Weight gain and unfavorable body composition are prevalent among midlife and older women; shifts in these characteristics can have detrimental implications on emotional and physical health and longevity. Efforts to attenuate weight-related factors detailing the potential development of obesity are traditionally driven by manipulation of nutrition and/or physical activity; however, sustained results are limited. Novel and integrative approaches are needed to reduce the burden of adverse changes in weight and associated consequences.

This dissertation is built around a model of effects of Tai Chi/Qigong in body composition and a pilot test of this intervention and model factors in a group of midlife/older women (N = 36). Three resulting manuscripts include: 1) a proposed biobehavioral model detailing how a Tai Chi/Qigong intervention may improve weight-related outcomes through psychological, behavioral, and physiological pathways, 2) a paper examining pre- to post- intervention differences in the primary outcomes of percent body fat, sleep quality, and emotional eating and the exploratory outcomes of perceived stress, mood state, mindfulness, self-compassion and body awareness; and 3) an exploratory analysis examining correlations between primary (sleep quality, emotional eating), exploratory (perceived stress, mood state, mindfulness, self-compassion and body awareness), and neurophysiological (heart rate variability) outcomes of interest—further, regression models were conducted to explore the predictive value of the independent variables on the dependent variables and associated changes.

In manuscript two, dependent t-tests were used to assess pre/post-differences (percent body fat and survey measures); this single group study (8-weeks of Tai Chi/Qigong) did not have a control group. Results of manuscript two demonstrate significant changes in sleep quality (p = .04), perceived stress (p = .05), and body awareness (p = .01). Findings of manuscript three indicate changes in the dependent variable of sleep quality were partially explained by perceived stress (adjusted R2 = 13.4%) and changes in the dependent variable of emotional eating were significantly explained by self-compassion (adjusted R2 = 42.1%). In the context of weight gain and unfavorable body composition in midlife/older women, results of this pilot study, using a standardized Tai Chi/Qigong intervention, indicate that select psycho-emotional factors may be important to explore further.

Excessive gestational weight gain (EGWG) affects 50% of US pregnant women and may be an important contributor to obesity in both the mother and child. Novel strategies to prevent EGWG are needed to reduce the risk of adverse health outcomes for the mother and child. This dissertation presents three manuscripts that 1) propose a novel model to explain how prenatal yoga may prevent EGWG through behavioral, psychological/emotional, and physical factors, 2) test the feasibility and preliminary efficacy of a prenatal yoga intervention to prevent EGWG compared to a pregnancy education comparison group, and 3) qualitatively investigate pregnant women’s experiences participating in a prenatal yoga intervention to prevent EGWG. In manuscript two, 49 women were recruited and randomized to a 12-week prenatal yoga intervention (n=23) or a time-matched pregnancy education comparison group (n=26). A satisfaction survey was administered at post-intervention to assess feasibility outcomes (e.g., acceptability, demand). Mindfulness, emotion regulation, self-awareness, sleep quality, depression, anxiety, and perceived stress were assessed at baseline and post-intervention (12-weeks) and GWG was assessed weekly. Linear mixed models were used to analyze pre-post changes in primary (i.e., GWG during pregnancy) and secondary (i.e., mindfulness, emotion regulation, self-awareness, sleep quality, depression, anxiety, and stress) outcomes. In manuscript three, interviews were conducted with pregnant women who participated in the prenatal yoga intervention (n=13). Interview responses were summarized using an inductive approach to thematic analysis. Findings in manuscript two suggest that prenatal yoga was a feasible method to prevent EGWG with high enjoyment and satisfaction reported among participants. The average number of prenatal yoga sessions attended was 8.84 (SD = 3.85). There was no significant group differences on the rate of GWG or total GWG throughout the intervention and a significant group x time interaction effect for stress (p=.03). In manuscript three, twelve themes were identified among the data and were organized into the following categories (three themes each): 1) experiences of prenatal yoga, 2) prenatal yoga and weight, 3) barriers to prenatal yoga, and 4) facilitators of prenatal yoga. This initial evidence suggests that prenatal yoga has potential as a strategy to prevent EGWG in pregnant women.

Job burnout, a prolonged reaction to job stress, includes mental and physical aspects of exhaustion related to professional work life. Linked to individual health-related problems, decreased job satisfaction, poor organizational commitment, and higher turnover, burnout poses a problem for both employees and organizations. The nursing profession identifies the prevalence of burnout and the resulting harmful effects in many settings, yet until now, rural critical access hospital settings have not been considered. To build and maintain a competent, healthy rural nursing workforce that responds innovatively to growing healthcare needs, it is important to examine burnout levels in rural nurses and to identify factors that might be associated with mitigating burnout.

This study focuses on how psychological capital, socio-demographic and organizational work-related factors are associated with burnout in this population. This cross-sectional, descriptive correlational study employed the Maslach Burnout Inventory for Health Professionals, the Psychological Capital Questionnaire, and a sociodemographic questionnaire assessing individual and organizational work-related factors as self-report tools. Descriptive statistics, correlations, and regression analyses were performed to assess aspects of the nurses’ work environment, while describing the relationships among the variables.Means and standard deviations were examined across key variables and compared to reports from other studies. Hypotheses predicted psychological capital would be associated with burnout (negatively associated with emotional exhaustion and depersonalization, positively associated with personal accomplishment), and that individual sociodemographic and organizational work-related factors would also be associated with BO. It was further hypothesized that PsyCap would moderate the relationship between work-related factors and BO.

Maslach Burnout Inventory results reveal similar findings to those in the global sample. However, levels of emotional exhaustion and professional accomplishment were greater in our rural nurse sample compared to published values. Higher levels of psychological capital were found to be related to decreases in depersonalization and correlated to greater professional accomplishment. Psychological capital was not found to moderate associations within this study. Intent to stay more than one year had a strong, negative correlation with emotional exhaustion. The findings suggest burnout in this sample resembles that of the global problem and sets a baseline from which psychological capital trainings may be built.

While obesity rates have plateaued within the last decade,

two-thirds of the United States

population is currently classified as overweight (defined a

s a body mass index [BMI] of

25-29.9 kg/m²) or obese (a BMI greater than 30 kg/m²). Bariatric

surgical interventions

are not only more effective than behavioral treatments

in the short term but are the only

form of obesity intervention with evidence of consisten

t long-term effectiveness.

However, even among bariatric surgery patients, weight

loss often stabilizes and it is

estimated that more than 20% of bariatric surgery patient

s will regain a significant

amount of weight that was initially lost long-term. Li

ttle research to date has been

conducted on physical activity in post bariatric surgery pati

ents. More specifically, there

have been no studies to date examining the effects of Me

ditative Movement (MM)

programs on body composition in bariatric patients. A s

tudy using an 8-week Tai Chi

Easy program was conducted in female gastric bypass patient

s to explore feasibility of

MM in the bariatric population as well as pre- and post-in

tervention changes in weight,

mindfulness, eating behaviors, body awareness, physical a

ctivity patterns, dietary quality

and mood. Data analysis revealed that there were no s

ignificant changes in weight or

physical activity patterns; however, significant changes w

ere observed in anxiety, overall

body awareness and cognitive restraint in eating. Addit

ionally, a significant decrease in

processed meat consumption and a weak trend towards increa

sed consumption of fruits

may suggest an overall improvement in dietary quality.