Evaluation of the Effects of Planned Trainings Given to Obese Adolescent Girls on Healthy Lifestyle Behaviors and Menstrual Symptoms
Evaluation of the Effects of Planned Trainings Given to Obese Adolescent Girls on Healthy Lifestyle Behaviors and Menstrual Symptoms
The aim of this study is to evaluate the effects of training given to obese female students
 in mid-adolescence period for improving nutrition, physical activity, and menstrual symptoms
 on the improvement of their healthy lifestyle behaviors and menstrual symptoms. The research
 sample consisted of 128 obese female students divided into groups as intervention and
 control. In this randomized controlled trial, pretest-posttest control group and random
 process were used. In the first stage of the study, total of 12 hours of training, 120
 minutes for each course per week, was provided. In the second stage, 120 minutes of
 reinforcement training were given every month for three months. The study lasted 16 weeks
 totally. Personal Information Form, Healthy Lifestyle Behavior Scale II (HLBS-II), Menstrual
 Symptom Questionnaire (MSQ) and Student Follow-up Schedule were used as data collection
 tools. Statistical analysis was performed using SPSS Statistics 23 Version. Hypotheses were
 (i) there was a difference between the total HLBS-II and MSQ scores of the students before
 and after the training and (ii) there was a correlation between the scales.
Method The research was carried out as a randomized controlled trial to identify menstrual
 symptoms and healthy lifestyle behaviors of obese adolescent girls and to determine the
 effects of planned trainings given to them for improving nutrition, physical activity, and
 menstrual symptoms on the improvement of their healthy lifestyle behaviors and menstrual
 symptoms.

 Research Hypotheses: H1: There is a difference between the mean scores of Healthy Lifestyle
 Behavior Scale II (HLBS-II) and H2: Menstrual Symptom Questionnaire (MSQ) before and after
 the trainings given to obese adolescent girls. H3: There is a correlation between the mean
 scores of HLBS-II and MSQ.

 Study population and data collection tools: The study was carried out in three state high
 schools providing full-time education in a district of Ankara on September 1, 2017-January
 21, 2018 and included 128 obese female students who accepted to participate voluntarily.
 These schools were chosen because the number of students was high and there were students
 from different socioeconomic levels. The study was approved by Yıldırım Beyazıt University
 Ethics Committee (decision numbered 12.04.2017/15 and coded 522). We obtained corporate
 permission from Ankara Provincial Directorate of National Education and informed consents of
 the students and their parents. Personal Information Form, HLBS-II, MSQ, and Student
 Follow-up Schedule, which were created by the researcher in accordance with the literature,
 were used as data collection tools.

 Personal Information Form was prepared by examining the literature on the relevant age group
 to examine the demographic, nutritional, physical activity, and menstrual characteristics of
 the participants.10,11,14,16-19,22,23 Student Follow-up Schedule was developed for the
 students to record their menstrual pain and symptoms, weight and body mass index (BMI)
 measurements during the specified periods.

 Menstrual Symptom Questionnaire was developed by Chesney and Tasto to assess menstrual pain
 and symptoms in 1975, and the usability of the questionnaire on adolescents was assessed by
 Negriff et al.24 and they updated the questionnaire in 2009. In 2013, Güvenç et al.24
 conducted the reliability and validity study. Following the adaptation process, the
 questionnaire was prepared as 5-point Likert type and to involve 22 items. The MSQ score is
 calculated by taking the average of the total scores of the items in the scale. The increase
 in the mean score indicates that the severity of menstrual symptoms increases. The Cronbach's
 Alpha value of the scale is 0.86. In our study, it was found to be 0.91 and 0.92 before and
 after the trainings, respectively.

 Healthy Lifestyle Behavior Scale II (HLSB-II): The scale was developed by Walker et al.25 in
 1987 and updated in 1996 and named as Healthy Lifestyle Behavior Scale II. Bahar et al.26
 studied the validity and reliability of its Turkish version in 2008. The 4-point Likert type
 scale consists of 52 items. Cronbach's Alpha value of the scale is 0.92. In our study, the
 Cronbach's Alpha value of the scale was found to be 0.91 and 0.92 before and after the
 trainings, respectively.

 Treatment and control groups: The study population covers all female high school students.
 Study sample: In accordance with BMI-for-Age Percentile for Girls (kg/m2) determined by WHO,2
 the study population was determined via two stages and consisted of volunteer female obese
 students aged 14 (BMI 26,7), 15 (BMI> 27,6) and 16 years (BMI> 28,2), who were currently at
 ninth, 10th and 11th grade in high school. In the first stage, BMIs, heights, and weights of
 1300 female students who participated in the study voluntarily were measured and the students
 who met the criteria were included in the study. In the second stage, students, who agreed to
 participate in training and monitoring, were determined and they were, then, randomly divided
 into two groups, namely intervention (n=63) and control (n=65) groups.

 The steps in the Implementation Phase are as follows: a) Sampling: measuring the BMIs,
 heights, and weights of 1300 female students, determining the sample group, and obtaining
 informed consent from them and their parents; b) Before the Training: applying Personal
 Information Form, HLBS-II, and MSQ to the intervention and control groups determined randomly
 and distributing the Student Follow-up Schedules; c) Providing trainings to the intervention
 group; d) Monitoring the weights, BMIs, and menstrual symptoms of intervention and control
 groups; and e) After the Training: Applying HLBS-II and MSQ scales to intervention and
 control groups, collecting the follow-up schedules, and providing training to the control
 group and all other students. Trainings: First stage: 120 minutes basic training per week for
 four weeks (40 minutes on diet, 40 minutes on physical activity, and 40 minutes on menstrual
 symptoms) . Second stage: Reinforcement trainings of 120 minutes were given once a month for
 three months. Periodic follow-up of intervention and control groups was carried out by
 recording their BMIs (Tanita BC 730 branded calibrated professional body analyzer was used to
 determine weight and BMI , which were measured three times in three periods) and menstrual
 symptoms ( participants were asked to mark Menstrual Pain and Symptoms in the first three
 days of menstruation in five periods) .

 Statistical Analysis: Data was analyzed by using SPSS Statistics for Windows, Version 23.0
 (IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp). Descriptive data was
 compared using Chi-Square and Mann-Whitney U tests, while Wilcoxon's and McNemar's tests were
 used to compare the menstruation findings of the students before and after the training.
 Dependent Samples t-Test was used in the intragroup comparison of total HLBS-II, MSQ, and
 sub-dimension scores. Comparison of differences between groups was performed by using the
 Independent Samples t-Test. Pearson's correlation analysis was used to determine the
 relationship between total HLBS-II and MSQ scores.
Inclusion Criteria:

 -  Regular Menstruation

 -  Obese

 -  9,10,11. class student

 Exclusion Criteria:

 Unregular menstruation non-attendance to training