Comparing national device-based physical activity surveillance systems: a systematic review.

BACKGROUND: Physical activity surveillance systems are important for public health monitoring but rely mostly on self-report measurement of physical activity. Integration of device-based measurements in such systems can improve population estimates, however this is still relatively uncommon in existing surveillance systems. This systematic review aims to create an overview of the methodology used in existing device-based national PA surveillance systems. METHODS: Four literature databases (PubMed, Embase.com, SPORTDiscus and Web of Science) were searched, supplemented with backward tracking. Articles were included if they reported on population-based (inter)national surveillance systems measuring PA, sedentary time and/or adherence to PA guidelines. When available and in English, the methodological reports of the identified surveillance studies were also included for data extraction. RESULTS: This systematic literature search followed the PRISMA guidelines and yielded 34 articles and an additional 18 methodological reports, reporting on 28 studies, which in turn reported on one or multiple waves of 15 different national and 1 international surveillance system. The included studies showed substantial variation between (waves of) systems in number of participants, response rates, population representativeness and recruitment. In contrast, the methods were similar on data reduction definitions (e.g. minimal number of valid days, non-wear time and necessary wear time for a valid day). CONCLUSIONS: The results of this review indicate that few countries use device-based PA measurement in their surveillance system. The employed methodology is diverse, which hampers comparability between countries and calls for more standardized methods as well as standardized reporting on these methods. The results from this review can help inform the integration of device-based PA measurement in (inter)national surveillance systems.

LOFIT (Lifestyle front Office For Integrating lifestyle medicine in the Treatment of patients): a novel care model towards community-based options for lifestyle change-study protocol.

BACKGROUND: A healthy lifestyle is indispensable for the prevention of noncommunicable diseases. However, lifestyle medicine is hampered by time constraints and competing priorities of treating physicians. A dedicated lifestyle front office (LFO) in secondary/tertiary care may provide an important contribution to optimize patient-centred lifestyle care and connect to lifestyle initiatives from the community. The LOFIT study aims to gain insight into the (cost-)effectiveness of the LFO. METHODS: Two parallel pragmatic randomized controlled trials will be conducted for (cardio)vascular disorders (i.e. (at risk of) (cardio)vascular disease, diabetes) and musculoskeletal disorders (i.e. osteoarthritis, hip or knee prosthesis). Patients from three outpatient clinics in the Netherlands will be invited to participate in the study. Inclusion criteria are body mass index (BMI) ≥25 (kg/m2) and/or smoking. Participants will be randomly allocated to either the intervention group or a usual care control group. In total, we aim to include 552 patients, 276 in each trial divided over both treatment arms. Patients allocated to the intervention group will participate in a face-to-face motivational interviewing (MI) coaching session with a so-called lifestyle broker. The patient will be supported and guided towards suitable community-based lifestyle initiatives. A network communication platform will be used to communicate between the lifestyle broker, patient, referred community-based lifestyle initiative and/or other relevant stakeholders (e.g. general practitioner). The primary outcome measure is the adapted Fuster-BEWAT, a composite health risk and lifestyle score consisting of resting systolic and diastolic blood pressure, objectively measured physical activity and sitting time, BMI, fruit and vegetable consumption and smoking behaviour. Secondary outcomes include cardiometabolic markers, anthropometrics, health behaviours, psychological factors, patient-reported outcome measures (PROMs), cost-effectiveness measures and a mixed-method process evaluation. Data collection will be conducted at baseline, 3, 6, 9 and 12 months follow-up. DISCUSSION: This study will gain insight into the (cost-)effectiveness of a novel care model in which patients under treatment in secondary or tertiary care are referred to community-based lifestyle initiatives to change their lifestyle. TRIAL REGISTRATION: ISRCTN ISRCTN13046877 . Registered 21 April 2022.

Effects of a comprehensive lifestyle intervention on cardiovascular health: the TANSNIP-PESA trial.

AIMS: To investigate the effectiveness of a 3-year worksite lifestyle intervention on cardiovascular metrics and to study whether outcomes are influenced by baseline subclinical atherosclerosis (SA) by non-invasive imaging. METHODS AND RESULTS: A randomized controlled trial was performed to compare a lifestyle intervention with standard of care in asymptomatic middle-aged subjects, stratified by SA. The intervention consisted of nine motivational interviews during the first year, followed by three further sessions between Years 1 and 3. The primary outcome was the change in a pre-specified adaptation of the Fuster-BEWAT score (Blood pressure, Exercise, Weight, Alimentation, and Tobacco) between baseline and follow-up Years 1-3. A total of 1020 participants (mean age 50 ± 4 years) were enrolled, of whom 510 were randomly assigned to the intervention and 510 to the control group. The baseline adapted Fuster-BEWAT score was 16.2 ± 3.7 points in the intervention group and 16.5 ± 3.5 points in the control group. At Year 1, the score improved significantly in intervention participants compared with controls [estimate 0.83 (95% CI 0.52-1.15) points]. However, intervention effectiveness decreased to non-significant levels at Year 3 [0.24 (95% CI -0.10 to 0.59) points]. Over the 3-year period, the intervention was effective in participants having low baseline SA [0.61 (95% CI 0.30-0.93) points] but not in those with high baseline SA [0.19 (95% CI -0.26 to 0.64) points]. CONCLUSION: In middle-aged asymptomatic adults, a lifestyle intervention was associated with a significant improvement in cardiovascular health and behavioural metrics. The effect attenuated after 1 year as the intensity of the intervention was reduced. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02561065).

The effectiveness of physical activity interventions using activity trackers during or after inpatient care: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Promoting physical activity (PA) in patients during and/or after an inpatient stay appears important but challenging. Interventions using activity trackers seem promising to increase PA and enhance recovery of physical functioning. OBJECTIVE: To review the effectiveness of physical activity interventions using activity trackers on improving PA and physical functioning, compared to usual care in patients during and/or after inpatient care. In addition, it was determined whether the following intervention characteristics increase the effectiveness of these interventions: the number of behaviour change techniques (BCTs) used, the use of a theoretical model or the addition of coaching by a health professional. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, EMBASE, Cinahl, SportDiscus and Web of Science databases were searched in March 2020 and updated in March 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomized controlled trials (RCTs) including interventions using activity trackers and feedback on PA in adult patients during, or less than 3 months after, hospitalization or inpatient rehabilitation. METHODS: Following database search and title and abstract screening, articles were screened on full text for eligibility and then assessed for risk of bias by using the Physiotherapy Evidence Database (PEDro) scale. Meta-analyses, including subgroup analysis on intervention characteristics, were conducted for the outcomes PA and physical functioning. RESULTS: Overall, 21 RCTs totalling 2355 patients were included. The trials covered a variety of clinical areas. There was considerable heterogeneity between studies. For the 13 studies that measured PA as an outcome variable(N = 1435), a significant small positive effect in favour of the intervention was found (standardized mean difference (SMD) = 0.34; 95%CI 0.12-0.56). For the 13 studies that measured physical functioning as an outcome variable (N = 1415) no significant effect was found (SMD = 0.09; 95%CI -0.02 - 0.19). Effectiveness on PA seems to improve by providing the intervention both during and after the inpatient period and by using a theoretical model, multiple BCTs and coaching by a health professional. CONCLUSION: Interventions using activity trackers during and/or after inpatient care can be effective in increasing the level of PA. However, these improvements did not necessarily translate into improvements in physical functioning. Several intervention characteristics were found to increase the effectiveness of PA interventions. TRIAL REGISTRATION: Registered in PROSPERO ( CRD42020175977 ) on March 23th, 2020.

Facilitators and barriers for the implementation of exercise are medicine in routine clinical care in Dutch university medical centres: a mixed methodology study on clinicians' perceptions.

OBJECTIVES: Despite the many proven advantages of a physically active lifestyle in patient populations, prescription of exercise is currently not widely implemented in routine clinical practice. The aims of this study were twofold: (1) to assess perceptions of clinicians on the current practice of exercise is medicine (E=M) prescription in two Dutch university medical centres and (2) to determine their perceived barriers and facilitators for the implementation of E=M in routine clinical care in Dutch university medical centres. DESIGN: A mixed methodologies study, using both online questionnaires and semi-structured interviews. SETTING: Dutch university medical centres. PARTICIPANTS: Clinicians working within the departments of medical oncology, orthopaedics and rehabilitation medicine of two university medical centres. RESULTS: Forty-five clinicians (response rate of 51%) completed the questionnaire, and 19 clinicians were interviewed. The results showed that even though clinicians had a positive attitude towards prescribing E=M, only a few reported to regularly prescribe E=M to their patients. The 52 identified facilitators and barriers for implementation of E=M were categorised into four main themes: (1) beliefs toward the implementation of E=M (eg, clinicians knowledge and skills, and social support), (2) factors related to the patient perspective (eg, patient priorities or motivation), (3) factors related to the referral options (eg, knowledge of and trust in local referral options) and (4) practical considerations when implementing E=M (eg, time constraints). CONCLUSIONS: Our study showed that even though many clinicians have a positive attitude toward an active lifestyle, many are not prescribing E=M on a regular basis. In order for clinicians to effectively implement E=M, strategies should focus on increasing clinicians E=M referral skills, improving clinicians knowledge of E=M referral options and develop a support system to ensure that E=M is high on the priority list of clinicians.

Contributions of changes in physical activity, sedentary time, diet and body weight to changes in cardiometabolic risk.

BACKGROUND: Increased physical activity (PA), reduced time spent sedentary (SED), healthier diet and reduced body weight may all have a positive impact on cardiometabolic risk. The relative importance of change in each of these variables on cardiometabolic risk, however, is unclear. We therefore sought to investigate the relative contributions of changes in PA, SED, diet and body weight on cardiometabolic risk. METHODS: This is a secondary analysis of data collected from the EuroFIT randomised controlled trial, which was a 12-week group-based lifestyle intervention for overweight middle-aged men delivered by coaches in football club stadia aiming to improve PA, SED, diet, and body weight. PA and SED were assessed by accelerometry, diet using the Dietary Instrument for Nutrition Education (DINE). An overall cardiometabolic risk score was derived from combining z-scores for glucose, HbA1c, insulin, lipids and blood pressure. In total, 707 men (from the overall cohort of 1113) with complete data for these variables at baseline and 12-month follow-up were included in the multivariable linear regression analyses. RESULTS: In multivariable analyses, change in number of steps (explaining 5.1% of R2) and dietary factors (less alcohol, fatty and sugary food, and more fruit and vegetables) (together explaining 4.5% of R2), but not changes in standing time or SED, were significantly associated with change in body weight. Changes in number of steps (R2 = 1.7%), fatty food score (R2 = 2.4%), and sugary food score (R2 = 0.4%) were significantly associated with change in cardiometabolic risk score in univariable models. However, in multivariable models which included changes in weight as well as changes in steps and dietary variables, change in weight explained a substantially larger proportion of the change in cardiometabolic risk score, explaining 14.1% of R2 (out of an overall model R2 of 19.0%). When baseline (as well as change) values were also included in the model, 38.8% of R2 for change in cardiometabolic risk score was explained overall, with 14.1% of R2 still explained by change in weight. CONCLUSION: Change in body weight, together with baseline cardiometabolic risk explained most of the change in cardiometabolic risk. Thus, the benefits of increasing physical activity and improving diet on cardiometabolic risk appear to act largely via an effect on changes in body weight. TRIAL REGISTRATION: International Standard Randomised Controlled Trials, ISRCTN-81935608. Registered 06052015. https://www.isrctn.com/ISRCTN81935608?q=&filters=recruitmentCountry:Portugal&sort=&offset=7&totalResults=92&page=1&pageSize=10&searchType=basic-search.

Striking the Right Balance: Evidence to Inform Combined Physical Activity and Sedentary Behavior Recommendations.

BACKGROUND: Crucial evidence gaps regarding: (1) the joint association of physical activity and sedentary time with health outcomes and (2) the benefits of light-intensity physical activity were identified during the development of recommendations for the World Health Organization Guidelines on physical activity and sedentary behavior (SB). The authors present alternative ways to evidence the relationship between health outcomes and time spent in physical activity and SB and examine how this could be translated into a combined recommendation in future guidelines. METHODS: We used compositional data analysis to quantify the dose-response associations between the balance of time spent in physical activity and SB with all-cause mortality. The authors applied this approach using 2005-2006 National Health and Nutrition Examination Survey accelerometer data. RESULTS: Different combinations of time spent in moderate- to vigorous-intensity physical activity, light-intensity physical activity, and SB are associated with similar all-cause mortality risk level. A balance of more than 2.5 minutes of moderate- to vigorous-intensity physical activity per hour of daily sedentary time is associated with the same magnitude of risk reduction for all-cause mortality as obtained by being physically active according to the current recommendations. CONCLUSION: This method could be applied to provide evidence for more flexible recommendations in the future with options to act on different behaviors depending on individuals' circumstances and capacity.

New global guidelines on sedentary behaviour and health for adults: broadening the behavioural targets.

BACKGROUND: In 2018, the World Health Organisation (WHO) commenced a program of work to update the 2010 Global Recommendations on Physical Activity for Health, for the first-time providing population-based guidelines on sedentary behaviour. This paper briefly summarizes and highlights the scientific evidence behind the new sedentary behaviour guidelines for all adults and discusses its strengths and limitations, including evidence gaps/research needs and potential implications for public health practice. METHODS: An overview of the scope and methods used to update the evidence is provided, along with quality assessment and grading methods for the eligible new systematic reviews. The literature search update was conducted for WHO by an external team and reviewers used the AMSTAR 2 (Assessment of Multiple Systematic Reviews) tool for critical appraisal of the systematic reviews under consideration for inclusion. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to rate the certainty (i.e. very low to high) of the evidence. RESULTS: The updated systematic review identified 22 new reviews published from 2017 up to August 2019, 14 of which were incorporated into the final evidence profiles. Overall, there was moderate certainty evidence that higher amounts of sedentary behaviour increase the risk for all-cause, cardiovascular disease (CVD) and cancer mortality, as well as incidence of CVD, cancer, and type 2 diabetes. However, evidence was deemed insufficient at present to set quantified (time-based) recommendations for sedentary time. Moderate certainty evidence also showed that associations between sedentary behaviour and all-cause, CVD and cancer mortality vary by level of moderate-to-vigorous physical activity (MVPA), which underpinned additional guidance around MVPA in the context of high sedentary time. Finally, there was insufficient or low-certainty systematic review evidence on the type or domain of sedentary behaviour, or the frequency and/or duration of bouts or breaks in sedentary behaviour, to make specific recommendations for the health outcomes examined. CONCLUSIONS: The WHO 2020 guidelines are based on the latest evidence on sedentary behaviour and health, along with interactions between sedentary behaviour and MVPA, and support implementing public health programmes and policies aimed at increasing MVPA and limiting sedentary behaviour. Important evidence gaps and research opportunities are identified.

Invest in physical activity to protect and promote health: the 2020 WHO guidelines on physical activity and sedentary behaviour.

In this editorial we discuss the new 2020 World Health Organization guidelines on physical activity and sedentary behaviour and a series of related papers that are published simultaneously in IJBNPA. The new guidelines reaffirm that physical activity is a 'best buy' for public health and should be used to support governments to increase investment in policy and research to promote and ensure physical activity opportunities are available for everyone. New recommendations on sedentary behaviour and inclusion of specific guidelines for people living with disability and/or chronic disease and pregnant and postpartum women are major developments since 2010. We discuss research priorities, as well as policy implementation and the contribution to the sustainable development agenda. The new guidelines can catalyse the paradigm shifts needed to enable equitable opportunities to be physically active for everyone, everywhere, every day.

Advancing the global physical activity agenda: recommendations for future research by the 2020 WHO physical activity and sedentary behavior guidelines development group.

BACKGROUND: In July, 2019, the World Health Organization (WHO) commenced work to update the 2010 Global Recommendations on Physical Activity for Health and established a Guideline Development Group (GDG) comprising expert public health scientists and practitioners to inform the drafting of the 2020 Guidelines on Physical Activity and Sedentary Behavior. The overall task of the GDG was to review the scientific evidence and provide expert advice to the WHO on the amount of physical activity and sedentary behavior associated with optimal health in children and adolescents, adults, older adults (> 64 years), and also specifically in pregnant and postpartum women and people living with chronic conditions or disabilities. METHODS: The GDG reviewed the available evidence specific to each sub-population using systematic protocols and in doing so, identified a number of gaps in the existing literature. These proposed research gaps were discussed and verified by expert consensus among the entire GDG. RESULTS: Evidence gaps across population sub-groups included a lack of information on: 1) the precise shape of the dose-response curve between physical activity and/or sedentary behavior and several of the health outcomes studied; 2) the health benefits of light-intensity physical activity and of breaking up sedentary time with light-intensity activity; 3) differences in the health effects of different types and domains of physical activity (leisure-time; occupational; transportation; household; education) and of sedentary behavior (occupational; screen time; television viewing); and 4) the joint association between physical activity and sedentary time with health outcomes across the life course. In addition, we acknowledge the need to conduct more population-based studies in low- and middle-income countries and in people living with disabilities and/or chronic disease, and to identify how various sociodemographic factors (age, sex, race/ethnicity, socioeconomic status) modify the health effects of physical activity, in order to address global health disparities. CONCLUSIONS: Although the 2020 WHO Guidelines for Physical Activity and Sedentary Behavior were informed by the most up-to-date research on the health effects of physical activity and sedentary time, there is still substantial work to be done in advancing the global physical activity agenda.

Five-year cost-effectiveness analysis of the European Fans in Training (EuroFIT) physical activity intervention for men versus no intervention.

OBJECTIVES: Increasing physical activity reduces the risk of chronic illness including Type 2 diabetes, cardiovascular disease and certain types of cancer. Lifestyle interventions can increase physical activity but few successfully engage men. This study aims to investigate the 5 year cost-effectiveness of EuroFIT, a program to improve physical activity tailored specifically for male football (soccer) fans compared to a no intervention comparison group. METHODS: We developed a Markov cohort model in which the impact of improving physical activity on five chronic health conditions (colorectal cancer, Type 2 diabetes, coronary heart disease, stroke and depression) and mortality was modelled. We estimated costs from a societal perspective and expressed benefits as quality adjusted life years (QALYs). We obtained data from a 4-country (England, Netherlands, Portugal and Norway) pragmatic randomised controlled trial evaluating EuroFIT, epidemiological and cohort studies, and meta-analyses. We performed deterministic and probabilistic sensitivity analyses to assess the impact of uncertainty in the model's parameter values on the cost-effectiveness results. We used Monte Carlo simulations to estimate uncertainty and presented this using cost-effectiveness acceptability curves (CEACs). We tested the robustness of the base case analysis using five scenario analyses. RESULTS: Average costs over 5 years per person receiving EuroFIT were €14,663 and per person receiving no intervention €14,598. Mean QALYs over 5 years were 4.05 per person for EuroFIT and 4.04 for no intervention. Thus, the average incremental cost per person receiving EuroFIT was €65 compared to no intervention, while the average QALY gain was 0.01. This resulted in an ICER of €5206 per QALY gained. CEACs show that the probability of EuroFIT being cost-effective compared to no intervention is 0.53, 0.56 and 0.58 at thresholds of €10,000, €22,000 and €34,000 per QALY gained, respectively. When using a time horizon of 10 years, the results suggest that EuroFIT is more effective and less expensive compared to (i.e. dominant over) no intervention with a probability of cost-effectiveness of 0.63 at a threshold of €22,000 per QALY gained. CONCLUSIONS: We conclude the EuroFIT intervention is not cost-effective compared to no intervention over a period of 5 years from a societal perspective, but is more effective and less expensive (i.e. dominant) after 10 years. We thus suggest that EuroFIT can potentially improve public health in a cost-effective manner in the long term.

Physical workload and obesity have a synergistic effect on work ability among construction workers.

PURPOSE: Obesity and high physical workload are both associated with poor work ability, but the interaction between obesity and high physical workload on work ability is not yet fully understood. Obesity and high physical workload may share a common mechanical pathway, possibly leading to a synergistic negative effect on work ability. The purpose of this study was to investigate the effect of obesity on work ability in workers with high versus low physical work load. METHODS: A longitudinal study was conducted among 36,435 Dutch construction workers who participated in at least two periodic medical examinations during the years 2008-2015. Logistic regression analyses were used to investigate the effect of manual material handling and strenuous work postures in sports on the association between obesity and work ability. Work ability was measured using the self-reported Work Ability Index consisting of seven dimensions. Confounding effects were tested for age, educational level, smoking, vigorous physical activity, psychosocial work demands, and working hours. Additive interaction between obesity and physical workload on work ability was tested using the relative excess risk due to interaction (RERI). RESULTS: Construction workers with overweight (OR = 1.09; 95% CI 1.02-1.16) or obesity (OR = 1.27; 95% CI 1.17-1.38) had an increased risk of poor/moderate work ability. Exposure to manual material handling (OR = 1.58; 95% CI 1.49-1.68) or strenuous work postures (OR = 1.80; 95% CI 1.70-1.90) also increased the risk of poor/moderate work ability. The effect of the combination of obesity with high physical workload was greater than the sum of the individual effects (strenuous work postures: RERI = 0.39; 95% CI 0.10-0.67; manual material handling: RERI = 0.26; 95% CI 0.02-0.51). CONCLUSIONS: Obesity and high physical workload were associated with poor work ability and had a synergistic, negative effect on work ability. Interventions that prevent obesity and high physical workload might have a beneficial effect on work ability.

The 2017 Dutch Physical Activity Guidelines.

BACKGROUND: The objective of this study was to derive evidence-based physical activity guidelines for the general Dutch population. METHODS: Two systematic reviews were conducted of English language meta-analyses in PubMed summarizing separately randomized controlled trials and prospective cohort studies on the relation between physical activity and sedentary behaviour on the one hand and the risk of all-cause mortality and incidence of 15 major chronic diseases and conditions on the other hand. Other outcome measures were risk factors for cardiovascular disease and type 2 diabetes, physical functioning, and fitness. On the basis of these reviews, an expert committee derived physical activity guidelines. In deriving the guidelines, the committee first selected only experimental and observational prospective findings with a strong level of evidence and then integrated both lines of evidence. RESULTS: The evidence found for beneficial effects on a large number of the outcome measures was sufficiently strong to draw up guidelines to increase physical activity and reduce sedentary behaviour, respectively. At the same time, the current evidence did not provide a sufficient basis for quantifying how much physical activity is minimally needed to achieve beneficial health effects, or at what amount sedentary behaviour becomes detrimental. A general tenet was that at every level of current activity, further increases in physical activity provide additional health benefits, with relatively larger effects among those who are currently not active or active only at light intensity. Three specific guidelines on (1) moderate- and vigorous-intensity physical activity, (2) bone- and muscle-strengthening activities, and (3) sedentary behaviour were formulated separately for adults and children. CONCLUSIONS: There is an unabated need for evidence-based physical activity guidelines that can guide public health policies. Research in which physical activity is measured both objectively (quantity) and subjectively (type and quality) is needed to provide better estimates of the type and actual amount of physical activity required for health.

Changing psychosocial determinants of physical activity and diet in women with a history of gestational diabetes mellitus.

BACKGROUND: To investigate how a behavioural lifestyle intervention influences psychosocial determinants of physical activity and dietary behaviours in a population at risk of type 2 diabetes (T2DM). METHODS: Fifty-nine women with a body mass index of ≥25 kg/m2 and a history of gestational diabetes mellitus (GDM) participated in a randomized controlled study. The intervention group (n = 29) received 2 face-to-face and 5 telephone lifestyle-counselling sessions with a health professional. The control group (n = 30) received care as usual. At baseline and 6 months, psychosocial determinants related to physical activity and diet were measured with a self-administrated questionnaire. Linear regression analyses were applied to test for intervention effects. RESULTS: The intervention was effective in improving social support (ß = 3.5, P < 0.001; ß = 2.1, P = 0.02), modifying self-efficacy (ß = -2.2, P = 0.02; ß = -4.3, P < 0.001), and reducing barriers (ß = -3.5, P = 0.01; ß = -3.8, P = 0.01) for, respectively, physical activity and diet from baseline to 6-month follow-up in the intervention group compared with the control group. The intervention reduced the following barriers to a physically active lifestyle: lack of energy and lack of motivation. Physical activity barriers like lack of time and lack of childcare were unchanged. The intervention reduced the following barriers to a healthy diet: lack of time, costs, having unhealthy snacks at home, and having cravings for sweets. CONCLUSION: This lifestyle intervention influenced psychosocial determinants relevant for overweight women with a history of gestational diabetes mellitus (GDM) in prevention of T2DM.

Reliability and Validity of Measures for Investigating the Determinants of Health Behaviors Among Women With a History of Gestational Diabetes.

AIM: Assisting women with a history of gestational diabetes mellitus (GDM) to adopt healthy lifestyles is a priority for diabetes prevention. The aim of this study was to develop and evaluate measures that can be used to assess the efficacy of behavior change interventions in this group. METHOD: Measures of psychosocial influences on physical activity and diet were derived from formative research and examination of established instruments. Item reduction by principal components analysis was undertaken following telephone survey administration to 160 women with recent GDM, and the internal reliability and construct validity of the derived scales were assessed. Test-retest reliability was assessed in another sample of 97 women. RESULTS: Scales with acceptable internal reliability were developed for physical activity outcome expectancies (α = .82), perceived barriers (α = .75), encouragement (α = .76) and self-efficacy (α = .82), weight control attitudes (α = .90), and diabetes-related fear (α = .70). Construct validity in relation to physical activity participation was found for the encouragement and self-efficacy scales. The weight control attitudes scale showed construct validity in relation to fruit and vegetable intake. The test-retest reliability of most scales was moderate to good (weighted κ = 0.55-0.69). CONCLUSION: Reliable and valid measures relevant to the psychosocial needs of women with GDM have been developed with a multiethnic population. These will assist future evidence generation, particularly in relation to the adoption of physical activity, which has been a challenging area of lifestyle intervention to date.

Correlates of occupational, leisure and total sitting time in working adults: results from the Singapore multi-ethnic cohort.

BACKGROUND: Evidence on the health risks of sitting is accumulating. However, research identifying factors influencing sitting time in adults is limited, especially in Asian populations. This study aimed to identify socio-demographic and lifestyle correlates of occupational, leisure and total sitting time in a sample of Singapore working adults. METHODS: Data were collected between 2004 and 2010 from participants of the Singapore Multi Ethnic Cohort (MEC). Medical exclusion criteria for cohort participation were cancer, heart disease, stroke, renal failure and serious mental illness. Participants who were not working over the past 12 months and without data on sitting time were excluded from the analyses. Multivariable regression analyses were used to examine cross-sectional associations of self-reported age, gender, ethnicity, marital status, education, smoking, caloric intake and moderate-to-vigorous leisure time physical activity (LTPA) with self-reported occupational, leisure and total sitting time. Correlates were also studied separately for Chinese, Malays and Indians. RESULTS: The final sample comprised 9384 participants (54.8% male): 50.5% were Chinese, 24.0% Malay, and 25.5% Indian. For the total sample, mean occupational sitting time was 2.71 h/day, mean leisure sitting time was 2.77 h/day and mean total sitting time was 5.48 h/day. Sitting time in all domains was highest among Chinese. Age, gender, education, and caloric intake were associated with higher occupational sitting time, while ethnicity, marital status and smoking were associated with lower occupational sitting time. Marital status, smoking, caloric intake and LTPA were associated with higher leisure sitting time, while age, gender and ethnicity were associated with lower leisure sitting time. Gender, marital status, education, caloric intake and LTPA were associated with higher total sitting time, while ethnicity was associated with lower total sitting time. Stratified analyses revealed different associations within sitting domains for Indians compared to Chinese and Malays. CONCLUSION: Our findings highlight the need to focus on separate domains of sitting (occupational, leisure or total) when identifying which factors determine this behavior, and that the content of intervention programs should be tailored to domain-specific sitting rather than to sitting in general. Finally, our study showed ethnic differences and therefore we recommend to culturally target interventions.

Determinants of diet and physical activity (DEDIPAC): a summary of findings.

The establishment of the Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub, 2013-2016, was the first action taken by the 'Healthy Diet for a Healthy Life' European Joint Programming Initiative. DEDIPAC aimed to provide better insight into the determinants of diet, physical activity and sedentary behaviour across the life course, i.e. insight into the causes of the causes of important, non-communicable diseases across Europe and beyond. DEDIPAC was launched in late 2013, and delivered its final report in late 2016. In this paper we give an overview of what was achieved in terms of furthering measurement and monitoring, providing overviews of the state-of-the-art in the field, and building toolboxes for further research and practice. Additionally, we propose some of the next steps that are now required to move forward in this field, arguing in favour of 1) sustaining the Knowledge Hub and developing it into a European virtual research institute and knowledge centre for determinants of behavioural nutrition and physical activity with close links to other parts of the world; 2) establishing a cohort study of families across all regions of Europe focusing specifically on the individual and contextual determinants of major, non-communicable disease; and 3) furthering DEDIPAC's work on nutrition, physical activity, and sedentary behaviour policy evaluation and benchmarking across Europe by aligning with other international initiatives and by supporting harmonisation of pan-European surveillance.

Individual and environmental correlates of objectively measured sedentary time in Dutch and Belgian adults.

As the detrimental health effects of sedentary behaviour are well established, insight into the individual and environmental factors that influence adults' sedentary behaviour is needed. Most studies to date rely on self-reported measures of sedentary time. Therefore, the aim of the current study was to examine individual and environmental correlates of objectively measured sedentary time in Dutch and Belgian adults. Between March and August 2014, Belgian (n = 133) and Dutch (n = 223) adults, recruited as sub-sample of the SPOTLIGHT survey, wore an ActiGraph accelerometer to provide objectively measured sedentary and moderate to vigorous physical activity time. Participants completed a questionnaire assessing sociodemographic (country of residence, age, gender and educational level), lifestyle (sleep, smoking, sugar-containing beverage consumption, alcohol intake), health (body mass index, self-rated health), work (employment status and type of work), happiness, physical environmental (owning a car, number of screens, socioeconomic status and residential density) and social environmental factors (social network, social cohesion). Univariate and multivariable regression analyses showed that Belgian participants had a lower odds of being sedentary for at least 9 hours per day compared to Dutch participants. Women, older participants and those meeting the WHO recommendation for physical activity were also less likely to sit for 9 hours or more per day. Participants doing (heavy) manual work or being in education, homemaker, unemployed had lower odds of being sedentary for at least 9 hours per day compared to participants with a sitting job. Those with a higher self-reported social network also had lower odds for sedentary time. No associations between physical and other social environmental characteristics and sedentary time were found. Our findings add to the growing evidence of factors associated with prolonged sedentary time in adults. These findings may be used to inform the development of strategies and interventions aimed at reducing sedentary time, and to identify high risk groups.

Assessing pre- and postoperative activity levels with an accelerometer: a proof of concept study.

BACKGROUND: Postoperative recovery after abdominal surgery is measured mostly based on subjective or self-reported data. In this article we aim to evaluate whether recovery of daily physical activity levels can be measured postoperatively with the use of an accelerometer. METHODS: In this multicenter, observational pilot study, 30 patients undergoing laparoscopic abdominal surgery (hysterectomy, adnexal surgery, cholecystectomy and hernia inguinal surgery) were included. Patients were instructed to wear an Actigraph wGT3X-BT accelerometer during one week before surgery (baseline) and during the first, third and fifth week after surgery. Wear time, steps taken and physical activity intensity levels (sedentary, light, moderate and vigorous) were measured. Patients were blinded for the accelerometer outcomes. Additionally, an activity diary comprising patients' self-reported time of being recovered and a list of 18 activities, in which the dates of resumption of these 18 activities were recorded after surgery, was completed by the patient. RESULTS: Five patients were excluded from analyses because of technical problems with the accelerometer (n = 1) and protocol non-adherence (n = 4). Light, moderate, vigorous, combined moderate and vigorous intensity physical activity (MVPA), and step counts showed a clear recovery curve after surgery. Patients who underwent minor surgery reached their baseline step count and MVPA three weeks after surgery. Patients who underwent intermediate surgery had not yet reached their baseline step count during the last measuring week (five weeks after surgery). The results of the activity diaries showed a fair agreement with the accelerometer results (Cohens Kappa range: 0.273-0.391). Wearing the accelerometer was well tolerated and not regarded as being burdensome by the patients. CONCLUSIONS: The accelerometer appeared to be a feasible way to measure recovery of postoperative physical activity levels in this study and was well tolerated by the patients. The agreement with self-reported physical recovery times was fair.

Inventory of surveillance systems assessing dietary, physical activity and sedentary behaviours in Europe: a DEDIPAC study.

Background: There is a need for harmonized public health surveillance systems to monitor regional variations and temporal trends of health behaviours and health outcomes and to align policies, action plans and recommendations in terms of healthy diet and physical (in)activity within Europe. We provide an inventory of currently existing surveillance systems assessing diet, physical activity, and sedentary behaviours in Europe as a tool to assist in the identification of gaps and needs and to contribute to the roadmap for an integrated pan-European surveillance system. Methods: An inventory questionnaire was completed by representatives of eleven European countries. Eligible surveillance systems were required to meet specific inclusion criteria. First, pre-screening of available surveillance systems in each country was conducted. Second, an in-depth appraisal of the retained surveillance systems complying with the pre-defined requirements was performed. Results: Fifty surveillance systems met the inclusion criteria: six multinational European surveys and forty-four national surveys. Dietary intake and physical activity are the domains predominantly assessed and adults are the most frequently studied age group. Conclusions: Many on-going activities were identified at the national level focussing on adults, but fewer surveillance systems involving vulnerable groups such as infants and pre-school children. Assessment of sedentary and dietary behaviours should be more frequently considered. There is a need for harmonization of surveillance methodologies, indicators and target populations for between-country and over time comparisons. This inventory will serve to feed future discussions within the DEDIPAC-JPI major framework on how to optimize design and identify priorities within surveillance.