I. De Bourdeaudhuij

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.

Reliability and validity of a questionnaire to measure personal, social and environmental correlates of fruit and vegetable intake in 10-11-year-old children in five European countries

OBJECTIVES To investigate the internal consistency of the scales and the test-retest reliability and predictive validity of behaviour theory-based constructs measuring personal, social and environmental correlates of fruit and vegetable intake in 10-11-year-old children. DESIGN Test-retest with one-week interval. SETTING Five European countries: Norway, Spain, Denmark, Portugal, Belgium. SUBJECTS Three hundred and twenty-six children completed the questionnaire during class hours. RESULTS For the total sample across all countries, the test-retest reliability was good to very good (intra-class correlation coefficient (ICC) >0.60) for 12 out of the 15 fruit constructs and also for 12 out of the 15 vegetable constructs. Acceptable ICCs, ranging between 0.50 and 0.59, were found for the remaining constructs. Test-retest reliability was comparable across countries. Only in Portugal were some significantly lower ICCs found for some constructs (knowledge and barriers related to fruit, general self-efficacy related to fruit and vegetables) compared with the other countries. Cronbachs alpha values were moderate to high (range 0.52 to 0.89) with the exception of the general self-efficacy scale, which had a value below 0.50 for both fruit (alpha=0.42) and vegetables (alpha=0.49). Spearman correlations with intake ranged between -0.16 and 0.54 for personal determinants and between 0.05 and 0.38 for environmental determinants. Compared with other studies, predictive validity can be considered moderate to good. CONCLUSIONS The questionnaire provides a reliable, valid and easy-to-administer tool for assessing personal, social and environmental factors of potential influence on fruit and vegetable intake in 10-11-year-olds.

The contribution of psychosocial and home environmental factors in explaining eating behaviours in adolescents

Objective:The present study aimed at investigating the influence of food availability, rules and television viewing habits on eating behaviours in adolescents.Design:Cross-sectional study.Setting:Four randomly selected middle schools.Subjects:A sample of 534 seventh and eighth graders.Interventions:Validated questionnaires were used to measure the family environment and fat, soft drink and fruit consumption. Hierarchical regression analyses on fat, soft drink and fruit consumption, with demographic and psychosocial variables entered as the first and environmental factors as the second block were conducted in boys and girls.Results:Boys with more unhealthy products available at home consumed more fat (P⩽0.001, 95% CI: 8.2–29.4) and more soft drinks (P⩽0.01, 95% CI: 0.2–1.4). Boys who reported better television viewing habits ate more fruit (P⩽0.001, 95% CI: −1.7 to −0.5). Girls who reported better television viewing habits consumed less fat (P⩽0.01, 95% CI: 1.4–9.0) and more fruit (P⩽0.05, 95% CI: −1.0 to −0.1). Girls who reported higher availability of healthy products at home (P⩽0.05, 95% CI: 0.3–3.1) and more food rules (P⩽0.001, 95% CI: −1.8 to −0.5), consumed more fruit. Environmental factors were poor predictors of soft drink consumption among girls.Conclusion:Availability of (un)healthy food products, family food rules and TV viewing habits were related to one or more eating behaviours in boys or girls. Although home environmental factors can play an important role in influencing adolescents’ eating behaviours, these factors were generally less predictive than demographic and psychosocial variables.Sponsorship:Ghent University and Policy Research Centre Sport, Physical Activity and Health funded by the Flemish Government.

A longitudinal analysis of gross motor coordination in overweight and obese children versus normal-weight peers

Background:The relationship of childhood overweight (OW) and obesity (OB) with motor skill and coordination is gaining due attention; however, longitudinal evidence is currently lacking.Objective:The dual purpose of this study was (1) to investigate the short-term evolution in the level of gross motor coordination according to childrens weight status, and (2) to identify those factors predicting their gross motor coordination performance over a 2-year interval.Subjects:Participants were 50 children with OW, including 8 with OB (aged 6–10 years at baseline, with 52% boys), and 50 with normal-weight (NW) matched for gender and age.Measurements:Anthropometrics (body height, body weight, body mass index (BMI), %body fat) and level of gross motor coordination (Körperkoordinationstest für Kinder, KTK) were assessed in 2007 (baseline) and 2 years later in 2009 (follow-up). At baseline, participants completed a survey based on the Flemish Physical Activity Questionnaire (FPAQ) to obtain socio-demographic information and to determine physical activity levels in diverse domains.Results:The evolution in the level of gross motor coordination over time was strongly related to childrens weight status. Participants in the NW group showed more progress than their OW/OB peers, who demonstrated significantly poorer performances. Accordingly, between-group differences in KTK outcomes (that is, raw item scores and total motor quotient) became more evident over time. Multiple linear regression analysis further indicated that, in addition to BMI per se (negative predictor), participation in organized sports within a sports club (positive predictor) determines gross motor coordination performance(s) 2 years later.Conclusion:Our results provide conclusive evidence for an increasingly widening gap of OW/OB childrens gross motor coordination relative to NW peers across developmental time in the absence of targeted initiatives. Special attention is thus needed for OW/OB children, especially for those not practicing sports in a club environment, in terms of motor skill improvement to promote regular participation in physical activity.

Personal, social and environmental predictors of daily fruit and vegetable intake in 11-year-old children in nine European countries

Objective:To investigate potential personal, social and physical environmental predictors of daily fruit intake and daily vegetable intake in 11-year-old boys and girls in nine European countries.Subjects:The total sample size was 13 305 (90.4% participation rate).Results:Overall, 43.2% of the children reported to eat fruit every day, 46.1% reported to eat vegetables every day. Daily fruit intake and daily vegetable intake was mainly associated with knowledge of the national recommendations, positive self-efficacy, positive liking and preference, parental modeling and demand and bringing fruit to school (odds ratio between 1.40 and 2.42, P<0.02). These factors were associated fairly consistently with daily fruit intake across all nine European countries, implying that a rather uniform intervention strategy to promote fruit can be used across Europe. For vegetables, the pattern was, however, less consistent. Differences between countries in cooking and preparing vegetables might be responsible for this larger diversity.Conclusions:This study showed that especially a combination of personal and social factors is related to daily fruit and vegetable intake in schoolchildren. This shows that a comprehensive multilevel intervention strategy based upon a series of individual and social correlates will be most promising in the promotion of daily fruit and vegetable intake in children.

Intrinsic risk factors for inversion ankle sprains in females – a prospective study

Ankle sprains are extremely common. However, very little is known about the variables that predispose individuals to these injuries. The purpose of this study was to examine prospectively intrinsic risk factors for inversion sprains in a young physically active female population. One hundred and fifty‐nine female physical education students were evaluated for several possible intrinsic risk factors for inversion sprains at the beginning of their academic study. The evaluated intrinsic risk factors included anthropometrical and physical characteristics, ankle joint position sense, isokinetic ankle muscle strength, lower leg alignment characteristics, postural control and muscle reaction time during a sudden inversion perturbation. All sports injuries were registered during 1–3 years and exposure to sport was recorded (mean: 15.33±4.33 h a week). Thirty‐two (20%) of the 159 females sprained their ankle. The number of ankle sprains per 1000 h of sports exposure was 0.75. The Cox regression analysis revealed that females with less accurate passive joint inversion position sense [hazard ratio (HR): 1.08, 95% confidence interval (CI): 1.02–1.14 for absolute error at 15° inversion], a higher extension range of motion at the first metatarsophalangeal joint (HR: 1.03, 95% CI: 1.00–1.06) and less coordination of postural control (HR: 0.96, 95% CI: 0.93–1.00 for endpoint excursion; HR: 0.94, 95% CI: 0.89–0.99 for maximal endpoint excursion) are at greater risk of an ankle sprain. The findings of this study suggest that effective prevention and conservative rehabilitation of ankle inversion sprains should include attention to these variables.

Correlates of energy balance-related behaviours in preschool children: a systematic review.

Childhood overweight is a multifactorial health problem influenced by several factors. The interaction of behaviours such as physical activity, sedentary behaviour and eating behaviour determines whether or not a positive energy balance or weight gain is experienced. Knowing the correlates of these behaviours in 4‐ to 6‐year‐old children is of major interest for intervention development. According to the systematic literature search, attending a rural preschool was positively associated with physical activity. Gender, age and socioeconomic status were not associated with physical activity, while an indeterminate result was found for ethnicity. Gender and ethnicity were not associated with sedentary behaviour and indeterminate results were found for age and socioeconomic status. Preschoolers were more physically active as well as sedentary on weekdays. Watching television was associated with a higher consumption of snacks and sweet beverages. Strategies aiming to influence energy balance‐related behaviours in preschoolers should target both boys and girls and all ethnic groups from low as well as high social status. During the week, there should be a focus on decreasing sedentary behaviour and in the weekend on increasing physical activity. Focusing on television viewing and the consumption of snacks and sweet beverages could/should also be a strategy.

The IDEFICS community-oriented intervention programme: a new model for childhood obesity prevention in Europe?

Background and objectives:The European Union—as well as other parts of the world—faces a major challenge of increasing incidence of overweight/obesity. In particular, the increase in childhood obesity gives rise to a strong imperative for immediate action. Yet, little is known about the effectiveness of community interventions, and further research in this field is needed. There is, however, a growing consensus that such research should start from the paradigm that the current living environments tend to counteract healthy lifestyles. Questioning these environments thoroughly can help to develop new pathways for sustainable health-promoting communities. Against this background, the IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study developed and implemented innovative community-oriented intervention programmes for obesity prevention and healthy lifestyle primarily in children aged 2–10 years in eight European countries: Sweden, Estonia, Germany, Belgium, Hungary, Italy, Spain and Cyprus.Materials and methods:The IDEFICS community-oriented intervention study mobilised an integrated set of interventional efforts at different levels of society, with the aim of facilitating the adoption of a healthy obesity-preventing lifestyle. The overall programme has been composed of 10 modules: three at community level, six at school level and one for parents. The main focus was on diet, physical activity and stress-coping capacity. The sphere of action encompassed both children and their (grand) parents, schools, local public authorities and influential stakeholders in the community. All materials for the interventions were centrally developed and culturally adapted.Results:So far, the following has been achieved: focus group research, literature review and expert consultations were done in an early phase as a basis for the development of the intervention modules. The intervention mapping protocol was followed as guide for structuring the intervention research. The overall intervention programmes duration was 2 years, but a longer-term follow-up programme is under development.Conclusions:This large-scale European effort is expected to contribute significantly to the understanding of this major public health challenge.

Weight status of European preschool children and associations with family demographics and energy balance‐related behaviours: a pooled analysis of six European studies

This study aimed to (i) gain insight in the prevalence of overweight indices in European preschoolers (4–7 years); (ii) identify energy balance‐related behaviours associated with overweight/obesity; and (iii) identify children at risk for overweight/obesity. Secondary analyses of six European data sets were conducted according to standardized protocols. Based on objectively measured height and weight, prevalence of overweight and obesity across the countries ranged from 8% to 30% and 1% to 13%, respectively, with highest rates in Southern European countries (i.e. Spain and Greece). Positive associations between sedentary behaviours and overweight indices were found. Physical activity and dietary behaviours were not associated, possibly because of methodological limitations. Children of parents with high body mass index or low socioeconomic status were at increased risk of overweight/obesity. In conclusion, large differences in prevalence of overweight and obesity among preschoolers across Europe were observed. Future obesity prevention interventions in preschoolers should target screen time giving specific attention to children from overweight and/or low socioeconomic status parents. There is a need for high methodological quality studies, preferably with a long‐term prospective design using sensitive, valid and reliable measures of behaviours, assessing whether and which physical activity and dietary behaviours are associated with overweight in preschoolers.

Perceived social and physical environmental correlates of physical activity in older adolescents and the moderating effect of self-efficacy.

OBJECTIVE To determine if perceptions of the social and physical environment are associated with active transport and leisure-time sports among Belgian youth and to investigate if this relationship is moderated by self-efficacy. METHODS In February-May 2008, 1445 adolescents (17.4+/-0.6 yrs) were recruited in 20 randomly selected Belgian schools. Physical activity, psychosocial, and environmental factors were assessed using validated questionnaires. Moderated multilevel regression analysis was used to examine the association between physical activity and possible correlates. RESULTS Social environmental variables (modeling and social support) were positively associated with active transportation and leisure-time sports (p<0.05). Higher land use mix diversity, higher street connectivity, more attractive environments, better access to recreational facilities, and higher emotional satisfaction with the neighborhood were associated with more active transportation (p<0.05). Higher perceived safety from traffic, better access to recreational facilities, more physical activity equipment at home, and fewer electronic devices in the bedroom were associated with more leisure-time sports (p<0.05). Lower perceived safety and poorer access to (recreational) facilities were only associated with lower active transport among youth with lower self-efficacy (p<0.05). CONCLUSION Creating more supportive environments could have the potential to affect the physical activity levels of Belgian adolescents with both high and low self-efficacy.