C. Niermann

Long-term health benefits of physical activity – a systematic review of longitudinal studies

BackgroundThe treatment of noncommunicable diseases (NCD), like coronary heart disease or type 2 diabetes mellitus, causes rising costs for the health system. Physical activity is supposed to reduce the risk for these diseases. Results of cross-sectional studies showed that physical activity is associated with better health, and that physical activity could prevent the development of these diseases. The purpose of this review is to summarize existing evidence for the long-term (>5 years) relationship between physical activity and weight gain, obesity, coronary heart disease, type 2 diabetes mellitus, Alzheimer’s disease and dementia.MethodsFifteen longitudinal studies with at least 5-year follow up times and a total of 288,724 subjects (>500 participants in each study), aged between 18 and 85 years, were identified using digital databases. Only studies published in English, about healthy adults at baseline, intentional physical activity and the listed NCDs were included.ResultsThe results of these studies show that physical activity appears to have a positive long-term influence on all selected diseases.ConclusionsThis review revealed a paucity of long-term studies on the relationship between physical activity and the incidence of NCD.

Family health climate scale (FHC-scale): development and validation

BackgroundThe family environment is important for explaining individual health behaviour. While previous research mostly focused on influences among family members and dyadic interactions (parent-child), the purpose of this study was to develop a new measure, the Family Health Climate Scale (FHC-Scale), using a family-based approach. The FHC is an attribute of the whole family and describes an aspect of the family environment that is related to health and health behaviour. Specifically, a questionnaire measuring the FHC (a) for nutrition (FHC-NU) and (b) for activity behaviour (FHC-PA) was developed and validated.MethodsIn Study 1 (N = 787) the FHC scales were refined and validated. The sample was randomly divided into two subsamples. With random sample I exploratory factor analyses were conducted and items were selected according to their psychometric quality. In a second step, confirmatory factor analyses were conducted using the random sample II. In Study 2 (N = 210 parental couples) the construct validity was tested by correlating the FHC to self-determined motivation of healthy eating and physical activity as well as the families’ food environment and joint physical activities.ResultsExploratory factor analyses with random sample I (Study 1) revealed a four (FHC-NU) and a three (FHC-PA) factor model. These models were cross-validated with random sample II and demonstrated an acceptable fit [FHC-PA: χ2 = 222.69, df = 74, p < .01; χ2/df = 3.01; CFI = .96; SRMR = .04; RMSEA = .07, CI .06/.08; FHC-NU: χ2 = 278.30, df = 113, p < .01, χ2/df = 2.46, CFI = .96; SRMR = .04; RMSEA = .06, CI .05/.07]. The perception of FHC correlated (p < .01) with the intrinsic motivation of healthy eating (r = .42) and physical activity (r = .56). Moreover, parental perceptions of FHC-NU correlated with household soft drink availability (r = -.31) and perceptions of FHC-PA with the frequency of joint physical activities with the child (r = .51). These patterns were found on the intraindividual and interindividual level.ConclusionsTwo valid instruments measuring the FHC within families were developed. The use of different informants’ ratings demonstrated that the FHC is a family level variable. The results confirm the high relevance of the FHC for individuals’ health behaviour. The FHC and the measurement instruments are useful for examining health-related aspects of the family environment.

Affect and Subsequent Physical Activity: An Ambulatory Assessment Study Examining the Affect-Activity Association in a Real-Life Context

Traditionally, cognitive, motivational, and volitional determinants have been used to explain and predict health behaviors such as physical activity. Recently, the role of affect in influencing and regulating health behaviors received more attention. Affects as internal cues may automatically activate unconscious processes of behavior regulation. The aim of our study was to examine the association between affect and physical activity in daily life. In addition, we studied the influence of the habit of being physically active on this relationship. An ambulatory assessment study in 89 persons (33.7% male, 25 to 65 years, M = 45.2, SD = 8.1) was conducted. Affect was assessed in the afternoon on 5 weekdays using smartphones. Physical activity was measured continuously objectively using accelerometers and subjectively using smartphones in the evening. Habit strength was assessed at the beginning of the diary period. The outcomes were objectively and subjectively measured moderate-to-vigorous physical activity (MVPA) performed after work. Multilevel regression models were used to analyze the association between affect and after work MVPA. In addition, the cross-level interaction of habit strength and affect on after work MVPA was tested. Positive affect was positively related to objectively measured and self-reported after work MVPA: the greater the positive affect the more time persons subsequently spent on MVPA. An inverse relationship was found for negative affect: the greater the negative affect the less time persons spent on MVPA. The cross-level interaction effect was significant only for objectively measured MVPA. A strong habit seems to strengthen both the positive influence of positive affect and the negative influence of negative affect. The results of this study confirm previous results and indicate that affect plays an important role for the regulation of physical activity behavior in daily life. The results for positive affect were consistent. However, in contrast to previous reports of no or an inverse association, negative affect decreased subsequent MVPA. These inconsistencies may be—in part—explained by the different measurements of affect in our and other studies. Therefore, further research is warranted to gain more insight into the association between affect and physical activity.

Family Health Climate and Adolescents' Physical Activity and Healthy Eating : A Cross-Sectional Study with Mother-Father-Adolescent Triads

Introduction The importance of the family environment for children’s and adolescents’ health behavior has been demonstrated, the underlying mechanisms of this influence remain unclear. Therefore, the aim of the study was to investigate the relationship between family environmental and individual determinants. It was hypothesized that the Family Health Climate (FHC) is associated with adolescents’ physical activity and dietary behavior and that intrinsic motivation mediates this association. Methods Cross-sectional data were collected from 198 families (mother, father, and child) using questionnaires. Perceptions of FHC of mothers, fathers, and their children were assessed using the FHC-scales for physical activity (FHC-PA) and nutrition (FHC-NU). The adolescents also rated their intrinsic motivation for exercise and healthy eating, their physical activity and consumption of healthful food. A structural equation model was analyzed and a bootstrapping procedure was used to test direct and indirect effects. Results The FHC-PA was related to the amount of weekly physical activity and the FHC-NU to the consumption of fruit, vegetables and salad. These effects were mediated by adolescents’ intrinsic motivation; the indirect effects were significant for both behaviors. Discussion These results emphasize the importance of the FHC in shaping adolescents’ physical activity and dietary behavior. Individual motivational factors are potential mediators of family and parental influences. Considering family-level variables and their interaction with individual factors contributes to the understanding of adolescents’ health behavior.

Effectiveness of a 16-Week Multimodal Exercise Program on Individuals With Dementia : Study Protocol for a Multicenter Randomized Controlled Trial

Background The increasing prevalence of dementia in the next decades is accompanied by various societal and economic problems. Previous studies have suggested that physical activity positively affects motor and cognitive skills in individuals with dementia (IWD). However, there is insufficient evidence probably related to several methodological limitations. Moreover, to date adequate physical activity interventions specifically developed for IWD are lacking. Objective This study aims to investigate the effectiveness of a multimodal exercise program (MEP) on motor and cognitive skills in IWD in a high-quality multicenter trial. Methods A multicenter randomized controlled trial with baseline and postassessments will be performed. It is planned to enroll 405 participants with dementia of mild to moderate stage, aged 65 years and older. The intervention group will participate in a 16-week ritualized MEP especially developed for IWD. The effectiveness of the MEP on the primary outcomes balance, mobility, and gait will be examined using a comprehensive test battery. Secondary outcomes are strength and function of lower limbs, activities of daily living, and cognition (overall cognition, language, processing speed, learning and memory, and visual spatial cognition). Results Enrollment for the study started in May 2015. It is planned to complete postassessments by the beginning of 2017. Results are expected to be available in the first half of 2017. Conclusions This study will contribute to enhancing evidence for the effects of physical activity on motor and cognitive skills in IWD. Compared to previous studies, this study is characterized by a dementia-specific intervention based on scientific knowledge, a combination of motor and cognitive tasks in the intervention, and high standards regarding methodology. Findings are highly relevant to influence the multiple motor and cognitive impairments of IWD who are often participating in limited physical activity. Trial Registration German Clinical Trials Register DRKS00010538; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00010538 (Archived by WebCite at http://www.webcitation.org/6oVGMbbMD)

Context matters! The relationship between mother-reported family nutrition climate, general parenting, food parenting practices and children's BMI

BackgroundEfforts to explain children’s nutrition behavior or weight often involve investigating the parent-child relationship, typically studying the associations between food parenting practices (FPPs) and child outcomes. However, these behaviors are embedded in a broader system: general parenting (GP, the general emotional climate at home), and the family health climate (an aspect of the broader family system in the context of health). In the current study, we combined the parent-child measures of parenting (FPPs and GP) and the nutritional dimension of the family health climate (family nutrition climate, FNC) to get a broader view of how these concepts are interrelated. The current study had two aims: predicting FPPs using GP and FNC as predictor variables, and investigating the relationship between FPPs and children’s weight in different groups of parents, based on low and high GP and FNC scores.MethodsWe collected cross-sectional data via an online survey panel. Mothers of 267 children aged 5–12 years filled out a questionnaire assessing demographics (e.g., children’s weight and height), GP, FPPs, and FNC. Bivariate correlation coefficients were calculated between all constructs. Structural equation modeling was performed to test the hypothesized relationships between GP, FNC and FPPs. Hereafter, different groups of parents were identified, using median split, based on a low or high score on GP or a low or high score on FNC. Bivariate correlation coefficients were calculated between FPPs and children’s BMI z-score for these different groups.ResultsGP and FNC were consistently positively correlated (all r’s ≥.177), and both concepts were positively associated with healthy FPPs (all r’s ≥.214). In families with a positive context (i.e. scoring high on GP and on FNC), healthy FPPs were associated with lower BMI z-scores of the children (r -.229). This association was not found for children with a more negative family context.ConclusionsFNC and GP are valuable additional concepts to investigate relationships between FPPs and child outcomes. We recommend that more studies, next to investigating the parent-child system, include a measure of the broader family system, in order to get a broader view of the mechanisms explaining child health behaviors and weight status.

Deutsche Übersetzung der COPD Self-Efficacy Scale: Entwicklung und Validierung einer Kurzform

Illness-specific self-efficacy is important in the disease-management of patients with COPD (Chronic Obstructive Pulmonary Disease). Nevertheless, there is no instrument to measure the illness-specific self-efficacy in the German speaking countries. The purposes of the study were to translate the COPD Self-Efficacy Scale (CSES) into German (CSES-D) and to determine the psychometric criteria. Another objective was to construct a short form of the CSES-D. A total of 199 participants with COPD were recruited. The factorial structure of the CSES including 5 dimensions could not be confirmed with exploratory and confirmatory factor analyses. However, the short form of the CSES-D indicated acceptable fit indices. The internal consistencies of the subscales psychological stress (α=0.95) and physical exertion (α=0.92) were good. The correlations between the CSES-Dkurz and convergent and discriminant questionnaires confirmed the validity of the instrument. The results indicate that the CSES-Dkurz is a valid and reliable instrument to assess illness-specific self-efficacy of COPD-patients. Further, studies are needed to verify the factorial construct validity of the CSES-Dkurz.