Saudi Cultural Missions Theses & Dissertations
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Item Restricted Associations Between Living Arrangements, Changes in Lifestyle and Anthropometric Traits During the First Year of University(Saudi Digital Library, 2026) Alharbi, Ferdous; Speakman, John; Hambly, CatherineIntroduction: The transition into university is often accompanied by lifestyle changes that can influence weight and health behaviours, with evidence highlighting increased risk of weight gain during the first academic year. While the “Freshman 15” theory, coined in the United States of America (USA), has been widely discussed, referring to an average weight gain of around 6.8 kg (15 lb) during the first year of university, findings remain inconsistent, and less is known about how different living arrangements may shape these changes. This thesis examines the associations between living arrangements, lifestyle behaviours, and anthropometric changes among first-year university students, and compares these with patterns observed in non-university peers. Methods: Two longitudinal observational studies were conducted. Study 1 followed 78 participants at baseline, three, and eight months after entering University (across one academic year), including those living at home, in private accommodation, in halls of residence (University accommodation), and non-university peers. Study 2 tracked 40 of these participants in halls, private accommodation, and at home as they transitioned to the second year. Anthropometric traits (body weight (BW), body mass index (BMI), body fat percentage (BF%), waist-to-hip ratio (WHR), and weight-for-age percentile (W/A)) were recorded. In addition, lifestyle behaviours (diet, physical activity, sleep, and stress) were assessed using questionnaires, complemented by objective assessments from the ActiGraph GT9X Link accelerometer (physical activity and sleep). Dietary intake was assessed via Intake24’s online 24-hour dietary recall tool and reassessed after excluding misreported records. Results: Most changes in weight, body composition and lifestyle behaviours occurred within groups across the academic year, with students living away from home showing the largest increases in weight, BMI and WHR. Although between-group differences were generally limited, living arrangements influenced the timing and magnitude of changes in diet, physical activity, sleep and stress, and WHR remained consistently higher among students in halls compared with those living at home or in private accommodation. Non-university participants also experienced behavioural and BF% changes, indicating that many challenges were not exclusive to university students. In the follow-up study after one year at university, similar within-group patterns persisted, suggesting that early behavioural and anthropometric changes tended to continue over time. Students who started university in halls and in private accommodation showed further increases in weight and BMI across the 12-month follow-up, while those living at home remained comparatively stable. Conclusions: These findings demonstrate that early lifestyle and body composition changes among young adults are shaped more by within-group patterns than by large differences between accommodation types. By integrating self-reported and objective measures across two longitudinal studies, this thesis provides clearer evidence on how diet, physical activity, sleep and stress evolve from university entry through the first full academic year and after one year at university. The thesis directly addressed its research objectives and answered all research questions by identifying when behavioural and anthropometric changes occur, which groups are most affected, and how living arrangements influence these trajectories over time. The results highlight areas that may benefit from future preventive efforts to support students’ health during the transition into university, such as improving food environments in halls, supporting affordable healthy eating for students living away from home, expanding access to physical activity opportunities, strengthening stress-management and sleep-support resources during this life stage.31 0Item Restricted How to improve talent identification in Saudi Arabia(Saudi Digital Library, 2025) Hafiz, Othman; Mighten, EddieThe main purpose of this research was to develop a deeper understanding of the talent identification (TID) system, and how to improve it in Saudi Arabia. The case study also aimed to understand and explain the current situation and challenges of the Saudi Arabian TID system. The research was guided by the following question: How to improve TID in Saudi Arabia? A qualitative approach was adopted, using semi-structured interviews analysed through Interpretative Phenomenological Analysis (IPA). The findings provide insights into the current capacity and limitations of the system, as well as the wider Saudi sport ecosystem.26 0Item Restricted THE RELATIONSHIP BETWEEN EXERCISE AND PROSPECTIVE MEMORY: A META-ANALYSIS(Saudi Digital Library, 2025) Alqahtani, Shaykhah; Loprinzi, PaulABSTRACT Prospective memory (PM)—the ability to remember and carry out future intentions—is essential for everyday functioning. This cognitive process involves intention formation, retention, cue detection, and execution. Emerging research suggests that physical exercise may influence prospective memory performance through potential enhancements in attention, executive functioning, and neuroplasticity. This thesis examines the relationship between physical exercise and prospective memory through a systematic review and meta-analysis of the existing literature. This review synthesized evidence from experimental studies to evaluate the effects of acute and chronic exercise interventions on prospective memory in diverse populations. Six studies met the eligibility criteria and were included in the quantitative synthesis. The aggregated meta-analytic effect of exercise on prospective memory was small, negative, and statistically nonsignificant (Hedges’ g ≈ −0.11, 95% CI ≈ −0.32 to 0.11). Between-study heterogeneity was very low (τ² ≈ 0; I² ≈ 0–3%), indicating limited systematic variation across studies. Exploratory moderator analyses suggested that acute exercise protocols tended to produce slightly more favorable effects compared to chronic programs, and that event-based tasks showed somewhat greater responsiveness than time-based or self-report measures; however, none of these moderation patterns reached statistical significance and should be regarded as preliminary. This thesis also discusses potential mechanisms—including attentional readiness, executive control, and neurobiological factors such as increased neurotrophic signaling—that may help explain why exercise could influence prospective memory under certain conditions. Although current evidence does not support a reliable overall effect, understanding this relationship may inform future behavioral strategies aimed at supporting cognitive health, particularly among aging adults or individuals at elevated risk of memory decline.35 0Item Restricted Policy, Cultural, Social, and Environmental Barriers to Physical Activity in the Southern Region of Saudi Arabia(Saudi Digital Library, 2025) Alzahrani, Ali Ahmed; Gebel, KlausPhysical activity levels in Saudi Arabia remain low, contributing to rising rates of obesity and non-communicable diseases, highlighting the need for effective strategies to promote active lifestyles. This thesis explores the policy, cultural, social, and environmental barriers to physical activity in the Gulf region, with a specific focus on the southern region of Saudi Arabia. Through three interconnected studies, it examines the complexities of physical activity promotion at both the policy and community levels. The first study was a qualitative study with semi structured interviews with 19 policymakers from Saudi Arabia and Oman, exploring cross-sectoral challenges and facilitators of physical activity (PA) policies. It identified key gaps in policy implementation and intersectoral coordination. The second study was a qualitative study in which 39 PA policy documents from across the six Gulf Cooperation Council (GCC) countries were analysed, providing a comparative overview that highlights policy inconsistencies and the absence of systematic evaluation mechanisms. The third study was based on interviews with 15 participants from diverse backgrounds in the southern region of Saudi Arabia. It offers a qualitative perspective on how local norms, safety concerns, and social expectations shape individuals' engagement in physical activity. One of the key findings was the need for improved collaboration among government sectors, particularly between health, education, municipal, and sports authorities, to effectively promote physical activity. The research highlights insufficient financial support and the lack of dedicated budgets for PA initiatives, which limits the scalability and sustainability of current efforts. Additionally, the findings underscore the importance of developing culturally adapted interventions that are sensitive to local traditions, gender norms, and environmental constraints specific to the southern region. Safety concerns, limited access to appropriate facilities, and social perceptions around physical activity, especially for women, emerged as critical barriers. The thesis contributes valuable insights for policymakers and public health practitioners by emphasising the importance of context-specific, multisectoral strategies to enhance physical activity participation and reduce health disparities in the region. Recommendations for future research and policy development are provided to further address the barriers identified and promote a healthier, more active population. Key recommendations include strengthening cross-sectoral collaboration to create more integrated approaches, increasing financial support to ensure sustainable initiatives, and aligning physical activity programs with local cultural norms to foster cultural change and greater community acceptance.24 0Item Restricted Exploring the attitudes, beliefs, barriers, and facilitators to the uptake of and adherence to exercise and physical activity among Saudi women diagnosed with coronary artery disease: a qualitative study(University of Leeds, 2025) AlSabei, Zainab; Horne, Maria; McHugh, GretlIntroduction: Coronary artery disease (CAD) is the leading cause of death among women in Saudi Arabia. However, women often underestimate their CAD risk. Physical activity (PA) is an integral part of secondary prevention of CAD. PA is known to lower mortality rates and improve the quality-of-life among individuals with established CAD. PA levels vary between different ethnicities and genders. In Saudi Arabia, the percentage of women meeting the PA recommendation is as low as 10%. Despite the low prevalence rate among Saudi women in general, little is known about their PA habits post-diagnosis of CAD. Aim: To explore attitudes, beliefs, barriers, and facilitators to the uptake of and adherence to exercise and PA among Saudi women diagnosed with CAD. Methods: A descriptive qualitative study was undertaken. Thirty-two semi-structured interviews were conducted between June 2024 and November 2024, sixteen with Saudi women diagnosed with CAD and sixteen with healthcare professionals. The theoretical domain framework informed the data collection and data analysis, which was undertaken using framework analysis. The findings were fed into the COM-B model and the behavioural change wheel (BCW) to identify a potential intervention to promote PA uptake and adherence among Saudi women post-CAD diagnosis. Findings: Nine themes and subthemes were identified from both datasets. Religious and sociocultural influences were highlighted as a main theme as women reported familial and social obligations take priority over being physically active, and discussed the effect of the lack of exercise during their upbringings on their ability to uptake and adhere to exercise and PA. Other themes discussed knowledge gap, social and professional support and the perceived barriers and facilitators to being physically active. Conclusion: This study has provided an insight into the experience of Saudi women diagnosed with CAD with exercise and PA. Identified facilitators and barriers were used to develop a potential PA-promoting intervention to improve overall health and well-being, which was visually illustrated in a logic model featuring the intervention’s key ingredients, based on the findings of the application of the COM-B model and BCW.18 0Item Restricted Developing an evidence-based recommendation to communicate physical activity knowledge for disabled adults with various health statuses in Saudi Arabia.(Durham University, 2025) Alfaifi, Husam; Smith, BrettOne of the key challenges faced by disabled people in leading active lifestyles is the lack of access to physical activity (PA) information. This challenge is further exacerbated by the limited research on health status and impairments, which intersects with social and environmental barriers, making access to PA information even more difficult. The primary aim of this thesis was to develop evidence-based recommendations to communicate PA knowledge for disabled adults with various health statuses in Saudi Arabia (SA). To achieve the primary aim, research objectives were established to understand the preferences of disabled adults with various health statuses regarding knowledge (including message content), key messengers, formats, and delivery mechanisms to support inclusivity. The objectives were accomplished through the use of a sequential mixed-methods design. First, the preferences of adults with disabilities (n = 559) regarding PA knowledge communication were measured through a carefully designed questionnaire based on trends, disability type, and health status. The quantitative research used descriptive analysis and chi-square tests to reveal diverse preferences among disabled adults with various health statuses for knowledge (including message content), trusted messengers, formats, and delivery mechanisms. Subsequently, interviews were conducted with 56 disabled adults of varying health statuses and analysed using a deductive-inductive thematic analysis to explore the underlying reasons and rationales behind their preferences for specific PA knowledge communication. The findings demonstrated a preference for formulating national PA guidelines for disabled persons to mitigate personal, environmental, and social obstacles for PA. Additionally, it was preferable to adapt formats and channels to deliver culturally, contextually, and health-appropriate PA message content to disabled individuals with various health conditions. The best PA messengers for sustainability were coaches, whereas health professionals were favoured for health. The research concludes by outlining methodological, policy, and practical implications and recommendations for advancing PA communication among disabled adults.24 0Item Restricted AI Conversational Agents in Healthcare for Type-2 Diabetes(University of Technology Sydney, 2024-09-12) Sawad, Abdullah Bin; Kocaballi, Baki; Prasad, Mukesh; Narayan, Bhuva; Lin, ShanshanType 2 diabetes (T2D) is a global health crisis with significant impacts on individuals and healthcare systems. This thesis develops AI conversational agents (CAs) to promote physical activity and lifestyle changes for those at risk of T2D through a multi-phase study, including a systematic review, a design framework, and empirical testing. The systematic review identified gaps in digital interventions, particularly the limited use of CAs in T2D prevention. A standardised framework was then developed, focusing on personalisation, user engagement, and proactive health management. This framework guided the iterative design and refinement of a CA prototype, tested across diverse populations in Sydney and Jeddah. The thesis integrated real-time activity tracking via Fitbit and enhanced conversational capabilities using large language models. Findings demonstrated that AI-driven, personalised interactions significantly encouraged physical activity, a key factor in preventing T2D progression. This thesis contributes to health informatics by demonstrating AI’s role in preventive healthcare. It highlights the importance of a user-centred design approach, ensuring that digital health tools are effective and align with the users’ needs and preferences. Future research should focus on long-term engagement strategies and integrating conversational agents with broader healthcare systems to enhance their effectiveness and reach.33 0Item Restricted Mobility in Multiple Sclerosis Patients(University of Sheffield, 2024) Binshalan, Tarub; McNeill, AlisdairMultiple Sclerosis (MS) is a chronic autoimmune disease that is highly associated with gait limitations in people with MS (pwMS), and severely disabled patients are particularly affected. Currently, clinicians use objective and semi-objective rating scales to assess ambulation. These scales lack accuracy and sensitivity to real-world mobility changes and disease progression. As the disease progresses physical therapy interventions for mobility become more limited. This thesis aimed at providing new tools to improve walking assessment procedures, as well as providing physical therapy interventions for improving mobility in this population. This thesis comprises four studies: 1. A systematic review and meta-analysis examined the effects of physical therapy interventions on mobility in severe MS patients. Results indicated that robot assisted gait training (RAGT) improved walking endpoints except timed up and go (TUG). 2. We validated free-living walking measurements derived from a physical activity monitor (PAM) against standard mobility outcome assessments. In a cohort of 35 pwMS, the PAM was highly correlated with clinically validated measurements of mobility and endurance. This suggests that PAM could be a valuable clinical trial output. 3. An RCT examined remote ischemic preconditioning (RIPC) as an intervention to improve mobility in severe pwMS. RIPC for 6 weeks, (n=14) received intervention while(n=11) in sham group. Results showed that RIPC did not improve mobility nor PROMs in pwMS. 4. We studied the range of responses for the multiple sclerosis impact scale (MSIS) and multiple sclerosis walking scale (MSWS) in the general population without MS. Both PROMs scores of (n=198) were significantly affected by comorbidities, while the MSWS score was directly related to age. This thesis highlighted physical therapy interventions for severe MS patients, offering practical measures of real-world activity. Additionally, it explored factors affecting MSIS and MSWS scores in the general population. Future research and implications of these findings were discussed20 0Item Restricted Activating the Transportation Potential of Greenways in Saudi Arabia: A Case Study of Jeddah City(University of Nottingham, 2024-04-08) Zawawi, Abdulrahman A.; Porter, Nicole; Ives, Chrisopher D.; Beccarelli, PaoloSince the early 1970s, auto-centric planning in Saudi Arabia (SA) has led to car-dependent lifestyles, resulting in health and environmental problems. In the past decade, ambitious policies (e.g., The Saudi Vision 2030), urban design manuals, awareness campaigns, city plans and projects have sought to address this problem by transitioning to sustainable urban mobility. Active transportation (AT) via networks of greenways is a dimension of such a transition and is currently being planned and advocated in Saudi cities. However, current walking and bicycling rates for transportation in SA are extremely low. Simultaneously, there is limited research on greenways in SA, and none has explored the influences on their usage as AT corridors (ATCs). An enhanced understanding of such factors is vital because academic journals found minimal effect on AT over the last thirty years from many greenway investments in various regions worldwide. Therefore, this PhD research aimed to explore the activation barriers and strategies of greenways’ function as facilitators for AT in SA, using Jeddah city as a case study. The review and synthesis of existing literature built an understanding of the state of knowledge concerning the planning and usage of AT and greenways in SA. It also explained the events that evolved greenways’ forms and functions internationally while chronologically relating to urban and open space planning in Saudi cities. Lastly, it examined where and when greenways would be considered routes for daily commutes using a systematic review of published peer-reviewed journal articles from 1991 until 2021. Due to the multidimensionality of such influences, the case study of Jeddah used mixed research methods (web-based questionnaire, environmental audits, field observations, and interviews with experts and leaders of local walking and bicycling groups). Interpretations and inferences of such an empirical study combined the results of these methods thematically and linked them to existing literature. Through (I) assessments of the physical environment at the city, neighbourhood, and site levels, (II) examining the preferences, behaviours, and opinions of users and non-users of greenways in Jeddah city, and (III) understanding the underlying causes to existing conditions, this thesis underscored key impediments that must be overcome. These include automobile-centric lifestyles, planning systems, outdoor temperature, social norms, long commuting distances, lack of AT infrastructure, bicycling skills and knowledge, proximity to greenways, and park facilities and amenities. Results also explained that religious and gender norms on women’s participation in bicycling can affect social support for policies advocating bicycle usage in Saudi cities and the effectiveness of any proposed greenway network in the future. Informed by the interviewed experts, existing literature, and global best practices, the proposed strategies to address the identified barriers stressed the importance of actions across social, environmental, technological, economic and legal domains. These strategies (e.g., improving stakeholders’ participation, integrating with public transit, increasing visibility and awareness, and implementing policies that enable AT) can accelerate the transition towards sustainable transportation in SA.32 0Item Restricted The Association between Healthy Lifestyle Behaviors and Polypharmacy in Older Adults: The Loma Linda Longevity Study(Loma Linda University, 2024) Bardesi, Abrar; Dos Santos, HildemarIntroduction: Polypharmacy—defined as taking numerous medications that may not be clinically necessary—is becoming a significant concern among the older adult population. This study examined the associations between lifestyle behaviors and the number of prescribed medications in older adults (75 years and older) living in the counties of San Bernardino and Riverside. Methods: This study employed a cross-sectional survey to assess lifestyle behaviors and medication use in 611 older adults aged 75 or over. Bivariate correlation and linear regression analyses were used to assess potential relationships between lifestyle behaviors and the number of prescribed medications. Results: Fruit consumption (p=0.005), mild physical activity per week (p<.001), and lifestyle index (p=0.003) had a highly significant inverse association with the number of prescribed medications. Fat consumption had a direct positive relationship with the number of prescribed medications (p=0.02). Conclusion: Higher fat intake was directly linked to an increased need for medications, while regular physical activity, a higher fruit intake, and a healthy overall lifestyle were all associated with a lower likelihood of polypharmacy. Future research can explore the mechanisms linking these behaviors with medication usage.41 0