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.

Friday, March 25, 2016

Implementation index and effect of school-based obesity prevention

In a study just published in the journal Health Education Research -with Dr. Femke van Nassau as first author- we investigated if and to what extent the Dutch Obesity Intervention in Teenagers (DOiT) program was implemented as intended and how this affected program effectiveness. We collected data at 20 prevocational education schools in the Netherlands. We assessed seven indicators that may reflect implementation succes: recruitment, reach, dosage, fidelity, satisfaction, effectiveness and continuation. Data collection involved questionnaire research among teachers and pupils, adiposity measures among the pupils. From the data we derived an implementation index scores. The percentage of accomplished activities in the participating s
chools ranged from 9 to 93%. The percentage of lessons delivered decreased from 74 to 18% towards the end of the program. Fidelity to the teacher manual ranged from 85 to 26%. In general, teachers were satisfied with the DOiT lessons and teaching materials. Despite teachers' satisfaction with the DOiT lessons and teaching materials, degree of program implementation was lower than expected, especially towards the end of the program. Further, some evidence was found for an association between a higher implementation index score and program effectiveness.

Tuesday, March 15, 2016

Clinical and behavioural correlates of physical activity among breast cancer survivors

The aim of a study that was published this week in the journal Supportive Care in Cancer  (with Caroline Kampshoff as first author) was to identify demographic, clinical, psychosocial, and environmental correlates of objectively assessed physical activity among breast cancer survivors. Information about such correlates can inform future interventions to promote physical activity in
cancer survivors, which has been shown to improve quality of life and reduce complaints about fatigue among cancer survivors.
For this study we analysed data from 574 female breast cancer survivors who participated in three different intervention studies. Study participants were aged ≥18 years and had completed primary cancer treatment. Physical activity was objectively assessed by accelerometers or pedometers. Participants completed self-reported questionnaires on demographic, psychosocial, and environmental factors. Information regarding clinical factors was obtained from medical records or patient self-report.
Older age, higher body mass index, lower self-efficacy, and less social support were significantly correlated with less physical activity.

Thursday, March 3, 2016

European Sitting Championship

Sedentary behaviour is increasingly recognized as an important health risk, but comparable data across Europe are scarce. The objective of a study we conducted and that was published this week in Plos ONE, was to explore the prevalence and correlates of self-reported sitting time in adults across and within the 28 European Union Member States. This study was linked to the determinants of diet and physical activity (DEDIPAC) joint action of the Healthy Diet for a Healthy Life joint programming initiative.

This study reports data from the Eurobarometer in 2013 with 27,919 randomly selected Europeans (approximately 1000 per Member State).

Median sitting time across Europe was five hours per day. Across Europe, 18.5 percent of the respondents reported to sit more than 7.5 hours per day, with substantial variation between countries (ranging from 8.9 to 32.1 percent). In general, northern European countries reported more sitting than countries in the south of Europe. ‘Current occupation’ and ‘age when stopped education’ were found to be the strongest correlates of sitting time, both across Europe and within most Member States. Compared to manual workers, people with office occupations were 5 times more likely to sit more than 7.5 hours per day. Students were more than 3 times more likely to sit more than 7.5 hours per day than manual workers.

There is thus substantial variation in  sitting time among European adults across countries as well as socio-demographic groups.