Implementation conditions for diet and physical activity interventions and policies

In an umbrella review just published in BMC Public Health, we aimed at identifying evidence-based conditions important for successful implementation of interventions and policies promoting a healthy diet, physical activity (PA), and a reduction in sedentary behaviors (SB). In particular, we examined if the implementation conditions identified were intervention-specific or policy-specific. This study was undertaken as part of the DEterminants of DIet and Physical Activity (DEDIPAC) Knowledge Hub, a joint action as part of the European Joint Programming Initiative a Healthy Diet for a Healthy Life.

We conducted a systematic review of reviews and stakeholder documents. Data from nine scientific literature databases were analysed. Additionally, published documentation of eight major stakeholders such as the World Health Organization were systematically searched. The RE-AIM


(reach, efficacy. adoption, implementation, maintenance) framework was used to categorize elicited conditions. Across the implementation conditions 25 % were identified in at least four documents and were subsequently classified as having obtained sufficient support.

We identified 312 potential conditions relevant for successful implementation; 83 of these received sufficient support. Using the RE-AIM framework eight implementation conditions that obtained support referred to the reach in the target population; five addressed efficacy of implementation processes; 24 concerned adoption by the target staff, setting, or institutions; 43 referred to consistency, costs, and adaptations made in the implementation process; three addressed maintenance of effects over time. The vast majority of implementation conditions were supported by documents referring to both interventions and policies. There were seven policy-specific implementation conditions, which focused on increasing complexities of coexisting policies/legal instruments and their consequences for implementation, as well as politicians’ collaboration in implementation.

The use of the proposed list of 83 conditions for successful implementation may enhance the implementation of interventions and policies which pursue identification of the most successful actions aimed at improving diet, PA and reducing SB.

Which behavior change techniques do we value in apps to promote physical activity?

Interventions delivered through new device technology, including mobile phone apps, appear to be an effective method to reach young adults. Previous research indicates that self-efficacy and social support for physical activity and self-regulation behavior change techniques (BCT), such as goal setting, feedback, and self-monitoring, are important for promoting physical activity; however, little is known about how people in the target population themselves value and rate such BCTs applied in physical activity apps.

In a study just published we aimed to explore young adults’ opinions regarding BCTs (including self-regulation techniques) applied in mobile phone physical activity promotion apps, and to examine associations between personality characteristics and these opinions.
We conducted a cross-sectional online survey among 179 healthy 18 to 30-year-old adults.
We  found  that young Dutch physically active adults rate self-regulation techniques as most positive and techniques addressing social support as less positive among mobile phone apps that aim to promote physical activity. Such ratings of BCTs differed according to personality traits and exercise self-efficacy. Future research should focus on which behavior change techniques in app-based interventions are most effective to increase physical activity.

Effects of exercise on physical fitness and fatigue in cancer survivors, REACT study

International evidence-based guidelines recommend physical exercise as part of standard care for all cancer survivors. However, at present, the optimum exercise intensity is unclear. Therefore, we aimed to evaluate the effectiveness of a high intensity (HI) and low-to-moderate intensity (LMI) resistance and endurance exercise program compared with a wait list control (WLC) group on physical fitness and fatigue in a mixed group of cancer survivors who completed primary cancer treatment, including chemotherapy. This study was just published in the journal BMC Medicine, with Caroline Kampshoff as first author.

277 cancer survivors were randomized to 12 weeks of HI exercise  LMI exercise, or WLC. Both interventions were identical with respect to exercise type, duration and frequency, and only differed in intensity. Measurements were performed at baseline (4–6 weeks after primary treatment) and post-intervention. The primary outcomes were cardiorespiratory fitness (peakVO 2 ), muscle strength (grip strength and 30-second chair-stand test), and self-reported fatigue (Multidimensional Fatigue Inventory; MFI). Secondary outcomes included health-related quality of life, physical activity, daily functioning, body composition, mood, and sleep disturbances.
HI and LMI exercise showed significantly larger improvements in peakVO 2 compared to WLC. Improvements in peakVO 2 were larger for HI than LMI exercise, but the difference was just short of statistically significant (P = 0.08). No intervention effects were found for grip strength and the 30-second chair-stand test. HI and LMI exercise significantly reduced general and physical fatigue and reduced activity (MFI subscales) compared to WLC, with no significant differences between both interventions. Finally, compared to WLC, we found benefits in global quality of life and anxiety after HI exercise, improved physical functioning after HI and LMI exercise, and less problems at work after LMI exercise.

Obesity-related behaviours and BMI in five urban regions across Europe: the SPOTLIGHT project

In a paper just published in BMJ Open, we describe the design, methods and first results of a survey on obesity-related behaviours and body mass index (BMI) in adults living in neighbourhoods from five urban regions across Europe. Dr. Jeroen Lakerveld is first author on this paper, and it is based on a cross-sectional observational study in the framework of a European Union-funded project on obesogenic environments (SPOTLIGHT).
60 urban neighbourhoods (12 per country) were randomly selected in large urban zones in Belgium, France, Hungary, the Netherlands and the UK, based on high or low values for median household income (socioeconomic status, i.e. SES) and residential area density.
A total of 6037 adults participated in the online survey. Self-reported physical activity, sedentary behaviours, dietary habits and BMI were obtained and other measures included general health; barriers and motivations for a healthy lifestyle, perceived social and physical environmental characteristics; the availability of transport modes and their use to specific destinations; self-defined neighbourhood boundaries and items related to residential selection. These survey data were obtained additionally to more objective data about the build and/or physical environmental contexts in these urban areas; initial earlier paper.
information on these data was published in an
The first results of the survey show that across five countries, residents from low-SES neighbourhoods ate less fruit and vegetables, drank more sugary drinks and had a consistently higher
BMI. SES differences in sedentary behaviours were observed in France, with residents from higher SES neighbourhoods reporting to sit more. Residents from low-density neighbourhoods were less physically active than those from high-density neighbourhoods; during leisure time and (most pronounced) for transport (except for Belgium). BMI differences by residential density were inconsistent across all countries.

Socio-demographic inequalities across a range of health status indicators and health behaviours among pregnant women

Suboptimal health behaviours and maternal health conditions (e.g. smoking, alcohol consumption, obesity, underweight, depression and stress) a during pregnancy have been associated with negative pregnancy outcomes. The first aim of our study just published in BMC Pregnancy & Child Birth was to provide an overview of the self-reported health status and health behaviours of pregnant women under midwife-led primary care in the Netherlands. Our second aim was to identify potential differences in these health status indicators and behaviours according to educational level and ethnicity of the mothers.
We used data from the DELIVER study, a multicentre prospective cohort study conducted from September 2009 to March 2011 among 6711 pregnant women.
Lower educated women were 11 times more likely to smoke and 10 times more likely to experience low health control. They were also less likely to attend antenatal classes and not take folic acid supplementation, as well as somewhat more likely to skip breakfast daily, be obese, underweight and depressed or anxious. Non-western women were especially more likely not to take folic acid supplementation; have low health control beliefs and not to attend antenatal classes.
We concluded that substantial socio-demographic inequalities persist with respect to many health-related issues in medically low risk pregnancies in the Ne
therlands. Improved strategies are needed to address the specific needs of socio-demographic groups at higher risk and the structures underlying social inequalities in pregnant women.

Determinants of engaging in sedentary behavior across the lifespan; lessons learned from two reviews conducted within DEDIPAC

As part of the Determinants of Diet and Physical Activity (DEDIPAC) joint action of the European Healthy Diet for a Health Life initiative, we conduct a series of reviews on determinants of dietary behaviours, physical activity and sedentary behaviour. In the International Journal of Behavioral Nutrition and Physical Activity recently two reviews were published on potential determinants of sedentary behaviour; one on older adults and one on youth.
Older adults are the most sedentary of all age groups and high sedentary time is associated with poor health and wellbeing. Identifying determinants of sedentary behaviour is a necessary step to develop interventions to reduce sedentary time. In the paper just published in the International Journal of Behavioural Nutrition and Physical Activity, we report on a systematic literature review to identify factors associated with sedentary behaviour in older adults. Twenty-two original studies were identified. Personal factors were the most frequently investigated. Higher age, obesity, retirement, and lower health status were consistently associated with more sedentary time.

In the same journal a second systematic review was published on potential determinants of sedentary behaviour in youth. Together with Prof. Mai Chin A Paw I wrote a short commentary paper on both reviews that was also published in the journal.  we concluded that in both reviews, the included studies were predominantly conducted in Europe, the US, and Australia. Most studies were limited to TV or ‘screen’ time rather than sedentary behavior and relied on self-report. In both age groups there is a lack of qualitative studies as well as studies looking into the more motivational and contextual potential determinants of sedentary behavior. Both reviews indicate that to date there is limited evidence on the determinants of sedentary behaviour in youth and older adults. In youth, age and weight status were identified as determinants of sedentary behavior, with more sedentary time among older and heavier kids. In adults, age and retirement were determinants, with older and retired elderly sitting more.

Additional Findings from the B-PROOF Study; no effects of Vit B12 and Folic Acid on Physical Performance, Strength, and Falling

Elevated homocysteine is associated with a decline in physical function in elderly persons. Homocysteine-lowering therapy may slow down this decline. In the B-proof study we aimed to examine the effect of a 2-year intervention of vitamin B12 and folic acid supplementation on -among other issues- physical performance, handgrip strength, and risk of falling in elderly subjects in a double-blind, randomized placebo-controlled trial. The results on these outcomes were just published in the journal Calcified Tissue International. Participants aged ≥65 years with elevated plasma homocysteine concentrations were randomly assigned to daily supplementation of vitamin B12, folic acid, and vitamin D3, or to placebo with vitamin D3. Physical performance and handgrip strength were measured at baseline and after 2 years. Falls were reported prospectively on a research calendar.  No differences in physical performance level and handgrip strength or time to first fall were found between the B12 and folic acid supplemented group and the placebo group. Despite the overall null-effect, the results provided indications for a positive effect of the intervention on gait, as well as on physical performance among compliant persons >80 years. These effects should be further tested in future studies. In earlier analyses of the B-proof data of the effects of the supplementation on fracture incidence, also no main effects were found.

Individual and family environmental correlates of TV and screen time among European children

Too much sitting, and especially too much time behind the TV or other 'screen-based' activities, may increase risk for cardiometabolic ill health. In order to design interventions to encourage and facilitate school-age children to spend less time behind screens, we aimed to investigate which individual and family environmental factors are related to television and computer time among 10- to-12-year-old children within and across five European countries (Belgium, Germany, Greece, Hungary, Norway). A paper describing this study was just published in the journal BMC Public Health, with Dr. Maite Verloigne as first author.
Data were used from the ENERGY-project. Children and one of their parents completed a questionnaire, including questions on screen time behaviours and related individual and family environmental factors.
In all countries, children reported more television and/or computer time, if children and their parents thought that the maximum recommended level for watching television and/or using the computer was higher and if children had a higher preference for television watching and/or computer use and a lower self-efficacy to control television watching and/or computer use. We also found different correlates across countries: parents watching TV together with their child was significantly positively associated with children’s television time in all countries, except for Greece. If parents watched more TV or spend more time behind other screens was associated with a higher level of children’s television and computer time in Hungary. Having parental rules regarding children’s television time was related to less television time in all countries, except for Belgium and Norway.

Reliability of a Photo-Rating Instrument for School Environments for Physical Activity and Healthy Eating

People's and especially children's health behaviours are importantly influenced by the environment they are exposed to. For example, in a school environment that offers ample opportunities for physical activity and health eating, and little opportunities for sedentariness and unhealthy snacking, children will be more likely to engage in health energy balance related behaviours. The school environment can thus play an important role in the prevention of childhood overweight and obesity. To further study the impact of such environments, measurement of the 'obesopreventive' characteristics of the school environment is important. Photos of the school environment may contribute to more adequate, systematic, objective measurement of the school environment, as photos can be rated by different assessors. In a study we recently published in the Journal of Physical Activity and Health, -with Dr. Teatske Altenburg as first author- we aimed to examine the inter-rater reliability for rating photo-based characteristics of primary school environments related to physical activity and eating.
Photos taken at 172 primary schools in seven European countries were rated according to a standardised protocol. Briefly, after categorising all photos in subsections of physical activity or eating opportunities, two researchers independently rated aspects of safety, functionality, aesthetics, type of food/drinks advertised, type/variety of foods provided. Inter-rater reliability was assessed using the intra-class correlation coefficient (ICC) and Cohen's kappa.
Six subsections of the photo-rating instrument showed excellent or good inter-rater reliability. Outdoor physical activity facilities showed moderate, and school canteens and vending machines showed poor inter-rater reliability.
Inter-rater reliability of the ENERGY photo-rating instrument was thus good-to-excellent for six out of nine characteristics of primary school environment components related to physical activity and eating.

Development of Motivate4Change: Interactive Physical Activity and Medication Adherence Promotion for Heart Failure Patients.

It is important that heart failure (HF) patients adhere to their medication regimen and engage in physical activity to optimally self-manage their condition. Evidence shows that adherence to these HF self-management behaviors can be improved with appropriate interventions. To further promote medication adherence and physical activity among HF patients, we developed an interactive -ICT supported- intervention for hospitalized HF patients. In a paper just published in JMIR Research Protocols, -with Rony Oosterom-Calo as first author- we describe how this intervention was developed.
The intervention mapping protocol was applied in the development of the intervention. This entailed performing a needs assessment (on which another paper was published in the same journal), defining change objectives, selecting determinants and strategies, and developing the materials. The resulting intervention, called Motivate4Change, makes use of interactive technology and provides HF patients with personalized feedback and advice. Specific change objectives were defined. The relevant behavioral determinants for the physical activity program were practical knowledge on physical activity performance and self-efficacy for, and perceived benefits of, physical activity. For medication-taking, the selected determinants were practical knowledge on medication-taking, perceived barriers to medication-taking, beliefs about the necessity and harm regarding the medication prescribed, and beliefs about overprescribing and harm of medication in general. The change objectives and behavior change determinants were translated in feedback and advice strategies in an interactive technology program that included tailored feedback and advice, and role models in videos in which the behaviors and overcoming barriers were demonstrated. Relevant stakeholders were involved in the interventions development process. The intervention was pretested among HF patients and adjustments were made accordingly.

Providing and promoting active video games does not prevent excessive weight gain in normal weight adolescents

The aim of our study just published in PLoS One -with Monique Simons as first author-, was to evaluate the effects of and adherence to an active video game promotion intervention on anthropometrics, sedentary screen time and consumption of sugar-sweetened beverages and snacks among primarily normal-weight non-active video gaming adolescents.
We assigned 270 gaming adolescents (i.e. adolescents who spent ≥2 hours/week on non-active video gaming) randomly to an intervention group (n = 140) (receiving active video games and encouragement to play) or a waiting-list control group (n = 130). The intervention group received a PlayStation Move upgrade package to play the active video games -i.e. games that require physical activity to play- on a PlayStation 3 console in their homes and the following active video games were provided during the intervention: Sport Champions, Move Fitness, Start the Party and Medieval Moves, Dance Star Party and Sorcery. A detailed description of these Move video games can be found at: http://nl.playstation.com/ps3/games/.
Unexpectedly, the control group decreased significantly more than the intervention group in body mass index and sum of skinfolds. The intervention group had a significantly higher decrease in self-reported non-active video game time and total sedentary screen time  than the control group. 14% of the adolescents in the intervention group played the Move video games every week ≥1 hour/week during the whole intervention period.
Our study shows that proving adolescents who are not yet overweight with active video game consoles and games does not result in prevention of unnecessary weight gain in this group of non-active video gamers.

Maternal efficacy and sedentary behavior rules predict child obesity resilience

In a paper just published in BMC Obesity with Prof. David Crawford as first author we aimed to identify longitudinal individual, social and environmental predictors of adiposity (BMI z-score), and of resilience to unhealthy weight gain, in healthy weight children and adolescents.
Two hundred healthy weight children aged 5–12 years at baseline and their parents living in socio-economically disadvantaged neighborhoods were surveyed at baseline and three years later. Children’s height and weight were objectively measured, parents completed a detailed questionnaire that examined the home, social and neighborhood environments, and objective measures of the neighborhood environment were assessed using geographic information system data. Children classified as healthy weight at baseline who had small or medium increases in their BMI z-score between baseline and three year follow up were categorized as ‘resilient to unhealthy weight gain’.
Maternal efficacy for preventing their child from engaging in sedentary behaviours and rules to limit sedentary behaviours were associated with better resilience.
The findings suggest that strategies to support parents to limit their children’s sedentary behavior may be important in preventing unhealthy weight gain in socioeconomically disadvantaged communities.

Correlates of dietary behavior in adults: an umbrella review

In order to inform interventions to promote healthy eating, insights in the potential determinants of dietary behaviour is important. Interventions should target such determinants to initiate dietary behaviour change. Multiple studies have been conducted on potential determinants of dietary behavior in adults, but a clear overview is currently lacking. In an open access paper just published in the journal Nutrition Reviews, with Dr. Esther Sleddens as first author, we describe a so-called umbrella review -or a review-of-reviews-  to summarize and synthesize the scientific evidence on correlates and determinants of dietary behavior in adults. We included reviews published between January 1990 and May 2014 and 14 reviews were considered eligible. We evaluated the strength of the evidence, and the methodological quality.
Social-cognitive determinants and environmental determinants (mainly the social-cultural environment) were included most often in the available reviews. Sedentary behavior and habit strength were consistently identified as important correlates of dietary behavior. Other correlates and potential determinants of dietary behavior, such as motivational regulation, shift work, and the political environment, have been studied in relatively few studies, but results were rather consistent. Because of the generally weak research design of the studies covered in the available reviews, the evidence for true determinants is suggestive, at best.

Breaking up sitting time among schoolchildren

Children sit too much and too long. Especially prolonged sitting may be detrimental to health, and breaking up sitting time -i.e. introducing short interruptions of sitting-, may be health promoting. There are currently no studies available reporting intervention effects on breaking up children’s sedentary time. In a study just published in Paediatric Exercise Science, with Dr. Maite Verloigne as first author, we examined the 'UP4FUN' intervention's effect on objectively measured number of breaks in sedentary time, number of sedentary bouts (≥ 10 mins) and total and average amount of time spent in those sedentary bouts among 10- to 12-year-old Belgian children. The total sample included 354 children (mean age: 10.9 ± 0.7years; 59% girls) with valid ActiGraph accelerometer data at pre- and posttest.
Only few and small intervention effects were found, namely on total time spent in sedentary bouts immediately after school hours and on average time spent in sedentary bouts before school hours ( and immediately after school hours in favor of children from intervention schools. Unexpectedly, girls from intervention schools decreased the number of breaks during school hours and increased the number of sedentary bouts on a weekend day, whereas girls in control schools showed an increase in number of breaks and a decrease in number of bouts. In conclusion, UP4FUN did not have a consistent or substantial effect on breaking up children’s sedentary time and these data suggest that more intensive and longer lasting interventions are needed.

Exercise and health‐related quality of life in older long‐term prostate cancer survivors

In a study just published in the journal Cancer -with Dr. Laurien Buffart as first author-, we examined the effects of 12 months of exercise on health-related quality of life (HRQoL) in older long-term survivors of prostate cancer. We also studied for whom this intervention was effective and what possible working mechanisms of the intervention were, i.e. we studied moderators (for whom?) and mediators (how?) of the intervention effects.
In total, 100 men with a mean age of 71.7 years participated in and RCT, and were randomly assigned to 6 months of supervised aerobic and resistance exercise followed by 6 months of a home-based exercise maintenance program (EX group) or printed education material regarding physical activity for 12 months (PA group).
The results show that aerobic and resistance exercise appear to have beneficial effects on HRQoL among older, long-term survivors of prostate cancer. These effects were larger among patients who were married, who started exercising sooner rather than later after diagnosis, and who previously used bisphosphonates. Improvements in lower body functional performance as a result of the exercise intervention mediated the effects on HRQoL.

Successful behavior change in obesity interventions in adults

Overweight and obesity are among the main determinants of avoidable burden of disease worldwide. many interventions have been developed, tested and implemented to treat obesity. Many of such interventions aim at lifestyle changes -i.e. better nutrition, more physical activity to help people lose weight and avoid further weight gain. However, relapse is high in lifestyle obesity interventions involving behavior and weight change. Identifying mediators of successful outcomes in these interventions is critical to improve effectiveness and to guide approaches to obesity treatment, including resource allocation. In an article that just appeared in the journal BMC Medicine -with Prof. Pedro Teixeira as first author, and as part of the larger European Commission-funded Spotlight project-, we reviewed the most consistent self-regulation mediators of medium- and long-term weight control, physical activity, and dietary intake in clinical and community behavior change interventions targeting overweight/obese adults. Using a systematic review methodology we reviewed thirty-five studies testing 42 possible mediators of intervention effect. The results indicate that important prerequisites for medium-/long-term weight control were higher levels of autonomous motivation, self-efficacy/barriers, self-regulation skills (such as self-monitoring), flexible eating restraint, and positive body image. For physical activity, significant mediators were high autonomous motivation, self-efficacy, and use of self-regulation skills. For dietary intake, the evidence was much less clear, and no consistent mediators were identified. We conclude that despite limited evidence, higher autonomous motivation, self-efficacy, and self-regulation skills emerged as the best predictors of beneficial weight and physical activity outcomes; for weight control, positive body image and flexible eating restraint may additionally improve outcomes. These variables represent possible targets for future lifestyle interventions in overweight/obese populations.

An intervention to break up sitting time among schoolchildren was not effective

Too much and prolonged sitting may be a risk factors for cardiometabolic health. The UP4FUN intervention is a family-involved school-based intervention aiming at reducing and breaking up sitting time at home (with special emphasis on screen time), and breaking up sitting time in school among 10–12 year olds in different countries across Europe. In a paper just published in the journal Plos One -with Dr. Froydis Vik as first author- we report on the intervention's short term effects.
A total of 3147 pupils from Belgium, Germany, Greece, Hungary and Norway participated in a school-randomized controlled trial. The intervention included 1–2 school lessons per week for a period of six weeks, along with assignments for the children and their parents. Screen time and breaking up sitting time were registered by self-report and total sedentary time and breaking up sitting time by accelerometry. The effect of the intervention on these behaviors was analysed by multilevel regression analyses. All analyses were adjusted for baseline values and gender. No significant intervention effects were observed, neither for self-reported TV/DVD or computer/game console time, nor for accelerometer-assessed total sedentary time and number of breaks in sitting time. The intervention group did report more positive attitudes towards and preferences/liking for breaking up sitting time than the control group.
Overall, these results do not warrant wider dissemination of the present UP4FUN intervention.

What features do Dutch university students prefer in a smartphone application for promotion of physical activity?

The transition from adolescence to early adulthood is a critical period in which there is a decline in physical activity (PA). College and university students make up a large segment of this age group. Smartphones may be used to promote and support PA. The purpose of a qualitative study just published in International Journal of Behavioral Nutrition & Physical Activity, with Anouk Middelweerd as first author, was to explore Dutch students’ preferences regarding a PA application (PA app) for smartphones. Thirty Dutch students (aged 18–25 years) used a PA app for three weeks and subsequently attended focus group discussions. To streamline the discussion, a discussion guide was developed covering seven main topics, including general app usage, usage and appreciation of the PA app, appreciation of and preferences for its features and the sharing of PA accomplishments through social media. The discussions were audio and video recorded, transcribed and analysed according to conventional content analysis.
Participants preferred for PA apps a simple and structured layout without unnecessary features. Ideally, the PA app should enable users to tailor it to their personal preferences by including the ability to hide features. Participants preferred a companion website for detailed information about their accomplishments and progress, and they liked tracking their workout using GPS. They preferred PA apps that coached and motivated them and provided tailored feedback toward personally set goals. They appreciated PA apps that enabled competition with friends by ranking or earning rewards, but only if the reward system was transparent. They were not willing to share their regular PA accomplishments through social media unless they were exceptionally positive. In conclusion,  participants prefer PA apps that coach and motivate them, that provide tailored feedback toward personally set goals and that allow competition with friends.

Associations between active video gaming and other energy-balance related behaviours in adolescents

Active video games, i.e. video games that require physical activity for play, may contribute to reducing time spent in sedentary activities, increasing physical activity and preventing excessive weight gain in adolescents. Active video gaming can, however, only be beneficial for weight management when it replaces sedentary activities and not other physical activity, and when it is not associated with a higher energy intake. In a study just published in International Journal of Behavioral Nutrition and Physical Activity, we report an examination of the association between active video gaming and other energy-balance-related behaviours (EBRBs). Adolescents (12–16 years) with access to an active video game and who reported to spend at least one hour per week in active video gaming were invited to participate in the study. They were asked to complete electronic 24-hour recall diaries on five randomly assigned weekdays and two randomly assigned weekend-days in a one-month period, reporting on time spent playing active and non-active video games and on other EBRBs. Adolescents who reported playing active video games also reported spending more time playing non-active video games compared to adolescents who did not report playing active video games. No differences between these groups were found in other EBRBs. Among those who played active video games, active video game time was positively yet weakly associated with TV/DVD time and snack consumption. Active video game time was not significantly associated with other activities and sugar-sweetened beverages intake.
The results suggest that it is unlikely that time spent by adolescents in playing active video games replaces time spent in other physically active behaviours or sedentary activities. Spending more time playing active video games does seem to be associated with a small, but significant increase in intake of snacks. This suggests that interventions aimed at increasing time spent on active video gaming, may have unexpected side effects, thus warranting caution.

Moderators of the effects of group-based physical exercise on cancer survivors’ quality of life

In order to further improve and enabling more personal tailoring of exercise programs for cancer survivors, better insight in for whom such exercise programs work best. In a study just published online in Supportive Care in Cancer, -with Joeri Kalter as first authors- we explored demographic, clinical, and psychological moderators of the effect of a group-based physical exercise intervention on global quality of life (QoL) among cancer survivors who completed treatment.
he physical exercise intervention effect on global QoL was larger for cancer survivors who received radiotherapy than for cancer survivors who did not receive radiotherapy, larger for cancer survivors who received a combination of chemoradiotherapy than for those who did not receive this combination of treatments, and larger for cancer survivors with higher baseline levels of fatigue than for those with lower levels. No other moderating effects were found.
Conclusions This study suggests that cancer treatment modality and baseline fatigue levels moderate the effect of a physical exercise program on cancer survivors’ global quality of life.

Many overweight children and their parents underestimate the children’s weight status

A first step to obesity prevention and treatment is that one is aware of one's overweight. In a study across Europe, as part of the ENERGY study, we explored if children and their parents are aware of the children's overweight and obesity. This study was just published in e-pub in Public Health Nutrition.

The study was conducted among 6113 children aged 10–12 years and their parents. Children’s weight and height were objectively measured. Parental anthropometric and sociodemographic data were self-reported. Children and their parents were asked to comment on children’s weight status based on five-point Likert-type scales, ranging from ‘I am much too thin’ to ‘I am much too fat’ (children) and ‘My child’s weight is way too low’ to ‘My child’s weight is way too much’ (parents). These data were combined with children’s actual weight status, in order to assess underestimation of children’s weight status by children themselves and by their parents, respectively. 

43% of overweight/obese children and 28% of parents of overweight/obese children underestimated their and their children’s weight status, respectively. A higher likelihood for this underestimation was observed in Eastern and Southern compared with Central/Northern countries. Overweight or obese parents, parents of boys, and children from overweight/obese or unemployed parents were more likely to underestimate children’s weight status.

Determinants of dietary behavior among youth: an umbrella review

The literature on potential determinants of dietary behavior among youth is extensive and unwieldy. We conducted an umbrella review (or a 'review-of-reviews') to present a comprehensive overview of the current scientific knowledge. This review of reviews was just published in the International Journal of Behavioral Nutrition & Physical Activity.
We included systematic reviews identified in four scientific literature databases (i.e. PubMed, PsycINFO, The Cochrane Library and Web of Science) that summarized determinants of observable child and adolescent dietary behaviors. Data extraction included a judgment of the importance of determinants, strength of evidence and evaluation of the methodological quality of the eligible reviews.
In total, 17 reviews were considered. Whereas social-cognitive determinants were addressed most frequently towards the end of the 20th century, environmental determinants (in particular social and physical environmental factors) have been studied most extensively during the past decade, thereby representing a paradigm shift.With regard to environmental determinants, mixed findings were reported. Sedentary behavior and intention were found to be significant determinants of a wide range of dietary behaviors in most reviews, but these results were based on cross-sectional studies only. Other potential determinants such as automaticity, self-regulation and subjective norm have been studied in relatively few studies, but results suggest that these factors are important.

Good practice characteristics of diet and physical activity interventions and policies

Diet, physical activity and sedentary behaviour are main determinants of avoidable burden of disease. To promote health healthy lifestyles, public policies that promote or endorse such lifestyles are of crucial importance. Within the DEDIPAC (Determinants of Diet and Physical Activity) joint action of the Healthy Diet for a Healthy Life European Joint Programming initiative, we conducted an umbrella review -i.e. a systematic reviews of existing reviews- aimed at eliciting good practice characteristics of interventions and policies aiming at healthy diet, increasing physical activity, and lowering sedentary behaviours. This umbrella review was just published in the journal BMC Public Health.
We applied the World Health Organization’s framework, and sought for 3 types of characteristics, reflecting: (1) main intervention/policy characteristics, referring to the design, targets, and participants, (2) monitoring and evaluation processes, and (3) implementation issues.
We derived a list of 149 potential good practice characteristics, of which 53 were classified as relevant. The main characteristics of intervention/policy fell into 6 categories: the use of intervention theory, participants, target behavior, content development/management, multidimensionality, practitioners/settings. Monitoring and evaluation characteristics were also grouped into 6 categories: costs/funding, outcomes, evaluation of effects, time/effect size, reach, the evaluation of participation and generalizability, active components/underlying processes. Implementation characteristics were grouped into eight categories: participation processes, training for practitioners, the use/integration of existing resources, feasibility, maintenance/sustainability, implementation partnerships, implementation consistency/adaptation processes, transferability.
The use of the proposed list of 53 good practice characteristics may foster further development of health promotion sciences, as it would allow for identification of success vectors in the domains of main characteristics of interventions/policies, their implementation, evaluation and monitoring processes.