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A Belgian updated consensus on the assessment and management of obesity. Obesity is the most prevalent chronic disease worldwide. The negative impacts of weight excess and obesity are considerable at the individual and collective levels, spreading across physical, mental, quality-of-life, societal and economic aspects. To give an example, only considering the economic burden of this health problem, a recent analysis estimated that weight excess reduces gross domestic product by 3.3% in OECD countries and those developed countries will spend 8.4% of their health budget to treat the consequences of excess weight.1 Fortunately, there are also favorable prospects for this health problem. The same analysis predicted that every single US dollar invested in addressing overweight will result in 5.6 US dollars of return in terms of economic benefits. At the individual level, it is proven that obesity management programs can improve or revert many symptoms or co-morbidities associated with obesity. [...]

INTRODUCTION AND HYPOTHESIS The prevalence of female stress urinary incontinence is high, and young adults are also affected, including athletes, especially those involved in "high-impact" sports. To date there have been almost no studies testing pelvic floor muscle (PFM) activity during dynamic functional whole body movements. The aim of this study was the description and reliability test of PFM activity and time variables during running. METHODS A prospective cross-sectional study including ten healthy female subjects was designed with the focus on the intra-session test-retest reliability of PFM activity and time variables during running derived from electromyography (EMG) and accelerometry. RESULTS Thirteen variables were identified based on ten steps of each subject: Six EMG variables showed good reliability (ICC 0.906-0.942) and seven time variables did not show good reliability (ICC 0.113-0.731). Time variables (e.g. time difference between heel strike and maximal acceleration of vaginal accelerator) showed low reliability. However, relevant PFM EMG variables during running (e.g., pre-activation, minimal and maximal activity) could be identified and showed good reliability. CONCLUSION Further adaptations regarding measurement methods should be tested to gain better control of the kinetics and kinematics of the EMG probe and accelerometers. To our knowledge this is the first study to test the reliability of PFM activity and time variables during dynamic functional whole body movements. More knowledge of PFM activity and time variables may help to provide a deeper insight into physical strain with high force impacts and important functional reflexive contraction patterns of PFM to maintain or to restore continence.

PURPOSE: Electric bicycles (e-bikes) may offer an opportunity to stimulate physical activity among older adults. The current study compared Flemish (Belgian) older e-bike users with those not using an e-bike on sociodemographics, health characteristics, and access to motorized transport. In addition, it examined the association between e-bike use and levels of cycling and the moderating effects of sex, body mass index (BMI), and cycling limitations. METHODS: An online or interview version of the same questionnaire was completed by 1146 participants. Data were analyzed using logistic regression and hurdle models. RESULTS: Women, those with a higher BMI, and those with one (compared with no) motorized vehicle in the household had higher odds of being an e-bike user. E-bike use was related to higher odds of having cycled for transport in the past week, and this relationship was stronger among those with a higher BMI (low BMI: odds ratio, 1.89; 95% confidence interval (CI), 1.24-2.91; high BMI: odds ratio, 3.34; 95% CI, 2.26-5.00). Among those who cycled for transport in the last week, e-bike use was associated with 35% more minutes of cycling for transport (95% CI, 17%-56%). E-bike use was related to 183% higher odds of having biked for recreation (95% CI, 115%-274%). Among women and those with cycling limitations who cycled for recreation in the last week, e-bike use was also related to 57% (95% CI, 18%-109%) and 180% (95% CI, 63%-381%) more minutes of cycling for recreation, respectively. CONCLUSION: E-bikes may provide an opportunity to promote cycling among older adults, particularly among subgroups at risk for physical inactivity.

In 2008, Stodden and colleagues took a unique developmental approach toward addressing the potential role of motor competence in promoting positive or negative trajectories of physical activity, health-related fitness, and weight status. The conceptual model proposed synergistic relationships among physical activity, motor competence, perceived motor competence, health-related physical fit ness, and obesity with associations hypothesized to strengthen over time. At the time the model was proposed, limited evidence was available to support or refute the model hypotheses. Over the past 6 years, the number of investigations exploring these relationships has increased significantly. Thus, it is an appropriate time to examine published data that directly or indirectly relate to specific pathways noted in the conceptual model. Evidence indi cates that motor competence is positively associated with perceived competence and multiple aspects of health (i.e., physical activity, cardiorespiratory fitness, muscular strength, muscular endurance, and a healthy weight status). However, questions related to the increased strength of associations across time and antecedent/consequent mech anisms remain. An individual’s physical and psychological development is a complex and multifaceted process that synergistically evolves across time. Understanding the most salient factors that influence health and well-being and how relationships among these factors change across time is a critical need for future research in this area. This knowledge could aid in addressing the declining levels of physical activity and fitness along with the increasing rates of obesity across childhood and adolescence. 4811-99FE-2ECD | Luis Paulo Rodrigues info:eu-repo/semantics/publishedVersion

BACKGROUND: Efficacy studies concerning robot assisted gait rehabilitation showed limited clinical benefits. A changed kinematic pattern might be responsible for this. Little is known about the kinematics of the trunk and pelvis during robot assisted treadmill walking (RATW). OBJECTIVE: The aim of this studywas to assess the trunk and pelvis kinematics of healthy subjects during RATW, with different amounts of body weight support (BWS) compared to regular treadmill walking (TW). METHOD: Eighteen healthy participants walked on a treadmill, while kinematics were registered by an electromagnetic tracking device. Hereafter, the kinematics of pelvis and trunk were registered during RATW (guidance force 30%) with 0%, 30% and 50% BWS. RESULTS: Compared to TW, RATW showed a decrease in the following trunk movements: axial rotation, anteroposterior flexion, lateral and anteroposterior translation. Besides, a decrease in lateral tilting and all translation of the pelvis was found when comparing RATW with TW. Furthermore, the anteroposterior tilting of the pelvis increased during RATW. CONCLUSION: In general, there was a decrease in trunk and pelvis movement amplitude during RATW compared with regular TW. Though, it is not known if these changes are responsible for the limited efficacy of robot assisted gait rehabilitation. Further research is indicated. Keywords: Kinematics, trunk, robotics, gait, rehabilitation

Active transport might be well suited to counteract the decrease in physical activity and the increase in weight gain in students and working young adults (18–25 years). To promote active transport in this neglected age group, knowledge of factors influencing all transport modes is needed. Focus groups were used to explore factors influencing transport choice of studying and working young adults, for short distance travel to various destinations. Nineteen students (mean age of 21±1.1 years) and 17 working young adults (mean age of 23±1.5 years) were recruited. Three focus groups were conducted with students and three with working young adults. Content analysis was performed using NVivo 9 software (QSR International). Grounded theory was used to derive categories and subcategories. Young adults talked about several factors that influence transport choice, which could be categorized in three themes: Personal factors, social factors and physical environmental factors. Some factors were reported as very important for choosing between transport modes, such as autonomy, travel time, financial cost and vehicle ownership; some as less important, such as the built environment and perceived safety and some as not important at all, such as ecology and health. Most factors were discussed by both students and working young adults, but some differences were found between the two groups, mainly based on income and living situation. When promoting active transport in young adults, health benefits or ecological benefits should not be emphasized. Focus should be put on cycling instead of walking, on flexibility, speed, good social support and low costs. Also, more bicycle storage and workplace facilities should be provided. It should be avoided that young adults own a private car and the public transport system should be optimized to fit their needs.

Objective: This explorative study examined potential performance indicators through a correlational analysis between morphological measures and international ranking within each alpine ski event for each gender separately. Methods: A cross-sectional sample of 58 elite alpine skiers were allocated into a technical or speed event group based on their international ski rankings. Several two-way (2 * 2) (M)ANOVA’s were used to examine the effect of gender and event group on age, BMI, sum of 6 skinfolds and somatotype. Forward stepwise discriminant analysis selected the most discriminating somatotype component between gender and/or event. Bivariate Pearson correlations between registered variables and international rankings per alpine ski event were examined for each gender separately. Results: Female speed specialists possessed more relative fat mass (P = 0.022) than female technical specialists. Irrespective of gender, technical specialists were lighter (P < 0.001) and had less relative fat mass than speed specialists (P = 0.008). Pearson values indicated moderate associations between speed rankings and body weight. High female speed rankings were associated with higher relative fat mass. High male speed rankings were associated with lower ectomorphy. Conclusion: Additional body weight appears to be beneficial in SPEED events. Fat mass correlated positively with higher rankings of female SPEED specialists. This observation should be monitored in female alpine skiers so that performance thresholds of relative body fat can be determined.

Background: Qualitative research is a method in which new ideas and strategies can be discovered. This qualitative study aimed to investigate parents’ and teachers’ opinions on physical activity and beverage consumption of preschool children. Through separate, independent focus groups, they expressed their perceptions on children’s current physical activity and beverage consumption levels, factors that influence and enhance these behaviours, and anticipated barriers to making changes. Methods: Multi-cultural and multi-geographical focus groups were carried out in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain). In total, twenty-four focus groups with 122 parents and eighteen focus groups with 87 teachers were conducted between October 2010 and January 2011. Based on a semi-structured interview guide, questions on preschoolers’ physical activity (opinions on preschoolers’ physical factivity, how to increase physical activity, facilitators and barriers of physical activity) and beverage consumption (rules and policies, factors influencing promotion of healthy drinking, recommendations for future intervention development) were asked. The information was analyzed using qualitative data analysis software (NVivo8). Results: The focus group results indicated misperceptions of caregivers on preschoolers’ physical activity and beverage consumption levels. Caregivers perceived preschoolers as sufficiently active; they argue that children need to learn to sit still in preparation for primary school. At most preschools, children can drink only water. In some preschools sugar-sweetened beverages like chocolate milk or fruit juices, are also allowed. It was mentioned that sugar-sweetened beverages can be healthy due to mineral and vitamin content, although according to parents their daily intake is limited. These opinions resulted in low perceived needs to change behaviours. Conclusions: Although previous research shows need of change in obesity-related behaviours, the participants in the current study didn’t perceive such. The awareness of parents and teachers needs to be raised concerning their shared responsibility about healthy behaviours in preschoolers. Providing preschool teachers with ready-to-use classroom material will encourage them to change physical activity and beverage consumption, and to implement related activities in the classroom. Involvement in activities that their children perform at preschool will motivate parents to extend these behaviours to the home environment.

Background/aims: Regional differences in percutaneous penetration and skin properties are well documented. However, only a few studies have investigated the relationship between substance penetration and specific skin characteristics in function of the body region. It was our aim to evaluate the physiological effect of topically applied substances in function of skin parameters determined at different body regions. Methods: The characterization of the blanching response to a topically applied corticosteroid and the characterization of the erythema response to topically applied nicotinates were used as two indicators for the percutaneous penetration at selected body regions. Stratum corneum hydration, skin temperature, TEWL, the amount of skin surface lipids and perfusion of the superficial microcirculation were determined at the same body regions. Results: Significant differences in pharmacodynamic response to the corticosteroids and the nicotinates were found in function of the body region. A strong correlation was detected between the parameters characterizing the pharmacodynamic response and the particular skin properties. Conclusion: The regional differences in pharmacological response to topically applied halcinonide and nicotinates may point to a body region dependent bioavailability of the vasoactive substances in the upper skin layers. The significant relationship between the parameters characterizing the physiological skin reaction and the determined skin parameters may be an indication of their involvement in the percutaneous penetration process. These regional differences in pharmacological response seem to be independent of the physicochemical properties of the topically applied substances.

Objectives : This study examined the effect of a 10 and 20% meal price increase when choosing French fries and a 10 and 20% meal price reduction when choosing fruit for dessert on university students' purchasing behaviour in an on-campus restaurant. The moderating effect of gender was also investigated. Secondly, this study aimed at gaining further insight into reasons why these price manipulations did or did not change students' purchasing behaviour. Materials and Methods : This two-phased mixed-methods study was conducted in a Belgian on-campus university restaurant with approximately 1200 to 1300 student visitors per day. In a first phase (French fries experiment), data were collected during a control week (no price manipulation) and two separate intervention weeks (10 and 20% meal price increase when students chose French fries). In a second phase (fruit experiment), following the same protocol but carried out a few weeks later, meal prices were reduced by 10 and 20% when students chose fruit for dessert. French fries and fruit sale counts relative to the total number of items sold were used as outcome measure. Short interviews were conducted in convenient subsamples of student customers to assess influences on food choice. Key findings : Increasing the meal price by 10 and 20% when choosing French fries was associated with respective 10.9 and 21.8% absolute reductions in French fries purchases, while reducing the meal price by 10 and 20% when choosing fruit for dessert was associated with absolute increases in fruit purchases of respectively 25.1 and 42.4% (all p

Objective to describe the demographic, socioeconomic, and nutritional behaviors associated with of sugar-sweetened beverage (SSB) consumption. Design: cross-sectional. Setting: in January 2014, 26,566 military personnel, representing 84.6% of the 31,412 men and women in active service were invited to participate in an online survey. Included questions were about consumption of fruits and vegetables, meat, SSB, number of breakfasts a week, and military rank. Subjects: 7,252 military subjects. Results: mean (standard deviation) age of the participants was 45.4 (7.9) years for 6,529 males and 41.9 (8.9) years for 723 females. Mean (standard deviation) body mass index was 26.6 (3.6) kg/m2 for males and 24.5 (3.9) kg/m2 for females. The probability of consuming daily SSB decreased with age, and with increasing body mass index, being female, and being a noncommissioned officer or officer. Consumption of fruits and vegetables decreased for daily SSB consumption, but meat consumption increased. The odds r...

AIMS: A better understanding of pelvic floor muscle (PFM) activation and strength components is a prerequisite to get better insight in PFM contraction mechanisms and develop more specific PFM-training regimens for female stress urinary incontinence (SUI) patients. The aim of this systematic review (2012:CRD42012002547) was to evaluate and summarize existing studies investigating PFM activation and strength components influencing female continence and SUI. METHODS: PubMed, EMBASE, and Cochrane databases were systematically searched for literature from January 1980 to November 2013 for cross-sectional studies comparing female SUI patients with healthy controls and intervention studies with SUI patients reporting on the association between PFM activation and strength components and urine loss. Trial characteristics, evaluated PFM components, their definitions, measurement methods, study outcomes, as well as quality measures, based on the Cochrane risk of bias tool, were independently extracted. The high heterogeneity of the retrieved data made pooling of results impossible and therefore restricted the analysis to a systematic review. RESULTS: Cross-sectional studies showed group differences in favor of the continent women compared to SUI patients for PFM activation or PFM maximal strength, mean strength or sustained contraction. All intervention studies showed an improvement of PFM strength and decrease in urine loss in SUI patients after physical therapy. CONCLUSIONS: Higher PFM activation and strength components influence female continence positively. This systematic review underscored the need for a standardized PFM components' terminology (similar to rehabilitation and training science), standardized test procedures and well matched diagnostic instruments.

It has been suggested that group composition can influence the experiences of individual group members in social programmes (Weiss, 1998). The purpose of the present study was to examine the relationship between peer group composition in sports programmes and positive youth development (PYD) in disadvantaged girls, as well as to determine whether it was moderated by personal characteristics. Two hundred young women aged between 10 and 24 completed a questionnaire including, among others, the “Youth Experience Survey for Sport” (YES-S) (MacDonald, Côté, Eys, & Deakin, 2012) and questions regarding participants’ socio-economic characteristics (i.e., nationality, education, family situation). Multilevel regression analyses were performed to take into account the hierarchical data structure. At the group level, a higher percentage of girls from a low educational track and with a migration background predicted greater PYD, as indicated by higher levels of personal and social skills, cognitive skills and goal setting. Results showed interaction effects between the respondents’ family structures on the participant and team levels. The overall statistical models for the different developmental domains accounted for variance ranging from 14.7% (personal and social skills) to 30.3% (cognitive skills). Results indicated that the extent to which disadvantaged girls derive benefits from their participation in sport also depends on the group composition. The interaction effects between the group composition and individual characteristics suggest that when girls participate in a group of similar peers, those from non-intact families will derive more benefits than their counterparts from intact families.

Background: Robot-assisted gait rehabilitation has been reported to improve gait- and balance related outcome measures, but it has not been proven that its effect is superior to other gait rehabilitation methods. The trunk and pelvis are important to maintain balance during gait. Despite, scarce research has been reported concerning the importance of the trunk and the pelvis for walking. One of the questions in this context is whether body weight support (BWS) may restrict the movements of the trunk and the pelvis during robot-assisted treadmill walking, consequently leading to insufficient training of the trunk balance. Purpose: The rationales behind this work are: to investigate the influence on trunk and pelvis kinematics (1) of slower walking than normal; (2) of walking with different levels of BWS; and (3) of walking with robot assistance (Lokomat system) at different levels of BWS. Methods: After an acclimatization period (4 minutes), kinematic analyses (Polhemus LibertyTM [240 Hz]) of the trunk and pelvis movements were performed in (1) 15 young and 18 older healthy participants during walking on a treadmill at different speeds (1, 2, 3, 4 and 5 kmph); (2) in 14 persons with multiple sclerosis and 14 healthy participants during walking on a treadmill with different levels of BWS (0%, 10%, 20%; 30%, 50% and 70% BWS) and (3) in 17 healthy participants during robot-assisted treadmill walking with the Lokomat-system (0%, 30% and 50% BWS). Descriptive statistics were calculated for baseline patient characteristics; mean, standard deviation and range for continuous variables and frequencies for categorical variables. Statistical analysis consisted of a repeated measures ANOVA with significance level (α) at 5%. Results: Globally, (1) when walking slower than normal on a treadmill, the movements of the trunk and pelvis changed significantly; (2) as compared with walking without BWS, increasing percentages of BWS were accompanied by a significant restriction in trunk and pelvis movements; and (3) duringrobot-assisted treadmill walking with the Lokomat-system complemented with the use of BWS, a decrease in trunk and pelvis kinematics was found as compared with treadmill walking without robot-assistance. Conclusion: It can be concluded that walking on a treadmill at a low speed, with high amounts of BWS or with robot-assistance with the Lokomat-system, leads to significant changes in trunk and pelvis movements. These differences may have an influence on the training of trunk balance during gait rehabilitation. Implications: The results of the current studies should be taken into account in developing gait rehabilitation robots and in gait rehabilitation itself. First, it can be suggested that BWS should be restricted to patients with no or limited trunk control. Furthermore, it is advisable to decrease the amount of BWS beneath 30% as soon as patients are able to carry their own weight. Secondly, for the development of gait rehabilitation robots it is advisable to have the body weight of the person carried by the exoskeleton to avoid the pendulum effect of the BWS system.

Objective: The primary aim of this study was to describe and analyse the physical activity and sedentary levels of secondary school teachers in Flanders. A secondary aim was to collect information regarding a possible worksite intervention of special relevance to secondary school teachers. Design: Mixed-methods quantitative and qualitative enquiry. Setting: Secondary school teachers in Flanders. Method: An online survey was conducted consisting of the International Physical Activity Questionnaire, demographic information and teaching aspects. Additionally, four focus groups ( n = 27) took place. Results: Respondents reported an average of 137.2 ± 96.8 minutes/day of physical activity and an average sitting time of 4.6 ± 4.2 hours/day. Overall, 66% of Flemish teachers met the physical activity guidelines of at least 150 minutes of moderate to vigorous activity a week. Lower levels of activity were more prevalent among female teachers, teachers working in technical and general education and those teaching theoretical courses. In focus group discussions, two types of barriers were identified influencing teachers’ physical activity at school: organisational barriers such as planning and lack of accommodation, and individual barriers such as having other responsibilities. Conclusions: Interventions can be developed to target less active teachers. However, a classic worksite physical activity intervention during working hours is not suitable for most teachers. Promoting leisure-time activity and active commuting are more fitting components of an intervention for this target group. Actions at school should be achievable and unforced, supporting teachers’ development of physical literacy.

Ron Clijsen,1,2 Jean Pierre Baeyens,2 André Odilon Barel,2 Peter Clarys2 1Department of Health Sciences, University of Applied Sciences and Arts of Southern Switzerland, Landquart, Switzerland; 2Faculty ofPhysical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium Aim: There is scarce information concerning the pharmacodynamic behavior of topical substances used in the physiotherapy setting. The aim of the present study was to estimate the formation and emptying of the diclofenac (DF) skin reservoir after passive, semiocclusive, and electrically assisted applications of DF.Subjects and methods: Five different groups of healthy volunteers (ntotal=60, 23 male and 37 female), participated in this study. A 1% DF (Voltaren Emulgel) formulation (12 mg) was applied on the volar forearms on randomized defined circular skin areas of 7 cm2. DF was applied for 20 minutes under three different conditions at the same time. The presence of DF in the skin results in a reduction of the methyl nicotinate (MN) response. To estimate the bioavailability of DF in the skin, MN responses at different times following initial DF application (1.5, 6, 24, 32, 48, 72, 96, and 120 hours) were analyzed.Results: At 1.5 hours after the initial DF application, a significant decrease in MN response was detected for the occluded and iontophoretic delivery. Passive application resulted in a decrease of the MN response from 6 hours post-DF application. The inhibition remained up to 32 hours post-DF application for the iontophoretic delivery, 48 hours for the occluded application, and 72 hours for the passive delivery. At 96 and 120 hours post-DF application none of the MN responses was inhibited.Conclusion: The formation and emptying of a DF skin reservoir was found to be dependent on the DF-application mode. Penetration-enhanced delivery resulted in a faster emptying of the reservoir. Keywords: transdermal drug delivery, passive diffusion, occlusion, iontophoresis, diclofenac

This study investigated moderating effects of psychosocial factors on the association between walkability and physical activity (PA) in 433 Belgian older adults. Furthermore, main effects of psychosocial factors on PA were determined. No moderating effects were observed for the associations between walkability and transport walking, or moderate-to-vigorous PA (MVPA). Walkability was positively associated with recreational walking in those with high self-efficacy. Regarding main effects, benefits and social norm were positively associated with recreational walking. Benefits were positively and barriers were negatively associated with MVPA. There were no significant main effects for transport walking. The overall lack of moderation suggests that environmental interventions might enhance all older adults' transport walking and MVPA. Recreational walking might be enhanced by simultaneously targeting self-efficacy and neighborhood environmental factors.

Background As physical activity levels decrease as children age, sustainable and accessible forms of physical activity are needed from a young age. Transportation cycling is one such physical activity and has been associated with many benefits. The aims of the study were to identify whether manipulating micro-environmental factors (e.g. speed limits, evenness of cycle path) within a photographed street influences the perceived supportiveness for transportation cycling; and whether changing these micro-environmental factors has the same effect across different street settings. Methods We recruited 305 fifth and sixth grade children and their parents from twelve randomly selected primary schools in Flanders, Belgium. They completed a web-based questionnaire including 12 choice-based conjoint tasks, in which they had to choose between two possible routes depicted on manipulated photographs, which the child would cycle along. The routes differed in four attributes: general street setting (enclosed, half open, open), evenness of cycle path (very uneven, moderately uneven, even), speed limit (70 km/h, 50 km/h, 30 km/h) and degree of separation between a cycle path and motorised traffic (no separation, curb, hedge). Hierarchical Bayes analyses revealed the relative importance of each micro-environmental attribute across the three street settings. Results For each attribute, children and their parents chose routes that had the best alternative (i.e. open street setting, even cycle path, 30 km/h, a hedge separating the cycle path from motorised traffic). The evenness of the cycle path and lower speed limit had the largest effect for the children, while the degree of separation and lower speed limit had the largest effect for their parents. Interactions between micro-scale and macro-scale factors revealed differences in the magnitude but not direction of their effects on route choice. The results held across the different kinds of street settings tested. Conclusions Improving micro-scale attributes may increase the supportiveness of a street for children’s transportation cycling. We call for on-site research to test effects of changes in micro-environmental attributes on transportation cycling among children. Electronic supplementary material The online version of this article (doi:10.1186/s12966-015-0216-2) contains supplementary material, which is available to authorized users.

BACKGROUND: Increasing participation in transportation cycling represents a useful strategy for increasing children's physical activity levels. Knowledge on how to design environments to encourage adoption and maintenance of transportation cycling is limited and relies mainly on observational studies. The current study experimentally investigates the relative importance of micro-scale environmental factors for children's transportation cycling, as these micro-scale factors are easier to change within an existing neighborhood compared to macro-scale environmental factors (i.e. connectivity, land-use mix, …). METHODS: Researchers recruited children and their parents (n = 1232) via 45 randomly selected schools across Flanders and completed an online questionnaire which consisted of 1) demographic questions; and 2) a choice-based conjoint (CBC) task. During this task, participants chose between two photographs which we had experimentally manipulated in seven micro-scale environmental factors: type of cycle path; evenness of cycle path; traffic speed; traffic density; presence of speed bumps; environmental maintenance; and vegetation. Participants indicated which route they preferred to (let their child) cycle along. To find the relative importance of these micro-scale environmental factors, we conducted Hierarchical Bayes analyses. RESULTS: Type of cycle path emerged as the most important factor by far among both children and their parents, followed by traffic density and maintenance, and evenness of the cycle path among children. Among parents, speed limits and maintenance emerged as second most important, followed by evenness of the cycle path, and traffic density. CONCLUSION: Findings indicate that improvements in micro-scale environmental factors might be effective for increasing children's transportation cycling, since they increase the perceived supportiveness of the physical environment for transportation cycling. Investments in creating a clearly designated space for the young cyclist, separated from motorized traffic, appears to be the most effective way to increase perceived supportiveness. Future research should confirm our laboratory findings with experimental on-site research. Keywords: SR2S Language: en

The aim of this review and meta-analysis was to critically determine the possible effects of different cooling applications, compared to non-cooling, passive post-exercise strategies, on recovery characteristics after various, exhaustive exercise protocols up to 96 hours (hrs). A total of n = 36 articles were processed in this study. To establish the research question, the PICO-model, according to the PRISMA guidelines was used. The Cochrane's risk of bias tool, which was used for the quality assessment, demonstrated a high risk of performance bias and detection bias. Meta-analyses of subjective characteristics, such as delayed-onset muscle soreness (DOMS) and ratings of perceived exertion (RPE) and objective characteristics like blood plasma markers and blood plasma cytokines, were performed. Pooled data from 27 articles revealed, that cooling and especially cold water immersions affected the symptoms of DOMS significantly, compared to the control conditions after 24 hrs recovery, with a standardized mean difference (Hedges' g) of -0.75 with a 95% confidence interval (CI) of -1.20 to -0.30. This effect remained significant after 48 hrs (Hedges' g: -0.73, 95% CI: -1.20 to -0.26) and 96 hrs (Hedges' g: -0.71, 95% CI: -1.10 to -0.33). A significant difference in lowering the symptoms of RPE could only be observed after 24 hrs of recovery, favouring cooling compared to the control conditions (Hedges' g: -0.95, 95% CI: -1.89 to -0.00). There was no evidence, that cooling affects any objective recovery variable in a significant way during a 96 hrs recovery period.

Objectives To examine 1) associations between life events and changes in leisure-time physical activity (LTPA) in school leavers and 2) whether these associations are moderated by psychosocial factors. Methods Final year students (n = 440) from high schools in rural Western Australia completed annual telephone interviews on three occasions; baseline (T1), one-year follow-up (T2; n = 440) and two-year follow-up (T3; n = 374). LTPA was measured using the Minnesota Leisure-time Physical Activity Questionnaire. Life events included moving out of home, working full-time and studying full-time. Psychosocial factors included enjoyment, self-efficacy, outcome expectations, club membership, and support from family and friends. Mixed linear regression models examined the effect of life events on changes in LTPA from T1 to T2 and T1 to T3. Results A decline in LTPA across all time points was observed. Those who continued full-time education had a smaller LTPA decline than those who did not. Those who were not amember of a sporting club at T1 had greater LTPA decline if they worked full-time at T2. Conclusions There is a need for interventions to prevent declines in LTPA among school leavers, especially those who do not enter tertiary education. Encouraging sporting club membership during high school might be important.

Background Pelvic floor muscle training is effective and recommended as first-line therapy for female patients with stress urinary incontinence. However, standard pelvic floor physiotherapy concentrates on voluntary contractions even though the situations provoking stress urinary incontinence (for example, sneezing, coughing, running) require involuntary fast reflexive pelvic floor muscle contractions. Training procedures for involuntary reflexive muscle contractions are widely implemented in rehabilitation and sports but not yet in pelvic floor rehabilitation. Therefore, the research group developed a training protocol including standard physiotherapy and in addition focused on involuntary reflexive pelvic floor muscle contractions. Methods/design The aim of the planned study is to compare this newly developed physiotherapy program (experimental group) and the standard physiotherapy program (control group) regarding their effect on stress urinary incontinence. The working hypothesis is that the experimental group focusing on involuntary reflexive muscle contractions will have a higher improvement of continence measured by the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence (short form), and — regarding secondary and tertiary outcomes — higher pelvic floor muscle activity during stress urinary incontinence provoking activities, better pad-test results, higher quality of life scores (International Consultation on Incontinence Modular Questionnaire) and higher intravaginal muscle strength (digitally tested) from before to after the intervention phase. This study is designed as a prospective, triple-blinded (participant, investigator, outcome assessor), randomized controlled trial with two physiotherapy intervention groups with a 6-month follow-up including 48 stress urinary incontinent women per group. For both groups the intervention will last 16 weeks and will include 9 personal physiotherapy consultations and 78 short home training sessions (weeks 1–5 3x/week, 3x/day; weeks 6–16 3x/week, 1x/day). Thereafter both groups will continue with home training sessions (3x/week, 1x/day) until the 6-month follow-up. To compare the primary outcome, International Consultation on Incontinence Modular Questionnaire (short form) between and within the two groups at ten time points (before intervention, physiotherapy sessions 2–9, after intervention) ANOVA models for longitudinal data will be applied. Discussion This study closes a gap, as involuntary reflexive pelvic floor muscle training has not yet been included in stress urinary incontinence physiotherapy, and if shown successful could be implemented in clinical practice immediately. Trial registration NCT02318251; 4 December 2014 First patient randomized: 11 March 2015 Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1051-0) contains supplementary material, which is available to authorized users.

Background: It has been demonstrated that core strength training is an effective means to enhance trunk muscle strength (TMS) and proxies of physical fitness in youth. Of note, cross-sectional studies revealed that the inclusion of unstable elements in core strengthening exercises produced increases in trunk muscle activity and thus provide potential extra training stimuli for performance enhancement. Thus, utilizing unstable surfaces during core strength training may even produce larger performance gains. However, the effects of core strength training using unstable surfaces are unresolved in youth. This randomized controlled study specifically investigated the effects of core strength training performed on stable surfaces (CSTS) compared to unstable surfaces (CSTU) on physical fitness in school-aged children. Methods: Twenty-seven (14 girls, 13 boys) healthy subjects (mean age: 14 ± 1 years, age range: 13-15 years) were randomly assigned to a CSTS (n = 13) or a CSTU (n = 14) group. Both training programs lasted 6 weeks (2 sessions/week) and included frontal, dorsal, and lateral core exercises. During CSTU, these exercises were conducted on unstable surfaces (e.g. TOGU © DYNAIR CUSSIONS, THERA-BAND. © STABILITY TRAINER). Results: Significant main effects of Time (pre vs. post) were observed for the TMS tests (8-22%, f = 0.47-0.76), the jumping sideways test (4-5%, f = 1.07), and the Y balance test (2-3%, f = 0.46-0.49). Trends towards significance were found for the standing long jump test (1-3%, f = 0.39) and the stand-and-reach test (0-2%, f = 0.39). We could not detect any significant main effects of Group. Significant Time x Group interactions were detected for the stand-and-reach test in favour of the CSTU group (2%, f= 0.54). Conclusions: Core strength training resulted in significant increases in proxies of physical fitness in adolescents. However, CSTU as compared to CSTS had only limited additional effects (i.e. stand-and-reach test). Consequently, if the goal of training is to enhance physical fitness, then CSTU has limited advantages over CSTS. Trial registration: ClinicalTrials.gov Identifier: NCT02290457 Registered 13 November 2014., SCOPUS: ar.j, info:eu-repo/semantics/published

Background: Obese youth are at increased risk for peer victimization, which may heighten their risk of psychosocial problems and physical activity avoidance, and lower the effectiveness of professional and lifestyle weight-loss initiatives. Little is known about obese adolescents' risk for victimization from cyber-bullying and how this relates to psychosocial functioning and healthy lifestyle barriers. The purpose of the study was to assess traditional and cyber-victimization among adolescents with severe obesity and its relation to psychosocial distress and barriers to healthy lifestyles. Methods: A sample of 102 obese adolescents (mean age = 15.32 +/- 1.71) in residential treatment was matched with 102 normal-weight youngsters from the Health Behavior in School-aged Children (HBSC) study (mean age = 15.30 +/- 1.73). Results: Adolescents with obesity were significantly more often cyber-victimized than normal-weight peers. Obese youth victimized by traditional bullying experienced lower quality of life, lower motivation for physical activity and higher avoidance and emotional coping towards healthy lifestyles than those non-victimized. Obese cyber-victims experienced significantly higher suicidal ideation. Conclusions: Traditional and cyber-victimization may hinder treatment effectiveness and healthy lifestyle change in adolescents with obesity. Health professionals should pro-actively address peer victimization and psychosocial functioning during multidisciplinary obesity treatment. Schools could contribute to a better physical and psychosocial health of obese youth by implementing multi-behavioral health-promotion programs.

Until today it is not entirely clear how humans interact with automated gait rehabilitation devices and how we can, based on that interaction, maximize the effectiveness of these exoskeletons. The goal of this study was to gain knowledge on the human-robot interaction, in terms of kinematics and muscle activity, between a healthy human motor system and a powered knee exoskeleton (i.e., KNEXO). Therefore, temporal and spatial gait parameters, human joint kinematics, exoskeleton kinetics and muscle activity during four different walking trials in 10 healthy male subjects were studied. Healthy subjects can walk with KNEXO in patient-in-charge mode with some slight constraints in kinematics and muscle activity primarily due to inertia of the device. Yet, during robot-in-charge walking the muscular constraints are reversed by adding positive power to the leg swing, compensating in part this inertia. Next to that, KNEXO accurately records and replays the right knee kinematics meaning that subject-specific trajectories can be implemented as a target trajectory during assisted walking. No significant differences in the human response to the interaction with KNEXO in low and high compliant assistance could be pointed out. This is in contradiction with our hypothesis that muscle activity would decrease with increasing assistance. It seems that the differences between the parameter settings of low and high compliant control might not be sufficient to observe clear effects in healthy subjects. Moreover, we should take into account that KNEXO is a unilateral, 1 degree-of-freedom device.