (Jan. 21, 22, or 23). Sincerely, Ralph Honderd RH i APPENDIX C Post-Posttest Contact Letter Concerning the Lifestyle Assessment Questionnaire 75 Dear Wellness Participant: Six months have passed since you were involved in the wellness program offered by the Adult and Continuing Eduation Program of Calvin College. Hopefully this letter finds you "well." The results of the data collected so far have been very exciting to me. I have really enjoyed the program and have learned much. There is one remaining task, however, that remains to be completed and i ask for your cooperation. In fact, this last task is very important so I would ask you to p lease take time right away to complete the test instrument and return it as soon as possible. Ihave no way of determining who returns the material so it will be impossible to send individual reminder letters. Hopefully, 1 will complete the analysis of the data by early November and would be willing to send you a summary of the study if you would like to have this information. Thank you in advance for your cooperation. Sincerely, Ralph Honderd RH/de Enclosures APPENDIX D Health History and Status Form 76 Health History and Status Form Name ' ‘ ‘ ' Sex( )M( )F Last First Middle Address Street L1. , . .L H . W City State Zip P ne Present Age ' Date of Birth Month Day Year OCCUPATIONAL INFORMATION Current Job Title Type of industry or business Approximate number of hours worked per week On a sale of 1 (least) to 10 (most), rate the following: responsibility ' job stress Person to notify in ase of an emergency: Name ' ‘ ' Relationship Telephone “ Your private physician providing consent for this program: Name Address (Street) (City) (State) (Zip) Telephone 77 Would you like us to send your physician a report of your tests ( ) Yes ( )No Please check "YES" or "NO" for EACH question YES NO 1. 2. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. Has your physician told you that you have high blood pressure? Do you ever have pains in your heart or chest? Are you ever bothered by thumping of your heart when not exercising? Does your heart ever beat rapidly when you are not exercising? Do you ever notice extra heartbeats or skipped beats? Has a doctor every said that you have or have had heart trouble or an abnormal electroardiogram (ECG or EKG)? Have you ever had a heart attack or coronary? Do you suffer from cramps in your legs? Do you ever have difficulty breathing? Do you sometimes have difficulty breathing when sitting still or sleeping? Has a doctor ever told you that your blood cholesterol or triglyceride level was high? Do you frequently feel faint or dizzy? Has you physician told you that you have a bone or joint problem, such as arthritis, that might be aggravated by exercise? Is there a good physial reason not listed here why you could not follow an activity program? Are you over age 65 and not accustomed to vigorous exercise? Are you presently taking medication? Are you diabetic? Are you pregnant? Do you have a chronic recurrent or morning cough? Do you have problems with recurrent fatigue? Do you have migraine or recurrent headaches? Do you ever have swollen or painful knees or ankles? Do you ever have swollen, stiff or painful joints? Do you ever have chronic back pain? Please list any other health problems “A A AA A AAAAAAAAAA vv V vv VV V VVVV vvvvvvvvvv “A A AA AA A AAAA AAAAAAAAAA A A VV V vv vv v vvvv Vvvvvvvvvv 78 Were you ever told by a doctor that you had any of the following conditions. Please check, for each condition, whether you never had it, had it in the past, or have it now. A doctor told me I had this My doctor condition, but told me I i never had I no longer have this this condition. have it. condition now. 1. Abnormal chest x-ray ( ) ( ) ( ) 2. Alcoholism or drug dependency ( ) ( ) ( ) 3. Allergy ( ) ( ) ( ) 4. Anemia ( ) ( ) ( ) 5. Arthritis ( 7 ( ) ( 7 6. Asthma ( ) ( ) ( ) 7. Broken bones ( ) ( ) ( ) 8. Cancer of the bladder ( ) ( ) ( ) 9. Cancer of the breast ( ) ( ) ( ) 10. Cancer of the colon or rectum ( ) ( ) ( ) 11. Cancer of the lung ( ) ( ) ( ) 12. Cancer of the prostate ( ) ( ) ( ) 13. Cancer of the uterus or cervix ( ) ( ) ( ) l4. Cirrhosis of the liver ( ) ( ) ( ) 15. Emphysema or Bronchitis ( ) ( ) ( ) l6. Epilepsy ( ) ( ) ( ) l7. Gout ( ) ( ) ( ) 18. Injuries to back, arms, legs, or joints ( ) ) l9. Kidney disease ( ) ) 20. Nervous breakdown or other mental disorder ( ) ( ) ( ) 21. Obesity ( ) ( ) ( ) 22. Pancreatitis ( ) ( ) ( ) 23. Phlebitis ( ) ( ) ( ) 24. Pneumonia ( ) ( ) ( ) 25. Polio ( ) ( ) ( ) 26. Rheumatic Heart Disease ( ) ( ) ( ) 27. Stroke ( ) ( ) ( ) 28. Ulcers of the stomach or small intestine ( ) ( ) ( ) 29. Varicose veins ( ) ( ) ( ) 30. Vitamin deficiency ( ) ( ) ( ) APPENDIX E Informed Consent Letter 79 EXPERIMENTAL GROUP INFORMED CONSENT FORM In recognition of the need to evaluate my present fitness level for the purpose of prescribing exercise, I hereby consent voluntarily to a multi-stage exercise test on a stationary bicycle to be given by the Calvin College Adult and Continuing Eduation Wellness Program. i understand that the exercise program will consist of fitness exercises based won the results of the recommendations of the directors of the Calvin College Adult and Continuing Eduation Wellness Program, and while I understand that there will be professional are, selection and swervision, there are certain risks involved. I understand that the recommendations will not exceed the limits as determined by my personal physician and will be mutually satisfactory to both my personal physician and the Directors of the Calvin Adult Health Promotion Program. I realize that these risks exist even though there will be adequate preautionary measures to reduce or eliminate such problem. I understand that in the unlikely event of injury resulting from research procedures, Michigan State University, its agents and employees will assume that responsibility as required by law. I have been advised that I should look toward my own health insurance program for payment of said medical expenses. 1 consent to be a participant in this program but lam guaranteed the right to withdraw without penalty from the program at any time that I desire to. My records will be held in strict confidence, to be used only by the Directors of the Calvin College Adult and Continuing Eduation Wellness Program. Finally, 1 permit registration of my data involving my responses to the Tennessee Self Concept Sale and Lifestyle Assessment Questionnaire, anonymously to be used by Ralph Honderd in his dissertation. Signed Date 80 CONTROL GROUP INFORMED CONSENT FORM 1 consent to allow my results from taking the Tennessee Self Concept Sale and the Lifestyle Assessment Questionnaire (both pre and post tests) to be used anonymously by Ralph Honderd in his dissertation. Signed Date APPENDIX F Study Instruments 81 LIFESTYLE ASSESSMENT QUESTIONNAIRE (LAQ) 82 INSTRUCTIONS: This section will help determine the current level of wellness that you are experiencing. We hope that it will also give you ideas for areas in which you might improve. Please respond to these statements using the following choices marking your responses on the attached answer sheet using a #2 pencil only. A - Almost always this is true (90% of more of the time) B - Very frequently this is true (approximately 75% of the time) C - Frequently this is true (approximately 50% of the time) D - Ocasionally this is true (approximately 25% of the time) E - Almost never is this true (less that 10% of the time) - If item does not apply to you do not mark item PHYSICAL EXERCISE—Measures one's commitment to maintaining physical fitness. lexercise vigorously for at least 20 minutes three or more times per week. I determine my activity level by monitoring my heart rate. 1 stop exercising before I feel exhausted. I approach exercise in a relaxed manner. I stretch before exercising. I stretch after exercising. Iwalk or bike whenever possible. When feeling tired, i arrange for sufficient sleep. I participate in a strenuous sport (tennis, running, swimming, handball, basketball, etc.) 10. 1 use foot gear of good quality, designed for the activity in which i participate. 11. If [am not in shape, I avoid sporadic (once a week or less often) strenuous exercise. 12. After vigorous exercise, 1 "cool down" (very light exercise such as walking) for at least five minutes before sitting or lying down. PPNP‘PFP’P?‘ NUTRITION—Measures the degree to which one chooses foods that are consistent with the dietary goals of the United States as pwlished by the Senate Select Committee on Nutrition and Human Needs. 13. When choosing non-vegetable protein, 1 select lean cuts of meat, poultry and fish. 14. 1 maintain an appropriate weight for my height and frame. 15. l minimize salt intake. 16. leat fruits and vegetables fresh and uncooked. 17. I eat breakfast. 83 18. l intentionally include fiber in my diet or a daily basis. 19. I drink enough fluid to keep by urine light yellow. 20. I plan my diet to insure an adequate amount of vitamins and minerals. 21. l minimize foods in my diet that contain large amounts of refined flour (bleached white flour, typical store bread, cakes, etc.) 22. 1 minimize my intake of fats and oils including margarine and animal fats. 23. I include items from all four basic food groups in my diet each day (fruits and vegetables; milk group; breads and cereals; meat, fowl, fish or vegetable proteins). 24. Todayrl‘fid unnecessary alories, I choose water as one of the beverages I r . 25. I avoid adding sugar to my food and 1 minimize my intake of pre-sweetened foods such as sugarcoated cereals, syrws, chocolate milk, and most processed and fast foods. STRESS MANAGEM ENT—Measures the apacity to appropriately control one's feelings and related behaviors including the realistic assessment of one's limitations. 26. I am able to be open with those with whom lam close. 27. I an express my feelings of anger. 28. Ian express my feelings of sadness. 29. 1 an express my feelings of happiness. 30. Ian express my feelings of fear. 31. I can compliment my self for a job well done. 32. I accept constructive criticism without reacting defensively. 33. I recognize that I an have wide variations of feelings about the same person (such as loving someone even though you are angry with her/him at the moment). 34. I am able to develop close, intimate relationships. 35. I make conscious decisions about my sexual activity based on personal/spiritual values. 36. I stid< to the limits I set for myself. 37. Ian say "no" without feeling guilty. 38. I would feel comfortable seeking professional help to better understand and cope with my feelings. 39. I set realistic objectives for m self. 40. Ian relax my body and mind without using drugs). 41. I an be alone without feeling lonely. 42. lam able to be spontaneous in expressing my feelings. 43. I accept responsibility for my actions. 44. lam willing to take the risks that come with making change. 45. I manage my feelings to avoid unnecessary suffering. 46. I make decisions with a minimum of stress and worry. 47. I accept the responsibility for creating my own feelings. 84 SPIRITUAL-Measures one's ongoing involvement in seeking meaning and purpose in human existence. It includes an appreciation for the depth and expanse of life and natural forces that exist in the universe. as. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. I feel good about my spiritual life. Prayer, meditation, and/or quiet personal reflection is/are important part(s) of my life. Icontemplate my purpose in life. I reflect on the meaning of events in my life. My values guide my daily life. My values and beliefs help me to meet daily challenges. I recognize that my spiritual growth is a lifelong process. lam concerned about humanitarian issues. i enjoy participating in discussions about spiritual values. I feel a sense of compassion to others in need. I seek spiritual knowledge. My spiritual awareness occurs other than at times of crisis. I believe in something greater or that lam part of something greater than myself. I share my spiritual values. 85 TENNESSEE SELF CONCEPT SCALE 86 INSTRUCTIONS On the top line of the separate answer sheet, fill in your name and the other information except for the time information in the last three boxes. You will fill these boxes in later. Write only on the answer sheet. Do not put any marks in this booklet. The statements in this booklet are to help you describe yourself as you see yourself. Please respond to them as if you were describing yourself _tg ourself. Do not omit'any item! Read each statement carefully; then select one of tHE five responses listed below. On your answer sheet, put a circle around the response you chose. If you want to change an answer after you have circled it, do not erase it but put an _)_(_ through the response and then circle the response you want. When you are ready to start, find the box on your answer sheet marked time started and record the time. When you are finished, record the time finished in the box on your answer sheet marked time finished. As you start, be sure that your answer sheet and this booklet are lined w evenly so that the item numbers match each other. Remember, put a circle around the response number you have chosen for each statement. Completely Mostly Partly false Mostly Completely false false and true true partly true Responses 1 2 3 4 5 You will find these response numbers repeated at the bottom of each page to help you remember them. 87 1. I have a healthy body. 3. 1am an attractive person. 5. I consider myself a sloppy person. 19. lam a decent sort of person. 21. lam an honest person. 23. I am a bad person. 37. I am a cheerful person. 39. lam a calm and easy going person. 41. lam a nobody. 55. I have a family that would always help me in any kind of trouble. 57. I am a member of a happy family. 59. My friends have no confidence in me. 73. I am a friendly person. 75. 1am popular with men. 77. lam not interested in what other people do. 91. 1 do not always tell the truth. 93. 1 get angry sometimes. Completely Mostly Partly false Mostly Completely false false and true true partly true Responses 1 2 3 4 5 88 2. 1 like to look nice and neat all the time. 4. I am full of aches and pains. 6. I am a sick person. 20. lam a religious person. 22. 1am a moral failure. 24. I am a morally weak person. 38. l have a lot of self-control. 40. lam a hateful person. 42. lam losing my mind. 56. lam an important person to my friends and family. 58. 1am not loved by my family. 60. I feel that my family doesn't trust me. 74. I am popular with women. 76. I am mad at the whole world. 78. lam hard to be friendly with. 92. Once 111 a while I think of things too bad to talk about. 94. Sometimes, when lam not feeling well, lam cross. Completely Mostly Partly false Mostly Completely false false and true true partly true Responses 1 2 3 4 5 89 7. lam neither too fat or too thin. 9. I like my looks just the way they are. 11. I would like to change some parts of my body. 25. 1am satisfied with my moral behavior. 27. I am satisfied with my relationship with God. 29. I ought to go to church more. 43. lam satisfied to be just what lam. 45. I am just as nice as I should be. 47. ldespise myself. 61. lam satisfied with my family relationships. 63. I understand my family as well as I should. 65. Ishould trust my family more. 79. lam as sociable as I want to be. 81. I try to please others, but I don't overdo it. 83. 1am no good at all from a social standpoint. 95. 1 do not like everyone I know. 97. Once in a while, I laugh at a dirty joke. Completely Mostly Partly false Mostly Completely false false and true true partly true Responses 1 2 3 4 5 90 8. lam neither too tall nor too short. 10. i don't feel as well as I should. 12. I should have more sex appeal. 26. lam as religious as I want to be. 28. 1 wish I could be more trustworthy. 30. lshouldn't tell so many lies. 44. i am as smart as I want to be. 46. lam not the person I would like to be. 48. 1 wish ldich't give up as easily as I do. 62. I treat my parents as well as i should (Use past tense if parents are not living) 64. 1am too sensitive to things my family say 66. Ishould love my family more. 80. 1am satisfied with the way I treat other people. 82. I should be more polite to others. 84. I ought to get along better with other people. 96. lgossip a little at times. 98. At times I feel like swearing. Completely Mostly Partly false Mostly Completely false false and true true partly true Responses 1 2 3 4 5 91 13. I take good care of myself physially. 15. 1 try to be areful about my appearance. 17. Ioften act like 1am "all thumbs." 31. lam true to my religion in my everyday life. 33. 1 try to change when I know I'm doing things that are wrong. 35. I sometimes do very bad things. 49. I can always take are of myself in any situation. 51. I take the blame for things without getting mad. 53. 1 do things without thinking about them first. 67. ltry to play fair with my friends and family. 69. I take a real interest in my family. 71. Igive In to my parents. (Use part tense if parents are not living) 85. I try to understand the other fellow's point of view. 87. lget along well with other people. 89. I do not forgive others easily. 99. lwould rather win than lose in a game. Completely Mostly Partly false Mostly Completely false false and true true partly true Responses 1 2 3 4 5 14. 16. l 8. 32. 34. 36. 50. 52. 54. 68. 70. 72. 86. 88. 90. 100. 92 I feel good most of the time. I do poorly in sports and games. lam a poor sleeper. ldo what is right most of the time. I sometimes use unfair means to get ahead. I have trouble doing the things that are right. I solve my problems quite easily. ichange my mind a lot. I try to run away from my problems. 1 do my share of work at home. I quarrel with my family. ldo not act like my family thinks I should. 1 see good points in all the people 1 meet. I do not feel as ease with other people. I find it hard to talk with strangers. Once in a while 1 put off until tomorrow what 1 ought to do today. Completely Mostly Partly false Mostly Completely false false and true true partly true Responses 1 2 3 4 5 REFERENCES 10. ll. 12. 13. 14. 93 REFERENCES Economic Report of the President, transmitted to Congress, January, 1980. U.S. Government Printing Office, p. 203. DHHS, Health—United States, Washington, D.C.: Government Printing Office, DHHS PM). No. (PHS) 82-1232, 1981. Naisbitt, John, Megatrends, New York: Warner Books, Inc., 1982. Ibid., p. 137. Fixx, James, The Complete Book of Running, New York: Random House, Inc., 1977. Morgan, W.P., and Pollock, M.L., "Physial Activity and Cardiovascular Health: Psychologial Aspects." Invited paper presented at the International Congress of Physical Activity Sciences, Quebec City, July 12, 1976. Kostrubala, T., The Joy of Running, New York: J.B. Lippincott, 1976. Bernstein, J.K., James, K., Duff, J.L., "Individual Responsibility for Health and Access to Health Information." Future Directors for Health and Healing Conference sponsored by the Science Museum of Minnesota, Feb. 18, 1978. Belloc, N.B., and Breslow, L. "Relationship of Physial Health Status and Health Practices," Preventive Medicine 1:409-21, 1972. Breslow, L., and Enstrom, J.E., "Persistence of Health Habits and Their Relationship to Mortality," Preventive Medicine 9:469-83, 1980. Wiley, J.A., and Camacho, T.C., "Life-Style and Future Health: Evidence from the Alameda County Study," Preventive Medicine 9:1-21, 1980. Wingard, D.L., Berkman, L.J., and Brand, R.J., "A Multivariate Analysis of Health-Related Practices: A Nine-Year Mortality Follow-Up of the Alameda County Study," Amerian Journal of EpidemiOlogy, 116:165-75, 1982. Harris, L., and Associates, "Health Maintenance," California: Pacific Mutual Life Insurance Company, 1978. Lamb, L.E., Stay Youthfu1 and Fit, New York: Harper and Row Publishers, 1974. 15. 16. l7. 18. 19. 20. 21. 22. 23. 24. 25. 26. 91 Blair, S.N., Collingwood, Reynolds, R., Smith, M., Hogan, D., and Sterling, C.L., "Health Promotion for Eduators: Impact on Health Behaviors, Satisfaction, and General Well-Being," Amerian Journal of Public Health, Vol. 74, No. 2, 147-149, Feb., 1984. "American Fitness Binge." U.S. News and World Report, 58—62, May 1982. Kaplan, J. P., Powell, K.E., Sikes, R.K., Shirley, R.W., and Campbell, C.C., "An Epidemiologic Study of the Benefits and Risks of Running," Journal of American Medial Association, 248: 3118-3131, 1982. Morris, J.N., Raffle, P.A.B., Roberts, C.G., and Parks, J.W., "Coronary Hearth Disease and Physical Activity of Work," Lancet, 265: 1053-57, 1953. Ibid., p. 1056. Ibid., p. 1057. Paffenbarger, R.S., Jr., Laughlin, M.E., Gima, A.S., and Black, R.A., "Work Activity of Longshoreman as Related to Death from Coronary Heart Disease and Stroke," New England Journal of Medicine, 282:1109-1114, 1970. likel, W.J., Lewis, R.H., Enterline, P.E., Painter, R.C., Ralston, L.S., Fawcett, R.M., Meredith, A.P., and Peterson, B., "A Short-term Community Study of the Epidemiology of Coronary Heart Disease," A preliminary report on the North Dakota Study. Amerian Journal of Public Health, 49:1630-1639, 1959. Taylor, H.L., Klepetan, E., Keys, A., Parlin, M.S., Blackburn, H., and Puchner, T., "Death Rates Among Physially Active and Sedentary Employees of the Railroad Industry." Amerian Journal of Public Health, 52: 1697- 1707, 1962. Paffenbarger, B.S., Jr., Hyde, R.T., Wing, A.L., and Steinmetz, C.H., "A National History of Athleticism and Cardiovascular Health," Journal of Merian Medial Association, 252(4): 491, 1984. Kannel, W.M., and Sorlie, P., "Some Health Benefits of Physial Activity: The Framingham Study." Archives of Internal Medicine, 139: 857-861, 1979. Dawber, T. R., "The Framingham Study," The Epidemiology of Atherosclerotic D___i________,sease Cambridge, Mass.: Harvard University Press, 151-171,1980. Magnus, L, Matroos, A., and Stracka, J., "Walking, Cycling, or Gardening with or without Seasonal Interrwtion in Relation to Acute Coronary Events." Amerian Journal 'Of Epidem'iOIORY, 110: 724-733, 1979. 28. 29. 30. 31. 32. 33. 35. 36. 37. 38. 39. 40. 41. 95 Salonen, J.T., Puska, P. and Tuomilehto, J. "Physial Activity and Risk of Myoardial Infarction, Cerebral Stroke and Death: A Longitudinal Study in Eastern Finland." Amerian Journal of Epidemiology, 115: 526-537, 1982. Keys, A. Seven Countries: Death and Coronary Heartgisease in Ten Years." Cambridge, Mass.: Harvard University Press, 1980. Marmot, M.G., Syme, S.L., Kagan, A., Kato, H., Cohen, J.B., and Belsky, J. "Epidemiological Studies of Coronary Heart Disease and Stroke in Japanese Men Living in Japan, Hawaii and California: Prevalence of Coronary and Hypertensive Heart Disease and Associated Risk Factors." American Journal of EpidemiOlogy, 102: 514-525, 1975. Gordon, T., Garcia-Palmeri, M.R., Kagan, A., Kannel, W.B., and Schiffman, J. "Differences in Coronary Heart Disease in Framingham, Honolulu, and Puerto Rico." Journal of Chronic Diseases, 27: 329-344, 1974. The Pooling Project Research Grow. "Relationship of Blood Pressure, Serum Cholesterol, Smoking Habits, Relative Weight, and ECG Abnormalities to incidence of Major Coronary Events: Final Report of the Pooling Projects." Journal of ChrOnic Diseases, 31:201-306, 1978. Connor, S.J., and Connor, W.E. "The Importance of Dietary Cholesterol in Coronary Heart Disease." Preventive Medicine, 12:115-123, 1983. Ibid., p. 120. Whelan, B., "Cancer and Diet: Making the Link," Journal Of Nursing Care, 11:24-30, 1978. Hiroyama, T., "Diet and Cancer," Nutrition and CanceL 1:67-81, 1979. D011, R., "Nutrition and Cancer, 35-45," Medial World News, 23, 1982. Council for Agricultural Sciences and Technology. "Diet, Nutrition, and Cancer: A Critique." Special Pwliation No. 13, Ames, lowa: Council for Agricultural Sciences and Technology, 1982. Committee on Diet, Nutrition, and Cancer, Assembly of Life Sciences, National Research Council, Diet, Nutrition, and Cancer, Washington, D.C.: National Aademy Press, 1982. Friedman, M., Rosenman, R.H., and Corral, V., "Changes in Serum Cholesterol and Blood Clotting Time in Men Slbjected to Cyclic Variations of Occupational Stress," Circulation, 17:852, 1958. Grundy, S.M., and Griffin, A.C., "Effects of Periodic Menal Stress on Serum Cholesterol Levels," Circulation, 19:496, 1959. 42. 43. an. 34. 46. 47. 48. 49. 50. 51. 52. 96 Friedman, M., and Rosenman, R.H. Type A Behavior and Your Heart. Greenwich, Conn: Fawcett, 1974. Sparcino, J., "The Type A Behavior Pattern: A Critial Assessment," Journal of Human Stress, 5:37-51, 1979. Riley, V., "Mouse Mammary Tumors: An Alteration of Incidence as Apparent Function of Stress," Science, 189:465-467, 1975. Solomon, G.L, Amkrout, A.A., and Kasper, P., "Immunity, Emotions and Stress" (with special reference to the mechanisms of stress effects on the immune system). Psychotherapy and Psychosomatics, 23: 209-217, 1974. Holmes, T.H., and Rahe, R.H., "The Social Readjustment Rating Sale," Journal of Psychosomatic Research, 11:213-218, 1967. Lundberg, V., Theorell, T. and Lind, 13., "Life Changes and Myoardial Infarction: Individual Differences in Life Change Saling," Journal of Psychosomatic Research, 19:27-32, 1975. Theorell, T., and Rahe, R., "Life-Change Events. Ballislocardiography and Coronary Death," Journal of Human Stress, 1:18-24, 1975. Masuda, M., "Life Events and Prisoners," Archives of General Psychiatry, 35:197-203, 1978. Dunn, H.L., High Level Wellness, Washington, D.C.: Mt. Vernon Publishing Co., 1961. Hoyman, R., "Rethinking an Ecologial System of Man's Health, Disease, Aging, Death," Journal of School Health, 45:509-518, 1975. Sorochan, W.D., "Health Concepts as a Basis for Orthobiosis," Journal of School Health, 38:678-679, 1968. Lafferty, J., "A Credo for Wellness," Health Eduation, 10:10-11, 1979. Tillid1, P. Dynamics of Faith, vol. 10, World Perspective Series. New York: Harper and Brothers, 1957. Benson, Herbert. The Relaxation Regonse. New York: Avon, 1976. Benson, Herbert. Beyond the Relaxation Response, New York: Time Books, 1984. Peale, Norman V. The Power of Positive Thinking. New York: Prentice- Hall, 1952. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 6 9. 70. 97 Ibid. Ibid. Plato. The Republic. Cleveland: Fund Editions Press, 1946. Morgan, W.P. "Psychologial Considerations," Journal of Health, Physial Eduation, and Recreation, 39:26-28, 1968. Greist, J.H., "Running as Treatment of Depression," unpwlished research, Department of Psychiatry, University of Wisconsin, Madison, 1978. Crocitto, J.A., "The Relationship of Jogging to Self Concept and Meaningful Existence." (Doctoral Dissertation, George Washington University, 1981), Dissertation Abstracts International, 42(9), 3870A, 1982. Smith, R.D., "The Relationship between Exercise, Self Concept, and Body Image. (Doctoral Dissertation, United States International University, 1982). Qissertation‘Abstracts International, 43(2) 536B, 1982. Rhodes, D.L., "Mens Sano, Corpore Sam: A Study of the Effects of Jogging on Depression, Anxiety, and Self Concept." (Doctoral dissertation, Dike University, 1980). Dissertation Abstracts International, 41(4) 1500A, 1980. Collingwood, T.R., "The Effects of Physical Training upon Behavior and Self Attitudes," Journal of Clinial ngchology, 28:583-585, 1972. Hilyer, J.C.V.R., and Mitchell, W. "Effects of Systematic Physial Fitness Training Combined with Counseling on the Self-Concept of College Students," Journal of Counseling ngchology, 26: 5,427-436, 1979. Wadden, T.A., Foster, G.O., Brownell, K.O., and Finley, E., "Self-Concept in Obese and Normal-Weight Children," Journal of Consulting and Clinial ngchdlogy, 52:6,1104-1105, i984. Savin, E.L., "External Cue Sensitivity, Res onse to Failure and Self Concept in Obese and Non-Obese Children." Doctoral dissertation, State University of New York at Binghamton, 1982). Dissertation Abstracts International, 42:4590B, 1982. Stoner, S., Fiorillo, M., "A Program for Self-Concept Improvement and Weight Reduction for Overweight Adolescent Females," Psychology, 13(3):30-35, 1976. 71. 72. 73. 74. 75. 76. 77. 78. 79. 98 Rankin, E.D., "A Study of the Relationship Between Self Concept and Reduction of Percent Body Fat Among Obese Females." (Doctoral dissertation, University of Maryland, 1979). Dissertation Abstracts International, 40(6), 2888-2889B, 1979. Helfman, S.B., "Effects of Different Treatment Modalities on the Self Concept of Overweight Women." (Doctoral dissertation, California School of Professional Psychology, 1981). Dissertation Abstracts InternationaL 42(5), 2058-2059B, 1981. Sullivan, Stefanie 5., "An Investigation of Stress and its Effect on Self Concept and Role Functioning." (Doctoral dissertation, Northeastern University, 1983). Dissertation Abstracts International, 45(5), 1597B, 1984. McEntee, Margaret A., "The Effect of a Stress Management Training Program on Self Concept, Perception of Lifespace Events, and Heart Rate Response among Bacalaureate Nursing Students who have Eiqaerienced High Versus Low Levels of Life Stresses." (Doctoral dissertation, University of Maryland, 1983). Dissertation Abstracts International, 45(5) 14303, 1984. Hobfall, Steven, B., Walfisch, Shlomo, "Coping with a Threat to Life: A Longitudinal Study of Self-Concept, Social Support, and Psychologial Distress," American Journal of Community PSychology, 12, 1:87-100, 1984. Pearlin, Leonard 1., Lieberman, Morton A., Menaghan, Elizabeth G., Mulland, Joseph T., "The Stress Process," Journal of Health and Social Behavior, 22:337-356, 1981. Campbell, D.T., and Stanley, J.C., "Experimental and Quasi-Experimental Designs for Research on Teaching," Handbook of Research on Teaching, Chiago: Rand McNally, 1963. Frederick, Calvin J., and Lague, Louise, "Dealing with the Crisis of Suicide." Public Affairs Pamphlet No. 406A, Public Affairs Committee, Inc., p. 5, 1972. Eliot, T2.S. Collected Poems. New York: Harcourt, Brace and Company, 69- 7 , 1930. ”111111111117111111“