No effects of tailored feedback and face to face counseling on health behaviors in hypercholesterolemia patients

In a paper just published in the journal PLOS ONE, with Karen Broekhuizen, who will defend her thesis this Friday and become Dr. Karen Broekhuizen- as first author, we describe the evaluation of an individualised tailored lifestyle intervention on physical activity, dietary intake, smoking and compliance to statin therapy in people with Familial Hypercholesterolemia (FH).
Adults with FH (n = 340) were randomly assigned to a usual care control group or an intervention group. The intervention consisted of web-based tailored lifestyle advice and face-to-face counselling. Physical activity, fat, fruit and vegetable intake, smoking and compliance to statin therapy were self-reported at baseline and after 12 months.
Individually tailored feedback did not prove to be superior to no intervention regarding changes in multiple lifestyle behaviours in people with FH. Earlier studies on computer-tailoring did show very promising effects. In the present study actual exposure to the intervention was also suboptimal, and a higher received dose of computer-tailored interventions should be achieved counsellor training should be more extensive.

Television in the bedroom and increased body weight

Kids who spent more time watching TV are more likely to be overweight. This may be because if kids watch a lot of TV they sit too much, they may snack while watching TV, and/or they more exposed to marketing of unhealthy foods. It has been suggested that in order to reduce TV time, the opportunities for watching TV should be diminished: TV should become less accessible and available. In another study just published in the journal Pediatric Obesity, with Dr. Adrian Cameron as first author, we studied if 10-12 year old schoolchildren across Europe who have a TV in their bedroom are more likely to watch more TV, be overweight, and drink more soft drinks. This study was part of the ENERGY project. We found that almost 40% of schoolchildren had a bedroom television, with the highest percentage among Hungarian children (65%) and lowest for Belgian, Slovenian and Spanish children (all ≈28%). A television in the bedroom was positively associated with time spent watching television, soft drink consumption and overweight and obesity. The relationship between a television in the bedroom and measures of body size was partly mediated by total television viewing time but not by sleep duration, physical activity time or soft drink consumption.

Sedentary time, physical activity, and overweight in European schoolchildren

As we published recently in the journal PLOS ONE, more than 20% of 10-12 year old schoolchildren across Europe is overweight or obese. In some countries these rates are much higher, with more than 40% of Greek children being overweight of obese. When kids eat more calories than they use, the gain weight. Preventing overweight and obesity thus means maintaining a good energy balance. At least one hour of medium to high intensity physical activity is recommended for children for fitness and energy-balance. Next to diet and physical activity, too much sedentary behavior, i.e. activities that children do while sitting -watching TV, playing computer games, reading, doing homework et cetera- may be a separate risk behavior for metabolic health; even when children are physically active enough, if they sit most of the rest of the day, they may still be more likely to be overweight and obese. The evidence to support this is mixed at best, however. In our PLOS ONE study we showed that children spend more than two hours per day in front of the TV or computer screen. In separate studies we also showed that such screen time was only a minor part of total sedentary time, and that children who sat most had higher body mass index and waist circumference, but we found no evidence for other negative metabolic health indicators. In a new study just published in Pediatric Obesity, with prof Ilse de Bourdeaudhuij from Ghent University as first author, we now find that girls who show low physical activity and high sedentary time are most likely to be overweight, while for boys physical activity seems more than sedentary time.

Overweight and health behaviors in school children: Switzerland is doing good...

Overweight in children and adolescents is a major public health issue. To allow international comparisons, Switzerland joined the ENERGY study's cross sectional survey consortium that investigated the prevalence of overweight and obesity as well as selected dietary, physical and sedentary behaviors of 10--12 years old pupils across seven other countries in Europe. The aim of the study just published in the International Journal of Behavioral Nutrition and Physical Activity was to compare body composition and energy-balance related behaviors of Swiss schoolchildren to those of the seven European ENERGY-countries (i,e, Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia and Spain) and to analyze overweight and energy-balance related behaviors of Swiss children according to socio-demographic factors. The results regarding these ENERGY countries were published in the journal Plos ONE earlier this year.
In Switzerland significantly less children were overweight (13.9%) or obese (2.3%) compared to the average across the ENERGY-countries (23.7% and 4.7%, respectively), and were even somewhat lower than the ENERGY countries with the lowest prevalence, i.e. Norway, Belgium and the Netherlands. Sugar sweetened beverage intakes and breakfast habits of Swiss children did not differ significantly from those of ENERGY. However, the mean time devoted by Swiss children to walking or cycling to school and attending sports activities was significantly higher and screen time significantly lower compared to the other ENERGY-countries. Within the Swiss, sample relatively large and consistent differences were observed between children from native and non-native ethnicity.

Is yoga beneficial for cancer survivors?

Physical activity and exercise have been found to help cancer survivors to improve fitness, reduce fatigue, and is associated with better survival. In a paper published in BMC Cancer, with Dr. Laurien Buffart as first author, we systematically reviewed and meta-analysed the results of existing randomized controlled trial (RCT) testing the effects of yoga on physical and psychosocial outcomes in cancer patients and survivors. Sixteen publications of 13 RCTs met the inclusion criteria, of which one included patients with lymphomas and the others focused on patients with breast cancer.

Of the outcomes studied in more than three studies among patients with breast cancer, we found large reductions in distress, anxiety, and depression, moderate reductions in fatigue, moderate increases in general quality of life, emotional function and social function, and a small increase in functional well-being. Evidence for effects on physical function and sleep was not found. We concluded that yoga appeared to be a feasible intervention and that beneficial effects on self-reported physical and psychosocial wellbeing were found among  patients with breast cancer, but no evidence was found for beneficial effects on physical function.

Micro-level economic factors and incentives in children's obesogenic behaviors

To date, most research on environments that may encourage children to eat too much and move too little, i.e. so-called obesogenic environments, has focused on physical and socio-cultural environments. Such environments determine what foods and physical activity opportunities are available and accessible (physical environment) and what is socially and culturally appropriate, acceptable and encouraged.The role of economic factors has been investigated to a much lesser extent. Our objective was to explore the association of micro-level economic factors and incentives with sports activities and intake of soft drinks and fruit juice in 10-12 year-old school children across Europe, and to explore price sensitivity in children's soft drink consumption and correlates of this price sensitivity. This study that was part of the ENERGY project was just published in the International Journal of Behavioral Nutrition and Physical Activity.
Data for the study originate from a cross-sectional survey undertaken in seven European countries (Belgium, Greece, Hungary, Netherlands, Norway, Slovenia and Spain) in 2010 among more than 7000 10-12 year-old school children and 6000 of their parents
Economic factors were found to be associated with children's sports participation and sugary drink consumption. Parents' financial support was found to be an important correlate of children's sports activities i.e. children whose parents financially supported their sports activities were more likely to engage in sports. Children's pocket money was a strong correlate of soft drink consumption; more pocket money was associated with more soft drinks. The majority of the responding children reported to expect that significantly higher prices of soft drinks would lead them to buy less soft drinks.

Family influences on children's soft drink and juice intakes

With the recently published paper in the New England Journal of Medicine, the evidence that sugary drinks contribute to unnecessary weight gain in children and adolescents is becoming more and more convincing.
The aim of a study we just published in e-pub in the scientific journal Appetite was to investigate associations of family-related factors with children's fruit drink/juice and soft drink consumption. We used the ENERGY study data from >7000 11 year old children and one of their parents from eight countries across Europe. We analyzed if the children's self-reported fruit drink/juice and soft drink intake and a range of family environment and parenting factors were associated. We looked at such factors as parental modeling (i.e. parents' own juice and soft drink intakes), availability of juice and soft drinks at home, whether parents monitored their children's intakes, their self-efficacy, parents' permissiveness, negotiations regarding intakes, communicating health beliefs, et cetera. Three of the 11 family-related factors considered (modeling, availability, and family consumption) were positively associated with children's fruit drink/juice and soft drink intake. Thus, children's intakes were on average higher when their parents had high intakes themselves, when drinks were readily available at home, and when family consumption was higher. Additionally, three other factors (permissiveness, monitoring, and self-efficacy) were solely associated with soft drink intake, i.e. children of parents who were more permissive regarding soft drinks, and who did not monitor children's intakes, and with lower self-efficacy drank more soft drinks. These results contribute to the body of evidence regarding the importance of the home environment for children's soft drink intakes. Most interventions aiming at contributing to the promotion of health behaviors in school-aged children are school-based and fail to involve the family; our study once more points to the importance of family, and especially parent, involvement.

ecancer TV covers our research on exercise among cancer patients

At the the UK National Cancer Research Institute Cancer Conference held in Liverpool, UK two weeks ago, ecancer TV covered our research on exercise = medicine, please see http://ecancer.org/tv/pubdate/1723

Annual Dutch meeting for the European Regional Development Fund is held at VU University medical center

This morning the annual meeting of Dutch regions regarding the European Regional Development Fund (ERDF) was held at our University Medical center here in Amsterdam. The 'West' region of the Netherlands, i.e. the Randstad provinces organised this annual meeting, highlighting the projects realised through ERDF in this region's ERDF program called Kansen voor West (Chances for West). After a few words of welcome by the representative of the province Elvira Sweet, Ruud van Raak, the program manager for Kansen voor West, and myself on behalf of the Vu University medical center, prof. Guus van Dongen highlighted VUmc's Medical Imaging Center's ambitions and how 'kansen voor west' had enabled an important step by providing support for a PET-MRI center on our campus. After these introductions, the representatives of the different Dutch regions visited different parts of the medical Imaging facilities on campus.

A symposium to report the results of the ENERGY project

This morning a final ENERGY symposium was held at VU University medical center to report the results of this project to our colleagues within VUmc, the VU University and from other Dutch research centers. ENERGY stands for EuropeaN Energy balance Research to prevent excessive weight Gain among Youth, and is a European Commission funded project for which we recently submitted our final report to the commission. Last summer we already presented our main results to an international audience in a special ENERGY symposium at the European Congres on Obesity in Lyon.Today we presented the latest update of our results to our local and regional colleagues here in Amsterdam. The publications regarding the ENERGY projects are available at the ENERGY website's specific publications page, and the first overall results were published in the open access PLOS One journal.

Exercise = medicine in cancer rehabilitation?

These days the UK National Cancer Research Institute Cancer Conference is held in Liverpool, UK. Yesterday afternoon a special symposium was held on primary and secondary cancer prevention, with a specific emphasis on lifestyle interventions. The session is chaired by Prof Annie Anderson from the University of Dundee, with contributions from Profs Wendy Demark Wahnefield from the University of Alabama and Michelle Harvie from the University Hospital South Manchester. My talk was on he importance of physical activity for cancer survivors. Evidence from recent meta analyses suggest that physical activity is important -not only for cancer prevention- but also for cancer rehabilitation. It is, however, unclear what the frequency, intensity, type or duration of physical activity is best, and what important mediators of moderators for the positive effects of physical activity and exercise are. Ongoing research at our center, especially the Alpe H'Huzes Cancer Rehabilitation program (A-CaRe) and Predicting OptimaL cAncer Rehabilitation and Supportive care Polaris study, will contribute to further insights in why, what and for whom physical activity for cancer patients and survivors is important.
(Since arriving in Liverpool, the Beatles can not be avoided.)

How good are the studies that evaluatie front of pack food labeling?

front of pack labels on food products are very common nowadays. They are meant to help consumers make informed decisions regarding what they buy and eat. The effects of such front of pack labels on consumer and producer behavior has been evaluated in a number of studies. In a earlier published studies we, with Dr. Ellis Vyth as first author, studied the effects of the choices / 'ik kies bewust' logo, and found that such a logo appears to be more effective in encouraging food producers to make 'healthier' food products -i.e. food products that comply to the logo's standards -, than in promoting healthier choices among consumers. Dr. Vyth has subsequently taken the lead in providing an overview of studies evaluation front of pack logo's and has reviewed the methodological quality of such studies. A paper describing this review just appeared in e-pub in the journal Nutrition Reviews. The quality of 31 studies was assessed. The results showed that the methodological quality of published front-of-pack labeling research is generally low to mediocre; objective observational data-based consumer studies were of higher quality than consumer studies relying on self-reports. Experimental studies that included a control group were lacking. The review further revealed a lack of a validated methodology to measure the use of front-of-pack labels and the effects of these labels in real-life settings. In conclusion, few methodologically sound front-of-pack labeling studies are presently available. The evidence for effects for front of pack labeling is thus weak.

Peter Kapitein received his honorary doctorate

Friday October 19 the Dies Natalis of the VU University was celebrated. At this annual event Peter Kapitein, founding father of the Alpe D'HuZes foundation and Inspire2Live, and the personification of patient advocate for patient participation in research, treatment, care and policy regarding cancer prevention, treatment and rehabilitation, received an honorary doctorate.

before this event a symposium was held, organised by Peter Kapitein together with the VUmc Cancer Center Amsterdam (VUmc-CCA). At this symposium, in a full Amsterzaal -with over 200 attendees -, the director of VUmc-CCA and professor of Hematology Prof. Peter Huijgens first discussed issues, dilemma's and progress in cancer treatment and care with two patients. Thereafter, the tow endowed chairs of Alpe D'HuZes -Profs Irma Verdonck and Ellen Kampman presented and discussed their work in research on 'living with cancer'  and 'nutrition and cancer', and Prof Guus van Dongen presented the developments in and future promise of advanced imaging techniques in realizing a more personalized cancer treatment. After a short brake, Stephen Friend the President of Sage Bionetworks, and Prof. Hans Clevers, the president of the Netherlands Royal Academy of Arts and Sciences, provided presentations. Friend presented his views that understanding human biology requires a new community-based vision of open access innovation that respects and links all stakeholders -including patients, researchers, medical professional, policy makers, and industry- and supports a new culture of cooperative, data-intensive science. He pledged to take up this challenge and for this he has drafted the Sage Bionetworks Commons Principles to guide the development of an open source community where computational biologists can develop and test competing models built from common resources.
Prof. Clevers presented his work on the origins of colon cancer.
After the symposium the attendees rushed to the Dies Natalis event to witness the ceremony granting the honorary doctorate to Peter Kapitein.

Tomorrow Peter Kapitein will receive his honorary doctorate

Tonight we had a preparatory dinner organized by the vice chancellor of the VU University Amsterdam to get ready for tomorrow's 'dies natalis', i.e. the university's 132nd birthday. At this celebration event two honorary doctorates will be granted, to Peter Kapitein, the ambassador and one of the founders of the Alpe D'Huzes foundation, and to the world famous Dutch architect Rem Koolhaas.
I have the honor to serve as Peter Kapitein's 'honorary promotor'.

Peter Kapitein receives this award in recognition of his exceptional contribution to research into improving the opportunities for ‘living with cancer’. Since its start in 2006, the Alpe D'Huzes foundation has contributed about 100 M€ to the Netherlands Cancer Foundation for cancer research, with a specific focus on research to improve 'living with cancer', i.e. research to support better evidence-based cancer rehabilitation, psychosocial support for cancer patients, et cetera. Additionally Peter Kapitein is a strong advocate and example for 'patient participation in cancer research, treatment and care. Before the Dies celebration a special symposium entitled 'Patients Firts' will be held to present and discuss important developments in cancer research.

Media attention for publication of the design of the SPOTLIGHT project to identify obesogenic environments across Europe

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. A paper describing the design an rationale for SPOTLIGHT was published this week in its definite form in BMC Public Health; this publication is 'highly accessed'. The publication of the paper was picked up by some media, including a coverage by Food Navigator.

Email-based health promotion for pregnant women in the Netherlands

In 2006, the Dutch government initiated Hello World, an email-based program promoting healthy lifestyles among pregnant women through quizzes with pregnancy-related questions. In 2008, an updated version was released.
In a paper just published in BMC Research Notes, with Hanneke van Dongen as first author we examined the reach of Hello World and the representativeness of its users for all pregnant women in the Netherlands, explored the relationship between program engagement and lifestyle characteristics, and investigated the relationship between the program content the participants accessed (content on smoking, physical activity, and nutrition) and their lifestyles.
Data from 4,363 pregnant women were obtained and analyzed. 
Hello World reached only about 4% of its target population. Relatively few lower educated and immigrant women registered for the program. Active participation in the program was positively related with more healthy lifestyles among the women but the participants did not necessarily choose the content that was most relevant for them to further improve their health behavior. ' Hello World' was noy continued as a separate health promotion site, but the information and feedback was integrated in the information of the Youth & Family centers (centrum jeugd en gezin informatiebank)lan, explored the relationship between program engagement and lifestyle characteristics, and investigated the relationship between the program content the participants accessed (content on smoking, physical activity, and nutrition) and their lifestyles.
Data from 4,363 pregnant women were obtained and analyzed. 
Hello World reached only about 4% of its target population. Relatively few lower educated and immigrant women registered for the program. Active participation in the program was positively related with more healthy lifestyles among the women but the participants did not necessarily choose the content that was most relevant for them to further improve their health behavior. ' Hello World' was noy continued as a separate health promotion site, but the information and feedback was integrated in the information of the Youth & Family centers (centrum jeugd en gezin informatiebank)

Hand hygiene in neonatal care

Good hand hygiene compliance, i.e. regular hand washing according to protocol, is essential to prevent infections in healthcare settings. To measure how well hospital workers comply to good hand hygiene is difficult. Direct observation of hand hygiene compliance is the gold standard but is time consuming, and thus expensive; furthermore, observations are an intervention in itself and may thus give biased result of true compliance to hand hygiene protocol. An electronic dispenser for hand alcohol with built-in wireless recording equipment allows continuous monitoring of its usage. 
The purpose of a study we conducted that was just published in BMC Infectious Diseases was to monitor the use of alcohol-based hand rub dispensers with a built-in electronic counter in a neonatal intensive care unit (NICU) setting and to determine compliance with hand hygiene protocols by direct observation. A one-year observational study was conducted at a 27 bed level III NICU at a university hospital. All healthcare workers employed at the NICU participated in the study. The use of bedside dispensers was continuously monitored and compliance with hand hygiene was determined by random direct observations.

In 65.8% of the 1,168 observations of patient contacts requiring hand hygiene, healthcare workers fully complied with the protocol. We conclude that the electronic devices provide useful information on frequency, time, and location of its use, and also reveal trends in hand disinfection events over time. Direct observations offer essential data on compliance with the hand hygiene protocol. In future research, data generated by the electronic devices can be supplementary used to evaluate the effectiveness of hand hygiene promotion campaigns.

A review of socio economic differences in physical activity in Europe

In a paper just published in the International Journal of Behavioral Nutrition & Physical Activity we reviewed the current research on socio-economic differences in physical activity in Europe. 

Considerable differences in the direction of inequalities were seen for the different domains of physical activity (PA). Most studies reported that those with high socioeconomic position were more physically active during leisure-time compared to those with low socioeconomic position. Occupational PA was more prevalent among the lower socioeconomic groups. Socioeconomic differences in total PA and active transport PA did not show a consistent pattern. 

Sustainable prevention of obesity through integrated strategies: The SPOTLIGHT project's conceptual framework and design

Today BMC Public Health published the paper describing the SPOTLIGHT project, a European Commission FP7-funded project on sustainable prevention of obesity through integrated strategies.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 reach, efficacy, adoption, implementation and maintenance (RE-AIM) of multi-level interventions to help to prevent obesity. 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.

Netherlands Nutrition Centre YouTube video shows the obesogenic eating environment from a child's perspective

In a video recently put on YouTube, produced by the Netherlands Nutrition Center, nicely shows the obesogenic eating environments a child is exposed to throughout the day. The video illustrates what foods a child is exposed to, how easily available and accessible high fat and sugar foods are throughout the day, and how other people encourage and enable children to eat almost anytime and anywhere. For a systematic review of studies on  environmental correlates of environmental correlates of obesity-related dietary behaviors in youth, click here.

Children's fruit and vegetable intakes: appropriate school lunches may make parents' jobs easier

Most children across Europe and beyond eat fewer fruits and vegetables than recommended by health authorities. Promoting fruit and vegetable consumption among schoolchildren is part of health promotion policy in most countries. In a paper published this week in e-pub ahead of print in the journal Public Health Nutrition, we present a collaborative study between Folkhälsan Research Center in Helsinki and the EMGO Institute for Health & Care Research at VU University Medical Center in Amsterdam. In this study we explored the importance of parenting practices regarding schoolchildren's fruit and vegetable intakes and the importance of school lunches. More precisely, we compared four countries, i.e. Finland, Sweden, and Germany and the Netherlands. The first two countries do provide free school lunches and these lunches are required to fit dietary recommendations, including fruit and vegetables. In the other two countries no school lunches are generally provided. Our study indicated that in countries where no school lunches were provided, parenting practices are of greater importance for children's fruit and vegetable intake; or in other words: if school lunches that include fruits and vegetables are provided, parents may have a bit of an easier job where their children's fruit and vegetables are concerned. The study was conducted as part of the European Commission funded ProGreens project.

Free news paper METRO highlights our research on genetic influences on sedentary activities

In a study from which our paper was recently published in the scientific journal Archives of Pediatric and Adolescent Medcine, we investigated the degree to which genetic and environmental influences affect individual differences in sedentary behavior, i.e. screen-viewing activities such as TV watching and computer-time, throughout adolescence. We used data from  5074 adolescent twins (aged 13-19 years) and 937 siblings (aged 12-20 years) from 2777 families from the Netherlands Twin Registry.

The results showed that the genetic architecture of screen-viewing sedentary behavior differed by age. Variation in sedentary behavior among 12-year-olds was accounted for by genetic (boys: 35%; girls: 19%), shared environmental (boys: 29%; girls: 48%), and nonshared environmental (boys: 36%; girls: 34%) factors. Variation in sedentary behavior among 20-year-olds was accounted for by genetic (boys: 48%; girls: 34%) and nonshared environmental (boys: 52%; girls: 66%) factors. Yesterday the free national newspaper METRO highlighted and covered our study on the front page.

A review on effectiveness of health promotion strategies by the American Heart Association

In an American Heart Association scientific statement published in August, a writing group systematically reviewed the scientific evidence for population approaches to improve dietary habits, increase physical activity, and reduce smoking. Their statement was published in the journal Circulation. Strategies were categorized and reviewed in six domains, i.e. media and educational campaigns; labeling and consumer information; taxation, subsidies, and other economic incentives; school and workplace approaches; local environmental changes; and direct restrictions and mandates. Thus, strategies mainly focussing on the individual as well as on the physical, social and economical environments were included in the review. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts. The group showed in their review that there is rather convincing evidence for some intervention approaches, such as subsidy programs for healthier foods, school fruit programs, comprehensive, multicomponent healthy diet and physical activity promotion at schools and workplaces, and restrictions on food advertisement. Labelling of foods was also rated as evidence-based, but not so much as a means to induce healthier choices among consumers, but rather as an incentive for the food industry to make healthier products.

Obesity and exposure to artificial light

Artificial light nowadays allows and enables us to work and be active 24 hours per day. However, such lifestyles and exposure to artificial light may disrupt our natural light-dark rythm and wake-sleep as well as meal rythms and other aspects of irregular lifestyle, and this may lead to higher risk for overweight and obesity.  At least a paper from Dr. Wyse from the University of Aberdeen  in BioEssays argues that metabolic disfunction and obesity may result from "desynchronization of circadian and environmental rhythms".
Please click here for a lay person friendly summary of the research provided by Cordis news.

Are people in more affluent countries in Europe more likely to be physically active during leisure time?

Socioeconomic inequalities in physical activity at the individual level are well reported; in the more affluent countries, people who are relatively less well off are less likely to engage in leisure time physical activities. Whether inequalities in economic development and other macro-environmental variables between countries are also related to physical activity at the country-level is less well documenten.

In a study that was recently published in e-pub -with Dr. Adrian Cameron from Deakin University, Melbourne, Australia, as first author- in the journal Medicine and Science in Sports and Exercise, we examined the relationship between country-level data on macro-economic environmental factors (Gross Domestic Product (GPD) per capita, public sector expenditure on health, percent living in urban areas and cars per 1000 population) with country-level physical activity prevalence obtained from previous pan-European studies. Studies that assessed leisure-time physical activity (n=3 studies including 27 countries in adults, n=2 studies including 28 countries in children) and total physical activity (n=3 studies in adults including 16 countries) were analysed separately.

We found strong and consistent positive correlations between leisure-time physical activity and country GDP per capita in adults. No such associations were found for children, nor for total physical activity.
Differences in national leisure-time physical activity levels in adults throughout Europe may this be a consequence of economic development. relative lack of economic development of some countries in Europe may make increasing leisure-time physical activity there more difficult, while these countries may be most in need of physical activity promotion.

Population density in terms of human biomass in stead of numbers of people...

Last June Walpole and colleagues published a paper in BMC Public Health in which they looked at population density in a bit different way. They provided an overview of 'human biomass'  per region, i.e. the product of population size and average body mass. Their calculations and analyses show that in 2005, global adult human biomass was approximately 287 million tonnes, of which 15 million tonnes were due to overweight. Furthermore, and not surprising, the population size based on biomass is different from the number of people. One tonne of human biomass corresponds to approximately 12 adults in North America and 17 adults in Asia, and North America has 6% of the world population but 34% of biomass due to obesity while Asia has 61% of the world population but 13% of biomass due to obesity (please see the Figure that was copied from their open access paper). Their conclusion is that increasing population fatness could have the same implications for world food energy demands as an extra half a billion people living on the earth.

Paper on validity of ENERGY parent questionnaire now also published

I have reported on the ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) study here before. This cross-European study looked at overweight and obesity, risk behaviors for overweight and obesity, determinants of these risk behaviors, and interventions to contribute to prevention among 10-12 year old school children in seven countries in Europe. The general purpose and framework of the study, and the methods have been published before, as well as a range of original research and review studies; the latter are mostly available via the project website. Please click here for the paper describing the main results regarding differences in overweight and risk behaviors between the different countries. The study also included research among parents of these children, and this week the study testing the reliability and validity of the parent questionnaire was published in BMC Research Notes. The paper describing these psychometrics of the child questionnaire were already published some time ago.

Neighbourhood social capital and sports participation

In a paper just published in the International Journal of Behavioral Nutrition and Physical Activity -with Dr. Rick Prins as first author - we aimed to explore whether adolescents are more likley to participate in sports when they live in neighbourhoods where there are more sport facilities and parks, and with more so-called 'neighbourhood social capital'. The study was conducted among adolsecents in Rotterdam, the Netherlands. Crucial to social capital at the community level is having common norms, behavioural

reciprocity and mutual trust. Neighbourhood social capital may influence health behaviors such as sports participation, via various pathways. For instance, neighbours that trust each other are more likely to help and support each other and do things together. In addition, in neighbourhoods with more social capital people may talk more with each other and this may enable faster and better transfer of information on healthy behaviours and better social support.  So basically, beter social capital may help to improve social norms, social support and positive role models for health behaviours such as sports participation.

We used data of the YouRAction study from 852 adolescents in the city of Rotterdam. Neighbourhood social capital was assessed with questionnaires; availability of sports facilities and parks was objectively obtained from geographic information systems.

Our analyses showed that neighbourhood social capital was significantly associated with sports participation; in neighbourhoods with higher social capital the liklehood that adolescents engaged in sports was more than three time that of their peers in lower social capital neighbourhoods. We did not find a significant association of availability of sports facilities or parks with sports participation, but a combination of high social capital and availability of parks did appear to make a difference.

The results thus indicate that leisure time sports participation is more likely in neighbourhoods that have positive social and physical environmental features.

Parental education and parents' physical activity is associated with physical activity of their children

Today a new paper from the ENERGY study was published in a preliminary version in the journal Preventive Medicine. The Spanish partner in the ENERGY study, i.e. the group of Prof. Luis Moreno from Zaragoza University, took the lead in this paper and David Jimenez Pavon is first author. In the analyses for this paper we sought to examine the independent associations of the level of education of the parents and the levels of physical activity (PA) of parents with PA levels of the children in the ENERGY study across Europe.

As we reported before, a total of 7214 children (10-12years) were recruited from a school-based cross sectional survey during 2010 in seven European countries. Weight and height were measured. Parental educational level and parents' and children´s PA were assessed using questionnaires. We found that parents education level and parents PA levels are both indeed associated with the children´s PA: children of lower educated and less active parents have lower levels of PA. However, the relationships were gender and country-specific; in some countries the association was more apparent than in others and in some countries associations ere stronger for boys than girls or vice versa. In promoting PA among school-aged children, level of education of the parents and their PA levels should be taken into account.

What do adolescents think about active gaming?

Lack of physical activity and too much sedentary time are important risk factors for obesity and metabolic disease as well as a range of other health issues. Young people spend a lot of time in sedentary activities such as watching TV, computer and electronic gaming activities. Our recent cross-European study showed that in some countries 10-12 year olds spend up to more than three hours per day on 'screen activities', and in that study and a second paper we reported that children from lower educated parents and of foreign ethnicity have higher screen times. 'Active gaming' may be a good alternative to passive screen activities. Active video and electronic games require whole-body movement and may be an innovative tool to substitute sedentary pastime with more active time and may therefore contribute to adolescents' health. We are conducting a series of studies to test the potential mertits of active gaming for adolsecent health promotion. As a first step to inform strategies aimed at reducing sedentary behavior by replacing non-active with active gaming, perceptions and context of active and non-active gaming were explored in qualitative research using focus group interviews. The results were recently published in a scientific paper with Monique Simons as first author in the journal Games for Health.

The focus groups showed that adolescents had positive attitudes toward active gaming, especially the social interactive aspect, which was greatly appreciated. However, it appeared that many adolescents enjoyed non-active games more than active ones, mainly because of better game controls and more diversity in non-active games. Active games were primarily played when there was a social gathering. Few game-related rules and restrictions at home were reported.

Given the positive attitudes of adolescents and the limited restrictions for gaming at home, active videogames may potentially be used in a home setting as a tool to reduce sedentary behavior. However, to make active games as appealing as non-active games, attention should be paid to the quality, diversity, and sustainability of active games, as these aspects are currently inferior to those of traditional non-active games.

An updated systematic review on the effects of computer-tailored nutrition and physical activity education

In 2006 we published a review of the scientific evidence regarding computer-tailored health education to promote healthful nutrition an physical activity. A review update was necessary to document the more recent evidence from scientific research regarding the effectiveness of computer-tailored physical activity and nutrition education. The purpose of a new review study just published in Annals of Behavioral Medicine was to summarize the latest evidence on the effectiveness of computer-tailored physical activity and nutrition education, and to compare the results to the 2006 review.

Databases were searched for randomized controlled trials evaluating computer-tailored physical activity and nutrition education published from September 2004 through June 2011. Compared to the findings in 2006, a larger proportion of studies found positive effects for computer-tailored programs compared to generic or no health education, for nutrition as well as physical activity promotion. Effect sizes were, however, small and effects were generally only found at short- or medium-term follow-up, and evidence for effect were still mostly based on self-report measures of effects.

In conclusion, the results of the 2006 review were generally confirmed and reinforced; computer-tailored health education appears to be superior to generic or no health education.

A symposium on behavior change at the European College of Sport Sciences annual meeting

The last couple of days the European College of SportS Science met in Bruges for its annual meeting. Most of the program is indeed dedicated to science on sport and exercise, but there is also interest in physical activity and health. Related to the latter, Prof. Stuart Biddle of Loughborough University organised a symposium at the meeting on behavior change regarding physical activity and sedentary behaviors. I provided a talk on the determinants of physical activity behavior first. Then Prof Ilse de Bourdeaudhuij presented her research on the Ghent 10,000 steps program - an intervention to promote daily physical activities, promoting accumulation of the equivalent of at least 10,000 steps per day, and then Prof. Biddle presented his work on the Sedentary Time ANd Diabetes (STAND) project. The 10,000 steps Ghent studies are very impressive. Prof de Boudeaudhuij and her colleagues have studied the effects, the reach, implementation and adoption and have explored the cost effectiveness of this intervention, all with quite impressive outcomes. The program has been widely adopted and is a positive example of evidence-based promotion of physical activity.

Fatigue mediates the relationship between physical fitness and quality of life in cancer survivors.

In a study just published in the Journal of Science and Medicine in Sports, with Dr. Laurien Buffart as first author, we aimed to investigate whether fatigue mediates the association between physical fitness and quality of life in cancer survivors, i.e. to explore if cancer patients who are physically more fit have higher quality of life because of reduced fatigue .
We used data from an intervention study. The intervention was an 18-week exercise program for cancer patients consisting of high-intensity resistance and interval training. We assessed physical fitness - peak oxygen uptake and peak power output - self-reported fatigue and quality of life. 
We found significant associations between changes in physical fitness and global quality of life, between physical fitness and fatigue, and between fatigue and global quality of life. General fatigue strongly mediated the positive association between physical fitness and quality of life; our analyses further indicated that physical aspects of fatigue were stronger mediators than mental aspects.

Immigrant families suffer high risk of child obesity

Children in families with non-native ethnicity are more likely to become overweight and obese, according to the results of a survey in seven European countries published in a scientific paper today in the journal Pediatric Obesity. This study was part of the ENERGY project on which I have reported here before.  While obesity levels are quite high to ver high among children across Europe, we found the levels are generally higher among children who have a non-native mother tongue, or whose parents who were born in another country.
We have found several possible causes of the difference between native and non-native families.The consumption of soft drinks tends to be higher in children from non-native families, and regular meals such as breakfast may get skipped more often. The children also watch more television and participate in less sporting activity. However, they do walk or cycle to school more often.
Cultural and lifestyle differences need to be set in the context of family resources, including skills and education but also financial resources and access to support and health information, we believe. Lower educational status is a risk factor for obesity in all communities, and is a contributory factor for these families.We should also recognise that the differences between native and non-native families is smaller than the differences between families in southern and northern Europe as we showed in an earlier publication. National factors matter more than immigration status.
Please click the following links for some press coverage in the Netherlands and Belgium of our study. http://www.volkskrant.nl/vk/nl/2672/Wetenschap-Gezondheid/article/detail/3275023/2012/06/22/Immigrantenkind-kampt-vaker-met-overgewicht.dhtml http://www.rsscockpit.com/article.do?action=show&id=2162618889 http://www.trouw.nl/tr/nl/4492/Nederland/article/detail/3275023/2012/06/22/Immigrantenkind-kampt-vaker-met-overgewicht.dhtml?utm_source=RSSReader&utm_medium=RSS http://www.ad.nl/ad/nl/1012/Nederland/article/detail/3275071/2012/06/22/Kwart-allochtone-kinderen-is-te-dik.dhtml?utm_source=RSSReader&utm_medium=RSS http://drimble.nl/binnenlands-nieuws/9699342/immigrantenkind-kampt-vaker-met-overgewicht.html http://www.nu.nl/gezondheid/2841495/kinderen-van-immigranten-vaker-dik.html http://www.standaard.be/artikel/detail.aspx?artikelid=DMF20120620_129 http://www.nieuwsbank.nl/inp/2012/06/22/T137.htm http://www.skynet.be/nieuws-sport/nieuws/belgie/artikel/889171/kinderen-uit-immigrantengezinnen-hebben-vaker-overgewicht?utm_source=facebook&utm_medium=social&utm_campaign

Individual factors appear to be more important than environmental factors in predicting fruit consumption in adults

In a study just published in Public Health Nutrition, we explored individual determinants of fruit intakes, such as attitudes, intentions and habit strength, and neighbourhood environment (such as availability of fruit points of purchase in the neighbourhood) and home environment (such as home availability of fruit and modeling by family members) determinants of fruit intakes. We more precisely explored if individual factors mediated the possible influence of environments, i.e. that neighbourhood and home environments have an impact on fruit intake via attitudes and intentions as predicted by recent socio-ecological models for predicting health behaviors. We used the GLOBE study (led by Dr. Frank van Lenthe) data for our analyses. Our study showed that individual factors were more strongly related to fruit intake in this population of adults than neighbourhood or home environment factors; modeling by family members, i.e. family member providing a good example by eating ample amounts of fruit themselves, was a significant home environment factor. The influence of family members appeared to be mediated by habit strength and perceived behavior control. This means that adults with fruit eating family members had stronger habits and experienced more control regarding fruit intake.

A joint programming initiative for research to endorse a healthy diet for a healthy life

Today an international meeting was held in The Hague to communicate and discuss the strategic research agenda for a European joint programming initiative (JPI) 'A Healthy Diet for a Healthy Life'. This JPI aims to realize joint programming of research across different countries in Europe to provide a road map for harmonized research efforts in the field of food, nutrition, health and physical activity. The strategic research agenda for this JPI comprises three main research areas:

1. Determinants of diet and physical activity
2. Diet and food production
3. Diet-related chronic disease

The next steps will be that the European Member states not only endorse this joint programming in theory, but also in practice by dedicating research funding to realize research into the prioritized areas. 

At the meeting in The Hague I had the honor to get the opportunity to address and reflect upon the first research area that aims at gaining better insights into the interplay between motivation, abilities and environmental opportunities in determining diet and physical activity behavior change.

The ISBNPA 2012 conference is underway

These days -from last Wednesday until tomorrow - the 11th annual meeting of the International Society of Behavioral Nutrition and Physical Activity (ISBNPA) is going on in Austin, Texas. With almost 600 delegates, hundreds of oral and poster presentations it is a well attended and interesting meeting. Cutting edge research is presented on the epidemiology, determinants and interventions regarding healthful nutrition and physical activity. I was just present at a very interesting symposium on studies that explored mediators of behavioral nutrition and physical activity and interventions, organized by our PhD student Mine Yildrim and with contributions by researchers from Belgium and Portugal -Prof. Pedro Teixeira presented his impressive results on mediation pathways in Self-determination theory -based interventions.
Prof. Tom Baranowski, one of the founders of the society, discussed the results presented.
Tomorrow we will hold a special symposium on the ENERGY study at the conference, presenting the design, and some of the first results of the project, published as well as not yet published.

Self-Reported Physical Activity and Quality of Life among Cancer Survivors

Physical activity (PA) is suggested to be an important non-pharmacologic means to improve health-related outcomes among cancer survivors. In a paper just published in the journal Plos ONE, with Dr. Laurien Buffart as first author, we aimed to describe PA levels and its association with health-related quality of life (HRQoL) in colorectal cancer (CRC) survivors.
CRC survivors identified from the Eindhoven Cancer Registry treated between 1998 and 2007 were included in the study. These CRC survivors completed questionnaires to assess their PA, HRQoL and a range of other factors and issues such as their experienced distress and fatigue.
We found that moderate to vigorous PA among CRC survivors was associated with higher physical quality of life, and that this association was mediated by distress and fatigue. These results suggest that more PA may lead to lower levels of distress and fatigue and that lower distress and fatigue improves  quality of life, but more rigorous research is needed to further confirm these findings.

Sitting Time and Metabolic Health in Dutch and Hungarian schoolchildren

Sitting time, or 'sedentary behavior' may have negative health consequences, independent of physical activity; thus, even when one is sufficiently physically active, prolonged or extensive sedentary time may contribute to higher risk for metabolic syndrome, diabetes, overweight and obesity. However, these associations need to be researched in more detail and in more rigorous studies.
The association between objectively assessed sedentary time and metabolic risk factors in childhood has hardly been studied at all. Therefore, we examined the independent relationship between objectively assessed and self-rated sedentary time and indicators of metabolic health in Dutch and Hungarian 10–12 year olds. The research paper reporting on this study, led by Dr. Mai Chin A Paw, was just published in the journal Plos ONE.
Sedentary time was measured using accelerometers and the children self-reported their TV and computer time. Weight, height and waist circumference of the kids were measured and fasting plasma glucose, C-peptide, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and triglycerides were determined in capillary blood and summed into a metabolic risk score.
Children spent on average 7.6 hours of their daily waking time in sedentary behavior and self-reported 116664 min/day watching TV and 85657 min/day using the computer. Comparing the quartile of kids with highest with the quartile of kids with the lowest objectively assessed sedentary time, we found that the most sedentary kids had higher body weights (BMI) bigger waists and higher C-Peptide levels. The difference in the total, overall metabolic risk score was only borderline significant. When we compared the kid who watched most TV with those who watched least we found that among the TV kids, BMI was significantly higher.
In summary: although BMI and WC were higher in the most sedentary versus the least sedentary children; we found no further consistent evidence that the most sedentary children were at increased metabolic risk.

Delfien van Dyck defended her thesis in Ghent

Yesterday Delfien van Dyck received her doctorate at Ghent University after successfully defending her thesis ' The physical environment and its association with physical activity and sedentary behaviors in adults and adolescents'. I had the honor to be part of the examination committee. Dr. van Dyck has written an exceptionally good thesis in the field of behavioral nutrition and physical activity. Her thesis comprises 16 scientific papers, most of these published in the best journals in the field. Before her defense she gave a very lively, clear and scientifically sound public lecture about her work, and after that she did a very good job in discussing her work with the examination committee.
The day after the thesis defense, Dr. van Dyck and her primary supervisor, Prof. Ilse de Bourdeaudhuij organized a symposium on behavioral nutrition and physical activity issues with four presentations. Profs. David Crawford (Deakin University, Australia), Neville Owen (Barker IDI, Australia), Jim Sallis (University of California, USA) and myself presented some of our work and discussed this with an audience of scientists, policy makers and people active in health promotion practice. The discussion focussed strongly on what the main drivers of healthy nutrition and physical activity behaviors are, the opportunities for health behavior in the environments where people live, or the individual motivations and abilities that people have for living healthily.