Heleen Spittaels

School-based interventions promoting both physical activity and healthy eating in Europe: a systematic review within the HOPE project

It is the purpose of this study to systematically review the evidence of school‐based interventions targeting dietary and physical activity behaviour in primary (6–12 years old) and secondary school (12–18 years old) children in Europe. Eleven studies (reported in 27 articles) met the inclusion criteria, six in primary school and five in secondary school children. Interventions were evaluated in terms of behavioural determinants, behaviour (diet and physical activity) and weight‐related outcomes (body mass index [BMI] or other indicators of obesity). The results suggest that combining educational and environmental components that focus on both sides of the energy balance give better and more relevant effects. Furthermore, computer‐tailored personalized education in the classroom showed better results than a generic classroom curriculum. Environmental interventions might include organized physical activities during breaks, or before and after school; improved availability of physical activity opportunities in and around the school environment; increased physical education lesson time; improved availability or accessibility of healthy food options; and restricted availability and accessibility of unhealthy food options. More high‐quality studies are needed to assess obesity‐related interventions in Europe.

Interventions for promoting physical activity among European teenagers: a systematic review

BackgroundAlthough physical activity is considered to yield substantial health benefits, the level of physical activity among European teenagers is not sufficient. Adolescence is characterized by a decline in physical activity level. Many studies investigated the effectiveness of interventions promoting physical activity among young people, but none dealt with the available evidence specific for Europe. This review was conducted to summarize the effectiveness of interventions to promote physical activity among European teenagers.MethodsA systematic review was conducted to identify European intervention studies published in the scientific literature since 1995. Four databases were searched, reference lists were scanned and the publication lists of the authors of the retrieved articles were checked. The ANGELO framework was used to categorise the included studies by setting and by intervention components.ResultsThe literature search identified 20 relevant studies. Fifteen interventions were delivered through the school setting, of which three included a family component and another three a family and community component. One intervention was conducted within a community setting, three were delivered in primary care and one was delivered through the internet. Ten interventions included only an individual component, whereas the other ten used a multi-component approach. None of the interventions included only an environmental component.Main findings of the review were: (1) school-based interventions generally lead to short term improvements in physical activity levels; (2) improvements in physical activity levels by school-based interventions were limited to school related physical activity with no conclusive transfer to leisure time physical activity; (3) including parents appeared to enhance school-based interventions; (4) the support of peers and the influence of direct environmental changes increased the physical activity level of secondary school children; (5) the assumption that a multi-component approach should produce synergistic results can not be confirmed; (6) when interventions aimed to affect more than one health behaviour the intervention appeared to be less effective in favour of physical activity.ConclusionOverall, the current European literature supports the short-term effectiveness of school-based physical activity promotion programmes. The available evidence for the effectiveness in other settings is rather limited and underscores the need for further research.

Objectively measured sedentary time and physical activity time across the lifespan: a cross-sectional study in four age groups

BackgroundFrom a health perspective it is suggested to promote a positive balance between time spent in light intensity physical activity (LIPA) and sedentary behaviour (SB) (i.e. spending more time in LIPA than time spent in SB). However, no studies have reported prevalence rates of the LIPA-SB balance yet. The aim of this study was to objectively investigate the time spent in SB, in LIPA and moderate-to-vigorous intensity physical activity (MVPA) in four Belgian age groups and to explore which proportion of the population had a favorable balance between LIPA and SB and combined this with recommended amount of MVPA.MethodsAccelerometer data from 7 cross-sectional studies (N=2083) in four age groups (preschoolers, primary schoolchildren, secondary schoolchildren and adults) were aggregated. Differences in SB and PA between age groups and between men and women were determined by two-way MANCOVA. LIPA-SB balance was calculated and participants were categorized into one of four groups: (1) positive LIPA-SB balance (LIPA> SB) & sufficient MVPA (2) negative LIPA-SB balance & sufficient MVPA (3) positive LIPA-SB balance & insufficient MVPA (4) negative LIPA-SB balance & insufficient MVPA.ResultsFor the total sample, 55% of the waking time was spent in SB, 39% in LIPA and 6% in MVPA. Differences in SB between age groups was dependent from gender (p<0.001). Further, a positive LIPA-SB balance was assessed in 18% of the total sample and only 10% combined this positive balance with recommended amount of MVPA. Secondary schoolgirls were most at risk, with only 1% of the sample combining a positive LIPA-SB balance with sufficient MVPA. Another risk group was the large proportion (43%) of adult men who combined sufficient MVPA with a negative LIPA-SB balance.ConclusionA high proportion of the Belgian population is at risk if taking into account both SB and PA levels. Secondary schoolgirls have the unhealthiest SB and PA profile and are therefore an important target group for interventions both increasing MVPA and decreasing SB. In men more attention should be given in promoting a positive LIPA-SB balance independently from their compliance with the MVPA guidelines.

Individual, social and physical environmental correlates of 'never' and 'always' cycling to school among 10 to 12 year old children living within a 3.0 km distance from school

BackgroundCycling to school has been identified as an important target for increasing physical activity levels in children. However, knowledge about correlates of cycling to school is scarce as many studies did not make a distinction between walking and cycling to school. Moreover, correlates of cycling to school for those who live within a distance, that in theory would allow cycling to school, stay undiscovered. Therefore, this study examined individual, social and physical environmental correlates of never and always cycling to/from school among 10 to 12 year old Belgian children living within a 3.0 km distance from school.Methods850 parents completed a questionnaire to assess personal, family, behavioral, cognitive, social and physical environmental factors related to the cycling behavior of their children. Parents indicated on a question matrix how many days a week their child (1) walked, (2) cycled, was (3) driven by car or (4) public transport to and from school during fall, winter and spring. Multivariate logistic regression analyses were conducted to examine the correlates.ResultsOverall, 39.3% of children never cycled to school and 16.5% of children always cycled to school. Children with high levels of independent mobility and good cycling skills perceived by their parents were more likely to always cycle to school (resp. OR 1.06; 95% CI 1.04-1.15 and OR 1.08; 95% CI 1.01-1.16) and less likely to never cycle to school (resp. OR 0.84; 95% CI 0.78-0.91 and OR 0.77; 95% CI 0.7-0.84). Children with friends who encourage them to cycle to school were more likely to always cycle to school (OR 1.08; 95% CI 1.01-1.15) and less likely to never cycle to school (OR 0.9; 95% CI 0.83-1.0). In addition, children with parents who encourage them to cycle to school were less likely to never cycle to school (OR 0.78; 95% CI 0.7-0.87). Regarding the physical environmental factors, only neighborhood traffic safety was significantly associated with cycling: i.e., children were more likely to always cycle to school if neighborhood traffic was perceived as safe by their parents (OR 1.18; 95% CI 1.07-1.31).ConclusionIndividual, social and physical environmental factors were associated with children’s cycling behavior to/from school. However, the contribution of the physical environment is limited and highlights the fact that interventions for increasing cycling to school should not focus solely on the physical environment.

The contribution of general and cancer-related variables in explaining physical activity in a breast cancer population 3 weeks to 6 months post-treatment

Physical activity determinants are subject to change when confronted with the diagnosis of ‘cancer’ and new cancer‐related determinants appear. The aim of the present study is to compare the contribution of cancer‐related determinants with more general ones in explaining physical activity 3 weeks to 6 months post‐treatment.

Are physical activity interventions equally effective in adolescents of low and high socio-economic status (SES): results from the European Teenage project

The aim was to study whether physical activity (PA) interventions in European teenagers are equally effective in adolescents of low versus high socio-economic status (SES). Based on a systematic review (Project TEENAGE), three school-based studies for secondary analyses were selected. SES stratified analyses were run in: (i) a Belgian multi-component intervention, (ii) a French multi-component intervention and (iii) a Belgian computer-tailored education trial. Results of the secondary analyses showed that no overall significant differences between low and high SES groups were found, but some interesting specific effects were revealed. Results from the first study showed an increase in objective PA in the low SES group (P = 0.015) compared with no significant effects in the high SES group. In the second study, larger effects were found in adolescents of high SES (increase of 11 min day(-1) P < 0.001), compared with adolescents of lower SES (increase of 7 min day(-1), P = 0.02) at the longer term. The third study showed a positive effect on school-related PA in adolescents of high SES (P < 0.05) and on leisure time transportation in adolescents of low SES (P < 0.05). To conclude, we were not able to show a significant widening or narrowing of inequalities in European adolescents.

Web-based, computer-tailored, pedometer-based physical activity advice: development, dissemination through general practice, acceptability, and preliminary efficacy in a randomized controlled trial.

Background Computer tailoring is a relatively innovative and promising physical activity intervention approach. However, few computer-tailored physical activity interventions in adults have provided feedback based on pedometer use. Objectives To (1) describe the development of a Web-based, pedometer-based, computer-tailored step advice intervention, (2) report on the dissemination of this tool through general practice, (3) report on its perceived acceptability, and (4) evaluate the preliminary efficacy of this tool in comparison with a standard intervention. Methods We recruited 92 participants through general practitioners and randomly assigned them to a standard condition (receiving a pedometer-only intervention, n = 47) and a tailored condition (receiving a pedometer plus newly developed, automated, computer-tailored step advice intervention, n = 45). Step counts, self-reported data obtained via telephone interview on physical activity, time spent sitting, and body mass index were assessed at baseline and postintervention. The present sample was mostly female (54/92, 59%), highly educated (59/92, 64%), employed (65/92, 71%), and in good health (62/92, 67%). Results Recruitment through general practitioners was poor (n = 107, initial response rate 107/1737, 6.2%); however, the majority of participants (50/69, 73%) believed it is useful that general practitioners help patients find ways to increase physical activity. In the tailored condition, 30/43 (70%) participants requested the computer-tailored step advice and the majority found it understandable (21/21, 100%), credible (17/18, 94%), relevant (15/18, 83%), not too long (13/18, 72%), instructive (13/18, 72%), and encouraging to increase steps (16/24, 67%). Daily step counts increased from baseline (mean 9237, SD 3749 steps/day) to postintervention (mean 11,876, SD 4574 steps/day) in the total sample (change of 2639, 95% confidence interval 105–5172; F 1 = 5.0, P = .04). No interaction or other time effects were found. Conclusions The majority of participants in the tailored condition accepted the step advice and indicated it was useful. However, in this selected sample of adults, the tailored condition did not show superior effects compared with the standard condition.

Treatment-related and psychosocial variables in explaining physical activity in women three weeks to six months post-treatment of breast cancer

OBJECTIVE This study examined treatment-related and psychosocial variables in explaining total and leisure time physical activity in breast cancer survivors three weeks to six months post-treatment. METHODS A questionnaire was used to measure total and leisure time physical activity and relevant determinants among 464 breast cancer survivors (aged 18-65 years). RESULTS Personal control was an important overall determinant in explaining physical activity in breast cancer survivors. The impact of treatment-related variables and psychological functioning depended on the working status of the women. Fatigue and poor body image prevented non-working women from being sufficiently physically active. In working women, chemotherapy and arm problems negatively influenced physical activity, whereas therapy side-effects (headaches, hot flashes, feeling unwell) and poor body image positively influenced physical activity. Social support and coping strategies could not explain post-treatment physical activity levels. CONCLUSION Personal control, treatment-related variables and psychological functioning influenced physical activity after cancer treatment. Relations depended on the working status of the women. PRACTICE IMPLICATIONS Incorporating self-control methods in physical activity interventions after breast cancer could be helpful. Furthermore, interventions should be tailored to the experienced symptoms (fatigue, arm-problems, body image) and working status of women.

The perception of the neighborhood environment changes after participation in a pedometer based community intervention

BackgroundThe aim of this study was to investigate whether the perception of the neighbourhood environment alters when changing the physical activity behaviour through a pedometer intervention.FindingsThe intervention was implemented for 15 weeks in a small village in Germany, and was based on the individual baseline activity level. Eighty-two inhabitants participated in the study and completed an environmental questionnaire before and after the intervention. Results showed that after the intervention the participants perceived a lower distance to local facilities, a higher availability of bike lanes and infrastructures, a better maintenance of infrastructure, a better network and a safer traffic situation.ConclusionThis suggests that a change in the levels of physical activity merges the levels of exposure to the environment which results in different environmental perceptions.

Reliability and validity findings of the ALPHA environmental questionnaire in Germany

AimThe objective of this study was to test whether the recently developed ALPHA (Instruments for Assessing Levels of Physical Activity and Fitness) environmental questionnaire for Europe is a reliable and valid instrument to assess perceptions of the physical environment in a German population.Subject and methodsWe conducted a survey at the University of Stuttgart. One hundred five participants (mean age 27.5 years, SD = 9.7; 68.1% men) were contacted by e-mail and filled in a computer-assisted self-administered version of the ALPHA environmental questionnaire and of the International Physical Activity Questionnaire long version. We calculated bivariate Pearson correlations between environmental sum scores and domain—as well as intensity-specific PA. After 1 week, we contacted all participants a second time by e-mail. All in all, 42 participants answered the German version of the ALPHA environmental questionnaire twice. We calculated intra-class correlations to assess test-retest stability.ResultsMost of the scales and items of the ALPHA environmental questionnaire showed a moderate to good test-retest reliability. Domain- and intensity-specific PA correlated with different attributes of the physical environment. The correlations were low, but pointed in the expected direction.ConclusionThe computer-assisted self-administered German version of the ALPHA environmental questionnaire appears to be a recommendable instrument to assess the perceived environment of a neighborhood for young adults. More representative studies across Europe are essential to finally determine the validity and reliability of this questionnaire.