M. J. M. Chinapaw

Tracking of childhood overweight into adulthood: a systematic review of the literature.

Overweight and obesity in youth are important public health concerns and are of particular interest because of possible long‐term associations with adult weight status and morbidity. The aim of this study was to systematically review the literature and update evidence concerning persistence of childhood overweight. A computerized bibliographical search – restricted to studies with a prospective or retrospective longitudinal design – was conducted. Two authors independently extracted data and assessed the methodological quality of the included studies in four dimensions (i) study population and participation rate; (ii) study attrition; (iii) data collection and (iv) data analysis. Conclusions were based on a rating system of three levels of evidence. A total of 25 publications were selected for inclusion in this review. According to a methodological quality assessment, 13 studies were considered to be of high quality. The majority of these high‐quality studies were published after 2001, indicating that recently published data, in particular, provide us with reliable information. All included studies consistently report an increased risk of overweight and obese youth becoming overweight adults, suggesting that the likelihood of persistence of overweight into adulthood is moderate for overweight and obese youth. However, predictive values varied considerably. Limiting aspects with respect to generalizability and methodological issues are discussed.

Disagreement in physical activity assessed by accelerometer and self-report in subgroups of age, gender, education and weight status

BackgroundThe purpose of this study is to compare self-reported time (by questionnaire) and objectively measured time (by accelerometer) spent on physical activity at moderate (MPA) and vigorous intensity (VPA) in subgroups of age, gender, education and weight status.MethodsIn total, 236 adolescents (aged 12–18) and 301 adults (aged 22–40), completed the questionnaire and wore an accelerometer for two weeks.ResultsAdolescents reported exceptionally more time spent on MPA (mean difference 596 ± 704 min/wk) and VPA (mean difference 178 ± 315 min/wk) than was assessed objectively by the accelerometer. Based on the questionnaire, high educated adolescents spent more time on MPA (205 min/wk, p = 0.002) and VPA (120 min/wk, p = 0.01) than low educated adolescents, but according to the accelerometer they spent less time on MPA (149 min/wk, p = 0.001) and VPA (47 min/wk, p = 0.001). Among adults there was moderate agreement between self-reported time and objectively measured time spent on MPA, but in general the reported time spent on MPA (mean difference 107 ± 334 min/wk) and VPA (mean difference 169 ± 250 min/wk) exceeded the time measured with the accelerometer. Overweight adults reported significantly more VPA (57 min/wk, p = 0.04) than normal weight adults, but this was not confirmed by the accelerometer data.ConclusionWe observed large differences in time spent on MPA and VPA measured by questionnaire and accelerometer in adolescents but reasonably good agreement in adults. Differences between methods varied by gender, education and weight status. This finding raises serious questions about the use of questionnaires to quantify MPA and VPA in adolescents. There is a clear need in advanced valid assessments of PA in adolescents.Trial numberISRCTN93896459

Relationship between young peoples' sedentary behaviour and biomedical health indicators: a systematic review of prospective studies

The aim of this systematic review was to describe the prospective relationship between childhood sedentary behaviour and health indicators. We identified prospective studies from searches in PubMed, EMBASE, PsycInfo and Cochrane, from January 1989 through April 2010. Two reviewers independently screened the titles and abstracts for eligibility, rated the methodological quality of the studies, and extracted data.

Walking or vitamin B for cognition in older adults with mild cognitive impairment? A randomised controlled trial

Objective: To examine the effects of aerobic exercise or vitamin B supplementation on cognitive function in older adults with mild cognitive impairment (MCI). Design: Randomised placebo-controlled trial. Setting: General community. Participants: Community-dwelling adults aged 70–80 with MCI. Interventions : The 152 participants were randomly assigned to two interventions: (1) a twice-weekly, group-based, moderate-intensity walking programme (WP, n = 77) or a low-intensity placebo activity programme (n = 75) for one year; and (2) daily vitamin pill containing 5 mg folic acid, 0.4 mg vitamin B-12, 50 mg vitamin B-6 (FA/B12/B6, n = 78) or placebo pill (n = 74) for one year. Outcome measures: Cognitive function, measured with neuropsychological tests at baseline and after six and 12 months. Results: Median session attendance at the exercise programmes (25th–75th percentile) was 63% (2%–81%) and median compliance with taking pills (25th–75th percentile) was 100% (99%–100%). Gender was an effect modifier. Intention-to-treat analysis revealed no main intervention effect for either intervention. In women in the WP, attention (Stroop combination task) improved by 0.3 seconds (p = 0.04) and memory (auditory verbal learning test) by 0.04 words (p = 0.06) with each percentage increase in session attendance. In men attending at least 75% of the sessions, the WP improved memory (β 1.5 (95% CI: 0.1 to 3.0) words). Conclusion: The walking programme and/or FA/B12/B6 supplementation were not effective in improving cognition within one year. The walking programme, however, was efficacious in improving memory in men and memory and attention in women with better adherence. Trial registration: International Standard Randomised Controlled Trial Number Register, 19227688, http://www.controlled-trials.com/isrctn/

Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials

BackgroundThis study aimed to systematically review the evidence from randomized controlled trials (RCTs) and to conduct a meta-analysis of the effects of yoga on physical and psychosocial outcomes in cancer patients and survivors.MethodsA systematic literature search in ten databases was conducted in November 2011. Studies were included if they had an RCT design, focused on cancer patients or survivors, included physical postures in the yoga program, compared yoga with a non-exercise or waitlist control group, and evaluated physical and/or psychosocial outcomes. Two researchers independently rated the quality of the included RCTs, and high quality was defined as >50% of the total possible score. Effect sizes (Cohen’s d) were calculated for outcomes studied in more than three studies among patients with breast cancer using means and standard deviations of post-test scores of the intervention and control groups.ResultsSixteen publications of 13 RCTs met the inclusion criteria, of which one included patients with lymphomas and the others focused on patients with breast cancer. The median quality score was 67% (range: 22–89%). The included studies evaluated 23 physical and 20 psychosocial outcomes. Of the outcomes studied in more than three studies among patients with breast cancer, we found large reductions in distress, anxiety, and depression (d = −0.69 to −0.75), moderate reductions in fatigue (d = −0.51), moderate increases in general quality of life, emotional function and social function (d = 0.33 to 0.49), and a small increase in functional well-being (d = 0.31). Effects on physical function and sleep were small and not significant.ConclusionYoga appeared to be a feasible intervention and beneficial effects on several physical and psychosocial symptoms were reported. In patients with breast cancer, effect size on functional well-being was small, and they were moderate to large for psychosocial outcomes.

What works in school-based energy balance behaviour interventions and what does not? A systematic review of mediating mechanisms

Objective:Obesity prevention requires effective interventions targeting the so-called energy balance-related behaviours (that is, physical activity, sedentary and dietary behaviours). To improve (cost-)effectiveness of these interventions, one needs to know the working mechanisms underlying behavioural change. Mediation analyses evaluates whether an intervention works via hypothesised working mechanisms. Identifying mediators can prompt intervention developers to strengthen effective intervention components and remove/adapt ineffective components. This systematic review aims to identify psychosocial and environmental mediators of energy balance-related behaviours interventions for youth.Method:Studies were identified by a systematic search of electronic databases (Pubmed, Embase, PsycINFO, ERIC and SPORTDiscus). Studies were included if they (1) were school-based randomised controlled or quasi-experimental studies; (2) targeted energy balance behaviours; (3) conducted among children and adolescents (4–18 years of age); (4) written in English; and (5) conducted mediation analyses.Results:A total of 24 studies were included. We found strong evidence for self-efficacy and moderate evidence for intention as mediators of physical activity interventions. Indications were found for attitude, knowledge and habit strength to be mediators of dietary behaviour interventions. The few sedentary behaviour interventions reporting on mediating effects prevented us from forming strong conclusions regarding mediators of sedentary behaviour interventions. The majority of interventions failed to significantly change hypothesised mediators because of ineffective intervention strategies, low power and/or use of insensitive measures.Conclusion:Despite its importance, few studies published results of mediation analysis, and more high-quality research into relevant mediators is necessary. On the basis of the limited number of published studies, self-efficacy and intention appear to be relevant mediators for physical activity interventions. Future intervention developers are advised to provide information on the theoretical base of their intervention including the strategies applied to provide insight into which strategies are effective in changing relevant mediators. In addition, future research is advised to focus on the development, validity, reliability and sensitivity of mediator measures.

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.

Bioelectrical impedance analysis to estimate body composition in children and adolescents: a systematic review and evidence appraisal of validity, responsiveness, reliability and measurement error

Bioelectrical impedance analysis (BIA) is a practical method to estimate percentage body fat (%BF). In this systematic review, we aimed to assess validity, responsiveness, reliability and measurement error of BIA methods in estimating %BF in children and adolescents.We searched for relevant studies in Pubmed, Embase and Cochrane through November 2012. Two reviewers independently screened titles and abstracts for inclusion, extracted data and rated methodological quality of the included studies. We performed a best evidence synthesis to synthesize the results, thereby excluding studies of poor quality. We included 50 published studies. Mean differences between BIA and reference methods (gold standard [criterion validity] and convergent measures of body composition [convergent validity]) were considerable and ranged from negative to positive values, resulting in conflicting evidence for criterion validity. We found strong evidence for a good reliability, i.e. (intra‐class) correlations ≥0.82. However, test‐retest mean differences ranged from 7.5% to 13.4% of total %BF in the included study samples, indicating considerable measurement error. Our systematic review suggests that BIA is a practical method to estimate %BF in children and adolescents. However, validity and measurement error are not satisfactory.

Differences in weight status and energy-balance related behaviours according to ethnic background among adolescents in seven countries in Europe: the ENERGY-project

The aim of this study was to explore differences in weight status and energy balance behaviours according to ethnic background among adolescents across Europe.

Motor fitness in Dutch youth: Differences over a 26-year period (1980–2006)

This study aimed to compare neuromotor fitness test scores of 9-12-year-old Dutch youth in 2006 with scores of same aged children in 1980. Body height, body weight and performance on neuromotor fitness test items were measured in 2050 Dutch children from 9 to 12 years in 2006 and were compared with data of 2603 same aged Dutch children measured in 1980 with the same neuromotor fitness test battery. Dutch 9-12 year olds in 2006 were significantly taller and heavier than their peers in 1980. Age- and sex-specific performance on almost all neuromotor fitness test items was significantly worse in 2006. Thus, our data suggest that neuromotor fitness of Dutch youth has significantly decreased over the past 26 years.