Tuesday, October 3, 2017

Lessons learned from process evaluation of an exercise intervention among cancer patients

In a paper just published in European Journal of Cancer Care -with Saskia Persoon as first author, and as part of the Alpe D'HuZes Cancer Rehabilitation research program (A-CaRe)-, we describe the process evaluation of an 18-week supervised exercise programme in 50 patients treated with high-dose chemotherapy followed by autologous stem cell transplantation. The intervention included 30 exercise sessions with six resistance exercises and interval training. We evaluated the context, dose delivered and received, and patients' and physiotherapists' satisfaction with the intervention. Ninety-two per cent of the patients trained within 15 km of their home address, with an average session attendance of 86%. Most patients trained at the prescribed intensity for four of the six resistance exercises, but the dose delivered and received of the two remaining resistance exercises and interval training could not be determined. Both patients and physiotherapists highly appreciated the program (score of 8.3 and 7.9 out of 10 respectively).

Monday, October 2, 2017

Which exercise prescriptions improve quality of life and physical function in patients with cancer?

Certain exercise prescriptions for patients with cancer may improve quality of life (QoL) and self-reported physical function (PF). In a systematic review and meta-analysis of the scientific literature, we investigated the effects of exercise on QoL and PF in patients with cancer and studied differences in effects between different intervention-related and exercise-related characteristics. This investigation has just been published online in the British Journal of Sports Medicine, with Maike Sweegers as first author, and as part of the POLARIS (Predicting OptimaL cAncer RehabIlitation and Supportive care) study
We searched four electronic databases to identify randomised controlled trials investigating exercise effects on QoL and PF in patients with cancer. Subgroup analyses were conducted based on intervention dimensions, including timing, duration and delivery mode, and exercise dimensions, including frequency, intensity, type and time (FITT factors).
Patients in exercise interventions had significantly improved QoL and PF compared with patients in control groups. Especially supervised exercise interventions were effective. No significant differences in intervention effects were found for variations in intervention timing, duration or exercise FITT factors. Unsupervised exercise with higher weekly energy expenditure was more effective than unsupervised exercise with lower energy expenditure.
Our conclusion is that exercise interventions, especially when supervised, have statistically significant and small clinical benefit on self-reported QoL and PF in patients with cancer. Unsupervised exercise intervention effects on PF were larger when prescribed at a higher weekly energy expenditure.

Monday, September 25, 2017

Social disparities in food preparation behaviours

Socio-economic differences in nutrition and eating behaviors are important for socio-economic health disparities, and differences in food preparation practices may partly explain such differences in nutrition and eating behaviors. In a study just published in Nutrition Journal (with Dr. Caroline Méjean as first author) we investigated whether there was an independent association of socio-economic indicators (education, occupation, income) with food preparation behaviors.
A total of 62,373 adults participating in the web-based NutriNet-Santé cohort study were included in the analyses. The study was part of the Determinants of Diet and Physical Activity (DEDIPAC) joint action. Cooking skills, preparation from scratch and kitchen equipment were assessed as well as frequency of meal preparation, enjoyment of cooking and willingness to cook better/more frequently.
Participants with the lowest education, the lowest income group and female manual and office workers spent more time preparing food daily than participants with the highest education, those with the highest income and managerial staff. The lowest educated individuals were more likely to be non-cooks than those with the highest education level, while female manual and office workers and the never-employed were less likely to be non-cooks. Female manual and office workers had lower scores of preparation from scratch and were less likely to want to cook more frequently than managerial staff. Women belonging to the lowest income group had less kitchen equipment and were less likely to enjoy cooking meal daily than those with the highest income.
Lower socio-economic groups, particularly women, spend more time preparing food than high socioeconomic groups, but were less likely to prepare meals from scratch with fresh ingredients and enjoy cooking less.

Saturday, August 5, 2017

Objectively measured sedentary time among five ethnic groups in Amsterdam

Sedentary behaviour is increasingly recognised as a health risk behaviour, partly independent of moderate to vigorous physical activity. An increasing number of studies focus on sedentary behaviour, but  studies on sedentary behaviour among ethnic minority groups are scarce. In a a study just published in Plos ONE -with Dr. Anne Loyen as first authors- we compared levels and socio-demographic and lifestyle-related correlates of objectively measured sedentary time in five ethnic groups in Amsterdam, the Netherlands.
Data were collected as part of the HELIUS study, a cohort study conducted in Amsterdam. The sample consisted of adults from a Dutch, Moroccan, African Surinamese, South-Asian Surinamese and Turkish ethnic origin. Data were collected by questionnaire, physical examination, and a combined heart rate and accelerometry monitor (Actiheart). Sedentary time was defined as waking time spent on activities of <1 .5="" a="" href="https://en.wikipedia.org/wiki/Metabolic_equivalent" target="_blank">metabolic equivalents
. All analyses were adjusted for gender and age.Sedentary time ranged from 569 minutes/day (9.5 hours/day) for participants with a Moroccan and Turkish origin to 621 minutes/day (10.3 hours/day) in African Surinamese participants. There were no statistically significant differences in the levels or correlates of sedentary time between the ethnic groups. Meeting the physical activity recommendations (150 minutes/week) was consistently inversely associated with sedentary time across all ethnic groups, while age was positively associated with sedentary time in most groups.

Wednesday, July 26, 2017

Effects of a high intensity exercise program after stem cell transplantation

In a paper just published in Plos ONE, we report on a single blind, multicenter randomized controlled trial in which we evaluate the effects of a supervised high intensity exercise program on physical fitness and fatigue in patients with multiple myeloma or lymphoma recently treated with autologous stem cell transplantation, with Saskia Persoon as first author.
A hundred and nine patients joined our study and were randomly assigned to the 18-week exercise intervention or a usual care control group. The primary outcomes included physical fitness (VO2peak and Wpeak determined using a cardiopulmonary exercise test; grip strength and the 30s chair stand test) and fatigue (Multidimensional Fatigue Inventory) and were assessed prior to randomization and after the patients in de intervention group had completed their exercise program.
Patients in the exercise intervention group a
ttended 86% of the prescribed exercise sessions. Of the patients in the control group, 47% reported to have attended more than 10 physiotherapy sessions in the same period of time. Such physiotherapy sessions most likely include supervised exercise. Thus, because the intervention group exercised less than planned, and the control group did more, the difference in exercise participation between the two groups was smaller than anticipated before the study was started.
Median improvements in physical fitness ranged between 16 and 25% in the intervention group and between 12 and 19% in the control group. Fatigue decreased in both groups. There were no statistical significant differences between the intervention and control group.

Sunday, July 16, 2017

Video analyses to study health information provided by midwives

To quantify to what extent evidence-based health behaviour topics relevant for pregnancy are discussed with clients during midwife-led prenatal booking visits and to assess the association of client characteristics with the extent of information provided, we conducted a study among midwives. This study was recently published in the journal Midwifery, with Dr. Ruth Baron as first author. 173 video recordings of prenatal booking visits with primary care midwives and clients in the Netherlands were analysed.
Thirteen topics regarding toxic substances, nutrition, maternal weight, supplements, and health promoting activities were categorized as either ‘never mentioned’, ‘briefly mentioned’, ‘basically explained’ or ‘extensively explained’. Rates on the extent of information provided were calculated for each topic and relationships between client characteristics and the extent of information provided were assessed.
Our findings showed that women who did not take folic acid supplementation, who smoked, or had a partner who smoked, were more likely to be provided with only basic about these topics. Furthermore, the majority of clients were provided with no information on recommended weight gain (91.9%), fish promotion (90.8%), caffeine limitation (89.6%), vitamin D supplementation (87.3%), physical activity promotion (81.5%) and antenatal class attendance (75.7%) and only brief mention of alcohol (91.3%), smoking (81.5%), folic acid (58.4) and weight at the start of pregnancy (52.0%). The importance of a nutritious diet was generally either never mentioned (38.2%) or briefly mentioned (45.1%). Nulliparous women were typically given more information on most topics than multiparous women.
In conclusion, the majority of women were provided with little or no information about pregnancy-relevant health behaviours examined in this study. Midwives may be able to improve prenatal health promotion by providing more extensive health behaviour information to their clients during booking visits.

Monday, July 10, 2017

Correlates of irregular family meal patterns among children

The importance of family meals to the consumption of healthful food choices has been demonstrated and discussed in recent reviews. However, little information is available on barriers that interfere with regular family meal patterns during childhood. In a paper just published in the journal Food and Nutrition Research, we describe family meal patterns among 11-year-old children across Europe and identify correlates of irregular family breakfast and dinner consumption. We used data from 13,305 children from nine European countries who participated in the Pro Children Study in 2003.
The proportions of children who regularly ate family breakfast and dinner were 62% and 90%, respectively. Children who ate less vegetables were less likely to engage in family breakfasts as well as dinners, irregular family breakfasts was associated with more television viewing, and social differences in family breakfast consumption was observed.