We investigated the hypothesis that combined resistance and endurance exercise improves cardiorespiratory fitness and muscle strength, thereby reducing fatigue and improving global quality of life ...(QoL) and physical function among cancer survivors who completed curative treatment including chemotherapy.
Cancer survivors were assigned to a 12-wk exercise intervention (n = 186) or a wait list control group (n = 91). Data were collected at baseline and after 12 wk. Path analyses using follow-up values adjusted for baseline values, age, and gender were conducted to test if the exercise effects on global QoL and physical function (European Organization Research and Treatment of Cancer Quality of Life questionnaire-Core 30) were mediated by changes in cardiorespiratory fitness (peak V˙O2), hand-grip strength, lower body muscle function (30-s chair stand test), and fatigue (Multidimensional Fatigue Inventory).
Compared with the wait list control, exercise increased cardiorespiratory fitness (β = 1.8; 95% confidence interval (CI), 1.0-2.6 mL·kg·min) and reduced general (β = -1.0; 95% CI, -1.8 to -0.2) and physical fatigue (β = -1.5; 95% CI, -2.3 to -0.6). The exercise effect on physical fatigue was mediated by change in cardiorespiratory fitness (β = -0.2; 95% CI, -0.4 to -0.1). Higher hand-grip strength was significantly associated with lower physical fatigue and better lower body muscle function with lower physical and general fatigue. Lower general fatigue and physical fatigue were significantly associated with higher global QoL (β = -1.6; 95% CI, -2.2 to -1.1; and β = -1.7; 95% CI, -2.3 to -1.1, respectively) and physical function (β = -1.0; 95% CI, -1.3 to -0.7; and β = -1.2; 95% CI, -1.6 to -0.9, respectively). The models explained 44%-61% of the variance in global QoL and physical function.
Beneficial effects of exercise on global QoL and physical function in cancer survivors were mediated by increased cardiorespiratory fitness and subsequent reductions in fatigue.
Insight in children's energy balance-related behaviours (EBRBs) and their determinants is important to inform obesity prevention research. Therefore, reliable and valid tools to measure these ...variables in large-scale population research are needed.
To examine the test-retest reliability and construct validity of the child questionnaire used in the ENERGY-project, measuring EBRBs and their potential determinants among 10-12 year old children.
We collected data among 10-12 year old children (n = 730 in the test-retest reliability study; n = 96 in the construct validity study) in six European countries, i.e. Belgium, Greece, Hungary, the Netherlands, Norway, and Spain. Test-retest reliability was assessed using the intra-class correlation coefficient (ICC) and percentage agreement comparing scores from two measurements, administered one week apart. To assess construct validity, the agreement between questionnaire responses and a subsequent face-to-face interview was assessed using ICC and percentage agreement.
Of the 150 questionnaire items, 115 (77%) showed good to excellent test-retest reliability as indicated by ICCs > .60 or percentage agreement ≥ 75%. Test-retest reliability was moderate for 34 items (23%) and poor for one item. Construct validity appeared to be good to excellent for 70 (47%) of the 150 items, as indicated by ICCs > .60 or percentage agreement ≥ 75%. From the other 80 items, construct validity was moderate for 39 (26%) and poor for 41 items (27%).
Our results demonstrate that the ENERGY-child questionnaire, assessing EBRBs of the child as well as personal, family, and school-environmental determinants related to these EBRBs, has good test-retest reliability and moderate to good construct validity for the large majority of items.
Purpose
In this study, we investigated the association between adherence to the Dutch Healthy Diet index 2015 (DHD15-index) and incidence of prediabetes (preT2D) and Type 2 Diabetes (T2D) in a ...representative sample for the general Dutch population.
Methods
Two prospective cohort studies, The Hoorn and The New Hoorn Study, were used for data analyses. In total, data from 2951 participants without diabetes at baseline (mean age 56.5 ± 7.5 years; 49.6% male) were harmonized. Baseline dietary intake was assessed with validated Food Frequency Questionnaires and adherence to the DHD15-index was calculated (range 0–130). PreT2D and T2D were classified according to the WHO criteria 2011. Poisson regression was used to estimate prevalence ratios between participant scores on the DHD15-index and preT2D and T2D, adjusted for follow-up duration, energy intake, socio-demographic, and lifestyle factors. Change in fasting plasma glucose levels (mmol/L) over follow-up was analysed using linear regression analyses, additionally adjusted for baseline value.
Results
During a mean follow-up of 6.3 ± 0.7 years, 837 participants developed preT2D and 321 participants developed T2D. The highest adherence to the DHD15-index was significantly associated with lower T2D incidence model 3, PR
T3vsT1
: 0.70 (0.53; 0.92),
p
trend
= 0.01. The highest adherence to the DHD15-index pointed towards a lower incidence of preT2D PR
T3vsT1
: 0.87 (0.74; 1.03),
p
trend
= 0.11. Higher adherence to the DHD15-index was not associated with change in fasting plasma glucose levels
β
10point
: − 0.012 (− 0.034; 0.009)mmol/L.
Conclusion
The present study showed that the highest compared to the lowest adherence to the DHD15-index was associated with a lower T2D incidence, and pointed towards a lower incidence of preT2D. These results support the benefits of adhering to the guidelines in T2D prevention.
Initiating and maintaining a healthy lifestyle -including healthy eating and sufficient physical activity- is key for cardiometabolic health. A health-promoting environment can facilitate a healthy ...lifestyle, and may be especially helpful to reach individuals with a lower socio-economic status (SES). In the Supreme Nudge project, we will study the effects of pricing and nudging strategies in the supermarket - one of the most important point-of-choice settings for food choices - and of a context-specific mobile physical activity promotion app. This paper describes the stepwise and theory-based design of Supreme Nudge, which aims to develop, implement and evaluate environmental changes for a sustained impact on lifestyle behaviours and cardiometabolic health in low SES adults.
Supreme Nudge uses a multi-disciplinary and mixed methods approach, integrating participatory action research, qualitative interviews, experimental pilot studies, and a randomized controlled trial in a real-life (supermarket) setting. First, we will identify the needs, characteristics and preferences of the target group as well as of the participating supermarket chain. Second, we will conduct a series of pilot studies to test novel, promising and feasible intervention components. Third, a final selection of intervention components will be implemented in a full-scale randomised controlled supermarket trial. Approximately 1000 low SES adults will be recruited across 8-12 supermarkets and randomised at supermarket level to receive 1) no intervention (control); 2) environmental nudges such as food product placement or promotion; 3) nudges and a tailored physical activity app that provides time- and context specific feedback; 4) pricing interventions, nudges, and the physical activity app. The effects on dietary behaviours and physical activity will be evaluated at 3, 6 and 12 months, and on cardiometabolic health at 6 and 12 months. Finally, we will evaluate the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) of the intervention, and we will use insights from System Innovation and Transition Management theories to define the best strategies for implementation and upscaling beyond the study period.
The Supreme Nudge project is likely to generate thorough evidence relevant for policy and practice on the effects of a mixed method and multi-disciplinary intervention targeting dietary behaviours and physical activity.
The real-life trial has been registered on 30 May 2018, NTR7302 .
The uptake, implementation, and maintenance of effective interventions promoting physical activity (PA) and a healthy diet and the implementation of policies targeting these behaviors are processes ...not well understood. We aimed to gain a better understanding of what health promotion professionals and policy makers think are important factors facilitating adoption, implementation, and maintenance of multi-level interventions and policies promoting healthy eating and PA in Belgium, Germany, Ireland, Norway, and Poland.
Six interventions and six policies were identified based on pre-defined criteria. Forty semi-structured interviews were conducted with stakeholders from various sectors to elicit information on factors impacting adoption, implementation, and maintenance of these interventions and policies. All interview transcripts were coded in NVivo, using a common categorization matrix. Coding in the respective countries was done by one researcher and validated by a second researcher.
Active involvement of relevant stakeholders and good communication between coordinating organizations were described as important factors contributing to successful adoption and implementation of both interventions and policies. Additional facilitating factors included sufficient training of staff and tailoring of materials to match needs of various target groups. The respondents indicated that maintenance of implemented interventions/policies depended on whether they were embedded in existing or newly created organizational structures in different settings and whether continued funding was secured.
Despite considerable heterogeneity of interventions and health policies in the five countries, stakeholders across these countries identify similar factors facilitating adoption, implementation, and maintenance of these interventions and policies.
Recently, Drs. Ken Resnicow and Roger Vaughan published a thought-provoking paper in the International Journal of Behavioral Nutrition and Physical Activity (IJBNPA). They argue that the most often ...used social-cognition theories in behavioral nutrition and physical activity are of limited use. These models describe behavior change as a linear event, while Resnicow and Vaughan posit that behavior change is more likely to occur in quantum leaps that are impossible to predict. They introduce Chaos Theory into the behavioral nutrition and physical activity domain as a more valid framework to study the complex process of health behavior change. The present paper is a commentary on Resnicow and Vaughan's article by Resnicow's opponent in a recent debate-session at the annual meeting of the International Society of Behavioral Nutrition and Physical Activity. The chair of that meeting, Prof. Tom Baranowski, provides a separate commentary on Resnicow and Vaughan's paper also published recently in the IJBNPA. In the present commentary I relate Resnicow and Vaughan's paper to the other contributions to the Theory debate in the IJBNPA. I recognize the limited success of social cognition models, and, next to a better application of these models and more thorough research to test these model, also support research to further test the quantum and chaotic character of health behavior change. However, if such research supports the chaotic and quantum nature of health behavior change, the implications for behavioral nutrition and physical activity interventions may be limited, because even if behavior change is quantum rather than linear, the social cognition models are still relevant to inform interventions to promote quantum leaps in behavior change.
The prevalence of overweight and obesity in Europe is high. It is a major cause of the overall rates of many of the main chronic (or non communicable) diseases in this region and is characterized by ...an unequal socio-economic distribution within the population. Obesity is largely determined by modifiable lifestyle behaviours such as low physical activity levels, sedentary behaviour and consumption of energy dense diets. It is increasingly being recognised that effective responses must go beyond interventions that only focus on a specific individual, social or environmental level and instead embrace system-based multi-level intervention approaches that address both the individual and environment. The EU-funded project "sustainable prevention of obesity through integrated strategies" (SPOTLIGHT) aims to increase and combine knowledge on the wide range of determinants of obesity in a systematic way, and to identify multi-level intervention approaches that are strong in terms of Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM).
SPOTLIGHT comprises a series of systematic reviews on: individual-level predictors of success in behaviour change obesity interventions; social and physical environmental determinants of obesity; and on the RE-AIM of multi-level interventions. An interactive web-atlas of currently running multi-level interventions will be developed, and enhancing and impeding factors for implementation will be described. At the neighbourhood level, these elements will inform the development of methods to assess obesogenicity of diverse environments, using remote imaging techniques linked to geographic information systems. The validity of these methods will be evaluated using data from surveys of health and lifestyles of adults residing in the neighbourhoods surveyed. At both the micro- and macro-levels (national and international) the different physical, economical, political and socio-cultural elements will be assessed.
SPOTLIGHT offers the potential to develop approaches that combine an understanding of the obesogenicity of environments in Europe, and thus how they can be improved, with an appreciation of the individual factors that explain why people respond differently to such environments. Its findings will inform governmental authorities and professionals, academics, NGOs and private sector stakeholders engaged in the development and implementation of policies to tackle the obesity epidemic in Europe.
To further test the validity and clinical usefulness of the steep ramp test (SRT) in estimating exercise tolerance in cancer survivors by external validation and extension of previously published ...prediction models for peak oxygen consumption (Vo
) and peak power output (W
).
Cross-sectional study.
Multicenter.
Cancer survivors (N=283) in 2 randomized controlled exercise trials.
Not applicable.
Prediction model accuracy was assessed by intraclass correlation coefficients (ICCs) and limits of agreement (LOA). Multiple linear regression was used for model extension. Clinical performance was judged by the percentage of accurate endurance exercise prescriptions.
ICCs of SRT-predicted Vo
and W
with these values as obtained by the cardiopulmonary exercise test were .61 and .73, respectively, using the previously published prediction models. 95% LOA were ±705mL/min with a bias of 190mL/min for Vo
and ±59W with a bias of 5W for W
. Modest improvements were obtained by adding body weight and sex to the regression equation for the prediction of Vo
(ICC, .73; 95% LOA, ±608mL/min) and by adding age, height, and sex for the prediction of W
(ICC, .81; 95% LOA, ±48W). Accuracy of endurance exercise prescription improved from 57% accurate prescriptions to 68% accurate prescriptions with the new prediction model for W
.
Predictions of Vo
and W
based on the SRT are adequate at the group level, but insufficiently accurate in individual patients. The multivariable prediction model for W
can be used cautiously (eg, supplemented with a Borg score) to aid endurance exercise prescription.
The aim of the present study was to explore if children who spend more time on screen-based sedentary behaviors (i.e.TV viewing and computer use) drink more sugar-sweetened soft drinks. The study ...also assessed whether these associations were independent of individual and home environmental correlates of soft drink consumption and whether they were moderated by parental education.
Data were collected from 7886 children participating in the EuropeaN Energy balance Research to prevent excessive weight Gain among Youth (ENERGY) survey conducted in eight European countries. Self-report questionnaires were used. Multilevel linear regression analyses with soft drink consumption as dependent variable, TV viewing and computer use as independent variables and age, gender, parental education, attitude towards soft drinks, self-efficacy, parental modelling, parental rules and home availability of soft drinks as covariates were conducted. Further interactions were tested to explore if these associations were moderated by parental education. Country-specific analyses were conducted.
In six of the eight included countries, a significant positive association was observed between TV viewing (min/day) and soft drink consumption (ml/day), independent of individual and home environmental correlates of soft drink consumption (B = 0.46 (0.26-0.66) in Greece, B = 0.77 (0.36-1.17) in Norway, B = 0.82 (0.12-1.51) in Hungary, B = 1.06 (0.67-1.46) in Spain, B = 1.21 (0.67-1.74) in Belgium and B = 1.49 (0.72-2.27) in Switzerland). There was no significant association between computer use and soft drink consumption in six of the eight included countries in the final models. Moderation effects of parental education in the association between TV viewing and soft drink consumption were found in Norway and Hungary, the association being stronger among those with low parental education.
TV viewing appears to be independently associated with soft drink consumption and this association was moderated by parental education in two countries only. Reducing TV time might therefore favorably impact soft drink consumption.
The goal was to assess risky and protective listening behaviors of adolescent users of MP3 players and the association of these behaviors with demographic characteristics and frequency of use.
In ...2007, 1687 adolescents (12-19 years of age) in 68 classes in 15 Dutch secondary schools were invited to complete questionnaires about their music-listening behaviors.
. Ninety percent of participants reported listening to music through earphones on MP3 players; 32.8% were frequent users, 48.0% used high volume settings, and only 6.8% always or nearly always used a noise-limiter. Frequent users were >4 times more likely to listen to high-volume music than were infrequent users, and adolescents in practical prevocational schools were more than twice as likely to listen to high-volume music as were those attending preuniversity education.
When using MP3 players, adolescents are very likely to engage in risky listening behaviors and are unlikely to seek protection. Frequent MP3 player use is an indicator of other risky listening behaviors, such as listening at high volumes and failing to use noise-limiters.
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