Educational differences in the validity of self-reported physical activity

The assessment of physical activity for surveillance or population based studies is usually done with self-report questionnaires. We studied if the validity of a much used self-reported physical activity questionnaire -the International Physical Activity Questionnaire (IPAQ) was different according to the level of education of the respondents.
In a paper just published in BMC public health, we compared physical activity as assessed with IPAQ to physical activity assessed with accelerometers (i.e. an objective measure of physical activity) and analysed if the results of these two measurements were better associated in higher than in lower educated people. This was indeed the case. The validity of IPAQ was moderate at best among higher educated respondents, but very poor among lower educated respondents. Our results suggest that questionnaires such as IPAQ should not be used among the lower educated.

Tim Lobstein on our SPOTLIGHT project analysis of community-based interventions

This week Dr. Tim Lobstein, director of policy at the World Obesity Federation, wrote a British Medical Journal Blog based on our analyses within the study into obesity and obesogenic environments, a cross-European collaboration (SPOTLIGHT) of community-based interventions for obesity prevention.

Lobstein focusses on the importance of evaluating community-based interventions on Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) to learn from such projects for future endeavours, and to avoid that such projects are being “top-down” by ensuring that all participants (beneficiaries, staff, funders) are involved in the planning process when the project is first mooted. Finally, Lobstein stresses that haste is a waste where community based obesity prevention projects are concerned: "Lastly, complex community-based interventions can experience tensions between delivering a high-quality, effective project in a short period of time on the one side, and achieving engagement in the community and its organisations and leaders on the other. "

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.