Johan de Jong

Equity-specific effects of 26 Dutch obesity-related lifestyle interventions

CONTEXTnReducing health inequalities is a policy priority in many developed countries. Little is known about effective strategies to reduce inequalities in obesity and its underlying behaviors. The goal of the study was to investigate differential effectiveness of interventions aimed at obesity prevention, the promotion of physical activity or a healthy diet by SES.nnnEVIDENCE ACQUISITIONnSubgroup analyses in 2010 and 2011 of 26 Dutch studies funded by The Netherlands Organization for Health Research and Development after 1990 (n=17) or identified by expert contact (n=9). Methodologic quality and differential effects were synthesized in harvest plots, subdivided by setting, age group, intensity, and time to follow-up.nnnEVIDENCE SYNTHESISnSeven lifestyle interventions were rated more effective and four less effective in groups with high SES; for 15 studies no differential effects could be demonstrated. One study in the healthcare setting showed comparable effects in both socioeconomic groups. The only mass media campaign provided modest evidence for higher effectiveness among those with high SES. Individually tailored and workplace interventions were either more effective in higher-SES groups (n=4) or no differential effects were demonstrated (n=9). School-based studies (n=7) showed mixed results. Two of six community studies provided evidence for better effectiveness in lower-SES groups; none were more effective in higher-SES groups. One high-intensity community-based study provided best evidence for higher effectiveness in low-SES groups.nnnCONCLUSIONSnAlthough for the majority of interventions aimed at obesity prevention, the promotion of physical activity, or a healthy diet, no differential effectiveness could be demonstrated, interventions may widen as well as reduce socioeconomic inequalities in these outcomes. Equity-specific subgroup analyses contribute to needed knowledge about what may work to reduce socioeconomic inequalities in obesity and underlying health behaviors.

The Groningen Active Living Model, an example of successful recruitment of sedentary and underactive older adults

OBJECTIVEnMany physical activity interventions do not reach those people who would benefit the most from them. The Groningen Active Living Model (GALM) was successful in recruiting sedentary and underactive older adults.nnnMETHODnIn the fall of 2000 older adults in three municipalities in the Netherlands received written information, were visited at home and, if eligible according to the GALM recruitment criteria, filled in the Stages of Change questionnaire and the Voorrips physical activity questionnaire.nnnRESULTSnBy using the strategy we succeeded in including 12.3% of the older adults (315 of the 2551 qualifying participants), 79.4% of whom could be indeed regarded as sedentary or underactive. These results can be considered in line with results described in the literature. The cost of successfully recruiting an older adult was estimated at

Lifestyle Approaches for People With Intellectual Disabilities: A Systematic Multiple Case Analysis

84.nnnCONCLUSIONSnThe GALM recruitment strategy is a potentially useful and effective method for reaching community-dwelling sedentary and underactive older adults.

Deelname aan een sport- en spelprogramma ter verbetering van de cardiorespiratoire fitheid bij ouderen

BACKGROUNDnHealth care organizations supporting individuals with intellectual disabilities (IDs) carry out a range of interventions to support and improve a healthy lifestyle. However, it is difficult to implement an active and healthy lifestyle into daily support. The presence of numerous intervention components, multiple levels of influence, and the explicit use of theory are factors that are considered to be essential for implementation in practice. A comprehensive written lifestyle policy provides for sustainability of a lifestyle approach. It is unknown to what extent these crucial factors for successful implementation are taken into consideration by health care organizations supporting this population.nnnAIMnTo analyze the intervention components, levels of influence, explicit use of theory, and conditions for sustainability of currently used lifestyle interventions within lifestyle approaches aiming at physical activity and nutrition in health care organizations supporting people with ID.nnnMETHODSnIn this descriptive multiple case study of 9 health care organizations, qualitative data of the lifestyle approaches with accompanying interventions and their components were compiled with a newly developed online inventory form.nnnRESULTSnFrom 9 health care organizations, 59 interventions were included, of which 31% aimed to improve physical activity, 10% nutrition, and 59% a combination of both. Most (49%) interventions aimed at the educational component and less at daily (19%) and generic activities (16%) and the evaluation component (16%). Most interventions targeted individuals with ID and the professionals whereas social levels were underrepresented. Although 52% of the interventions were structurally embedded, only 10 of the 59 interventions were theory-driven.nnnCONCLUSIONnHealth care organizations could improve their lifestyle approaches by using an explicit theoretical basis by expanding the current focus of the interventions that primarily concentrate on their clients and professionals toward also targeting the social and external environment as well as the introduction of a written lifestyle policy. This policy should encompass all interventions and should be the responsibility of those in the organization working with individuals with ID. In conclusion, comprehensive, integrated, and theory-driven approaches at multiple levels should be promoted.

Decrease in heart rate after longitudinal participation in the Groningen Active Living Model (GALM) recreational sports programme

Het doel van deze studie was het bepalen van de veranderingen in hartslag tijdens submaximale inspanning, als maat voor het cardiorespiratoire functioneren van ouderen die deelnemen aan een veelzijdig sport- en spelprogramma. Gedurende twee jaar volgden 151 deelnemers het sport- en spelprogramma en werden de veranderingen in hartslag tijdens submaximale inspanning (wandelsnelheden), als maat voor het cardiorespiratoire functioneren, geanalyseerd. Van de baseline- tot de laatste follow-upmeting werden significante afnamen in de gemiddelde hartslag gevonden van 5,5, 6,0, 10,0 en 9,0 slagen per minuut bij wandelsnelheden van 4, 5, 6 en 7 km/uur, hetgeen overeenkomt met relatieve afnamen van 5,1 tot 7,4 procent. Deze resultaten duiden op een potentiele verbetering van het cardiorespiratoire functioneren van ouderen na deelname aan het sport- en spelprogramma.

Six-month effects of the Groningen Active Living Model (GALM) on physical activity, health, and fitness outcomes in sedentary and underactive older adults aged 55-65

Abstract The aim of this study was to investigate changes in heart rate during submaximal exercise as an index of cardiovascular function in older adults participating in the Groningen Active Living Model recreational sports programme who were sedentary or underactive at baseline. A repeated measurement design was conducted; 151 participants were included, providing 398 heart rate files over a period of 18 months. Multi-level analyses were conducted; growth and final models were developed. Significant decreases in mean heart rate over time were observed for all walking speeds. The covariates of sex and body mass index (BMI) were significantly related to mean heart rate at each walking speed, except for BMI at 7 km · h−1. No significant relationships were observed between energy expenditure for recreational sports activities and leisure-time physical activities and mean heart rate, except for energy expenditure for leisure-time physical activities at 7 km · h−1. From baseline to December 2002, decreases in predicted mean heart rate were 5.5, 6.0, 10.0, and 9.0 beats · min−1 at walking speeds of 4, 5, 6, and 7 km · h−1; relative decreases ranged from 5.1 to 7.4%. Significant decreases in heart rate observed during submaximal exercise reflected a potential increase in cardiovascular function after 18 months of participation in the Groningen Active Living Model recreational sports programme.