Tuesday, September 13, 2016

Correlates of adherence to a physical exercise program after cancer treatment

In a paper just published in the International Journal of Behavioral Nutrition and Physical Activity we studied demographic, clinical, psychosocial, physical and environmental factors associated with participation in and adherence to a combined resistance and endurance exercise program among cancer survivors, shortly after completion of primary cancer treatment. Data from the randomized controlled Resistance and Endurance exercise After ChemoTherapy (REACT) study were used for this study.
Participants were randomly allocated to either a high intensity (HI) or low-to-moderate intensity (LMI) exercise program. Patients’ participation rate was defined as their decision to participate in the REACT study. Exercise adherence reflected participants’ attendance to the scheduled exercise sessions and their compliance to the prescribed exercises. High session attendance rates were defined as attending at least 80 % of the sessions. High compliance rates were defined as performing at least of 90 % of the prescribed exercise across all sessions. Correlates of exercise adherence were studied separately for HI and LMI exercise. Demographic, clinical, and physical factors were assessed using self-reported questionnaires. Relevant clinical information was extracted from medical records.

Cancer survivors who participated in the exercise program were more likely to have higher education, be non-smokers, have lower psychological distress, higher outcome expectations, and perceive more exercise barriers than non-participants. In HI exercise, higher self-efficacy was significantly associated with high session attendance and high compliance with endurance exercises, and lower psychological distress was significantly associated with high compliance with resistance exercises. In LMI exercise, being a non-smoker was significantly associated with high compliance with resistance exercises and higher BMI was significantly associated with high compliance with resistance and endurance exercises. Furthermore, breast cancer survivors were less likely to report high compliance with resistance and endurance exercises in LMI exercise compared to survivors of other types of cancer.

In conclusion, several demographic, clinical and psychosocial factors were associated with participation in and adherence to exercise among cancer survivors. Psychosocial factors were more strongly associated with adherence in HI than LMI exercise.

Tuesday, September 6, 2016

lack of association of health behaviors and psychosocial characteristics with preterm birth

Preterm birth is the leading pregnancy outcome associated with perinatal morbidity and mortality and remains difficult to prevent. There is evidence that some modifiable maternal health characteristics may influence the risk of preterm birth. The aim of our study just published in Maternal and Child Health Journal was to investigate the relationships of self-reported maternal health behaviour and psychological characteristics in nulliparous women with spontaneous preterm birth in prenatal primary care. We used data from the nationwide DELIVER multicentre cohort study, which was designed to examine perinatal primary care in the Netherlands. In our study, consisting of 2768 nulliparous women, we estimated the relationships of various self-reported health behaviours (smoking, alcohol consumption, folic acid supplementation, daily fruit, daily fresh vegetables, daily hot meal and daily breakfast consumption) and psychological characteristics (anxious/depressed mood and health control beliefs) with spontaneous preterm birth.
Of all variables investigated, low health control beliefs was the sole characteristic significantly associated with spontaneous preterm birth.

Saturday, August 27, 2016

Breakfast, lunch and dinner among school kids across Europe

In a study just published in Preventive Medicine, with Dr. Froydis Vik as first author, we aimed to assess (i) the prevalence of having regular family breakfast, lunch, dinner among 10–12 year olds in Europe, (ii) the association between family meals and child weight status, and (iii) potential differences in having family meals according to country of residence, gender, ethnicity and parental levels of education.
7716 children (mean age: 11.5 ± 0.7 years, 52% girls) in eight European countries (Belgium, Greece, Hungary, The Netherlands, Norway, Slovenia, Spain, Switzerland) participated in a cross-sectional school-based survey in 2010, as part of the ENERGY study. Data on family meals were self-reported by the parents and children's height and weight were objectively measured to determine overweight status.
The prevalence of regular family meals was 35%, 37% and 76% for breakfast, lunch and dinner respectively. Having regular family breakfast, but not lunch or dinner, was inversely associated with overweight. Children of higher educated parents were more likely to have regular family breakfast and less likely to have regular family lunch compared to children of lower educated parents.

Tuesday, July 19, 2016

SOS: systems of sedentary behaviour framework

Ecological models are currently in fashion to study and influence energy balance related behaviours, including sedentary behaviour. However, these ecological models are limited in their ability to capture the complexity of and interplay between determinants. The aim of the project described in a recent publication in the International Journal of Behavioural Nutrition and Physical Activity, with Seb Chasten as first author, was to develop a transdisciplinary dynamic framework, grounded in a system-based approach, for research on determinants of sedentary behaviour across the life span and intervention and policy planning and evaluation. This endeavour was part of the Determinants of Diet and Physical Activity (DEDIPAC) knowledge hub of the Healthy Diet for a Healthy Life joint programming initiative.

We conducted a comprehensive concept mapping approach to develop what we call the Systems Of Sedentary behaviours (SOS) framework, involving four main phases: (1) preparation, (2) generation of statements, (3) structuring (sorting and ranking), and (4) analysis and interpretation.

During the first phase, 550 factors regarding sedentary behaviour were listed across three age groups (i.e., youth, adults and older adults), which were reduced to a final list of 190 life course factors in phase 2 used during the consensus meeting. In total, 69 international delegates, seven invited experts and one concept mapping consultant attended this consensus meeting. The final framework obtained during that meeting consisted of six clusters of determinants: Physical Health and Wellbeing (71 % consensus), Social and Cultural Context (59 % consensus), Built and Natural Environment (65 % consensus), Psychology and Behaviour (80 % consensus), Politics and Economics (78 % consensus), and Institutional and Home Settings (78 % consensus). Conducting studies on Institutional Settings was ranked as the first research priority. The view that this framework captures a system-based map of determinants of sedentary behaviour was expressed by 89 % of the participants.

In summary, through an international transdisciplinary consensus process, the SOS framework was developed for the determinants of sedentary behaviour through the life course. Investigating the influence of Institutional and Home Settings was deemed to be the most important area of research to focus on at present and potentially the most modifiable. The SOS framework can be used as an important tool to prioritise future research and to develop policies to reduce sedentary time.

Sunday, July 3, 2016

Variation in population levels of physical activity in European adults

In a systematic literature review just published in the International Journal of Behavioural Nutrition & Physical Activity, with Anne Loyen as first authors- we aim to provide an overview of all existing cross-European studies that assess physical activity in European adults, describe the variation in population levels according to these studies, and discuss the impact of the assessment methods. The review is registered in the PROSPERO database under registration number CRD42014010334.
All but two of the studies used questionnaires to assess physical activity, with the majority of studies using the IPAQ-short questionnaire. The remaining studies used accelerometers. The percentage of participants who either were or were not meeting the physical activity recommendations was the most commonly reported outcome variable, with the percentage of participants meeting the recommendations ranging from 7 % to 96 % across studies and countries.
The included studies showed substantial variation in the assessment methods, reported outcome variables and, consequently, the presented physical activity levels. Because of this, absolute
population levels of physical activity in European adults are currently unknown. However, when ranking countries, Ireland, Italy, Malta, Portugal, and Spain generally appear to be among the less active countries. Objective data of adults across Europe is currently limited. These findings highlight the need for standardisation of the measurement methods, as well as cross-European monitoring of physical activity levels.

In the same journals we also published similar systematic reviews regarding sedentary time among adults across Europephysical activity among children and adolescents across Europe, and sedentary behaviour in children and adolescents across Europe. These reviews were all part of the DEDIPAC (determinants of diet and physical activity) joint action of the European joint programming initiative 'A Healthy Diet for a Healthy Life'.

Sunday, May 1, 2016

Mediators of exercise effects on quality of life in cancer survivors

There is growing evidence that exercise is beneficial for cancer patients' quality of life. In a study just published on line in the journal Medicine & Science in Sports & Exercise, we explored via which pathways this effect may come about. More specifically we explored if 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.
One hundred and eighty six cancer survivors were assigned to a 12-week exercise intervention and 91 patients to a wait list control group (WLC).
Compared with WLC, exercise increased cardiorespiratory fitness and reduced general and physical fatigue. The exercise effect on physical fatigue was mediated by change in cardiorespiratory fitness, while 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 and physical fatigue were significantly associated with higher global QoL, and physical function.
We concluded that beneficial effects of exercise on global QoL and physical function in cancer survivors were
mediated by increased cardiorespiratory fitness, and subsequent reductions in fatigue.

Wednesday, April 6, 2016

Summary of new Dutch food-based dietary guidelines published

In a paper just published -on behalf of the committee Dutch dietary guidelines 2015 of the Dutch Health Council- in the European Journal of Clinical Nutrition, the methods and results of the committee's work to derive food-based dietary guidelines for the Dutch population is described and discussed. These new dietary guidelines  for the Dutch are based on 29 systematic reviews of English language meta-analyses in PubMed summarizing randomized controlled trials and prospective cohort studies on nutrients, foods and food patterns and the risk of 10 major chronic diseases: coronary heart disease, stroke, heart failure, diabetes, breast cancer, colorectal cancer, lung cancer, chronic obstructive pulmonary disease, dementia and depression. The committee also selected three causal risk factors for cardiovascular diseases or diabetes: systolic blood pressure, low-density lipoprotein cholesterol and body weight. Findings were categorized as strong or weak evidence, inconsistent effects, too little evidence or effect unlikely for experimental and observational data separately. Next, the committee selected only findings with a strong level of evidence for deriving the guidelines. Convincing evidence was based on strong evidence from the experimental data either or not in combination with strong evidence from prospective cohort studies. Plausible evidence was based on strong evidence from prospective cohort studies only. A general guideline to eat a more plant food-based dietary pattern and limit consumption of animal-based food and 15 specific guidelines have been formulated. There are 10 new guidelines on legumes, nuts, meat, dairy produce, cereal products, fats and oils, tea, coffee and sugar-containing beverages. Three guidelines on vegetables, fruits, fish and alcoholic beverages have been sharpened, and the 2006 guideline on salt stayed the same. A separate guideline has been formulated on nutrient supplements. We concluded that completely food-based dietary guidelines can be derived in a systematic and transparent way.