Psychometric properties of the Dutch-Flemish PROMIS® pediatric item banks Anxiety and Depressive Symptoms in a general population.

PURPOSE: This study aims to validate the Dutch-Flemish PROMIS pediatric item banks v2.0 Anxiety and Depressive Symptoms, the short forms 8a, and computerized adaptive tests (CATs) in a general Dutch population and to provide reference data. METHODS: Participants (N = 2,893, aged 8-18), recruited by two internet survey providers, completed both item banks. These item banks were assessed on unidimensionality, local independence, monotonicity, Graded Response Model (GRM) item fit, and differential item functioning (DIF) for gender, age group, region, ethnicity, and language. The short forms and CATs were assessed on reliability and construct validity compared to the Revised Child Anxiety and Depression Scale short version (RCADS-22) subscales. Reference scores were calculated. RESULTS: Both item banks showed sufficient unidimensionality, local independence, monotonicity, and GRM item fit, except for three Depressive Symptoms items that showed insufficient GRM item fit. No DIF was found when using ordinal regression analyses, except for two Depressive Symptoms items that showed DIF for language; all items showed DIF for language when using IRT PRO, except for one Anxiety item. Both short forms and CATs revealed sufficient reliability for moderate and severe levels of anxiety and depression, as well as high positive correlations with corresponding RCADS-22 subscales and slightly lower correlations with non-corresponding RCADS-22 subscales. CONCLUSION: The Dutch-Flemish PROMIS pediatric item banks v2.0 Anxiety and Depressive Symptoms, the short forms 8a and CATs are useful to assess and monitor anxiety and depression in a general population. Reference data are presented.

Return to work experiences of patients treated with stem cell transplantation for a hematologic malignancy.

PURPOSE: This qualitative study aimed to identify hematopoietic stem cell transplantation (HSCT) survivors' (1) work perceptions; (2) barriers to and facilitators of return to work (RTW); and (3) possible solutions to improve RTW. METHOD: Fifteen patients treated with HSCT 1-5 years ago participated in face-to-face semi-structured interviews. Interviews were analyzed following the steps of thematic content analyses. RESULTS: RTW was often characterized as a complex and prolonged trajectory, and it was frequently incomplete in working hours, tasks, and/or responsibilities. Work perceptions varied between patients; most valued work as positive, but some also reported a decline in work capacity and/or in importance. Perceived barriers included the duration and side effects of cancer treatment, the presence of comorbidity and poor health before diagnosis, having difficulties commuting and doing household tasks. Perceived facilitators were financial incentives, keeping in touch with the workplace, support of other patients and family, and looking after one's health. Proposed solutions to improve RTW included discussing RTW at the hospital, enhanced employer support, improved accessibility of rehabilitation programs, and more information about the consequences of being sick-listed. CONCLUSIONS: Many HSCT survivors value work as important and they are motivated to RTW. Insight in work perceptions, RTW barriers, and solutions might help researchers, healthcare professionals, and employers to develop and/or tailor individualized multidisciplinary care to facilitate RTW.

An activity-friendly environment from the adolescent perspective: a concept mapping study.

BACKGROUND: In today's society, few adolescents meet physical activity guidelines and effects of physical activity promoting programmes are disappointing. In studies exploring determinants of physical activity, the perspective of adolescents themselves is largely lacking. Also, there is a lack of knowledge on potential environmental determinants of adolescent physical activity. Therefore, this study aimed to explore adolescents' perspectives on characteristics of an activity-friendly environment. METHODS: Concept mapping meetings were conducted with four secondary school classes, including 115 adolescents (13-17 years). Each student generated ideas regarding the characteristics of an activity-friendly environment. For each school class, ideas were combined and identical ideas were removed. Next, students individually sorted all ideas, based on self-perceived similarity, and rated their importance on a five-point Likert-scale. A concept map was created for each school class using multidimensional scaling and hierarchical cluster analysis. Finally, the researchers named the potential environmental determinants within the clusters. RESULTS: The concept maps depicted 23 unique potential determinants of activity friendliness, of which 15 were similar across all school classes. Potential determinants were categorized in the physical-, social-, economic-, and motivational domain. The most frequent and important adolescent-perceived determinants of activity friendliness across all school classes belonged to the physical domain, e.g. a suitable area including a proper surface for a variety of sports, and good lighting in the playground. CONCLUSIONS: Our findings show that adolescents perceive potential determinants in the physical and economic domain as most important for activity friendliness, indicating that future interventions might benefit from targeting potential determinants within these domains.

Lessons learnt from a process evaluation of an exercise intervention in patients treated with autologous stem cell transplantation.

This paper describes the process evaluation of an 18-week supervised exercise programme in 50 patients treated with high-dose chemotherapy followed by autologous stem cell transplantation. The intervention included 30 exercise sessions with six resistance exercises and interval training. We evaluated the context, dose delivered and received, and patients' and physiotherapists' satisfaction with the intervention. Ninety-two per cent of the patients trained within 15 km of their home address, with an average session attendance of 86%. Most patients trained at the prescribed intensity for four of the six resistance exercises, but the dose delivered and received of the two remaining resistance exercises and interval training could not be determined. Both patients and physiotherapists highly appreciated the programme (score of 8.3 and 7.9 out of 10 respectively). This process evaluation provided valuable lessons for future trials: (1) It is possible to deliver supervised exercise training to this patient group in local physiotherapy practices; (2) to determine dose received all intervention components should be standardised; and (3) to optimise data collection, all study materials should be tested more extensively prior to the start of the intervention.

Comment on "Should we reframe how we think about physical activity and sedentary behavior measurement? Validity and reliability reconsidered".

With great interest we read the article by Kelly et al. on the measurement of physical activity (PA) and sedentary behavior (SB) (Kelly P et al. Int J Behav Nutr Phys Act 13:(1) 32, 2016). We appreciate the invitation of the authors to provide feedback on their ideas and we take this opportunity to contribute to the discussion. Our main proposition is that this field can learn much from the field of quality of life research and the methodology developed for validating quality of life questionnaires.

The association of birth weight and infant growth with physical fitness at 8-9 years of age--the ABCD study.

BACKGROUND: Low birth weight and accelerated infant growth are independently associated with childhood obesity. We hypothesized that birth weight and infant growth are associated with physical fitness in childhood, and thereby could act as a link in the developmental origins of obesity. In addition, we assessed whether these associations were mediated by fat-free mass (FFM), moderate-to-vigorous physical activity (MVPA) or sedentary behavior (SB). METHODS: We assessed physical fitness in 194 children of Dutch ethnicity aged 8.6 (±0.35) years from the ABCD cohort. Aerobic fitness was assessed using the 20-meter multistage shuttle run test (20-m MSRT), and neuromuscular fitness using the standing broad jump (SBJ) test and hand grip strength test. MVPA and SB were measured by accelerometry, and FFM by bioelectrical impedance analysis. Low birth weight was defined as below the 10th percentile and accelerated infant growth as an s.d. score weight gain of >0.67 between birth and 12 months. RESULTS: Children with low birth weight and subsequent accelerated infant growth attained a lower 20-m MSRT score than the remainder of the cohort, adjusted for multiple confounders (P<0.01). Birth weight and infant growth were both independently positively associated with hand grip strength, but not after adjusting for current height and body mass index. There was no association of birth weight or infant growth with SBJ. FFM mediated >75% of the association of birth weight and infant growth with hand grip strength, but FFM, MVPA and SB did not mediate the associations with 20-m MSRT. CONCLUSIONS: Our results indicate that low birth weight and accelerated infant growth might negatively affect childhood aerobic and neuromuscular fitness. Differences in FFM largely explain the developmental origins of neuromuscular fitness. Consequently impaired fitness may constitute a link between low birth weight, accelerated infant growth and obesity. Hence, optimization of fitness in these children may affect their obesity and cardiovascular disease risk.

Occurrence and duration of various operational definitions of sedentary bouts and cross-sectional associations with cardiometabolic health indicators: the ENERGY-project.

OBJECTIVE: This study examined the occurrence and duration of sedentary bouts and explored the cross-sectional association with health indicators in children applying various operational definitions of sedentary bouts. METHODS: Accelerometer data of 647 children (10-13 years old) were collected in five European countries. We analyzed sedentary time (<100 cpm) accumulated in bouts of at least 5, 10, 20 or 30 min based on four operational definitions, allowing 0, 30 or 60s ≥100 cpm within bouts. Health indicators included anthropometrics (i.e. waist circumference and body mass index (BMI)) and in a subsample from two European countries (n=112) fasting capillary blood levels of glucose, C-peptide, high-density- and low-density cholesterol, and triglycerides. Data collection took place from March to July 2010. Associations were adjusted for age, gender, moderate-to-vigorous physical activity, total wear time and country. RESULTS: Occurrence of sedentary bouts varied largely between the various definitions. Children spent most of their sedentary time in bouts of ≥5 min while bouts of ≥20 min were rare. Linear regression analysis revealed few significant associations of sedentary time accumulated in bouts of ≥5-30 min with health indicators. Moreover, we found that more associations became significant when allowing no tolerance time within sedentary bouts. CONCLUSION: Despite a few significant associations, we found no convincing evidence for an association between sedentary time accumulated in bouts and health indicators in 10-13 year old children.

Person-related determinants of TV viewing and computer time in a cohort of young Dutch adults: Who sits the most?

We aimed to assess the associations of person-related factors with leisure time television (TV) viewing and computer time among young adults. We analyzed self-reported TV viewing (h/week) and leisure computer time (h/week) from 475 Dutch young adults (47% male) who had participated in the Amsterdam Growth and Health Longitudinal Study at the age of 32 and 36 years. Sociodemographic factors (i.e., marital and employment status), physical factors (i.e., skin folds, aerobic fitness, neuromotor fitness, back problems), psychological factors (i.e., problem- and emotion-focused coping, personality), lifestyle (i.e., alcohol consumption, smoking, energy intake, physical activity), and self-rated health (i.e., general health status, mild health complaints) were assessed. Univariable and multivariable generalized estimating equations were performed. Male gender, higher sum of skin folds, lower values of aerobic fitness, higher rigidity, higher self-sufficiency/recalcitrance, and smoking were positively associated with TV time. Male gender, higher sum of skin folds, higher scores on self-esteem, low energy intake, and a not so good general health status were significantly associated with higher computer time. Determinants of TV viewing and computer time were not identical, suggesting that both behaviors (a) have different at-risk populations and (b) should be targeted differently.

Mediators of physical exercise for improvement in cancer survivors' quality of life.

OBJECTIVE: Mediating mechanisms of a 12-week group-based exercise intervention on cancer survivors' quality of life (QoL) were examined to inform future exercise intervention development. METHODS: Two hundred nine cancer survivors ≥ 3 months posttreatment (57% breast cancer) aged 49.5 (± 10.4) years were assigned to physical exercise (n = 147) or wait-list control (n = 62). QoL, fatigue, emotional distress, physical activity, general self-efficacy and mastery were assessed at baseline and post-intervention using questionnaires. Path analysis was conducted using Mplus to explore whether improved physical activity, general self-efficacy and mastery mediated the effects of exercise on fatigue and distress and consequently QoL. RESULTS: The intervention was associated with increased physical activity (ß = 0.46, 95% confidence interval (CI) = 0.14;0.59), general self-efficacy (ß = 2.41, 95%CI = 0.35;4.73), and mastery (ß = 1.75, 95%CI = 0.36;2.78). Further, the intervention had both a direct effect on fatigue (ß = -1.09, 95%CI = -2.12;0.01), and an indirect effect (ß = -0.54, 95%CI = -1.00;-0.21) via physical activity (ß = -0.29, 95%CI = -0.64;-0.07) and general self-efficacy (ß = -0.25, 95%CI = -0.61;-0.05). The intervention had a borderline significant direct effect on reduced distress (ß = -1.32, 95%CI = -2.68;0.11), and a significant indirect effect via increased general self-efficacy and mastery (ß = -1.06, 95%CI = -1.89;-0.38). Reductions in fatigue (ß = -1.33, 95%CI =-1.85;-0.83) and distress (ß = -0.86, 95%CI = -1.25;-0.52) were associated with improved QoL. Further, increased physical activity was directly associated with improved QoL (ß = 3.37, 95%CI = 1.01;5.54). CONCLUSION: The beneficial effect of group-based physical exercise on QoL was mediated by increased physical activity, general self-efficacy and mastery, and subsequent reductions in fatigue and distress. In addition to physical activity, future interventions should target self-efficacy and mastery. This may lead to reduced distress and fatigue, and consequently improved QoL of cancer survivors.

Cancer patients' experiences with and perceived outcomes of yoga: results from focus groups.

PURPOSE: Yoga is a "mind-body" exercise, a combination of physical poses with breathing and meditation, and may have beneficial effects on physical and psychosocial symptoms. We aimed to explore cancer patients' motives for practicing yoga, experiences of practicing yoga, and perceived physical and psychosocial outcomes. METHODS: Participants (n = 45) following yoga classes for cancer patients were asked to participate in focus group interviews, of whom 29 participated. The focus groups (n = 5) were audio taped with prior consent and transcribed verbatim. Data were analyzed by two coders and independently coded into key issues and themes. RESULTS: Mean age of the participants was 53.8 (SD 10.8) years, of whom 25 were women, and 18 were diagnosed with breast cancer. Motives for participation in yoga were relaxation, the will to be physically active, the wish to pay more attention to one's body, coping with psychosocial symptoms, contributing to their cancer rehabilitation process, and combing physical and mental processes. Main physical and psychosocial experiences of yoga mentioned by patients were regaining body awareness, raising attention to the inner self, learning how to relax, enjoyment, and finding recognition and understanding. Increased physical fitness and function, mental strength and resilience, increased coping, being more relaxed, and happiness were frequently mentioned experiences of patients. CONCLUSIONS: Patients with different types of cancer perceived several benefits on physical and psychosocial outcomes by practicing yoga. Therefore, yoga can be a valuable form of supportive care for cancer patients.

Correlates of screen time in the early years (0-5 years): A systematic review.

The majority of young children engage in high levels of screen time. To inform future interventions, knowledge on correlates of screen time is important. This review expands on previous work by focusing on the entire early childhood range, and including a broad focus regarding types of correlates and screens. A literature search (PubMed, Embase, PsycINFO, SPORTDiscus) was performed from 2000 up to October 2021. Included studies (cross-sectional and prospective) examined associations between a potential correlate and screen time (duration or frequency) in typically developing, apparently healthy children aged 0-5 years. Methodological quality was assessed by two independent researchers. Fifty-two of 6,614 studies were included. Two studies had high methodological quality. We found moderate evidence for a positive association between an electronic device in the bedroom, parental screen time, having a TV on at home, descriptive norms and screen time, and a negative association between sleep duration, household features, high value on physical activity, monitoring screen time, being in childcare, parental self-efficacy and screen time. We found no evidence for an association for child sex, body mass index, physical activity, temperament, number of siblings, being a first-born, neighborhood-related factors, socio-economic indicators, and parental marital status, physical activity, weight status, depression, wellbeing, sex, age and positive outcome expectations. The evidence for other investigated correlates was inconsistent or insufficient. Despite the evidence for moderate associations, we were unable to draw strong conclusions. More high-quality research is needed to identify correlates of screen time in early childhood.

Comparing different accelerometer cut-points for sedentary time in children.

Actigraph accelerometers are hypothesized to be valid measurements for assessing children's sedentary time. However, there is considerable variation in accelerometer cut-points used. Therefore, we compared the most common accelerometer sedentary cut-points of children performing sedentary behaviors. Actigraph Actitrainer uniaxial accelerometers were used to measure children's activity intensity (29 children, 5-11 years old) during different activities, namely playing computer games, nonelectronic sedentary games, watching television and playing outdoors. A structured protocol was the criterion for assessing the validity of four common cut-points (100, 300, 800, 1100 counts/minute). The median counts during all sedentary behaviors were below the lowest comparison cut-point of 100 cpm. The 75th percentile values for the sedentary behaviors were always below the cut-point of 300 cpm. Our results suggest that the cut-point of <100 cpm is the most appropriate.

What works in school-based energy balance behaviour interventions and what does not? A systematic review of mediating mechanisms.

OBJECTIVE: Obesity prevention requires effective interventions targeting the so-called energy balance-related behaviours (that is, physical activity, sedentary and dietary behaviours). To improve (cost-)effectiveness of these interventions, one needs to know the working mechanisms underlying behavioural change. Mediation analyses evaluates whether an intervention works via hypothesised working mechanisms. Identifying mediators can prompt intervention developers to strengthen effective intervention components and remove/adapt ineffective components. This systematic review aims to identify psychosocial and environmental mediators of energy balance-related behaviours interventions for youth. METHOD: Studies were identified by a systematic search of electronic databases (PubMed, Embase, PsycINFO, ERIC and SPORTDiscus). Studies were included if they (1) were school-based randomised controlled or quasi-experimental studies; (2) targeted energy balance behaviours; (3) conducted among children and adolescents (4-18 years of age); (4) written in English; and (5) conducted mediation analyses. RESULTS: A total of 24 studies were included. We found strong evidence for self-efficacy and moderate evidence for intention as mediators of physical activity interventions. Indications were found for attitude, knowledge and habit strength to be mediators of dietary behaviour interventions. The few sedentary behaviour interventions reporting on mediating effects prevented us from forming strong conclusions regarding mediators of sedentary behaviour interventions. The majority of interventions failed to significantly change hypothesised mediators because of ineffective intervention strategies, low power and/or use of insensitive measures. CONCLUSION: Despite its importance, few studies published results of mediation analysis, and more high-quality research into relevant mediators is necessary. On the basis of the limited number of published studies, self-efficacy and intention appear to be relevant mediators for physical activity interventions. Future intervention developers are advised to provide information on the theoretical base of their intervention including the strategies applied to provide insight into which strategies are effective in changing relevant mediators. In addition, future research is advised to focus on the development, validity, reliability and sensitivity of mediator measures.

Comparing machine learning to a rule-based approach for predicting suicidal behavior among adolescents: Results from a longitudinal population-based survey.

INTRODUCTION: Suicidal thoughts and suicide attempts are one of the most prominent public health concerns in adolescents and therefore early detection is important to initiate preventive interventions and closer monitoring. METHOD: We examined whether the Machine Learning models Random Forest and Lasso Regression better predict future suicidal behavior than a simple decision rule that classifies every adolescent with history of suicide ideation at baseline as at risk (current practice). We used data from a general population of students in second and fourth year of secondary education in Amsterdam, the Netherlands. RESULTS: Both the Random Forest and the Lasso Regression resulted in slightly better prediction. The AUC of the Random Forest (0.79) and Lasso regression (0.76) were both higher than the AUC of the decision rule (0.64). The Random Forest achieved slightly (but non-significantly) higher sensitivity than the decision rule (0.37 versus 0.34), with the same specificity (0.94). With Lasso Regression the sensitivity increased significantly (0.52), but at the expense of the specificity (0.85). LIMITATIONS: The loss of cases after merging the data, the use of self-reported data, confidential data collection and the use of only four questions to measure suicidal behavior. CONCLUSIONS: This is the first study applying Machine Learning techniques to predict future suicidal behavior on survey data collected in a general population of adolescents. Our study showed that integrating machine learning techniques in screening practice will result in a small improvement in the ability to predict suicide. The models need to be further optimized to improve accuracy.

Promoting physical activity in children: The stepwise development of the primary school-based JUMP-in intervention applying the RE-AIM evaluation framework.

BACKGROUND: There is a lack of effective intervention strategies that promote physical activity (PA) in school children. Furthermore, there is a gap between PA intervention research and the delivery of programmes in practice. Evaluation studies seldom lead to adaptations in interventions that are subsequently evaluated by implementation on a wider scale. The stepwise development and study of JUMP-in aims to add knowledge to better understand how, when and for whom intervention effects (or lack of effects) occur. METHODS: This paper describes the stepwise development of JUMP-in, a Dutch school-based multi-level intervention programme, aimed at the promotion of PA behaviour in 6-12-year-old children. JUMP-in incorporates education, sports, care and policy components. JUMP-in consists of six programme components: 1. Pupil Follow-up Monitoring System; 2. School sports clubs; 3. In-class exercises with "The Class Moves!"; 4. Personal workbook "This is the way you move!"; 5. Parental Information Services; 6. Extra lessons in physical education, Motor Remedial Teaching and extra care. The process and effect outcomes of a pilot study were translated into an improved programme and intervention organisation, using the RE-AIM framework (Reach, Efficacy, Adoption, Implementation and Maintenance). This paper presents the process and results of the application of this framework, which resulted in a widescale implementation of JUMP-in. RESULTS: The application of the RE-AIM framework resulted in challenges and remedies for an improved JUMP-in intervention. The remedies required changes at three different levels: (1) the content of the programme components; (2) the organisation and programme management; and (3) the evaluation design. CONCLUSIONS: Considering factors that determine the impact of PA interventions in 'real life' is of great importance. The RE-AIM framework appeared to be a useful guide by which process and effect outcomes could be translated into an improved programme content and organisation.

Walking or vitamin B for cognition in older adults with mild cognitive impairment? A randomised controlled trial.

OBJECTIVE: To examine the effects of aerobic exercise or vitamin B supplementation on cognitive function in older adults with mild cognitive impairment (MCI). DESIGN: Randomised placebo-controlled trial. SETTING: General community. PARTICIPANTS: Community-dwelling adults aged 70-80 with MCI. Interventions : The 152 participants were randomly assigned to two INTERVENTIONS: (1) a twice-weekly, group-based, moderate-intensity walking programme (WP, n = 77) or a low-intensity placebo activity programme (n = 75) for one year; and (2) daily vitamin pill containing 5 mg folic acid, 0.4 mg vitamin B-12, 50 mg vitamin B-6 (FA/B12/B6, n = 78) or placebo pill (n = 74) for one year. OUTCOME MEASURES: Cognitive function, measured with neuropsychological tests at baseline and after six and 12 months. RESULTS: Median session attendance at the exercise programmes (25th-75th percentile) was 63% (2%-81%) and median compliance with taking pills (25th-75th percentile) was 100% (99%-100%). Gender was an effect modifier. Intention-to-treat analysis revealed no main intervention effect for either intervention. In women in the WP, attention (Stroop combination task) improved by 0.3 seconds (p = 0.04) and memory (auditory verbal learning test) by 0.04 words (p = 0.06) with each percentage increase in session attendance. In men attending at least 75% of the sessions, the WP improved memory (beta 1.5 (95% CI: 0.1 to 3.0) words). CONCLUSION: The walking programme and/or FA/B12/B6 supplementation were not effective in improving cognition within one year. The walking programme, however, was efficacious in improving memory in men and memory and attention in women with better adherence. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number Register, 19227688, http://www.controlled-trials.com/isrctn/

Recommendations for obesity prevention among adolescents from disadvantaged backgrounds: a concept mapping study among scientific and professional experts.

The present study aimed to enrich the scientific evidence on obesity prevention programmes for adolescents from socio-economically disadvantaged backgrounds with practice-based experiences from both scientific and professional experts in the field of youth obesity prevention. We used the participatory method of concept mapping. Two concept mapping sessions were conducted: one with programme coordinators of national/regional obesity prevention programmes across Europe (n = 8) and one with scientists participating in European obesity prevention projects (n = 5). Five recommendations were extracted from both concept maps: (1) involve adolescents in the design and delivery of the programme, (2) invest in family/parental capacity building, (3) provide and support a healthy school food and physical activity environment, (4) regulate exposure to unhealthy messages/advertising and (5) facilitate safe and active travel. These recommendations can be used as a conceptual framework for programme development for preventing obesity in adolescents.

Long-term effectiveness and cost-effectiveness of high versus low-to-moderate intensity resistance and endurance exercise interventions among cancer survivors.

PURPOSE: This study aimed to evaluate the long-term effectiveness and cost-effectiveness of high intensity (HI) versus low-to-moderate intensity (LMI) exercise on physical fitness, fatigue, and health-related quality of life (HRQoL) in cancer survivors. METHODS: Two hundred seventy-seven cancer survivors participated in the Resistance and Endurance exercise After ChemoTherapy (REACT) study and were randomized to 12 weeks of HI (n = 139) or LMI exercise (n = 138) that had similar exercise types, durations, and frequencies, but different intensities. Measurements were performed at baseline (4-6 weeks after primary treatment), and 12 (i.e., short term) and 64 (i.e., longer term) weeks later. Outcomes included cardiorespiratory fitness, muscle strength, self-reported fatigue, HRQoL, quality-adjusted life years (QALYs) and societal costs. Linear mixed models were conducted to study (a) differences in effects between HI and LMI exercise at longer term, (b) within-group changes from short term to longer term, and (c) the cost-effectiveness from a societal perspective. RESULTS: At longer term, intervention effects on role (ß = 5.9, 95% CI = 0.5; 11.3) and social functioning (ß = 5.7, 95%CI = 1.7; 9.6) were larger for HI compared to those for LMI exercise. No significant between-group differences were found for physical fitness and fatigue. Intervention-induced improvements in cardiorespiratory fitness and HRQoL were maintained between weeks 12 and 64, but not for fatigue. From a societal perspective, the probability that HI was cost-effective compared to LMI exercise was 0.91 at 20,000€/QALY and 0.95 at 52,000€/QALY gained, mostly due to significant lower healthcare costs in HI exrcise. CONCLUSIONS: At longer term, we found larger intervention effects on role and social functioning for HI than for LMI exercise. Furthermore, HI exercise was cost-effective with regard to QALYs compared to LMI exercise. TRIAL REGISTRATION: This study is registered at the Netherlands Trial Register [NTR2153 [ http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2153 ]] on the 5th of January 2010. IMPLICATIONS FOR CANCER SURVIVORS: Exercise is recommended to be part of standard cancer care, and HI may be preferred over LMI exercise.

The effectiveness and promising strategies of obesity prevention and treatment programmes among adolescents from disadvantaged backgrounds: a systematic review.

This review aimed to summarize the evidence on the effectiveness of obesity prevention and treatment programmes for adolescents from socioeconomically disadvantaged backgrounds. A secondary aim was to identify potential successful intervention strategies for this target group. PubMed, EMBASE, PsycINFO and Cochrane Library were searched from January 2000 up to February 2016. Intervention studies targeting adolescents from disadvantaged backgrounds were included, with body mass index as outcome. Secondary outcomes were other adiposity measures, physical activity, diet, sedentary behaviour and screen time. Two independent reviewers extracted data, coded intervention strategies and conducted quality assessments. Fourteen studies were included: nine obesity prevention and five obesity treatment studies. Two preventive and four treatment studies showed significant beneficial effects on body mass index. Five of six studies (four preventive, one treatment studies) measuring dietary behaviour reported significant intervention effects. Evidence on other secondary outcomes was inconclusive. We found no conclusive evidence for which specific intervention strategies were particularly successful in preventing or treating obesity among disadvantaged adolescents. However, the current evidence suggests that involving adolescents in the development and delivering of interventions, the use of experiential activities and involvement of parents seem to be promising strategies. More high quality studies are needed. PROSPERO registration number: CRD42016041612.

[An evidence-update on the prospective relationship between childhood sedentary behaviour and biomedical health indicators: a systematic review and meta-analysis]. / Gezondheidseffecten van veel zitten tijdens de jeugd.

This systematic review and meta-analysis summarizes the evidence on the prospective relationship between childhood sedentary behaviour and biomedical health indicators, overall and stratified by type of sedentary behaviour (TV viewing, computer use/games, screen time and objective sedentary time).