Author ORCID Identifier
Year of Publication
Doctor of Philosophy (PhD)
Dr. Johanna Hoch
Dr. Rachel Hogg-Graham
Injury to the anterior cruciate ligament (ACL) is common in physically active populations. Anterior cruciate ligament reconstruction (ACLR) is commonly performed after injury in order to restore joint stability and knee function and return patients to desired levels of physical activity. However, not everyone will return to their pre-injury levels of sport after surgery and recent evidence reveals that individuals with a history of ACLR are less likely to meet the recommended physical activity guidelines. Specifically, previous literature has reported that individuals with a history of ACLR take fewer daily steps and participate in less moderate-to-vigorous physical activity compared to their healthy counterparts. This is problematic as physical inactivity is linked to the development of numerous illnesses and diseases and results in billions of dollars in health care costs annually.
While numerous studies have sought to identify factors that impact physical activity participation in individuals with history of ACLR, evidence to date has focused primarily on physical and psychological factors such as knee pain, decreased muscular strength, and fear of reinjury. These physical and psychological factors fail to account for personal, social, and environmental factors that may serve as facilitators or barriers to physical activity participation in this population. Physical literacy is the motivation, confidence, physical competence, and knowledge and understanding to value physical activity across a lifespan. This multidimensional concept may be an essential factor to investigate as it accounts for personal, social, and environmental factors that may influence physical activity participation. Physical literacy has been linked to physical activity participation, overall health, and quality of life in youth and adolescent populations. Additionally, the individual components of motivation, confidence, and knowledge have been shown to influence rehabilitation success, return to activity rates, and physical activity participation after ACLR, while physical competence has been shown to improve fundamental movement skills. Understanding the role of physical literacy and its individual components in a young adult population with a history of ACLR could provide insight into additional factors that serve as facilitators or barriers to physical activity participation.
The purpose of this dissertation was to explore personal, social, and environmental factors associated with physical activity and examine the relationship between physical literacy and physical activity in individuals with a history of ACLR. The purposes of these studies were to determine if physical literacy and its components are associated with self-reported and objectively measured physical activity and to explore perceptions of physical literacy and experiences with physical activity after ACLR. The results of these studies indicate that physical literacy is associated with self-reported and objectively measured physical activity in young adults with a history of ACLR. Specifically, self-description of physical literacy explained approximately 12% of the variance of self-reported physical activity while the physical competence component explained approximately 30% of the variance in objectively measured physical activity. Additionally, individuals with a history of ACLR described how aspects of motivation, confidence, physical competence, and knowledge influence physical activity participation after ACLR. The results of this study support the use of physical literacy for understanding and predicting physical activity in young adults with a history of ACLR.
Digital Object Identifier (DOI)
1. This study was supported by the University of Kentucky Endowed University Professor in Health Sciences Fund in 2021-2022.
2. This study was supported by the University of Kentucky Graduate Student Congress Research Award in 2021-2022.
Kleis, Rachel Renee, "The Utilization of Physical Literacy to Understand Physical Activity in Individuals with a History of Anterior Cruciate Ligament Reconstruction" (2022). Theses and Dissertations--Rehabilitation Sciences. 89.
Available for download on Wednesday, July 12, 2023