Development and content validity of an application to assess 24-hour movement behaviors in 0-4-year-old children involving end-users and key stakeholders: the My Little Moves app.

BACKGROUND: Recently, research focus has shifted to the combination of all 24-h movement behaviors (physical activity, sedentary behavior and sleep) instead of each behavior separately. Yet, no reliable and valid proxy-report tools exist to assess all these behaviors in 0-4-year-old children. By involving end-users (parents) and key stakeholders (researchers, professionals working with young children), this mixed-methods study aimed to 1) develop a mobile application (app)-based proxy-report tool to assess 24-h movement behaviors in 0-4-year-olds, and 2) examine its content validity. METHODS: First, we used concept mapping to identify activities 0-4-year-olds engage in. Parents (n = 58) and professionals working with young children (n = 21) generated a list of activities, sorted related activities, and rated the frequency children perform these activities. Second, using multidimensional scaling and cluster analysis, we created activity categories based on the sorted activities of the participants. Third, we developed the My Little Moves app in collaboration with a software developer. Finally, we examined the content validity of the app with parents (n = 14) and researchers (n = 6) using focus groups and individual interviews. RESULTS: The app has a time-use format in which parents proxy-report the activities of their child, using eight activity categories: personal care, eating/drinking, active transport, passive transport, playing, screen use, sitting/lying calmly, and sleeping. Categories are clarified by providing examples of children's activities. Additionally, 1-4 follow-up questions collect information on intensity (e.g., active or calm), posture, and/or context (e.g., location) of the activity. Parents and researchers considered filling in the app as feasible, taking 10-30 min per day. The activity categories were considered comprehensive, but alternative examples for several activity categories were suggested to increase the comprehensibility and relevance. Some follow-up questions were considered less relevant. These suggestions were adopted in the second version of the My Little Moves app. CONCLUSIONS: Involving end-users and key stakeholders in the development of the My Little Moves app resulted in a tailored tool to assess 24-h movement behaviors in 0-4-year-olds with adequate content validity. Future studies are needed to evaluate other measurement properties of the app.

Development of an action programme tackling obesity-related behaviours in adolescents: a participatory system dynamics approach.

System dynamics approaches are increasingly addressing the complexity of public health problems such as childhood overweight and obesity. These approaches often use system mapping methods, such as the construction of causal loop diagrams, to gain an understanding of the system of interest. However, there is limited practical guidance on how such a system understanding can inform the development of an action programme that can facilitate systems changes. The Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme combines system dynamics and participatory action research to improve obesity-related behaviours, including diet, physical activity, sleep and sedentary behaviour, in 10-14-year-old adolescents in Amsterdam, the Netherlands. This paper illustrates how we used a previously obtained understanding of the system of obesity-related behaviours in adolescents to develop an action programme to facilitate systems changes. A team of evaluation researchers guided interdisciplinary action-groups throughout the process of identifying mechanisms, applying the Intervention Level Framework to identify leverage points and arriving at action ideas with aligning theories of change. The LIKE action programme consisted of 8 mechanisms, 9 leverage points and 14 action ideas which targeted the system's structure and function within multiple subsystems. This illustrates the feasibility of developing actions targeting higher system levels within the confines of a research project timeframe when sufficient and dedicated effort in this process is invested. Furthermore, the system dynamics action programme presented in this study contributes towards the development and implementation of public health programmes that aim to facilitate systems changes in practice.

Is the transition from primary to secondary school a risk factor for energy balance-related behaviours? A systematic review.

OBJECTIVE: The substantial changes in the physical and social environment during the transition from primary to secondary school may significantly impact adolescents' energy balance-related behaviours (i.e. dietary behaviour, sedentary behaviour, sleep behaviour and physical activity (PA)). This is the first review systematically summarising evidence on changes in four energy balance-related behaviours of adolescents across the school transition from primary to secondary school. DESIGN: For this systematic review, the electronic databases Embase, PsycINFO and SPORTDiscus were searched for relevant studies from inception to August 2021. PubMed was searched for relevant studies from inception to September 2022. Inclusion criteria were: (i) longitudinal studies reporting; (ii) one or more energy balance-related behaviours; and (iii) across the school transition, that is, with measurement(s) during both primary and secondary school. SETTING: Transition from primary to secondary school. PARTICIPANTS: Adolescents across the transition from primary to secondary school. RESULTS: Thirty-four studies were eligible. We found strong evidence for an increase in sedentary time, moderate evidence for a decrease in fruit and vegetable consumption, and inconclusive evidence for a change in total, light, and moderate-to-vigorous PA, active transport, screen time, unhealthy snack consumption, and sugar-sweetened beverages consumption among adolescents across the school transition. CONCLUSIONS: During the transition from primary to secondary school, sedentary time and fruit and vegetable consumption tend to change unfavourably. More high-quality, longitudinal research is needed specifically on changes in energy balance-related behaviour across the school transition, especially regarding sleep behaviour. (Prospero registration: CRD42018084799).

Systematic Review of Contemporary Theories Used for Co-creation, Co-design and Co-production in Public Health.

BACKGROUND: There is a need to systematically identify and summarize the contemporary theories and theoretical frameworks used for co-creation, co-design and co-production in public health research. METHODS: The reporting of this systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Given substantial interest in and application of co-creation, co-design and co-production, we searched PubMed, CINAHL, Scopus and APA PsycINFO from 2012 to March-April 2022. A quality assessment and data extraction for theory content was performed. RESULTS: Of the 3763 unique references identified through the comprehensive search strategy, 10 articles were included in the review: four articles named co-creation, two articles named co-creation and co-design, two articles named co-production and co-design, and two articles named co-design. Empowerment Theory was employed by two articles, whereas other theories (n = 5) or frameworks (n = 3) were employed by one article each. For the quality assessment, eight articles received a strong rating and two articles received a moderate rating. CONCLUSION: There is little indication of theory applications for the approaches of co-creation, co-design and co-production in public health since 2012, given 10 articles were included in this review. Yet, the theories described in these 10 articles can be useful for developing such co-approaches in future public health research.

A systematic review of proxy-report questionnaires assessing physical activity, sedentary behavior and/or sleep in young children (aged 0-5 years).

BACKGROUND: Accurate proxy-report questionnaires, adapted to the child's developmental stage, are required to monitor 24-h movement behaviors in young children, especially for large samples and low-resource settings. OBJECTIVES: This review aimed to summarize available studies evaluating measurement properties of proxy-report questionnaires assessing physical activity, sedentary behavior and/or sleep in children aged 0-5 years. METHODS: Systematic literature searches were carried out in the PubMed, Embase and SPORTDiscus databases, up to January 2021. For physical activity and sedentary behavior questionnaires this is a review update, whereas for sleep questionnaires we included all relevant studies published up to now. Studies had to evaluate at least one of the measurement properties of a proxy-report questionnaire assessing at least duration and/or frequency of physical activity, sedentary behavior and/or sleep in 0- to 5-year-old children. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline was used to evaluate the quality of evidence. RESULTS: Thirty-three studies were included, examining a total of 37 questionnaires. Ten questionnaires were designed for infants, two for toddlers, 11 for preschoolers, and 14 for a broader age range targeting multiple of these age groups. Twenty questionnaires assessed constructs of sleep, four assessed constructs of physical activity, two assessed screen behavior, five assessed constructs of both physical activity and sedentary behavior, and six assessed constructs of all 24-h movement behaviors. Content validity was evaluated for six questionnaires, structural validity for two, internal consistency for three, test-retest reliability for 16, measurement error for one, criterion validity for one, and construct validity for 26 questionnaires. None of the questionnaires were considered sufficiently valid and/or reliable for assessing one or more movement behaviors in 0- to 5-year-old children, and the quality of evidence was mostly low or very low. CONCLUSIONS: Valid and/or reliable questionnaires assessing 24-h movement behaviors in 0- to 5-year-olds are lacking. High-quality studies are therefore required, to develop proxy-report questionnaires and evaluate their measurement properties. PROSPERO REGISTRATION NUMBER: CRD42020169268.

Systematic review of accelerometer-based methods for 24-h physical behavior assessment in young children (0-5 years old).

BACKGROUND: Accurate accelerometer-based methods are required for assessment of 24-h physical behavior in young children. We aimed to summarize evidence on measurement properties of accelerometer-based methods for assessing 24-h physical behavior in young children. METHODS: We searched PubMed (MEDLINE) up to June 2021 for studies evaluating reliability or validity of accelerometer-based methods for assessing physical activity (PA), sedentary behavior (SB), or sleep in 0-5-year-olds. Studies using a subjective comparison measure or an accelerometer-based device that did not directly output time series data were excluded. We developed a Checklist for Assessing the Methodological Quality of studies using Accelerometer-based Methods (CAMQAM) inspired by COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). RESULTS: Sixty-two studies were included, examining conventional cut-point-based methods or multi-parameter methods. For infants (0-12 months), several multi-parameter methods proved valid for classifying SB and PA. From three months of age, methods were valid for identifying sleep. In toddlers (1-3 years), cut-points appeared valid for distinguishing SB and light PA (LPA) from moderate-to-vigorous PA (MVPA). One multi-parameter method distinguished toddler specific SB. For sleep, no studies were found in toddlers. In preschoolers (3-5 years), valid hip and wrist cut-points for assessing SB, LPA, MVPA, and wrist cut-points for sleep were identified. Several multi-parameter methods proved valid for identifying SB, LPA, and MVPA, and sleep. Despite promising results of multi-parameter methods, few models were open-source. While most studies used a single device or axis to measure physical behavior, more promising results were found when combining data derived from different sensor placements or multiple axes. CONCLUSIONS: Up to age three, valid cut-points to assess 24-h physical behavior were lacking, while multi-parameter methods proved valid for distinguishing some waking behaviors. For preschoolers, valid cut-points and algorithms were identified for all physical behaviors. Overall, we recommend more high-quality studies evaluating 24-h accelerometer data from multiple sensor placements and axes for physical behavior assessment. Standardized protocols focusing on including well-defined physical behaviors in different settings representative for children's developmental stage are required. Using our CAMQAM checklist may further improve methodological study quality. PROSPERO REGISTRATION NUMBER: CRD42020184751.

The ENCOMPASS framework: a practical guide for the evaluation of public health programmes in complex adaptive systems.

BACKGROUND: Systems thinking embraces the complexity of public health problems, including childhood overweight and obesity. It aids in understanding how factors are interrelated, and it can be targeted to produce favourable changes in a system. There is a growing call for systems approaches in public health research, yet limited practical guidance is available on how to evaluate public health programmes within complex adaptive systems. The aim of this paper is to present an evaluation framework that supports researchers in designing systems evaluations in a comprehensive and practical way. METHODS: We searched the literature for existing public health systems evaluation studies. Key characteristics on how to conduct a systems evaluation were extracted and compared across studies. Next, we overlaid the identified characteristics to the context of the Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme evaluation and analyzed which characteristics were essential to carry out the LIKE evaluation. This resulted in the Evaluation of Programmes in Complex Adaptive Systems (ENCOMPASS) framework. RESULTS: The ENCOMPASS framework includes five iterative stages: (1) adopting a system dynamics perspective on the overall evaluation design; (2) defining the system boundaries; (3) understanding the pre-existing system to inform system changes; (4) monitoring dynamic programme output at different system levels; and (5) measuring programme outcome and impact in terms of system changes. CONCLUSIONS: The value of ENCOMPASS lies in the integration of key characteristics from existing systems evaluation studies, as well as in its practical, applied focus. It can be employed in evaluating public health programmes in complex adaptive systems. Furthermore, ENCOMPASS provides guidance for the entire evaluation process, all the way from understanding the system to developing actions to change it and to measuring system changes. By the nature of systems thinking, the ENCOMPASS framework will likely evolve further over time, as the field expands with more completed studies.

Cross-validation of cut-points in preschool children using different accelerometer placements and data axes.

The present study cross-validated various cut-points to assess physical activity and sedentary behaviour in preschoolers, using hip- and wrist-worn accelerometers and both vertical axis and vector magnitude data. Secondly, we examined the influence of epoch length on time estimates of physical activity and sedentary behaviour. Sixty-four preschoolers (34 girls) wore two accelerometers, on their right hip and dominant wrist, during 1 hour of free play. Preschoolers' activities were observed by two trained researchers. Area under the curve (AUC) was calculated for the receiving operating characteristic (ROC) curves as a measure of precision. AUC ranges were 0.603-0.723 for sedentary behaviour, 0.472-0.545 for light physical activity and 0.503-0.661 for moderate-to-vigorous physical activity (MVPA), indicating poor to fair precision. Percentage of time classified as sedentary behaviour, light or MVPA according to observation and accelerometer data varied largely between cut-points, accelerometer placements and axes. The influence of epoch length on time estimates was minimal across cut-points, except for one hip-based vector magnitude cut-point. Across all accelerometer placements and data axes, no set of cut-points demonstrated adequate precision for sedentary behaviour, light physical activity and MVPA. The highly variable and omnidirectional activity pattern of preschoolers may explain the lack of adequate cut-points.

Physical activity and prospective associations with indicators of health and development in children aged <5 years: a systematic review.

BACKGROUND: Early childhood is a critical period for growth and development, yet the association with physical activity during this important period is unknown. The aim of this review is to critically summarize the evidence on the prospective associations between physical activity and health and development in children aged < 5 years. METHODS: A systematic search in three electronic databases (Pubmed, PsycINFO, and Sportdiscus) was conducted to identify prospective studies examining the associations between physical activity (all types; specified by quantity) and health indicators (body composition, cardiometabolic health, bone health and risks/harm) or development (motor, cognitive and social-emotional development) in young children (mean age < 5 years at baseline). Two independent researchers assessed the methodological quality using the 'Quality Assessment Tool for Quantitative Studies' (EPHPP). This tool covers eight quality criteria: selection bias, study design, confounders, blinding, data collection methods, withdrawals and drop-outs, intervention integrity and data-analysis. RESULTS: Thirty-nine studies, predominantly conducted in preschoolers (ages 3-5 years), were included of which nine were rated as high methodological quality. There was moderate evidence for a positive association between physical activity and motor (n = 11 studies) and cognitive development (n = 10 studies) based on consistent findings from studies having low-to-moderate methodological quality. There was insufficient evidence for an association between physical activity and body composition (n = 15 studies), cardiometabolic health indicators (n = 7 studies), social-emotional development (n = 2 studies) and bone health (n = 2 studies) based on inconsistent findings from studies having weak-to-high methodological quality. CONCLUSIONS: There is a need for more high-quality research in order to determine the dose-response relationship between physical activity and health and development in early childhood. Special attention should be paid to studies in children below the age of 3 years.

Strategies and effects of school-based interventions to promote active school transportation by bicycle among children and adolescents: a systematic review.

BACKGROUND: Promoting cycling to school may benefit establishing a lifelong physical activity routine. This systematic review aimed to summarize the evidence on strategies and effects of school-based interventions focusing on increasing active school transport by bicycle. METHODS: A literature search based on "PICo" was conducted in eight electronic databases. Randomized and non-randomized controlled trials with primary/secondary school students of all ages were included that conducted pre-post measurements of a school-based intervention aimed at promoting active school travel by bicycle and were published in English between 2000 and 2019. The methodological quality was assessed using the "Effective Public Health Practice Project" tool for quantitative studies. Applied behavior change techniques were identified using the "BCT Taxonomy v1". Two independent researchers undertook the screening, data extraction, appraisal of study quality, and behavior change techniques. RESULTS: Nine studies investigating seven unique interventions performed between 2012 and 2018 were included. All studies were rated as weak quality. The narrative synthesis identified 19 applied behavior change techniques clustered in eleven main groups according to their similarities and a variety of 35 different outcome variables classified into seven main groups. Most outcomes were related to active school travel and psychosocial factors, followed by physical fitness, physical activity levels, weight status, active travel and cycling skills. Four studies, examining in total nine different outcomes, found a significant effect in favor of the intervention group on bicycle trips to school (boys only), percentage of daily cycling trips to school, parental/child self-efficacy, parental outcome expectations, moderate-to-vigorous intensity physical activity (total, from cycling, before/after school), and total basic cycling skills. Seven of these outcomes were only examined in two studies conducting the same intervention in children, a voluntary bicycle train to/from school accompanied by adults, including the following clustered main groups of behavior change techniques: shaping knowledge, comparison of behavior, repetition and substitution as well as antecedents. CONCLUSIONS: The applied strategies in a bicycle train intervention among children indicated great potential to increase cycling to school. Our findings provide relevant insights for the design and implementation of future school-based interventions targeting active school transport by bicycle. TRIAL REGISTRATION: This systematic review has been registered in the international prospective register of systematic reviews "PROSPERO" at (registration number: CRD42019125192 ).

Co-creating a 24-hour movement behavior tool together with 9-12-year-old children using mixed-methods: MyDailyMoves.

BACKGROUND: All 24-h movement behaviors, i.e. physical activity, sedentary behavior and sleep, are important for optimal health in children. Currently, no tools exist that include all 24-h behaviors and have been proven to be both reliable and valid. Potential reasons for the inadequate validity and reliability of existing questionnaires are the lack of focus on the content validity and lack of involvement of children in the development. Therefore, the aim of this study was to co-create a 24-h movement behavior tool together with 9-12-year-old children. METHODS: Concept mapping and photovoice meetings were held to identify children's physical activity behaviors. During concept mapping meetings with four groups of children (n = 40), children generated an extensive list of physical activities they engaged in, sorted the activities in categories and rated the frequency and perceived intensity of these activities. Using photovoice, three groups of children (n = 24) photographed their physical activities during one weekday and one weekend day, named the photographs, and placed them on a timeline. Furthermore, researchers obtained information on relevant items regarding sleep and sedentary behavior by screening existing questionnaires. Thereafter, we developed the first version of MyDailyMoves. Subsequently, we examined the content validity of the tool together with three groups of children (n = 22) and one group of researchers (n = 7) using focus group meetings. RESULTS: MyDailyMoves has a timeline format, onto which children add the activities they performed the previous day. Based on the concept mapping and photovoice studies, eight physical activity categories were included: playing inside, playing outside, sports, hobbies, chores, personal care, transport, and others. Sleep questions and two more sedentary categories (schoolwork and screen time) were added to MyDailyMoves to define and complete the timeline. The content validity study showed that all items in the tool were relevant. However, children mentioned that the activity category 'eating' was missing and the understandability of how to use the tool should be improved by adding an explanatory video. Both suggestions were adopted in the second version. CONCLUSION: Including the children's perceptions throughout the tool development process resulted in a comprehensive and practical tool which is easy for children to use.

Tracking of total sedentary time and sedentary patterns in youth: a pooled analysis using the International Children's Accelerometry Database (ICAD).

BACKGROUND: To gain more understanding of the potential health effects of sedentary time, knowledge is required about the accumulation and longitudinal development of young people's sedentary time. This study examined tracking of young peoples' total and prolonged sedentary time as well as their day-to-day variation using the International Children's Accelerometry Database. METHODS: Longitudinal accelerometer data of 5991 children (aged 4-17y) was used from eight studies in five countries. Children were included if they provided valid (≥8 h/day) accelerometer data on ≥4 days, including ≥1 weekend day, at both baseline and follow-up (average follow-up: 2.7y; range 0.7-8.2). Tracking of total and prolonged (i.e. ≥10-min bouts) sedentary time was examined using multilevel modelling to adjust for clustering of observations, with baseline levels of sedentary time as predictor and follow-up levels as outcome. Standardized regression coefficients were interpreted as tracking coefficients (low: < 0.3; moderate: 0.3-0.6; high: > 0.6). RESULTS: Average total sedentary time at study level ranged from 246 to 387 min/day at baseline and increased annually by 21.4 min/day (95% confidence interval [19.6-23.0]) on average. This increase consisted almost entirely of prolonged sedentary time (20.9 min/day [19.2-22.7]). Total (standardized regression coefficient (B) = 0.48 [0.45-0.50]) and prolonged sedentary time (B = 0.43 [0.41-0.45]) tracked moderately. Tracking of day-to-day variation in total (B = 0.04 [0.02-0.07]) and prolonged (B = 0.07 [0.04-0.09]) sedentary time was low. CONCLUSION: Young people with high levels of sedentary time are likely to remain among the people with highest sedentary time as they grow older. Day-to-day variation in total and prolonged sedentary time, however, was rather variable over time.

Physical activity in patients with cancer: self-report versus accelerometer assessments.

PURPOSE: The level of daily physical activity in patients with cancer is frequently assessed by questionnaires, such as the Physical Activity Scale for the Elderly (PASE). Objective assessments, with for example accelerometers, may be a good alternative. The aim of this study was to investigate the agreement between the PASE questionnaire and accelerometer-assessed physical activity in a large group of patients with different types of cancer. METHODS: Baseline accelerometer and PASE questionnaire data of 403 participants from the REACT (Resistance and Endurance Exercise After Chemotherapy, n = 227), the EXIST (Exercise Intervention After Stem-Cell Transplantation, n = 74), and NET-QUBIC (NEtherlands QUality of Life And Biomedical Cohort Studies In Cancer, n = 102) studies were available for the current analyses. Physical activity was assessed by the PASE questionnaire (total score) and accelerometers (total minutes per day > 100 counts). Linear mixed models regression analysis was used to assess the agreement between the PASE questionnaire and accelerometer-assessed physical activity. RESULTS: The mean (SD) PASE score was 95.9 (75.1) points and mean (SD) time in physical activity measured with the accelerometer was 256.6 (78.8) min per day. The agreement between the PASE score and the accelerometer data was significant, but poor (standardized regression coefficient (B) = 0.36, 95%CI = 0.27; 0.44, p < 0.01). CONCLUSION: Agreement between the PASE questionnaire and accelerometer-assessed physical activity was poor. The poor agreement indicates that they measure different physical activity constructs and cannot be used interchangeably to assess the level of daily physical activity in patients with cancer.

Muscle contractile properties of cancer patients receiving chemotherapy: Assessment of feasibility and exercise effects.

BACKGROUND: This pilot trial explores the feasibility of measuring muscle contractile properties in patients with cancer, effects of exercise during chemotherapy on muscle contractile properties and the association between changes in contractile muscle properties and perceived fatigue. METHOD: Patients who received (neo)adjuvant chemotherapy for breast or colon cancer were randomized to a 9-12 week exercise intervention or a waitlist-control group. At baseline and follow-up, we measured knee extensor strength using maximal voluntary contraction (MVC), contractile muscle properties of the quadriceps muscle using electrical stimulation, and perceived fatigue using the Multidimensional Fatigue Inventory. Feasibility was assessed by the proportion of patients who successfully completed measurements of contractile muscle properties. Exercise effects on muscle contractile properties were explored using linear regression analyses. Between-group differences >10% were considered potentially relevant. Pearson correlation (rp ) of changes in contractile muscle properties and changes in perceived fatigue was calculated. RESULTS: Twenty two of 30 patients completed baseline and follow-up assessments. Measurements of contractile properties were feasible except for muscle fatigability. We found a potentially relevant between-group difference in the rate of force development favoring the intervention group (1192 N/s, 95% CI = -335; 2739). Change in rate of force development was negatively correlated with change in perceived general (rp  = -0.54, P = .04) and physical (rp  = -0.59, P = .02) fatigue. CONCLUSION: Chemotherapy induces a decrease in the rate of force development, which may reflect a larger loss in type II muscle fibers. This may be attenuated with (resistance) exercise. The increase in the rate of force development was related to a decrease in perceived fatigue.

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.

Co-designing obesity prevention interventions together with children: intervention mapping meets youth-led participatory action research.

BACKGROUND: Youth-led Participatory Action Research (YPAR) involves children throughout the process of developing and implementing interventions. Combining YPAR with a structural approach for designing and planning interventions, such as Intervention Mapping (IM), may further improve implementation and effectiveness of interventions. This paper describes how YPAR and IM were combined in the Kids in Action study. METHODS: The Kids in Action study aims to improve health behaviors of 9-12-year old children living in a low socioeconomic neighborhood in Amsterdam, by co-designing interventions with these children. At each of four schools 6-8 children (N = 18-24 total per year) and two academic researchers formed participatory groups that met weekly or every fortnight during two school years. An IM expert panel advised the participatory groups on the application of IM. RESULTS: Following the IM protocol, we conducted a participatory needs assessment with children, parents and professionals, in IM-step 1. In IM-step 2, the IM expert panel constructed matrices of program objectives, and the children provided feedback. In collaboration with children programs were designed and produced using an iterative process during IM-steps 3-4. In IM-step 5, the participatory groups and professional community partners designed the implementation plan. Finally, in IM-step 6, the protocol of the process and effect evaluation - executed by academic researchers with input from children - was developed. CONCLUSIONS: By combining YPAR and IM, several interventions have been developed and implemented, varying from a school water policy to extracurricular sports activities. Sharing responsibility with children was challenging when combining IM with YPAR. In YPAR children are given as much autonomy as possible, while traditional IM development work is primarily done by academic researchers. Strengths in combining IM and YPAR include the involvement of the end-users - children - throughout the process while at the same time developing interventions based on existing evidence. Time-management, a multidisciplinary team, and flexibility are important conditions when combining IM with YPAR. A strong community project group, with professionals who were willing to help children develop and execute their ideas, was an important success factor. This study can serve as an example to other YPAR studies developing interventions using the IM protocol.

Examining accelerometer validity for estimating physical activity in pre-schoolers during free-living activity.

The present study examined the efficacy of accelerometers for the assessment of free play physical activity (PA) in pre-school-aged children with consideration of epoch length and wear location. Following ethics approval, parental informed consent, and child assent, 66 pre-schoolers aged 3-4 years (30 females and 36 males) wore an accelerometer (ActiGraph GT3X; sampling at 100 Hz) on their non-dominant wrist and their right hip during 1 hour of free play. Concurrently, direct observation, using the OSRAC-P, was used to determine sedentary behavior (SB), light (LPA), or moderate-to-vigorous (MVPA) intensity PA. For the ActiGraph, vertical axis counts and summed vector magnitude (VM) for hip, and VM for wrist, were downloaded using 5-, 10-, 15-, and 30-second epoch lengths. Accelerometer counts were averaged over each 30 seconds to match the observation periods. Receiver operating curve analysis was used to evaluate the ability of the ActiGraph to predict SB, LPA, and MVPA. SB and MVPA obtained from wrist- and hip-worn accelerometers demonstrated fair agreement with direct observation (AUC => 0.7). LPA determined by accelerometer had poor agreement with observed LPA, for both the hip and wrist placement (AUC = 0.53-0.56), with weak levels of specificity (0.34-0.43), although sensitivity was fair (0.74-0.84). This study is the first to examine accelerometer validity, considering wear location and epoch in pre-schoolers during free play, and suggests that the ActiGraph is a fair measure for SB and MVPA in pre-school children. Neither placement performed predominantly better irrespective of epochs or used count data (vertical axis, VM).

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.

Total volume versus bouts: prospective relationship of physical activity and sedentary time with cardiometabolic risk in children.

BACKGROUND/OBJECTIVES: Examine the prospective relationship of total volume versus bouts of sedentary behaviour (SB) and moderate-to-vigorous physical activity (MVPA) with cardiometabolic risk in children. In addition, the moderating effects of weight status and MVPA were explored. SUBJECTS/METHODS: Longitudinal study including 454 primary school children (mean age 10.3 years). Total volume and bouts (i.e. ≥10 min consecutive minutes) of MVPA and SB were assessed by accelerometry in Nov 2009/Jan 2010 (T1) and Aug/Oct 2010 (T2). Triglycerides, total cholesterol/HDL cholesterol ratio (TC:HDLC ratio), homoeostatic model assessment of insulin resistance, systolic blood pressure and waist circumference were assessed at T2 (Sept/Oct 2010) and combined in a composite cardiometabolic risk score. Associations of total time and uninterrupted MVPA and SB were examined using multilevel mixed linear models, with or without mutual adjustments between MVPA and SB. The moderating effects of weight status and MVPA (for SB only) were examined by adding interaction terms. RESULTS: Children engaged daily in about 60 min of total MVPA and 0-15 min/week in MVPA bouts. Mean total sedentary time was around 7 h/day with over 3 h/day accumulated in bouts. Higher mean levels of MVPA were significantly associated with a lower waist circumference, triglycerides, insulin resistance, TC:HDLC ratio and composite cardiometabolic risk, with non-significant associations for uninterrupted MVPA. Associations with sedentary time were much smaller and inconsistent: higher total sedentary time was associated with higher insulin resistance; after adjusting for MVPA, higher mean total and bouts of sedentary time were associated with lower waist circumference, and sedentary bouts with lower composite cardiometabolic risk. CONCLUSIONS: Children accumulated MVPA intermittently and rarely in bouts, and about half their total sedentary time in bouts. Total MVPA is important for lowering cardiometabolic risk in children, whereas both total and uninterrupted sedentary time seem of less importance.

Stabilization of the obesity epidemic and increasing thinness in children in Caribbean Bonaire.

BACKGROUND: In 2008, the prevalence of overweight and obesity among children in Bonaire was twice as high as the prevalence in northern Europe but comparable to that of other Caribbean islands and the United States. The aim of this study was to examine change in the body mass index status of children in Bonaire and report children's energy balance-related behaviours (EBRB) in 2015. METHODS: Two school-based cross sectional surveys of children age 4-14 years were conducted in 2008 and 2015. Height (m) and weight (kg) were measured, body mass index (BMI) calculated and children's BMI categorised according to the International Obesity Task Force criteria. In 2015, children age 10-14 years completed a questionnaire on EBRB and responses were compared between non-overweight/obese children and overweight/obese children. RESULTS: In total 2117 children age 4-14 years participated (92.4% response rate). The prevalence of thinness significantly increased between 2008 and 2015 (adjusted OR 1.5 95% CI: 1.2-1.8). There were no other significant differences in children's weight status between survey years. One quarter of children (25.4%) were overweight/obese in 2015. There were no significant differences in EBRB between non-overweight/obese and overweight/obese children in 2015. Few children met recommendations for EBRB. CONCLUSIONS: The prevalence of overweight/obesity in children in Bonaire did not significantly change between 2008 and 2015 and remained high. However, the prevalence of thinness has significantly increased. Interventions to improve children's current EBRB are required.