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.