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Postural Health Communication through Stretch Breaks & The Effects on

Psychosocial Well-Being and Public Health By: N. A. Chahrour, M. MacNeill
Faculty of Kinesiology and Physical Education, University of Toronto
 
 
Abstract  
 
Background: Musculoskeletal disorders (MSDs) are considered complex conditions involving physical

and psychosocial risk factors. MSDs impact Canadian society by costing the health care system $20

billion (McGee, 2007). Despite growing knowledge of MSDs, little research about physical activity as a

factor in reducing the impact has been conducted.

Purpose: To investigate the effects of postural health communication sent through a social media

application (app) on students’ perceptions of psychosocial well-being, motivation to carry out daily tasks,

and awareness of postural health.

Methodology: Participants have completed a brief postural awareness online questionnaire before the

daily stretching intervention. During the intervention, a gentle stretch exercise is communicated via the

app to participants (n=20). The specific time of day the app arrives has been chosen by the students so

important activities are not disrupted. The app instructs students using simple words and visual

illustrations about how to stretch and improve posture. Stretching protocols have been adapted from

ACSM (2000) to create these simple and gentle daily stretches.

Twice a week the stretch app has been accompanied by follow-up questionnaires to request participants

rate: (1) their posture before/after the daily stretch; (2) perceptions of how they felt during the stretch; (3)

sense of motivation and energy stemming from the activity; and (4) the usefulness of the stretching

reminder.

Preliminary Findings: Preliminary results support some of the existing literature and demonstrate

improved motivation to carry out daily tasks and postural awareness. Similar to research findings by
Trujillo and Zeng (2006) – participants in a social media-based postural intervention experienced reduced

MSD symptoms, increased workplace output and productivity – this study found similar responses. A

more detailed data analysis is being conducted as more participants are added to the data pool.

Introduction

Sitting for prolonged periods of time can affect health both physically and have psychosocial

impacts  (Trujillo & Zeng, 2006, Galinsky, Swanson, Sauter, Dunkin, Hurrell, & Schleifer, 2007). In

Canada we have evolved from being physically active hunters and gatherers to sedentary workers whom

spend the day sitting in front of a desktop with a slouched back and horrible posture(McGee, 2007).

“Sitting is the new smoking of our generation” is a term used by a few epidemiologists to refer to the

effects of sitting and not being physically active for long periods of time (Sharman, Melanie, Cresswell,

& Riek, 2006). Studies conducted on students to demonstrate how stretching might be used as a form of

physical activity to reduce the risk of musculoskeletal disorders will be reviewed. Use of social media,

such as computer programs conducted by Saltzman (2000), Trujillo and Zeng (2006), Jepsen & Thomsen

(2008) as a tool to promote stretching exercises to sedentary computer users, is another key topic to be

explored.

Musculoskeletal Disorders (MSD)

Musculoskeletal disorders or (MSD) are forms of injuries affecting connective tissue such as

muscles, nerves, joints, cartilage and spinal discs (Bureau of Labor Statistics, 2008). These injuries may

occur when muscles or tendons are either over-used or stretched past their capabilities. Ergonomic risk

factors such as repetitive motion, awkward posture, forceful exertions, pressure points, and static postures

can cause or worsen MSD (NIOSH, 2007). Repetitive strain injury (such as carpal tunnel syndrome , and

tendinitis) of the wrist and arm have risen by 80% since 1990 according to the US bureau of Statistics,

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and are now the single most cause of work related injury. This is being described as the epidemic of the

nineties. In the US alone, more than 600,000 workers have MSD resulting in days away from work each

year (Bureau of Labor Statistics, U.S. Department of Labor, (2001). MSDs impact Canadian society by

costing the health care system $20 billion (McGee, 2007).

There have been efforts to reduce these risk factors such as ergonomic engineering and

administrative controls, however redesigning offices or work spaces may be a costly investment which

may not change sedentary work styles. Height adjustable work tables are often used for individuals who

work for long periods of time to restrict the amount of sitting at any given time. Other efforts to break up

sedentary behaviour of business professionals was bringing in personal trainers to lead stretch breaks

every day of the week (Jepsen & Thomson, 2008). All these efforts are great at getting people to be more

physically active however they require a decent investment both with time and finance.

Long periods of using a computer at work settings can cause musculoskeletal discomfort and

mood disturbances; however frequent rest breaks and stretches have shown to decrease the incidence of

such disturbances (Sundelin et al. 1986, Zwahlen and Adams 1987, Swanson et al. 1989, Carter and

Banister 1994, Hales et al. 1994). Frequent rest breaks and stretches can also reduce static loads on the

musculoskeletal system (Sundelin and Hagberg 1989) as well as on the spine and could cause repetitive

strain injuries to areas such as the wrist (Fisher et al. 1993).

Electromyographic studies were conducted by Anderson (1984) to measure muscle activation in a

set of office workers using surface electrodes which were placed strategically on various muscles in the

neck/ shoulder and back. Results demonstrated that certain muscles like the upper trapezius muscle, were

highly activated during 90 degree elevation of the shoulder joint (Anderson, 1984). Therefore a possible

reason could be that computer workers postures are poor due to slouching over their computers with

elevation of the arms typing on the keyboard all day. They conclude, specific back muscles were overly

activated and reached peak force when constantly stimulated. Stretching may lower the peak force and

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rate of force production, however this is only a hypothesis and no studies yet have addressed this

phenomenon.

Stretching is a form of physical activity in which skeletal muscles are lengthened to improve

muscles elasticity and reduce tensile stress (Knudson et al. 2000; Harvey et al., 2002; Shrier, 2004;

Decoster et al., 2005). Stretching’s benefits include increased flexibility, improved range of motion within

joints, improved circulation improved posture, and stress relief (Magnusson and Renstrom, 2006). In

biomechanics terms, flexibility is the ability to change muscle tendon length which is brought about by

visco elastic properties (Sharman, Melanie, Cresswell, Riek. 2006). Viscoelasticity is a measure of a

tissue’s ability to deform or change length when a load is applied over time and to resume its original size

and shape when the force is removed, much like stretching and releasing a rubber band (Sharman et al.,

2006). There are three common stretching techniques which are proprioceptive neuromuscular facilitation

(PNF), static and isometric. PNF stretching combines static and isometric stretches and is the most

recommended type of stretch (Wiemann and Hahn, 1997; Magnusson, 1998, Sharman et al., 2006).).

Stretching increases the distance a tissue can stretch as well as the force required to tear the

muscle tendon unit, making injury less likely. The presumption is that, for individuals with short or

“tight” muscles, stretching increases flexibility by elongating tissues to a more physiologically normal

range, promoting optimal function and reducing the risk of musculoskeletal injury.

Several research studies have shown that stretching as mentioned results in elongation of the

muscle tendon unit, as well as reductions in peak force and rate of force production, therefore making the

muscle tendon less stiff (Knudson et al., 2000; Harvey et al. 2002; Guissard and Duchateau, 2004;

Decoster et al. 2005). This increases the distance a tissue can stretch as well as force required to tearing it,

thus onset of injury is reduced. The presumption is that if muscles are tight (i.e. shorter in length) chances

of injury may increase, however this may not be correct and more research needs to be done in this field

of study.

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More research needs to be done on the field of flexibility and risk of injury as the few studies that

have been done show contradicting results of being more flexible therefore higher risk of lower back pain

while other studies show the opposite finding of being less flexible and having lower incidence of pain

and injury. Studies by (Osternig, Robertson, Troxel, Hansen, Magnusson, Aagard, 1987) have shown that

hypermobile individuals were more susceptible to lower back pain than their counterparts being

hypomobile. This contradictory observation leads to what is known as “optimal range of motion” and if

there is what constitutes optimal perhaps having hypomobile individuals do stretching exercises is a good

idea.

Stretching with Help of Social Media Computer Programs

Jepsen and Thomson (2008) from the University of Wisconsin conducted a study with 184

computer operators to examine the effects of stretching on the prevention in upper limb disorders. All

participants spent at least 20% of their time on a computer. The age range of the individuals as well as

gender was not indicated in the research methods. A baseline was set with computer users that spent at

least 20% of their time on computer workstations, these subjects had to fill out a questionnaire and

complete a neurological examination. The stretching program went on for six consecutive months in

which it consisted of four stretches focusing on different regions of the right arm, the control group did

not do any of the stretches. The results were followed up with a neurological exam which indicated that

subjects had significant improvements in the function of pronator muscles. Mechanosensitivity which is

the mechanical response to stimuli was also improved for the median nerve. However they concluded that

stretching alone could not prevent upper extremity disorders among individuals who work on computers

(Jepsen and Thomsen, 2008).

A study by the National Institute of Occupational Safety and Health (NIOSH) and the Internal

Revenue Service (IRS) examined the symptoms and performance of data-entry workers.  Participants from

the Cincinnati IRS Service Center were sampled for analyses. The data sample included 47 women and 4

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men, aged 23–60 years, with a mean age of 36 years. Data-entry experience ranged from 1 month to 24

years, with a mean of 6 years. One group had rest breaks along with stretch exercises and the control

group did not do either. The stretch breaks were organized as follows: 4 weeks (two 15 min breaks/day);

4 weeks with supplementary breaks (two 15 min breaks plus four 5 min breaks/day). A questionnaire was

then filled out by both groups and workers reported only participating in 25% of conventional breaks and

39% of supplementary breaks: no major conclusion of stretching and discomfort or performance were

found. This was due to the low compliance and participation rates to perform the stretches as mentioned

by Galinsky, Swanson, Sauter, Dunkin, Hurrell, & Schleifer, (2007). This low compliance may be

attributed to lack of motivation or forgetting to do the stretches. However the individuals whom did

perform the stretches had lower discomfort and eyestrain during work sessions. Also, the efficiency of the

workers was significantly faster in data-entry speed at work and therefore making up the 20 minute breaks

by producing better output. Trujillo & Zeng (2006) from East Carolina University observed how a

computer based program that notified the computer user to stop and stretch in hope of offsetting

musculoskeletal disorders.  There computer program demonstrated that wrist exercises helped relax tense

muscles, improve blood circulation, increase the person’s ROM and prevent cumulative trauma disorders.

Their study had 19 computer user subjects that were followed up with an online questionnaire a month

later. This included 13 (68.4%) males and 6 (31.6%) females in which selection was based on  an on-site

coordinator whom individually asked the participant's if they would participate in the study. Researchers

found 53% of the subjects claimed reduced MSD symptoms and all of them believed it was helpful in

overall output. 63.3% stated that it had a positive effect on productivity. The limitation with this study is

that the stretches were unknown, making the study difficult to replicate. It is not known if subjects

reported results due to the rest break or to the actual stretches that factored into the reporting of the

questionnaire.

Saltzman (2000) from California State University deployed a computer based program to remind

individual computer users to take a 1-2 minute stretch break every 45 minutes. The demographics of his

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study were from 3 different companies (Department in city government, military base, and a utility

provider) that had computer data entry workers agree to take part in his study. A total of 44 participants

took part and the gender ratio was 44% male to 56% female. His results demonstrated computer users

found the reminder helped reduce stiffness and muscle aches from long hours at the keyboard. Stress

levels were also identified as being lower; however these results did not prove that it was the stretches

that were the cause and not the rest break. Regardless, the computer program is credited for reminding the

subjects to take the rest break and do the stretches.

Tailoring a Stretch Exercise Program

Stretch exercise programs should be designed or tailored towards the need of the individuals work

style. For example, the set of exercise routines for a physically demanding job such as (construction

work) may be different then for an office worker that sits behind a computer all day. Stretching should

also be designed with the body region most at risk again a construction worker is more susceptible to

lower back injury. For example an office worker would benefit more from shoulder, neck and upper back

stretches as those are muscle groups that are being stressed most of the day. Below is a stretching routine

that could be tailored to any individual and the focus on specific stretches would be tailored accustom to

their daily tasks (American College of Sports Medicine Guide-lines for Exercise Testing and Prescription,

2000). Stretching a muscle should be done by putting the muscle in a position that produces a slight pull

but not to the point of pain. Static stretches put the muscle in that position and should be held for 15-30

seconds. Stretches should be gentle and not cause pain or take the joint past the normal range of motion.

ACSM (2000) guidelines recommend that stretching activities be done at least two days per week. If

range of motion is lost or feels stiff, stretches should be done daily. Muscles that are most often tight are

the hamstrings, hip flexors, calves and chest muscles. Each of these can be stretched using different

positions, and some general motions may stretch more than one muscle group. For simplicity’s sake, only

common static stretches will be described below.

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• Hamstrings. Sit on the ground with legs straight in front of you. Gently lean forward from the hips

(try to keep the back fairly straight) until a stretch is felt on the back of the thighs.

• Hip flexors. Stand on one foot, and bring the other foot to the buttocks. Pull back gently, while

keeping your knee pointed at the ground and your hip straight. If needed, hold onto a counter or

chair to keep your balance.

• Calves. Step forward with one leg. Shift your weight toward the front leg while keeping the back

heel on the ground. If you press the hip of your back leg forward, this will also help stretch the hip

flexors.

• Chest muscles. Standing in a corner, bring hands up to shoulder height and place against the wall on

either side. Keeping hands in position, lean body forward until a stretch is felt in the front of the

chest. This can also be done using a doorway, turning away from the hand that is on the wall.

Stretching is still an understudied area of research. The benefits of stretches are still under

investigation. More research needs to be done on the field of stretching and risk of injury as the few

studies that have been done reveal contradicting results particularly those with greater risk of lower

back pain. On the contrary, other studies show the opposite finding of being less flexible and having

lower incidence of pain and injury. There should also be more research on computer programs and

social media use to help facilitate stretch exercise programs, and these studies should be designed

with the user in mind. In the study by Trujillo & Zeng (2006) subjects showed improved mood,

performance and overall health when given rest breaks combined with stretches. This shows promise

and serves as rationale for this study. Stretch exercise programs should be tailored towards the user’s

daily work (i.e. physically demanding work vs. sitting all day). Using social media as Trujillo and

Zeng did with the computer based program to intervene on sedentary behaviour is one form on

intervention using social media. However that serves people whom are always sitting close by to a

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computer and as an alternative having a social media application or notifications sent to individuals

smart phones would be beneficial to remind them to complete their daily stretches.      

 

Methodology  

Study Requirements

Seven University male and female undergraduate students in the faculty of Kinesiology and

Physical Education were recruited as participants for the study, ages were 18-23 years of age. The mean

age of the participants was 21.5 years with a ratio of 3 males to 4 females. As a requirement of the study

participants were selected on the bases of being sedentary for at least one hour during the waking hours of

the day. As well, whether or not they were injured to carry out the gentle stretch breaks. Announcements

to recruit participants were proceeded before the beginning of lecture in one of the Kinesiology and

Physical Education class. A snow ball method was used to obtain participants to take part in this study, all

participants were promised to receive a copy of the final research report upon request and once completed

as well as the social media application.

Pre-Intervention Posture Questionnaire

Participants completed a brief postural awareness questionnaire before the daily stretching

intervention began. This is included as "Pre-Intervention Posture Health Awareness Questionnaire" in

Appendix A. This questionnaire was filled out only once and is prior to taking part in any stretch breaks.

Questions were tailored to determine whether participants performed any daily stretching prior to taking

part in the study. Questions also were used to determine the duration of time they were sedentary for at

any given day and the longest bout of time they were sedentary before getting up and moving.

Participants were asked to rate how they perceived their overall posture on a 10 point numerical scale,

with 10/10 being ideal posture and 1/10 being very poor posture.

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Intervention

During the intervention, a gentle stretch exercise was communicated via an online application

(app) or via email to participants smart phones. These daily stretches arrived for a period of three

academic weeks across March of 2014. The reminders instructed students, using simple words and visual

illustrations, how to stretch and improve posture. The stretching protocols of the American College of

Sports Medicine Guidelines for Exercise Testing Prescription 6th ed., 137-164, 2000) was deployed to

create simple and gentle daily stretches and instructions. Refer to (Appendix C) for an example of a

stretching exercise and the accompanying instructions and postural advice. Stretches were modified for

students so they can carry out a stretch break even if they were in a setting such as the library or

classroom where they can perform most stretches while sitting.

Stretches

A set of 12 stretches which were deemed to be safe/appropriate in an indoor environment as well

as practical for minimal work disruption were chosen. Stretches ranged from brief 10-15 second stretch to

the neck, upper shoulders, lower back , wrists, lower extremities and required no more than 2 minutes in

duration to complete them all. The intervention suggests particular stretches that can be done sitting or

standing in their academic environment in a non-disruptive manner, with 10/12 stretches could be

performed while sitting and only two require you to stand.

Follow-up Post Intervention Questionnaire

Twice a week on Tuesdays and Fridays the stretching reminder was sent via email. The email was

accompanied by a brief (5 minute) follow-up questionnaire that requested the participants to rate on a 10

point category rating scale in which the whole numbers 1-10 indicated "none at all" and 10-10 indicated

"extreme", respectively. The follow up questionnaire requested participants rate: (1) their posture

before/after the daily stretch; (2) perceptions of how they felt during the stretch; (3) sense of motivation

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and energy stemming from the activity; and (4) the usefulness of the stretching reminder. Refer to

questionnaire (Appendix B) labeled, "Stretching and Posture Questionnaire".

Limitations

Due to the obvious intervention aspect of this study, it was not possible to prevent likely results

from the questionnaire regarding the positive effects of stretch breaks. Therefore, instructions were used

in an attempt to minimize biased expectations. All participants were reminded to fill out the questionnaire

as honestly as possible. Knowing whether or not the participant actually completed the stretches or not

was also something that could not be controlled for.

Participants that were injured were told not to take part in any of the stretch exercises. Participants were

also reminded that if they ever felt physically, emotionally or socially uncomfortable about adjusting their

posture, they can choose not to participate in that stretching episode and/ or drop out of the study at any

time to reduce risks to a minimal level. Only completed questionnaires were used in the data analysis. An

individual's data set was deemed incomplete if more than 2 consecutive questionnaires were not filled out

and submitted or if more than 4 questionnaires were missing from either the first or second week period

of the study.

Results

Pre-Intervention Posture Questionnaire Results

Participants in the study indicated that they were sedentary on average for most of the waking day

(i.e. not including sleep) with just over seven hours of sedentary behavior throughout their academic days

(Monday-Friday). The longest period of time participants sat in any single episode without taking a break

while they were on campus was 2 hours and 15 minutes (average length of a long lecture). Results from

the "Pre-Intervention Posture Health Awareness Questionnaire" in (appendix A) showed varying results

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in terms of associated pain in differing body regions. All participants indicated they had pain or

discomfort in one of more body regions with most cases having lower back and shoulder pain. This may

be due to the fact that none of the participants took part in routine stretch breaks before this study as

indicated on the questionnaire. However when asked if they thought stretching was beneficial for

managing musculoskeletal disorders and whether stretching is beneficial, all of the participants indicated

that it was, however they never took part in a daily stretching routine prior to the study. Finally

participants were asked to rate how they perceived their overall posture to be on a 10 point category rating

scale. The average was 6/10 with a standard deviation of (±1.0) in which the whole numbers 1-10

indicated "poor posture" and 10-10 indicated "ideal posture", respectively.

Follow-up Post Intervention Questionnaire Results

Twice a week on Tuesdays and Fridays participants would fill out the follow up post-intervention

questionnaire entitled "Stretching and Posture Questionnaire" in (appendix B). Results were tracked from

week to week and compared to check for any significant difference in perception of the stretch reminders.

In week one 71.4% of participants indicated that they were more energized and motivated to carry out

daily tasks for example studying. After completing the suggested stretches, participants were asked to

indicate on the follow up questionnaire how they felt on a numerical 10 point category rating scale similar

to the previous questionnaire only this time 1-10 indicates "low feeling and energy levels" whereas 10-10

indicates "high feeling of energy and motivation". Results were compared between all three weeks, with

week one having a mean of 6.75 and a standard deviation (SD) of ± 1.89 (refer to figure 1). However

comparing week two and three results to week one there was a significant difference with week two

having a mean score of 8.17 with SD of ± 1.33 and week three mean score of 7.66 with SD of ±0.44

indicating there is slight significance between week two and week three, however week three did have a

lower SD as compared to week two (refer to figure 1).

Perception of the participants posture was also indicated on the questionnaire of how they

perceived there overall posture was before and after completing the stretches. Starting with week one

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having a before mean of 5.25 with a SD of ± 1.72 of as compared to the after mean of 6.5 with a SD of ±

1.87 (refer to figure 2) . Week two however the before and after perceptions increased proportionally as

compared to week one, however there is low to no significance between the before results from both

weeks but an observable difference that is significant between the after results from both weeks. The

difference between the before and after results from week one was 1.25 compared to week two with 2.17

this supports the notion that perception of overall posture was increased significantly just after completing

two minutes of the stretches (refer to figure 2). Results of week three had similar readings as week two

with very low to no significance.

Finally the usefulness of the stretch break reminder was also indicated on the questionnaire again

with a numerical 10 point category rating scale, where 1-10 indicates "Reminder not very useful" and 10-

10 indicates "Reminder being very useful". Observing the mean difference between week one and week

two (as shown in figure 3) participants indicated that the usefulness of the reminder was 6.83 with a SD ±

2.32 however in week two the mean increased to 8.2 with a SD ± 1.47 and stayed relatively the same in

week 3, however a lower SD of ± 0.71 (refer to figure 3). This trend supports the notion that participants

found it more and more useful as time went by. Comments were also indicated on the questionnaire form

in the comments section with positive feedback regarding the simplicity of the stretches and plain simple

language to help assist the participant in carrying out the specified stretch. Comments on the stretches

themselves was also reported by participants and a few stated that it helped them relax and reduced their

stress levels when studying.

 

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10  
feeling  a)er  stretch  completed  
9   8.17  
7.66  
8  
6.75  
7  
6  
5  
4  
3  
2  
1  
0  
1   2   3  
Weeks      
 
Figure  1.  Feeling  of  Motivation  and  Energy  After  Completing    Daily  Stretches  
10  
9  
7.67   7.66  
8  
feeling  of  overall  posture    

Before    
7   6.5  
5.83   A3er    
6   5.25   5.5  
5  
4  
3  
2  
1  
0  
1   2   3  
Weeks      
 
Figure  2.  Perception  of  Overall  Posture  Before/After  Completing  Daily  Stretches        
 
 

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10.00  
9.00   8.17   8.00  
Usefulness  of  reminder    

8.00  
6.83  
7.00  
6.00  
5.00  
4.00  
3.00  
2.00  
1.00  
0.00  
1   2   3  
Weeks    
 

Figure  3.    Usefulness  of  the  Stretch  Break  Reminder  
 
 
 

Discussion
 
  This study intended to review the interdisciplinary knowledge about stretching and postural

expertise, to question the potential value of social media platforms for health communication and for

research data gathering. As well to acquire scholarly research to contribute to the literature about postural

health and use of social media as a health communication tool. The purpose of the study was to

investigate the perception of effects of postural health communication and motivation to carry out daily

tasks. Participants were reminded to carry out stretch breaks that were sent through email reminders on

their smart phones throughout their academic day.

This study reported whether students at the University of Toronto would experience affects of

stretch breaks similar to that of (Galinsky et al., 2007) in which perception of posture was measured. As

shown in the results perception of posture was affectively better after completing the stretches. The

second purpose was to measure the psychosocial aspects of musculoskeletal disorders and how a

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computer based program would notify participants of stretch breaks was beneficial to their overall output

and productivity (Trujillo and Zeng., 2006). As seen in this study motivation and energy were increased

from week to week. However this study differed in terms of communicating the stretching reminder via

an email notification to the participants smart phone rather than a program installed to a computer like

that of Trujillo and Zeng (2006). This was marked by the fact that participants found it very useful to be

reminded of a stretch break via there smart phones as all participants had their emails synced with the

smart phone and therefore would get the notification instantaneously. Results indicated that as time went

by in the three week long study participants found the reminders more and more useful in there every day

busy study schedule.

Stretch break reminders such as this with the same exercises could get boring and therefore

dropout rates would increase as a result. However, trying to incorporate new exercises every week that

stretch the intended muscle groups could be implemented and therefore reduce the chance of participant

boredom. Having a comments section on the questionnaire helped provide the researcher feedback on

what the participants liked or did not necessarily find very useful. Comments such as basic and simple

stretches was preferred along with plain language describing each stretch. However having the same exact

stretches every time for three consecutive weeks did give off a couple comments on repetition of the

stretches and how they may become boring after a while. For this reason researchers should always try to

incorporate new stretches while having the same stretch mechanism in mind.

Limitations

A couple of limitations were faced in conducting this research study such as whether the

participants actually took part in the stretch break and completed all the stretches provided, this was

something out of the researchers control. Another limitation was the mood of the individual and state of

mental tiredness when completing the stretches and filling out the post-intervention questionnaire in

Appendix B. These factors could alter the participants choice when completing the "feeling of motivation

and energy" questions and may have an impact on their choice. Another limitation of the study was the

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duration of the study and conducting it in only eight months due to the academic year and the duration of

data collection from participants as they are students and may have exams during specific periods when

post-intervention questionnaires would be sent via email.

Conclusion

Ideally more research studies should focus on why people are sedentary and not physically active.

Students or people in general should not associate sitting all day in class or at the library and going home

to “rest” by being even more sedentary as something positive. Physical activity should be rewarding and

framed positively not just by going to the gym for aesthetic purposes but for well-being and psychosocial

health. Future research should focus on the culture and lifestyle of individuals and try to intervene at an

upstream approach with policies implemented in workplace and classroom setting where people are most

sedentary. This research has focused on a downstream approach by trying to get the individual to change

their lifestyle and breakup sedentary behaviour, but certainly upstream approach such as University

policies of mandatory 5-10 minute breaks every hour of lecture should be implemented to break up bouts

of sedentary behavior. Being a Kinesiology and Physical Education candidate student we always learn

about the importance of being physically active and the effects of sedentary behavior, however

implementation of changing sedentary behavior needs to be set in place. For that reason the University of

Toronto should mandate rules on lectures longer than one hour by providing students a stretch break, this

initiative could start at our very own KPE faculty as role models to other faculties and possibly spreading

to UofT and other universities in Ontario. Future research should also understanding job demands of

individuals in the workforce and what they do at work as well as outside of work to find interventions for

breaking up sedentary behaviour and ultimately try to reduce the rate of musculoskeletal disorders.

Therefore by providing stretch breaks students could be more productive both in class and outside class

when studying. The motivation and energy to take part in note taking or studying as demonstrated in this

study would increase, meaning higher satisfaction for student and higher self-efficacy as a result. Results

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also indicated that participants perception of posture improved from 5.25 at the beginning of the study to

7.66 by the end of three weeks. this was just after 2 minutes of stretching everyday for 3 consecutive

weeks. Finally participants found the app reminder to be more and more useful as time went elapsed

from week one to week three.

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Appendix A: Questionnaire Forms Part A (Appendix A)

Pre-Intervention Posture Health Awareness Questionnaire

This questionnaire will take about 10 minutes to complete. Please return it to me in person or by email:

nour.chahroar@mail.utoronto.ca. To protect your privacy, you can choose to use a pseudonym (made up

name) on this questionnaire.

Name: ___________________________________________

1.How old are you? _______years of age

2.Estimate the amount of time you are sedentary on-campus: off campus*:

Monday ________ hours ________ hours

Tuesday ________ hours ________ hours

Wednesday ________ hours ________ hours

Thursday ________ hours ________ hours

Friday: ________ hours ________ hours

*If you live on campus in residence, please fill in sedentary time while in the residence in the “off
campus” section above.

3.What is the longest period of time you sit in any single episode without taking a break while on campus
(e.g. length of a long lecture) ? ____ hours.

4.Do you ever feel discomfort in your upper body regions (e.g. wrists, arms, shoulders, neck, upper back)
or lower back region due to sitting for prolonged periods of time?

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__No __Yes If yes, where to you feel the discomfort?

5.How often do you stretch on a daily basis?

6.Do you believe stretching is good for you? Why?

7.When do you think stretching is good for you? Why?

8.Do you consider your body to be flexible or inflexible?

9.Rate your overall posture on this scale (Circle): Poor 1..2..3..4..5..6..7..8..9..10 Excellent
 

 

 

 

 

 

 

 

 

 

 

 

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Stretching and Posture Questionnaire Part B (Appendix B)

This questionnaire will take about 5 minutes to complete. Please use the same pseudonym if you

made up a name for first questionnaire response. Return this to me today my email:

nour.chahrour@mail.utoronto.ca.

Name: _____________________________________

1) Did you do today’s suggested stretch? Yes __ No __

2) If yes, how did feel after completing the stretch in comparison to sitting?

Not good 1..2..3..4..5..6..7..8..9..10 Excellent

3) How useful was the stretch exercise on the app today?

Not useful 1..2..3..4..5..6..7..8..9..10 Very useful

4) Do you feel more energized after a stretch break? Yes__ No__

5) Do you feel more motivated to be productive after a stretch break? Yes __ No __

6) What did you like or dislike about the stretching app today?

7) Rate your overall posture today before doing the daily stretch:

Poor 1..2..3..4..5..6..7..8..9..10 Excellent

8) Rate your overall posture today after doing the daily stretch:

Poor 1..2..3..4..5..6..7..8..9..10 Excellent
 

 

 

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Appendix  C  

 

Chahrour, N. (2013). Postural Health Communication through Stretch Breaks & The Effects on
Psychosocial Well-Being and Public Health. American College of Sports Medicine
Guide-lines for Exercise Testing Prescription 6th ed.,137–164, 2000
 

 

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Chahrour, N. (2013). Postural Health Communication through Stretch Breaks & The Effects on
Psychosocial Well-Being and Public Health. American College of Sports Medicine
Guide-lines for Exercise Testing Prescription 6th ed.,137–164, 2000

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Index
 
Electromyography (EMG): is a technique for evaluating and recording the electrical activity produced

by skeletal muscles.

Isometric stretching: is a type of static stretching (meaning it does not use motion) which involves the

resistance of muscle groups through isometric contractions (tensing) of the stretched muscles

Mechanosensitivity: is the mechanical response to stimuli felt in a body region.

Musculoskeletal disorders (MSD): are forms of injuries affecting connective tissue such as muscles,

nerves, joints, cartilage and spinal discs. These injuries may occur when muscles or tendons are either

over-used or stretched past their capabilities.

Proprioception: "one's own", "individual" and perception, is the sense of the relative position of

neighbouring parts of the body and strength of effort being employed in movement.

Proprioceptive neuromuscular facilitation (PNF) stretching: is a set of stretching techniques commonly

used in clinical environments to enhance both active and passive range of motion with the ultimate goal

being to optimize motor performance and rehabilitation.

Psychosocial: for a concept to be psychosocial means it relates to one's psychological development in,

and interaction with, a social environment. The individual needs not be fully aware of this relationship

with his or her environment.

Static stretching: is used to stretch muscles while the body is at rest. It is composed of various techniques

that gradually lengthen a muscle to an elongated position.

Stretching: is a form of physical activity in which skeletal muscles are lengthened to improve muscles

elasticity and reduce tensile stress.

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