Intervention Fidelity of Telephone Motivational Interviewing On Physical Activity, Fruit Intake, and Vegetable Consumption in Dutch Outpatients With and Without Hypertension.

BACKGROUND: In theory, Motivational Interviewing (MI) fidelity should be associated with client outcomes. Nevertheless, this fidelity-effectiveness association is rarely investigated. This study evaluated the extent to which Telephone Motivational Interviewing (TMI) fidelity is associated with change in self-reported physical activity (PA), fruit intake, and vegetable consumption. METHOD: Adults in primary care (45-70 years) participated in a study that compared the effect of tailor print communication, telephone motivational interviewing (TMI), and a combination of the two on PA, fruit intake, and vegetable consumption. MI fidelity was assessed using the behavioral coding method "Motivational Interviewing Treatment Integrity Code (MITI)" in 409 randomly selected audio-recorded sessions, representing 232 participants of the TMI group. The associations between MI fidelity scores and the behavioral changes from baseline to 47-week follow-up were examined using backward multiple linear regression analyses (adjusted for covariates). RESULTS: A significant and positive association between the percentage of MI adherent responses and improvements in PA and fruit consumption was found with respectively a small and medium effect size. The global rating "Spirit" (which resembles an all-at-once appraisal of the interviewer's MI competence) was significantly, but inversely associated with progress in vegetable intake with a medium effect size. CONCLUSION: The finding that relatively lower MI competency was associated with higher vegetable consumption went against our expectations. Findings suggest that practicing MI-consistent skills was beneficial in promoting PA and fruit consumption, but moderated vegetable intake. This study contributes to the scientific confidence that TMI enables change in PA and fruit intake.

A randomized controlled trial comparing community lifestyle interventions to improve adherence to diet and physical activity recommendations: the VitalUM study.

Worldwide, adherence to national guidelines for physical activity (PA), and fruit and vegetable consumption is recommended to promote health and reduce the risk for (chronic) disease. This study reports on the effectiveness of various social-cognitive interventions to improve adherence to guidelines and the revealed adherence predictors. Participants (n = 1,629), aged 45-70 years, randomly selected and recruited in 2005-2006 from 23 Dutch general practices, were randomized (centralized stratified allocation) to four groups to receive a 12-month lifestyle intervention targeting guideline adherence for PA and fruit and vegetable consumption. Study groups received either four computer-tailored print communication (TPC) letters (n = 405), four telephone motivational interviewing (TMI) sessions (n = 407), a combined intervention (two TPC letters and two TMI sessions, n = 408), or no intervention (control group, n = 409). After the baseline assessment, all parties were aware of the treatment groups. Outcomes were measured with self-report postal questionnaires at baseline, 25, 47 and 73 weeks. For PA, all three interventions were associated with better guideline adherence than no intervention. Odds ratios for TPC, TMI and the combined intervention were 1.82 (95% CI 1.31; 2.54), 1.57 (95% CI 1.13; 2.18), and 2.08 (95% CI 1.50; 2.88), respectively. No pedometer effects were found. For fruit and vegetable consumption, TPC seemed superior to those in the other groups. Odd ratio for fruit and vegetable consumption were 1.78 (95% CI 1.32; 2.41) and 1.73 (95% CI 1.28; 2.33), respectively. For each behaviour, adherence was predicted by self-efficacy expectations, habit strength and stages of change, whereas sex, awareness and the number of action plans predicted guideline adherence for fruit and vegetable intake. The season predicted the guideline adherence for PA and fruit consumption. The odds ratios revealed were equivalent to modest effects sizes, although they were larger than those reported in systematic reviews. This study indicated that less resource intensive interventions might have the potential for a large public health impact when widely implemented. The strengths of this study were the participation of lower educated adults and evaluation of maintenance effects. (Trial NL1035, 2007-09-06).

Ultra-processed food consumption patterns among older adults in the Netherlands and the role of the food environment.

PURPOSE: To describe the patterns of ultra-processed foods (UPFs) consumption in the Netherlands; to test if exposure to the food environment is associated with UPFs consumption; and if this association differed across educational levels and neighbourhood urbanisation. METHODS: Cross-sectional study using 2015-data of 8104 older adults from the Dutch EPIC cohort. Proportion of UPFs consumption was calculated from a validated food-frequency questionnaire. Exposure to the food environment was defined as proximity and availability of supermarkets, fast-food restaurants, full-service restaurants, convenience stores, candy stores and cafés. Consumption of UPFs was expressed as both percentage of total grams and total kilocalories. RESULTS: The study population was aged 70(± 10 SD) years and 80.5% was female. Average UPFs consumption was 17.8% of total food intake in grams and 37% of total energy intake. Those who consumed greater amounts of UPFs had a poorer overall diet quality. Adjusted linear regression models showed that closer proximity and larger availability to any type of food retailer was associated with lower UPFs consumption (both in grams and kilocalories). Somewhat stronger significant associations were found for proximity to restaurants (ß = - 1.6%, 95% confidence interval (CI) = - 2.6; - 0.6), and supermarkets (ß = - 2.2%, 95%CI = - 3.3; - 1.1); i.e., Individuals living within 500 m from the closest supermarket, as compared to 1500 m, had 2.6% less calories from UPFs. No differences were found on analyses stratified for urbanisation and education. CONCLUSIONS: Using various measures of exposure to the food environment, we found that exposure to restaurants and supermarkets was associated with somewhat lower consumption of UPFs.

Dietary intake of heme iron is associated with ferritin and hemoglobin levels in Dutch blood donors: results from Donor InSight.

Whole blood donors, especially frequently donating donors, have a risk of iron deficiency and low hemoglobin levels, which may affect their health and eligibility to donate. Lifestyle behaviors, such as dietary iron intake and physical activity, may influence iron stores and thereby hemoglobin levels. We aimed to investigate whether dietary iron intake and questionnaire-based moderate-to-vigorous physical activity were associated with hemoglobin levels, and whether ferritin levels mediated these associations. In Donor InSight-III, a Dutch cohort study of blood and plasma donors, data on heme and non-heme iron intake (mg/day), moderate-to-vigorous physical activity (10 minutes/day), hemoglobin levels (mmol/L) and ferritin levels (µg/L) were available in 2,323 donors (1,074 male). Donors with higher heme iron intakes (regression coefficients (ß) in men and women: 0.160 and 0.065 mmol/L higher hemoglobin per 1 mg of heme iron, respectively) and lower non-heme iron intakes (ß: -0.014 and -0.017, respectively) had higher hemoglobin levels, adjusted for relevant confounders. Ferritin levels mediated these associations (indirect effect (95% confidence interval) in men and women respectively: 0.074 (0.045; 0.111) and 0.061 (0.030; 0.096) for heme and -0.003 (-0.008;0.001) and -0.008 (-0.013;-0.003) for non-heme). Moderate-to-vigorous physical activity was negatively associated with hemoglobin levels in men only (ß: -0.005), but not mediated by ferritin levels. In conclusion, higher heme and lower non-heme iron intake were associated with higher hemoglobin levels in donors, via higher ferritin levels. This indicates that donors with high heme iron intake may be more capable of maintaining iron stores to recover hemoglobin levels after blood donation.

Recent changes in the Dutch foodscape: socioeconomic and urban-rural differences.

BACKGROUND: Obesogenic food environments may influence dietary behaviours and contribute to obesity. Few countries quantified changes in their foodscape. We explored how the availability of different types of food retailers has changed in the Netherlands across levels of neighbourhood socioeconomic status (SES) and urbanisation. METHODS: This longitudinal ecological study conducted in the Netherlands had as unit of analysis administrative neighbourhoods. From 2004 to 2018, the geographic location and type of each food retailer were objectively assessed by a commercial company. Food retailers were categorised as local food shops, fast food restaurants, food delivery, restaurants, supermarkets, and convenience stores. Information on neighbourhood SES and urbanisation was obtained from Central Bureau of Statistics (CBS). To test the change in the counts of food retailers we used negative binomial generalized estimating equations (GEE), with neighbourhoods as the group variable, time as the independent variable and the counts of each type of food retailer as outcome. To account for changes in population density, analyses were adjusted for the number of inhabitants per neighbourhood. We tested effect modification by adding an interaction term for neighbourhood SES and urbanisation to the models. RESULTS: In Dutch neighbourhoods between 2004 and 2018, a 120 and 35% increase was found in the count of food delivery outlets and restaurants, respectively, and a 24% decrease in count of local food shops. Stratified analyses showed an increase in the availability of supermarkets and convenience stores in the more urbanised and lower SES neighbourhoods, while a decrease was observed in the less urbanised and higher SES neighbourhoods. CONCLUSIONS: We observed considerable changes in the Dutch foodscape. Over a 14 years period, the foodscape changed towards a higher availability of food retailers offering convenience and ready-to-eat foods. These findings can help policy makers aiming to promote a healthier food environment and obesity prevention.

Neighbourhood drivability: environmental and individual characteristics associated with car use across Europe.

BACKGROUND: Car driving is a form of passive transportation associated with higher sedentary behaviour, which is associated with morbidity. The decision to drive a car is likely to be influenced by the 'drivability' of the built environment, but there is lack of scientific evidence regarding the relative contribution of environmental characteristics of car driving in Europe, compared to individual characteristics. This study aimed to determine which neighbourhood- and individual-level characteristics were associated with car driving in adults of five urban areas across Europe. Second, the study aimed to determine the percentage of variance in car driving explained by individual- and neighbourhood-level characteristics. METHODS: Neighbourhood environment characteristics potentially related to car use were identified from the literature. These characteristics were subsequently assessed using a Google Street View audit and available GIS databases, in 59 administrative residential neighbourhoods in five European urban areas. Car driving (min/week) and individual level characteristics were self-reported by study participants (analytic sample n = 4258). We used linear multilevel regression analyses to assess cross-sectional associations of individual and neighbourhood-level characteristics with weekly minutes of car driving, and assessed explained variance at each level and for the total model. RESULTS: Higher residential density (ß:-2.61, 95%CI: - 4.99; -0.22) and higher land-use mix (ß:-3.73, 95%CI: - 5.61; -1.86) were significantly associated with fewer weekly minutes of car driving. At the individual level, higher age (ß: 1.47, 95%CI: 0.60; 2.33), male sex (ß: 43.2, 95%CI:24.7; 61.7), being employed (ß:80.1, 95%CI: 53.6; 106.5) and ≥ 3 person household composition (ß: 47.4, 95%CI: 20.6; 74.2) were associated with higher weekly minutes of car driving. Individual and neighbourhood characteristics contributed about equally to explained variance in minutes of weekly car driving, with 2 and 3% respectively, but total explained variance remained low. CONCLUSIONS: Residential density and land-use mix were neighbourhood characteristics consistently associated with minutes of weekly car driving, besides age, sex, employment and household composition. Although total explained variance was low, both individual- and neighbourhood-level characteristics were similarly important in their associations with car use in five European urban areas. This study suggests that more, higher quality, and longitudinal data are needed to increase our understanding of car use and its effects on determinants of health.

Adherence to a food group-based dietary guideline and incidence of prediabetes and type 2 diabetes.

PURPOSE: In this study, we investigated the association between adherence to the Dutch Healthy Diet index 2015 (DHD15-index) and incidence of prediabetes (preT2D) and Type 2 Diabetes (T2D) in a representative sample for the general Dutch population. METHODS: Two prospective cohort studies, The Hoorn and The New Hoorn Study, were used for data analyses. In total, data from 2951 participants without diabetes at baseline (mean age 56.5 ± 7.5 years; 49.6% male) were harmonized. Baseline dietary intake was assessed with validated Food Frequency Questionnaires and adherence to the DHD15-index was calculated (range 0-130). PreT2D and T2D were classified according to the WHO criteria 2011. Poisson regression was used to estimate prevalence ratios between participant scores on the DHD15-index and preT2D and T2D, adjusted for follow-up duration, energy intake, socio-demographic, and lifestyle factors. Change in fasting plasma glucose levels (mmol/L) over follow-up was analysed using linear regression analyses, additionally adjusted for baseline value. RESULTS: During a mean follow-up of 6.3 ± 0.7 years, 837 participants developed preT2D and 321 participants developed T2D. The highest adherence to the DHD15-index was significantly associated with lower T2D incidence [model 3, PRT3vsT1: 0.70 (0.53; 0.92), ptrend = 0.01]. The highest adherence to the DHD15-index pointed towards a lower incidence of preT2D [PRT3vsT1: 0.87 (0.74; 1.03), ptrend = 0.11]. Higher adherence to the DHD15-index was not associated with change in fasting plasma glucose levels [ß10point: - 0.012 (- 0.034; 0.009)mmol/L]. CONCLUSION: The present study showed that the highest compared to the lowest adherence to the DHD15-index was associated with a lower T2D incidence, and pointed towards a lower incidence of preT2D. These results support the benefits of adhering to the guidelines in T2D prevention.

Associations of self-reported physical activity and anxiety symptoms and status among 7,874 Irish adults across harmonised datasets: a DEDIPAC-study.

BACKGROUND: Anxiety is an adaptive response to an objective or perceived threat; however, when symptoms become severe and chronic it that can become a maladaptive anxiety disorder. Limited evidence suggests that physical activity may be associated with prevention against anxiety. This study uses data from The Irish Longitudinal Study on Ageing (TILDA) and The Mitchelstown Cohort Study to investigate cross-sectional associations between physical activity and anxiety symptoms and status among Irish adults. METHODS: Both datasets were harmonized (n = 7874). The short form International Physical Activity Questionnaire measured physical activity. Participants were classified as meeting World Health Organization physical activity guidelines (≥150 min weekly of moderate intensity physical activity, ≥75 min weekly of vigorous intensity physical activity, or ≥ 600 MET-minutes) or not. They were also divided into three groups based on weekly MET-minutes of moderate-to-vigorous physical activity (Low: 0-599; Moderate: 600-1199; High: ≥1200), and three groups based on weekly minutes of walking (Low: 0-209; Moderate: 210-419; High: 420+). Anxiety symptoms were measured by the Hospital Anxiety and Depression Scale with a score of ≥8 indicating anxiety. Binomial logistic regression, adjusted for relevant confounders examined physical activity-anxiety associations. RESULTS: Females had higher rates of anxiety than males (28.0% vs 20.0%; p < 0.001). Following adjustment for relevant covariates, meeting physical activity guidelines was associated with 13.5% (95% CI: 2.0-23.7; p = 0.023) lower odds of anxiety. Moderate and High physical activity were associated with 13.5% (- 11.0-32.6; p = 0.254) and 13.6% (1.4-4.2; p = 0.030) lower odds of anxiety compared to Low physical activity, respectively. Moderate and High walking were associated with 2.1% (- 14.5-16.3; p = 0.789) and 5.1% (- 9.3-17.6; p = 0.467) lower odds of anxiety compared to Low walking, respectively. CONCLUSION: Meeting physical activity guidelines is associated with lower odds of anxiety, but the strength of associations did not increase considerably with increased physical activity levels.

How Does a Supervised Exercise Program Improve Quality of Life in Patients with Cancer? A Concept Mapping Study Examining Patients' Perspectives.

BACKGROUND: Previous systematic reviews and meta-analyses demonstrated beneficial effects of exercise during or following cancer treatment on quality of life (QoL). Aiming to understand how exercise contributes to a patient's QoL, we examined patients' perspectives via a process called concept mapping. This unique method provides structure and objectivity to rich qualitative data. METHODS: Patients with cancer who were participating in an exercise program were invited to enroll. Eleven meetings with 3-10 patients were organized in which patients generated ideas in response to the question "How has participating in a supervised exercise program contributed positively to your QoL?" Next, patients individually clustered (based on similarity) and rated (based on importance) the ideas online. The online assessments were combined, and one concept map was created, visualizing clusters of ideas of how patients perceive that participating in a supervised exercise program improved their QoL. The research team labelled the clusters of ideas, and physiotherapists reflected on the clusters during semistructured interviews. RESULTS: Sixty patients attended the meetings; of these, one patient was not able to generate an idea in response to the statement. Forty-four patients completed the online clustering and rating of ideas. The resulting concept map yielded six clusters: personalized care, coaching by a physiotherapist, social environment, self-concept, coping, and physical fitness and health. Personalized care was rated as most important. Overall, physiotherapists recognized these clusters in practice. CONCLUSION: Patients with cancer reported that participating in a supervised exercise program improved their physical fitness and influenced social, mental, and cognitive factors, resulting in improvements in QoL. These results can be used to increase the awareness of the importance of supervised exercise programs for the QoL of patients with cancer. IMPLICATIONS FOR PRACTICE: According to patients, a supervised exercise program contributes positively to their quality of life by improving physical fitness and health and providing personalized care, coaching by a physiotherapist, and improved social environment, self-concept, and coping. This knowledge could help to increase physicians' and patients' awareness of the importance of an exercise program during or following cancer treatment, possibly improving referral, participation, and adherence rates to these programs. Furthermore, patients' perspectives may be used to improve supervised exercise programs, taking into account the importance of personalized care, the supervision of a physiotherapist, the social environment, self-concept, and coping.

The association between population density and blood lipid levels in Dutch blood donors.

BACKGROUND: In low and middle-income countries (LMIC), the total and LDL cholesterol and triglyceride levels of residents of urban areas are reported to be higher than those of rural areas. This may be due to differences in lifestyle behaviors between residents of urban areas and rural areas in LMIC. In this study, our aims were to (1) examine whether or not LDL cholesterol, total/HDL ratios and triglyceride levels of individuals in densely populated areas are higher than those of individuals living in less-densely populated areas in a high-income country (HIC) and (2) investigate the potential mediating roles of physical activity and sedentary behavior. METHODS: We used cross-sectional data from 2547 Dutch blood donors that participated in Donor InSight-III. Linear regression was used to analyze the association between population density and LDL cholesterol, total/HDL cholesterol ratio and HDL cholesterol. The mediating roles of moderate-to-vigorous physical activity (MVPA) and sedentary behavior were investigated in a subsample (n = 740) for which objectively measured MVPA/sedentary behavior data was available. Multiple mediation with linear regression analyses were performed and the product-of-coefficients method was used to calculate direct and indirect effects. RESULTS: Mean LDL cholesterol and median total cholesterol/HDL cholesterol ratio and triglyceride levels were 2.89, 3.43 and 1.29 mmol/L, respectively. Population density was not associated with LDL cholesterol [ß 0.00 (- 0.01; 0.01)], log transformed total/HDL cholesterol ratio [ß 1.00 (1.00; 1.00)] and triglyceride levels [ß 1.00 (0.99; 1.00)]. No statistically significant direct or indirect effects were found. CONCLUSION: Contrary to previous findings in LMIC, no evidence was found that population density is associated with blood lipid levels in blood donors in the Netherlands or that MVPA and sedentary behavior mediate this association. This may be the result of socioeconomic differences and, in part, may be due to the good health of the study population and the relatively high population density in the Netherlands. Also, compared to LMIC, differences in physical activity levels in more versus less populated areas may be less pronounced in HIC.

Effects and moderators of exercise on muscle strength, muscle function and aerobic fitness in patients with cancer: a meta-analysis of individual patient data.

OBJECTIVE: To optimally target exercise interventions for patients with cancer, it is important to identify which patients benefit from which interventions. DESIGN: We conducted an individual patient data meta-analysis to investigate demographic, clinical, intervention-related and exercise-related moderators of exercise intervention effects on physical fitness in patients with cancer. DATA SOURCES: We identified relevant studies via systematic searches in electronic databases (PubMed, Embase, PsycINFO and CINAHL). ELIGIBILITY CRITERIA: We analysed data from 28 randomised controlled trials investigating the effects of exercise on upper body muscle strength (UBMS) and lower body muscle strength (LBMS), lower body muscle function (LBMF) and aerobic fitness in adult patients with cancer. RESULTS: Exercise significantly improved UBMS (ß=0.20, 95% Confidence Interval (CI) 0.14 to 0.26), LBMS (ß=0.29, 95% CI 0.23 to 0.35), LBMF (ß=0.16, 95% CI 0.08 to 0.24) and aerobic fitness (ß=0.28, 95% CI 0.23 to 0.34), with larger effects for supervised interventions. Exercise effects on UBMS were larger during treatment, when supervised interventions included ≥3 sessions per week, when resistance exercises were included and when session duration was >60 min. Exercise effects on LBMS were larger for patients who were living alone, for supervised interventions including resistance exercise and when session duration was >60 min. Exercise effects on aerobic fitness were larger for younger patients and when supervised interventions included aerobic exercise. CONCLUSION: Exercise interventions during and following cancer treatment had small effects on UBMS, LBMS, LBMF and aerobic fitness. Demographic, intervention-related and exercise-related characteristics including age, marital status, intervention timing, delivery mode and frequency and type and time of exercise sessions moderated the exercise effect on UBMS, LBMS and aerobic fitness.

Spatial access to restaurants and grocery stores in relation to frequency of home cooking.

BACKGROUND: Little is known about the relation between the neighbourhood food environment and home cooking. We explored the independent and combined associations between residential neighbourhood spatial access to restaurants and grocery stores with home cooking in European adults. METHODS: Data of 5076 participants of the SPOTLIGHT study were collected across five European countries in 2014. Food retailers were classified into grocery stores (supermarkets and local food shops) and restaurants (full-service restaurants, fast food and take-away restaurants, café/bars). We used multinomial logistic regression models to test the associations between tertiles of spatial access to restaurants and spatial to access grocery stores and the outcome 'frequency of home cooking' categorized into 0-3; 4-5; and 6-7 days/week. Additive interaction analysis was used to test the combined association between access to grocery stores and to restaurants with home cooking. RESULTS: Mean age was 52.3 years; most participants were women (55.5%) and completed higher education (53.8%). Residents with highest access to restaurants had a reduced likelihood of home cooking 6-7 days/week (vs. 0-3 days/week) (relative risk ratio (RRR) 0.42; 95%CI = 0.23-0.76) when compared with lowest access to restaurants. No association was found for spatial access to grocery stores. Additive interaction analysis showed that individuals with medium access to grocery stores and highest access to restaurants had the lowest likelihood (RRR = 0.29, 95%CI = 0.10-0.84) of cooking 6-7 days/week when compared to individuals with lowest access to restaurants and highest access to grocery stores. CONCLUSION: Greater neighbourhood spatial access to restaurants was associated with lower frequency of home cooking, largely independent of access to grocery stores.

Patient-reported physical activity and the association with health-related quality of life in head and neck cancer survivors.

PURPOSE: This study aimed to assess patient-reported levels of physical activity (PA) and its associations with health-related quality of life (HRQoL) adjusted for important demographic, lifestyle-related, and clinical factors, among head and neck (HNC) survivors. METHODS: This cross-sectional study included 116 HNC survivors. PA was assessed with the Physical Activity Scale for the Elderly (PASE) and HRQoL with the EORTC-QLQ-C30 and EORTC-HN35. Associations were studied using univariable and multivariable regression analyses. RESULTS: Median PASE score was 100.3 (interquartile range 65.1;170.8) of which 54% were household, 34% leisure-time, and 12% occupational activities. Younger HNC survivors had higher levels of PA. Higher PA was significantly associated with higher global QoL (p < 0.05). Findings for physical function, role function, social function, fatigue, and pain were in line, but not statistically significant (0.05 ≤ p < 0.10). CONCLUSIONS: Among HNC survivors, a large proportion of PA consists of household activities. Younger HNC survivors had higher PA levels, and higher PA levels were associated with higher HRQoL.

Functional determinants of dietary intake in community-dwelling older adults: a DEDIPAC (DEterminants of DIet and Physical ACtivity) systematic literature review.

OBJECTIVE: The identification of determinants of dietary intake is an important prerequisite for the development of interventions to improve diet. The present systematic literature review aimed to compile the current knowledge on individual functional determinants of dietary intake in community-dwelling older adults. DESIGN: A systematic search was performed in PubMed, Scopus, Web of Science and the Cochrane Library. Titles, abstracts and full texts were screened according to predefined inclusion and exclusion criteria. Studies were included when focusing on dietary intake as an outcome and on chemosensory, oral, cognitive or physical function as a determinant. SETTING: Community. SUBJECTS: Older adults at least 65 years old without acute or specific chronic diseases. RESULTS: From initially 14 585 potentially relevant papers, thirty-six were included. For chemosensory, cognitive and physical function only a few papers were found, which reported inconsistent results regarding the relationship to dietary intake. In contrast, oral function was extensively studied (n 31). Different surrogates of oral function like dental status, number of teeth, bite force or chewing problems were associated with food as well as nutrient intakes including fibre. As all except six studies had a cross-sectional design, no causal relationships could be derived. CONCLUSIONS: Among functional determinants of dietary intake oral factors are well documented in older adults, whereas the role of other functional determinants remains unclear and needs further systematic research.

Associations of self-reported physical activity and depression in 10,000 Irish adults across harmonised datasets: a DEDIPAC-study.

BACKGROUND: Depression is a prevalent, debilitating, and often recurrent mood disorder for which successful first-line treatments remains limited. The purpose of this study was to investigate the cross-sectional associations between self-reported physical activity (PA) and depressive symptoms and status among Irish adults, using two existing datasets, The Irish Longitudinal Study on Ageing (TILDA) and The Mitchelstown Cohort Study. METHODS: The two selected databases were pooled (n = 10,122), and relevant variables were harmonized. PA was measured using the short form International Physical Activity Questionnaire. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression (CES-D) questionnaire. Participants were classified as meeting World Health Organization moderate-to-vigorous PA (MVPA) guidelines or not, and divided into tertiles based on weekly minutes of MVPA. A CES-D score of ≥16 indicated elevated depressive symptoms. Data collection were conducted in 2010-2011. RESULTS: Significantly higher depressive symptoms were reported by females (7.11 ± 7.87) than males (5.74 ± 6.86; p < 0.001). Following adjustment for age, sex, BMI, and dataset, meeting the PA guidelines was associated with 44.7% (95%CI: 35.0 to 52.9; p < 0.001) lower odds of elevated depressive symptoms. Compared to the low PA tertile, the middle and high PA tertiles were associated with 25.2% (95%CI: 8.7 to 38.6; p < 0.01) and 50.8% (95%CI: 40.7 to 59.2; p < 0.001) lower odds of elevated depressive symptoms, respectively. CONCLUSION: Meeting the PA guidelines is associated with lower odds of elevated depressive symptoms, and increased volumes of MVPA are associated with lower odds of elevated depressive symptoms.

Improving cardiometabolic health through nudging dietary behaviours and physical activity in low SES adults: design of the Supreme Nudge project.

BACKGROUND: Initiating and maintaining a healthy lifestyle -including healthy eating and sufficient physical activity- is key for cardiometabolic health. A health-promoting environment can facilitate a healthy lifestyle, and may be especially helpful to reach individuals with a lower socio-economic status (SES). In the Supreme Nudge project, we will study the effects of pricing and nudging strategies in the supermarket - one of the most important point-of-choice settings for food choices - and of a context-specific mobile physical activity promotion app. This paper describes the stepwise and theory-based design of Supreme Nudge, which aims to develop, implement and evaluate environmental changes for a sustained impact on lifestyle behaviours and cardiometabolic health in low SES adults. METHODS: Supreme Nudge uses a multi-disciplinary and mixed methods approach, integrating participatory action research, qualitative interviews, experimental pilot studies, and a randomized controlled trial in a real-life (supermarket) setting. First, we will identify the needs, characteristics and preferences of the target group as well as of the participating supermarket chain. Second, we will conduct a series of pilot studies to test novel, promising and feasible intervention components. Third, a final selection of intervention components will be implemented in a full-scale randomised controlled supermarket trial. Approximately 1000 low SES adults will be recruited across 8-12 supermarkets and randomised at supermarket level to receive 1) no intervention (control); 2) environmental nudges such as food product placement or promotion; 3) nudges and a tailored physical activity app that provides time- and context specific feedback; 4) pricing interventions, nudges, and the physical activity app. The effects on dietary behaviours and physical activity will be evaluated at 3, 6 and 12 months, and on cardiometabolic health at 6 and 12 months. Finally, we will evaluate the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) of the intervention, and we will use insights from System Innovation and Transition Management theories to define the best strategies for implementation and upscaling beyond the study period. DISCUSSION: The Supreme Nudge project is likely to generate thorough evidence relevant for policy and practice on the effects of a mixed method and multi-disciplinary intervention targeting dietary behaviours and physical activity. TRIAL REGISTRATION: The real-life trial has been registered on 30 May 2018, NTR7302 .

Which exercise prescriptions improve quality of life and physical function in patients with cancer during and following treatment? A systematic review and meta-analysis of randomised controlled trials.

OBJECTIVE: Certain exercise prescriptions for patients with cancer may improve self-reported quality of life (QoL) and self-reported physical function (PF). We investigated the effects of exercise on QoL and PF in patients with cancer and studied differences in effects between different intervention-related and exercise-related characteristics. DESIGN: We searched four electronic databases to identify randomised controlled trials investigating exercise effects on QoL and PF in patients with cancer. Pooled effects (Hedges' g) were calculated using Comprehensive Meta-Analysis software. Subgroup analyses were conducted based on intervention dimensions, including timing, duration and delivery mode, and exercise dimensions, including frequency, intensity, type and time (FITT factors). RESULTS: We included 74 exercise arms. Patients who were randomised to exercise interventions had significantly improved QoL (g=0.15, 95% CI (0.10 to 0.20), n=67 exercise arms) and PF (g=0.21, 95% CI (0.15 to 0.27), n=59 exercise arms) compared with patients in control groups. We found a significant between-group difference for exercise delivery mode, with significant beneficial effects for supervised exercise interventions (g=0.20, 95% CI (0.14 to 0.26) for QoL and g=0.27, 95% CI (0.20 to 0.33) for PF), but not for unsupervised interventions (g=0.04, 95% CI (-0.06 to 0.13) for QoL and g=0.09, 95% CI (-0.01 to 0.19) for PF). No statistically significant differences in intervention effects were found for variations in intervention timing, duration or exercise FITT factors. Unsupervised exercise with higher weekly energy expenditure was more effective than unsupervised exercise with lower energy expenditure (z=2.34, p=0.02). CONCLUSIONS: Exercise interventions, especially when supervised, have statistically significant and small clinical benefit on self-reported QoL and PF in patients with cancer. Unsupervised exercise intervention effects on PF were larger when prescribed at a higher weekly energy expenditure.

Measurement of availability and accessibility of food among youth: a systematic review of methodological studies.

BACKGROUND: Comprehensive and psychometrically tested measures of availability and accessibility of food are needed in order to explore availability and accessibility as determinants and predictors of dietary behaviors. The main aim of this systematic review was to update the evidence regarding the psychometric properties of measures of food availability and accessibility among youth. A secondary objective was to assess how availability and accessibility were conceptualized in the included studies. METHODS: A systematic literature search was conducted using Medline, Embase, PsycINFO and Web of Science. Methodological studies published between January 2010 and March 2016 and reporting on at least one psychometric property of a measure of availability and/or accessibility of food among youth were included. Two reviewers independently extracted data and assessed study quality. Existing criteria were used to interpret reliability and validity parameters. RESULTS: A total of 20 studies were included. While 16 studies included measures of food availability, three included measures of both availability and accessibility; one study included a measure of accessibility only. Different conceptualizations of availability and accessibility were used across the studies. The measures aimed at assessing availability and/or accessibility in the home environment (n = 11), the school (n = 4), stores (n = 3), childcare/early care and education services (n = 2) and restaurants (n = 1). Most studies followed systematic steps in the development of the measures. The most common psychometrics tested for these measures were test-retest reliability and criterion validity. The majority of the measures had satisfactory evidence of reliability and/or validity. None of the included studies assessed the responsiveness of the measures. CONCLUSIONS: The review identified several measures of food availability or accessibility among youth with satisfactory evidence of reliability and/or validity. Findings indicate a need for more studies including measures of accessibility and addressing its conceptualization. More testing of some of the identified measures in different population groups is also warranted, as is the development of more measures of food availability and accessibility in the broader environment such as the neighborhood food environment.

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.

Sitting too much: A hierarchy of socio-demographic correlates.

Too much sitting (extended sedentary time) is recognized as a public health concern in Europe and beyond. Time spent sedentary is influenced and conditioned by clusters of individual-level and contextual (upstream) factors. Identifying population subgroups that sit too much could help to develop targeted interventions to reduce sedentary time. We explored the relative importance of socio-demographic correlates of sedentary time in adults across Europe. We used data from 26,617 adults who participated in the 2013 Special Eurobarometer 412 "Sport and physical activity". Participants from all 28 EU Member States were randomly selected and interviewed face-to-face. Self-reported sedentary time was dichotomized into sitting less or >7.5h/day. A Chi-squared Automatic Interaction Detection (CHAID) algorithm was used to create a tree that hierarchically partitions the data on the basis of the independent variables (i.e., socio-demographic factors) into homogeneous (sub)groups with regard to sedentary time. This allows for the tentative identification of population segments at risk for unhealthy sedentary behaviour. Overall, 18.5% of the respondents reported sitting >7.5h/day. Occupation was the primary discriminator. The subgroup most likely to engage in extensive sitting were higher educated, had white-collar jobs, reported no difficulties with paying bills, and used the internet frequently. Clear socio-demographic profiles were identified for adults across Europe who engage in extended sedentary time. Furthermore, physically active participants were consistently less likely to engage in longer daily sitting times. In general, those with more indicators of higher wealth were more likely to spend more time sitting.