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BackgroundUK and global policies recommend whole-school approaches to improve childrens’ inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective interventions, which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure ‘systems’ change, a framework is required that identifies all components of a whole-school PA approach. The study’s aim was to co-develop a whole-school PA framework using the double diamond design approach (DDDA).MethodologyFifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder (n= 9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed (n= 6) stakeholder groupings. Six draft frameworks were created before stakeholders voted for one ‘initial’ framework. Next, stakeholders reviewed the ‘initial’ framework, proposing modifications. Following the workshop, stakeholders voted on eight modifications using an online questionnaire.ResultsFollowing voting, the Creating Active Schools Framework (CAS) was designed. At the centre, ethos and practice drive school policy and vision, creating the physical and social environments in which five key stakeholder groups operate to deliver PA through seven opportunities both within and beyond school. At the top of the model, initial and in-service teacher training foster teachers’ capability, opportunity and motivation (COM-B) to deliver whole-school PA. National policy and organisations drive top-down initiatives that support or hinder whole-school PA.SummaryTo the authors’ knowledge, this is the first time practitioners, policymakers and researchers have co-designed a whole-school PA framework from initial conception. The novelty of CAS resides in identifying the multitude of interconnecting components of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, CAS presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives ‘with’ schools, while abandoning outdated traditional approaches of implementing interventions ‘on’ schools.

Both parents' and children's perception of children's weight status may be important predictors of slimming and energy-balance related behaviours, independent of children's actual weight status.; We examined the cross-sectional association of children's self-reported slimming and energy-balance related behaviours with children's (i) actual, (ii) self-perceived and (iii) parent-perceived weight status.; Data of 10- to 12-year-old European children and their parents were used. Multilevel logistic and linear regression analyses were performed, adjusting for age, gender, parental weight controlling behaviours, education, marital status and ethnicity.; Independent of their actual weight status, a higher proportion of children reported slimming when they or their parents perceived them as too fat. Children's self-perceived weight status was more strongly associated with slimming than their parents' perception or their actual weight status. Moreover, children who perceive themselves as overweight reported less physical activity and more screen time. Children whose parents perceive them as overweight reported less physical activity.; Children's own perception of their weight status appears to be more important for their self-reported slimming than their actual or their parent's perceptions of their weight status. Additionally, children's self-perceived weight status seems important in engaging more physical activity and reduces screen time.

The Daily Mile (TDM) is a school-based physical activity intervention encompassing a 15-minute run at least three times per week. This study aimed to determine (1) the effects of performing TDM for 12 weeks on Dutch primary school children&rsquo, s aerobic fitness levels and (2) if additional personal support for teachers impacted the effectiveness of TDM. Nine Dutch primary schools (n = 659 children, grades 5&ndash, 8) were allocated to a control (no TDM), intervention (12 weeks TDM) or intervention-plus (12 weeks TDM, additional personal support) group. The Shuttle Run Test (SRT) was used to assess aerobic fitness at baseline and follow-up. Data were analyzed using a multiple-imputed dataset and multilevel linear regression models to account for the clustering of students within classes and classes within schools. The regression analyses were adjusted for sex and age. Compared with the control group, significant intervention effects of TDM on SRT score were observed for the intervention group (&beta, = 1.1, 95% CI: 0.8, 1.5) and the intervention-plus group (&beta, = 0.6, 95% CI 0.3, 0.9). Additional personal support had no impact on the effectiveness of TDM. These results suggest that performing TDM at least three times per week for approximately 12 weeks increases primary school children&rsquo, s aerobic fitness. Additional personal support did not improve the effectiveness of TDM on aerobic fitness within this period. These results contribute to the body of evidence surrounding TDM, but further research is needed regarding long-term implementation of TDM.

Participation in structured physical activity is assumed to have a positive effect on cognitive and academic performance. A single bout of moderate to vigorous exercise has been found to have a small acute positive effect on the cognitive performance of children and adolescents. However, the dose-response effects of exercise duration are largely unknown. Therefore, the current study examined the acute effects of moderate-to-vigorous exercise with a duration of either 10, 20, or 30 min on selective attention and working memory performance of young adolescents. One hundred and nineteen adolescents (11–14 years old) participated in a randomized, controlled crossover study. Adolescents were assigned to one of the three exercise durations, each paired with a sedentary control session of the same duration. Cognitive performance was measured before and immediately after the exercise and control condition. The Attention Network Test and n-back task were used to measure selective attention and working memory, respectively. There were no significant exercise effects on selective attention (i.e., alerting, orienting, or executive control) or working memory performance measured immediately after the exercise bouts. Furthermore, there were no differential effects of exercise duration. In sum, acute exercise bouts with a duration of 10, 20, or 30 min did not improve, but neither deteriorate cognitive performance of young adolescents compared to a sedentary control condition.

Objective We assessed whether differences in children's sports participation and television time according to parental education were mediated by parental modeling. Moreover, we explored the differences between parental and child reports on parental sports participation and television time as potential mediators. Methods 5729 children and 5183 parents participating in the EuropeaN Energy balance Research to prevent excessive weight Gain among Youth (ENERGY-project) during 2010 in seven European countries provided information on sports participation and television time using validated self-report questionnaires. Multilevel country-specific mediation models analyzed the potential mediation effect of parental self-reports and child-reports on parental sports participation and television time. Results Significant mediation effect was found for parental self-reported television time in four countries (Greece, Hungary, The Netherlands and Slovenia), with the highest proportion for Slovenia (40%) and the lowest for Greece (21%). Child-reported parental television time showed mediation effect in Greece only. Parental self-reported sports participation showed significant mediation effect only in Greece. With child-reported parental sports participation, significant mediation was observed in Greece and Norway. Conclusions Parental behaviors appear to be important in explaining parental educational differences in children's sports participation and television time. However, child reports on parental behavior appear to be more relevant than parents' self-reports as correlates of children's own sports participation and television time.

ObjectiveTo investigate the magnitude and country-specific differences in underestimation of children’s weight status by children and their parents in Europe and to further explore its associations with family characteristics and sociodemographic factors.DesignChildren’s weight and height were objectively measured. Parental anthropometric and sociodemographic data were self-reported. Children and their parents were asked to comment on children’s weight status based on five-point Likert-type scales, ranging from ‘I am much too thin’ to ‘I am much too fat’ (children) and ‘My child’s weight is way too little’ to ‘My child’s weight is way too much’ (parents). These data were combined with children’s actual weight status, in order to assess underestimation of children’s weight status by children themselves and by their parents, respectively. Chi-square tests and multilevel logistic regression analyses were conducted to examine the aims of the current study.SettingEight European countries participating in the ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project.SubjectsA school-based survey among 6113 children aged 10–12 years and their parents.ResultsIn the total sample, 42·9 % of overweight/obese children and 27·6 % of parents of overweight/obese children underestimated their and their children’s weight status, respectively. A higher likelihood for this underestimation of weight status by children and their parents was observed in Eastern and Southern compared with Central/Northern countries. Overweight or obese parents (OR=1·81; 95 % CI 1·39, 2·35 and OR=1·78, 95 % CI 1·22, 2·60), parents of boys (OR=1·32; 95 % CI 1·05, 1·67) and children from overweight/obese (OR=1·60; 95 % CI 1·29, 1·98 and OR=1·76; 95 % CI 1·29, 2·41) or unemployed parents (OR=1·53; 95 % CI 1·22, 1·92) were more likely to underestimate children’s weight status.ConclusionsChildren of overweight or obese parents, those from Eastern and Southern Europe, boys, younger children and children with unemployed parents were more likely to underestimate their actual weight status. Overweight or obese parents and parents of boys were more likely to underestimate the actual weight status of their children. In obesity prevention such underestimation may be a barrier for behavioural change.

Published version of an article in the journal: PLoS One. Also available from the publisher: http://dx.doi.org/10.1371/journal.pone.0111775 Open Acces Objective: To design interventions that target energy balance-related behaviours, knowledge of primary schoolchildren’s perceptions regarding soft drink intake, fruit juice intake, breakfast consumption, TV viewing and physical activity (PA) is essential. The current study describes personal beliefs and attitudes, home- and friend-related variables regarding these behaviours across Europe. Design: Cross-sectional study in which personal, family and friend -related variables were assessed by validated questionnaires, and dichotomized as favourable versus unfavourable answers. Logistic regression analyses were conducted to estimate proportions of children giving unfavourable answers and test between-country differences. Setting: A survey in eight European countries. Subjects: A total of 7903 10–12 year old primary schoolchildren. Results: A majority of the children reported unfavourable attitudes, preferences and subjective norms regarding soft drink, fruit juice intake and TV viewing accompanied with high availability and accessibility at home. Few children reported unfavourable attitudes and preferences regarding breakfast consumption and PA. Many children reported unfavourable health beliefs regarding breakfast consumption and TV viewing. Substantial differences between countries were observed, especially for variables regarding soft drink intake, breakfast consumption and TV viewing. Conclusion: The surveyed children demonstrated favourable attitudes to some healthy behaviours (PA, breakfast intake) as well as to some unhealthy behaviours (soft drink consumption, TV viewing). Additionally, many children across Europe have personal beliefs and are exposed to social environments that are not supportive to engagement in healthy behaviours. Moreover, the large differences in personal, family and friend-related variables across Europe argue for implementing different strategies in the different European countries.

We aimed to assess the associations of person-related factors with leisure time television (TV) viewing and computer time among young adults. We analyzed self-reported TV viewing (h/week) and leisure computer time (h/week) from 475 Dutch young adults (47% male) who had participated in the Amsterdam Growth and Health Longitudinal Study at the age of 32 and 36 years. Sociodemographic factors (i.e., marital and employment status), physical factors (i.e., skin folds, aerobic fitness, neuromotor fitness, back problems), psychological factors (i.e., problem- and emotion-focused coping, personality), lifestyle (i.e., alcohol consumption, smoking, energy intake, physical activity), and self-rated health (i.e., general health status, mild health complaints) were assessed. Univariable and multivariable generalized estimating equations were performed. Male gender, higher sum of skin folds, lower values of aerobic fitness, higher rigidity, higher self-sufficiency/recalcitrance, and smoking were positively associated with TV time. Male gender, higher sum of skin folds, higher scores on self-esteem, low energy intake, and a not so good general health status were significantly associated with higher computer time. Determinants of TV viewing and computer time were not identical, suggesting that both behaviors (a) have different at-risk populations and (b) should be targeted differently.

Summary Objectives The aim of this study was to compare anthropometrics of 12- to 14-year-old Dutch adolescents attending lower levels of education in 2011 with adolescents measured in 2003. Methods We used baseline data from two trials evaluating a school-based obesity prevention programme in 2003 (randomized controlled trial with 18 schools) and in 2011 (cluster controlled trial with 29 schools). We measured adolescents' body height and weight, skin-fold thickness, and waist circumference in 2003 (n = 1000; response rate 76%) and 2011 (n = 1898; response rate 86%). We used multivariable multilevel linear or logistic regression analyses stratifying for gender, ethnicity and prevocational education track (vocational or theoretical) where appropriate. Results In boys, prevalence of overweight, waist circumference, triceps, biceps and subscapular skin-folds were significantly higher in 2011. This was also true for vocational girls, except for the subscapular skin-fold. Girls, attending the theoretical track, had a significantly larger waist circumference, but thinner subscapular and suprailiac skin-fold thickness in 2011. Conclusions The increased prevalence of overweight and obesity in Dutch adolescents attending prevocational education is worrisome. Trial registration number Current Controlled Trials ISRCTN87127361 and Current Controlled Trials ISRCTN92755979.

Purpose: This study aimed to examine the longitudinal associations of person-related factors with physical activity (PA) behavior in young adults. Methods: We analyzed longitudinal self-reported time spent in moderate-intensity PA (MPA; 4-7 METs) and vigorous-intensity PA (VPA; >7 METs) from 499 young adults (49% male) who participated in the Amsterdam Growth and Health Longitudinal Study at the age of 21, 27, 32, and 36 yr. Sociodemographic factors (i.e., marital and employment status), physical factors (i.e., skinfolds, aerobic fitness, neuromotor fitness, back problems, and general health status), psychological factors (i.e., problem and emotion focused coping, mild health complaints, and personality), and behavioral factors (i.e., alcohol consumption, smoking, and energy intake) were assessed at each time point. We performed sex-specific univariable and multivariable generalized estimating equations. Results: Men and women with higher aerobic fitness were more moderately and vigorously active. Not having paid work was associated with more MPA in both men and women. Men with part-time paid work, lower scores on dominance, higher scores on hostility, and above moderate alcohol consumption (i.e., ≥140 g of alcohol per week) were more moderately active. Divorced women and those with better physical flexibility spent more time in MPA. Men having full-time paid work, with a good general health status and nonsmokers, were more vigorously active. Women being married/living together, who had better physical flexibility, lower scores on inadequacy, higher scores on dominance, and low caloric intake (around 2000 kcal·d) were more vigorously active. Conclusion: Several sociodemographic, physical, psychological, and behavioral factors were associated with PA in Dutch young adults. Determinants were different for MPA and VPA and for men and women. © 2014 by the American College of Sports Medicine.

Objective The aim of the study was to evaluate mediating effects of energy balance-related behaviors on measures of adiposity in the Dutch Obesity Intervention in Teenagers-study (DOiT). Design and Methods DOiT was an 8-month behavioral intervention program consisting of educational and environmental components and evaluated in 18 prevocational secondary schools in the Netherlands (n = 1,108, baseline age 12.7 years, 50% girls). Outcome measures were changes in body mass index (BMI), waist circumference, and sum of skinfold thickness. Self-reported consumption of sugar-containing beverages and high caloric snacks, active transport to/from school, and screen-viewing behaviors were the hypothesized mediators. Data were collected at 0, 8, 12, and 20 months. For the data analysis, parallel process latent growth modeling was used. Results Total sugar-containing beverages consumption mediated the intervention effects on BMI (ab = −0.01, 95%CI = −0.20, −0.001). The intervention group lowered their sugar-containing beverages consumption more than controls (B = −0.14, 95%CI = −0.22, −0.11) and this, in turn, led to smaller increases in BMI. No significant mediated effect by the targeted behaviors was found for waist circumference or sum of skinfolds. Conclusions Future school-based overweight prevention interventions may target decreasing sugar-containing beverages consumption.

Purpose To evaluate and implement supportive programs, it is important to understand which cancer survivors (CSs) are participating in these programs and which motives exist for declining participation. Recently, a supportive return-to-work (RTW) program was offered to CSs with job loss. The purpose of this study was to identify factors and motives associated with (non-)participation of CSs with job loss in the RTW program. Methods In this cross-sectional study (N = 286), information on socio-demographic, health-related, psychosocial, and work-related characteristics of CSs in the program was collected. Similar data were collected from those who declined participation. Multivariable logistic regression analyses were conducted (p

This study investigates if and to what extent the Dutch Obesity Intervention in Teenagers (DOiT) program was implemented as intended and how this affected program effectiveness. We collected data at 20 prevocational education schools in the Netherlands. We assessed seven process indicators: recruitment, reach, dosage, fidelity, satisfaction, effectiveness and continuation. Data collection involved teacher questionnaires (n= 110), adolescent questionnaires and adiposity measures (n= 938). Using multi-level confirmatory factor analyses, we applied an innovative method to obtain explorative implementation index scores. The percentage of accomplished activities ranged from 9% (for 'closure meeting') up to 93% (for 'obtaining support within the school for adoption'). The percentage of lessons delivered decreased from 74 to 18% towards the end of the program. Fidelity to the teacher manual ranged from 85 to 26%. In general, teachers were satisfied with the DOiT lessons and teaching materials. Despite teachers' satisfaction with the DOiT lessons and teaching materials, degree of program implementation was lower than expected, especially towards the end of the program. Further, some evidence was found for an association between a higher implementation index score and program effectiveness, but more research is needed to test the validity of the implementation index.

Objective The aim of this study was to explore differences in weight status and energy balance behaviours according to ethnic background among adolescents across Europe. Methods A school-based survey among 10–12-year-old adolescents was conducted in seven European countries. Weight, height and waist circumference were measured; engagement in physical activity, sedentary and dietary behaviour, and sleep duration was assessed by child and parent-report. A distinction between native and non-native ethnic background was based on language spoken at home, and the parents' country of birth. Analyses were conducted with and without adjustment for parental education. Results With valid data on both indicators of ethnic background for 5149 adolescents, 7307 adolescents (52% girls; 11.6 ± 0.7 years) participated. Significantly higher prevalence of overweight, obesity, body mass index and waist circumference were observed among non-native compared with native adolescents. Non-native adolescents had less favourable behavioural patterns (sugary drinks, breakfast skipping, sport, TV and computer time, hours of sleep) with the exception of active transport to school. Similar patterns were observed for both indicators of ethnicity, and in most of the separate countries; however, in Greece, weight status indicators were better among non-native adolescents. After adjustment for parental education, most differences remained significant according to country of origin of the parents, but not according to language spoken at home. Conclusion Adolescents of native ethnicity of the country of residence have, in general, more favourable weight status indicators and energy balance-related behaviours than adolescents of non-native ethnicity across Europe.

Objective: To describe the prospective relationship between physical activity and academic performance. Data Sources: Prospective studies were identified from searches in PubMed, PsycINFO, Cochrane Central, and Sportdiscus from 1990 through 2010. Study Selection: We screened the titles and abstracts for eligibility, rated the methodological quality of the studies, and extracted data. Main Exposure: Studies had to report at least 1 physical activity or physical fitness measurement during childhood or adolescence. Main Outcome Measures: Studies had to report at least 1 academic performance or cognition measure during childhood or adolescence. Results: We identified 10 observational and 4 intervention studies. The quality score of the studies ranged from 22% to 75%. Two studies were scored as high quality. Methodological quality scores were particularly low for the reliability and validity of the measurement instruments. Based on the results of the best-evidence synthesis, we found evidence of a significant longitudinal positive relationship between physical activity and academic performance. Conclusions: Participation in physical activity is positively related to academic performance in children. Because we found only2high-quality studies, future high-quality studies areneededtoconfirmourfindings.Thesestudiesshould thoroughly examine the dose-response relationship between physical activity and academic performance as well as explanatory mechanisms for this relationship. ©2012 American Medical Association. All rights reserved.

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. We identified 31 papers, examining 27 different cohorts. The quality score of the studies ranged from 38 to 88%. Nine studies were scored as high quality. According to the best evidence synthesis we found insufficient evidence for a longitudinal positive relationship between 'sedentary time'- mainly TV viewing - and body mass index (BMI) and more specific indicators of fat mass. One high quality and two low quality studies found a significant inverse relationship between sedentary time - mainly TV viewing - and aerobic fitness, leading to moderate evidence for this inverse relationship. There was insufficient evidence for a longitudinal relationship between sedentary time and blood pressure, blood lipids or bone mass. Our systematic review suggests that there is moderate evidence for a longitudinal inverse relationship between screen time and aerobic fitness during childhood. Thus there is evidence to limit screen time in young people in order to prevent low levels of fitness. The possible detrimental health effects of prolonged or excessive sitting on other health indicators needs further study.

Context Nowadays, people spend a substantial amount of time per day on sedentary behaviors and it is likely that the time spent sedentary will continue to rise. To date, there is no review of prospective studies that systematically examined the relationship between diverse sedentary behaviors and various health outcomes among adults. Purpose This review aimed to systematically review the literature as to the relationship between sedentary behaviors and health outcomes considering the methodologic quality of the studies. Evidence acquisition In February 2010, a search for prospective studies was performed in diverse electronic databases. After inclusion, in 2010, the methodologic quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions. Evidence synthesis 19 studies were included, of which 14 were of high methodologic quality. Based on inconsistency in findings among the studies and lack of high-quality prospective studies, insufficient evidence was concluded for body weight–related measures, CVD risk, and endometrial cancer. Further, moderate evidence for a positive relationship between the time spent sitting and the risk for type 2 diabetes was concluded. Based on three high-quality studies, there was no evidence for a relationship between sedentary behavior and mortality from cancer, but strong evidence for all-cause and CVD mortality. Conclusions Given the trend toward increased time in sedentary behaviors, additional prospective studies of high methodologic quality are recommended to clarify the causal relationships between sedentary behavior and health outcomes. Meanwhile, evidence to date suggests that interventions aimed at reducing sedentary behavior are needed.

Background: Ample fruit and vegetable (F&V) intake has been associated with a decreased risk of chronic disease. The health-enhancing effects of increased F&V consumption, however, would be even more apparent if the increased F&V consumption additionally led to a lower intake of unhealthy, high calorie snacks. Therefore, the present study aimed to investigate whether a primary school-based intervention (the Dutch Schoolgruiten Project) that promoted F&V intake could additionally reduce the intake of unhealthy, high calorie snacks during school breaks. Methods: The study applied a longitudinal design with baseline and two follow-up measurements. Children were aged 9–10 years old at baseline; 705 children were included. The main strategy was a F&V scheme that improved the availability, accessibility and exposure to F&V at school by providing one serving of fruit or vegetables twice a week at no cost. The amounts of F&V and unhealthy snacks for consumption at school were measured using a single-item question included in a questionnaire. Multilevel autoregressive logistic regression models with a three-level structure (school, child and time) were used to assess the effect of the intervention on both F&V and unhealthy snack consumption. Results: The children of the intervention group brought FV 1.90] and brought fewer unhealthy snacks (OR = 0.56, 95% CI = 0.34; 0.92). Conclusion: The present study provides some evidence that the Schoolgruiten intervention effect on F&V intake also reduced unhealthy snacking during school breaks.

To determine whether a multicomponent health promotion intervention for Dutch adolescents (defined as persons between 12 and 14 years of age) would be successful in influencing body composition and dietary and physical activity behavior in both the short and long terms.Randomized controlled trial.Ten intervention and 8 control prevocational secondary schools.A total of 1108 adolescents (mean age, 12.7 years). Intervention An interdisciplinary program with an adapted curriculum for 11 lessons in biology and physical education and environmental change options.Body height and weight, waist circumference, 4 skinfold thickness measurements, and dietary and physical activity behavior data.Multilevel analyses showed that the intervention remained effective in preventing unfavorable increases in important measures of body composition after 20-month follow-up in girls (biceps skinfold and sum of 4 skinfolds) and boys (triceps, biceps, and subscapular skinfolds). Consumption of sugar-containing beverages was significantly lower in intervention schools both after intervention (boys: -287 mL/d; 95% confidence interval [CI], -527 to -47; girls: -249; -400 to -98) and at 12-month follow-up (boys: -233; -371 to -95; girls: -271; -390 to -153). For boys, screen-viewing behavior was significantly lower in the intervention group after 20 months (-25 min/d; 95% CI, -50 to -0.3). No significant intervention effects on consumption of snacks or active commuting to school were found.The Dutch Obesity Intervention in Teenagers program resulted in beneficial effects on the sum of skinfold thickness measurements in girls and consumption of sugar-containing beverages in both boys and girls in both the short and long terms.

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.

Objective To determine whether a multicomponent health promotion intervention for Dutch adolescents would be successful in influencing body composition and aerobic fitness. Design Randomized controlled trial. Setting Ten intervention and 8 control prevocational secondary schools. Participants A total of 978 adolescents (mean age, 12.7 years). Intervention An interdisciplinary multicomponent intervention program with an adapted curriculum for 11 biology and physical education lessons and environmental change options, including additional lessons on physical education and advice on the school canteen selection. Main Outcome Measures Body height and weight, hip and waist circumference, 4 skinfold thickness measurements, and aerobic fitness. Results Multilevel analyses showed significant differences in changes after the 8-month intervention period in favor of the intervention group with regard to hip circumference (mean difference, 0.53 cm; 95% confidence interval, 0.07 to 0.98) and sum of skinfolds among girls (mean difference, −2.31 mm; 95% confidence interval, −4.34 to −0.28). In boys, the intervention resulted in a significant difference in waist circumference (mean difference, −0.57 cm; 95% confidence interval, −1.10 to −0.05). No significant intervention effects were found related to aerobic fitness. Conclusions The multicomponent Dutch Obesity Intervention in Teenagers program positively influenced several measures of body composition among both girls and boys. Our results indicate that secondary prevocational school curriculum changes may contribute to excessive weight gain prevention among adolescents.

Objectives To identify the biological, socio-demographic, work-related and lifestyle determinants of physical activity in young adult women. Design Prospective cohort study. Methods Self-reported data from 11,695 participants (aged 22–27 years in 2000) in the Australian Longitudinal Study on Women's Health were collected over 9 years in 2000, 2003, 2006 and 2009. Generalised Estimating Equations were used to examine univariable and multivariable associations of body mass index, country of birth, area of residence, education, marital status, number of children, occupational status, working hours, smoking, alcohol intake, and stress with physical activity status (active, ≥600 MET·min/week; or inactive, Results All variables were significantly associated with physical activity in univariable models. In the multivariable model, the lowest odds of being active (compared with the relevant reference categories) were for women who: were born in Asia (OR = 0.53), had less than 12 years of education (OR = 0.79), were married (OR = 0.66) or in a de facto relationship (OR = 0.79), had at least one child (OR ranging from 0.67 to 0.69), and were classified as non (OR = 0.66) or rare drinkers (OR = 0.79). Conclusions These results are among the first to confirm the biological, socio-demographic, work-related and lifestyle determinants of physical activity in women in their twenties and early thirties. These findings may be used to inform and improve the development of strategies, and to identify target groups most in need of intervention effort.

ObjectiveTo explore the influences of migration to a Western country on obesity and related risk factors by comparing measures of body composition and energy balance-related behaviours between Turkish adolescents in Turkey (TR-TR) and adolescents from Turkish immigrant ethnicity in the Netherlands (TR-NL).DesignCross-sectional survey or baseline intervention data from six Dutch school-based studies and one Turkish study.SettingPrimary and secondary schools.SubjectsA total of 915 (49 % girls; mean age 13·1 (sd 0·8) years) TR-TR adolescents and 433 (51 % girls; mean age 11·7 (sd 1·3) years) TR-NL adolescents were included. Outcome measures were self-reported sugar-containing beverage consumption, fruit and vegetable intake, screen time, physical activity, measured body height and weight, BMI, waist and hip circumferences, and skinfold thicknesses.ResultsOur data showed that more TR-NL adolescents were overweight (31 % v. 26 %) and obese (9 % v. 6 %) and had significantly higher mean BMI (21·1 v. 20·0 kg/m2), waist circumference (72·2 v. 71·3 cm) and suprailiac skinfold thickness (19·8 v. 13·1 mm) than TR-TR adolescents. TR-NL adolescents reported significantly higher sugar-containing beverage consumption (1173 v. 115 ml/d), less fruit and vegetable intake (295 v. 647 g/d), less screen time (253 v. 467 min/d) and higher physical activity levels (61 v. 27 min/d) than TR-TR adolescents.ConclusionsImmigrant adolescents in the Netherlands were more often overweight and had a less favourable dietary pattern than their peers in Turkey, while their physical activity and screen time patterns were more favourable. These results suggest that adolescents from Turkish immigrant ethnicity in the Netherlands have adopted lifestyles towards the host culture.

Objective To investigate the relationship between physical activity and lung cancer among smokers and whether this relationship differed according to physical activity intensity, smoking status, and gender. Design Meta-analysis. Methods A computerized bibliographical search was conducted in five databases. Study inclusion criteria were: (i) the study population was not diagnosed with lung cancer at baseline; (ii) the study provided information concerning the effect size of physical activity on the risk of developing lung cancer in smokers; and (iii) the study distinguished different physical activity intensity levels. Two authors independently extracted data and assessed the methodological quality. Pooled rate ratios (RR) were calculated for all data, and for subgroups of physical activity intensity, smoking status, and gender. Results Pooled RRs of 7 cohort studies showed that physical activity was associated with a reduced risk of lung cancer in smokers (RR = 0.82, 95% CI = 0.77; 0.87). We did not find clear dose–response relationship regarding exercise or smoking intensity, i.e. high levels of physical activity did not show a higher risk reduction than moderate physical activity levels, and the association between physical activity and risk reduction did not differ between heavy and light smokers. The reduced risk associated with physical activity was greater in women than in men (p = 0.03), but this finding was based on only one study that reported data on women. Conclusions Results of this meta-analysis indicate that leisure time physical activity is associated with reduced risk of developing lung cancer among smokers. Future studies should provide insight into a potential dose–response relationship, and should use reliable and valid physical activity measurements.

Background The Dutch Obesity Intervention in Teenagers (DOiT) programme is an evidence-based obesity prevention programme tailored to adolescents attending the first two years of prevocational education in the Netherlands. The initial programme showed promising results during an effectiveness trial. The programme was adapted and prepared for nationwide dissemination. To gain more insight into the process of translating evidence-based approaches into ‘real world’ (i.e., ‘natural’) conditions, our research aims were to evaluate the impact of the DOiT-implementation programme on adolescents’ adiposity and energy balance-related behaviours during natural dissemination and to explore the mediating and moderating factors underlying the DOiT intervention effects. Methods We conducted a cluster-controlled implementation trial with 20 voluntary intervention schools (n=1002 adolescents) and 9 comparable control schools (n = 484 adolescents). We measured adolescents’ body height and weight, skinfold thicknesses, and waist circumference. We assessed adolescents’ dietary and physical activity behaviours by means of self-report. Data were collected at baseline and at 20-months follow-up. We used multivariable multilevel linear or logistic regression analyses to evaluate the intervention effects and to test the hypothesised behavioural mediating factors. We checked for potential effect modification by gender, ethnicity and education level. Results We found no significant intervention effects on any of the adiposity measures or behavioural outcomes. Furthermore, we found no mediating effects by any of the hypothesised behavioural mediators. Stratified analyses for gender showed that the intervention was effective in reducing sugar-containing beverage consumption in girls (B = -188.2 ml/day; 95% CI = -344.0; -32.3). In boys, we found a significant positive intervention effect on breakfast frequency (B = 0.29 days/week; 95% CI = 0.01; 0.58). Stratified analyses for education level showed an adverse intervention effect (B = 0.09; 95% CI = 0.02; 0.16) on BMI z-scores for adolescents attending the vocational education track. Conclusions Although not successful in changing adolescents’ adiposity, the DOiT-implementation programme had some beneficial effects on specific obesity-related behaviours in subgroups. This study underlines the difficulty of translating intervention effectiveness in controlled settings to real world contexts. Adaptations to the implementation strategy are needed in order to promote implementation as intended by the teachers. Trial registration Current Controlled Trials ISRCTN92755979. Electronic supplementary material The online version of this article (doi:10.1186/s12966-014-0158-0) contains supplementary material, which is available to authorized users.

Background Parents and their parenting practices play an important role in shaping their children’s environment and energy-balance related behaviours (EBRBs). Measurement of parenting practices can be parent- or child-informed, however not much is known about agreement between parent and child perspectives. This study aimed to assess agreement between parent and child reports on parental practices regarding EBRBs across different countries in Europe and to identify correlates of agreement. Methods Within the ENERGY-project, a cross-sectional survey was conducted among 10–12 year old children and their parents in eight European countries. Both children and parents filled in a questionnaire on 14 parental practices regarding five different EBRBs (i.e. soft drink, fruit juice and breakfast consumption, sports activity and watching TV) and socio-demographic characteristics. Children’s anthropometric measurements were taken at school. We calculated percentages of agreement between children and their parents and weighted kappa statistics (for ordinal variables) per practice and country and assessed factors associated with agreement using multilevel linear regression. Results Reports of 6425 children and their parents were available for analysis. Overall mean agreement between parent and child reports was 43% and varied little among countries. The lowest agreement was found for questions assessing joint parent–child activities, such as sports (27%; Kappa (κ) = 0.14) or watching TV (30%;κ = 0.17), and for parental allowance of the child to have soft drinks (32%;κ = 0.24) or fruit juices (32%;κ = 0.19), or to watch TV (27%;κ = 0.17). Having breakfast products available at home or having a TV in the child’s bedroom were the only practices with moderate to good agreement (>60%;κ = 0.06 and 0.77, respectively). In general, agreement was lower for boys, younger children, younger parents, parents with less than 14 years of education, single parents, parents with a higher self-reported body mass index and parents who perceived their child to be underweight. Conclusions Parents and children perceive parental practices regarding dietary, physical activity and sedentary behaviours differently in all parts of Europe, with considerable variation across specific practices and countries. Therefore, future studies should assess both, parents and children’s view on parental practices. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-918) contains supplementary material, which is available to authorized users.

Background To explore differences in personal and home environmental factors that are regarded as determinants of energy balance-related behaviors (EBRBs) according to parental education and ethnic background among 10–12 year old schoolchildren across Europe. Methods A school-based survey among 10–12 year olds was conducted in eight countries across Europe. A range of personal and home environment variables relevant for soft drink consumption, daily breakfast, sport participation and TV time was assessed by means of child report. Personal factors included attitude, health beliefs, and preference/liking. Home environment factors included parental subjective norm, modeling, support, practices and home availability. Children were classified based on parental education (i.e., low vs. high) and ethnic background (i.e., native vs. non-native). Data from 6018 children originating from 83 schools were included in the analyses. Results Multilevel logistic regression analyses showed that the majority of the factors tested –and especially home environment variables- were more favorable among children from higher educated parents and from native ethnicity. None of the personal and home environment factors was found to be more favorable among children from lower educated parents or non-native ethnicity. Conclusions The present study indicates that schoolchildren from lower educated and non-native parents across Europe have EBRB-related beliefs and are exposed to home environments that are less favorable for engagement in healthy EBRBs.

BackgroundIn affluent countries, children from non-native ethnicity have in general less favourable body composition indicators and energy balance-related behaviors (EBRBs) than children from native ethnicity. However, differences between countries have been reported.Methodology/principal findingsA school-based survey among 10-12 years old children was conducted in seven European countries with a standardized protocol. Weight, height and waist circumference were measured; engagement in EBRBs was self-reported. For those countries with significant ethnic differences in body composition (Greece and the Netherlands), multilevel mediation analyses were conducted, to test the mediating effect of the EBRBs in the association between ethnic background and body composition indicators. Analyses were adjusted for gender and age, and for parental education in a later step. Partial mediation was found for sugared drinks intake and sleep duration in the Greek sample, and breakfast in the Dutch sample. A suppression effect was found for engagement in sports activites in the Greek sample.Conclusions/significanceEthnic differences in children's body composition were partially mediated by differences in breakfast skipping in the Netherlands and sugared drinks intake, sports participation and sleep duration in Greece.

Background Sitting is associated with health risks. Factors that influence sitting are however not well understood. The aim was to examine the biological, socio-demographic, work-related and lifestyle determinants of sitting time (including during transport, work and leisure) in young adult Australian women. Methods Self-reported data from 11,676 participants (aged 22–27 years in 2000) in the Australian Longitudinal Study on Women’s Health were collected over 9 years in 2000, 2003, 2006 and 2009. Generalised Estimating Equations were used to examine univariable and multivariable associations of body mass index (BMI), country of birth, area of residence, education, marital status, number of children, occupational status, working hours, physical activity, smoking, alcohol intake and stress with week- and weekend-day sitting time. Results Compared with women in the respective referent categories, (1) women with higher BMI, those born in Asia, those with less than University level education, doing white collar work, working 41–48 hours a week, current smokers, non, rare or risky/high risk drinkers and those being somewhat stressed had significantly higher sitting time; and (2) women living in rural and remote areas, partnered women, those with children, those without a paid job and blue collar workers, those working less than 34 hours a week, and active women had significantly lower sitting time. Conclusions Among young adult Australian women, those with higher BMI, those born in Asia, those with higher level occupations and long working hours, were most at risk of higher sitting time. These results can be used to identify at-risk groups and inform intervention development.

Background The evidence-based Dutch Obesity Intervention in Teenagers (DOiT) program is a school-based obesity prevention program for 12 to 14-year olds attending the first two years of prevocational education. This paper describes the study protocol applied to evaluate (a) the nationwide dissemination process of DOiT in the Netherlands, and (b) the relationship between quality of implementation and effectiveness during nationwide dissemination of the program in the Netherlands. Methods In order to explore facilitating factors and barriers for dissemination of DOiT, we monitored the process of adoption, implementation and continuation of the DOiT program among 20 prevocational schools in the Netherlands. The study was an observational study using qualitative (i.e. semi-structured interviews) and quantitative methods (i.e. questionnaires and logbooks). Eight process indicators were assessed: recruitment, context, reach, dosage, fidelity, satisfaction, effectiveness and continuation. All teachers, students and parents involved in the implementation of the program were invited to participate in the study. As part of the process evaluation, a cluster-controlled trial with ten control schools was conducted to evaluate the effectiveness of the program on students’ anthropometry and energy balance-related behaviours and its association with quality of implementation. Discussion The identified impeding and facilitating factors will contribute to an adjusted strategy promoting adoption, implementation and continuation of the DOiT program to ensure optimal use and, thereby, prevention of obesity in Dutch adolescents. Trial registration Current Controlled Trials ISRCTN92755979.

Published version of an article in the journal: International Journal of Behavioral Nutrition and Physical Activity. Also available from the publisher at: http://dx.doi.org/10.1186/1479-5868-10-5 Open access Background: Recent research and literature reviews show that, among schoolchildren, some specific energy balance-related behaviors (EBRBs) are relevant for overweight and obesity prevention. It is also well known that the prevalence of overweight and obesity is considerably higher among schoolchildren from lower socio-economic backgrounds. This study examines whether sugared drinks intake, physical activity, screen time and usual sleep duration cluster in reliable and meaningful ways among European children, and whether the identified clusters could be characterized by parental education. Methods: The cross-sectional study comprised a total of 5284 children (46% male), from seven European countries participating in the ENERGY-project (" EuropeaN Energy balance Research to prevent excessive weight Gain among Youth"). Information on sugared drinks intake, physical activity, screen time and usual sleep duration was obtained using validated self-report questionnaires. Based on these behaviors, gender-specific cluster analysis was performed. Associations with parental education were identified using chi-square tests and odds ratios. Results: Five meaningful and stable clusters were found for both genders. The cluster with high physical activity level showed the highest proportion of participants with highly educated parents, while clusters with high sugared drinks consumption, high screen time and low sleep duration were more prevalent in the group with lower educated parents. Odds ratio showed that children with lower educated parents were less likely to be allocated in the active cluster and more likely to be allocated in the low activity/sedentary pattern cluster. Conclusions: Children with lower educated parents seemed to be more likely to present unhealthier EBRBs clustering, mainly characterized by their self-reported time spent on physical activity and screen viewing. Therefore, special focus should be given to lower educated parents and their children in order to develop effective primary prevention strategies.

Background Screen time has been associated with pediatric overweight. However, it is unclear whether overweight predicts or is predicted by excessive amounts of screen time. The aim of this study was to examine the direction of the association between screen time and body fatness in Dutch adolescents. Methods Longitudinal data of 465 Dutch adolescents (mean age at baseline 13 years, 53% boys) was used. Body fatness (objectively measured BMI, four skin folds and waist- and hip circumference), self-reported time spent watching TV and computer use, and aerobic fitness (shuttle run test) were assessed in all participants at three time points during 12 months. Multi-level linear autoregressive analyses was used to examine whether screen time predicted body fatness in the following time period and whether body fatness predicted screen time. Analyses were performed for boys and girls separately and adjusted for ethnicity and aerobic fitness. Results Time spent TV viewing did predict changes in BMI and hip circumference in boys, but not in girls, in the subsequent period. Computer time significantly predicted increases in skinfolds in boys and girls and increases in BMI in girls. Body fatness did not predict any changes in screen time. Conclusion The present study only partly supports the widely posited hypothesis that higher levels of screen time cause increases in body fatness. In addition, this study demonstrates that high levels of body fatness do not predict increases in screen time.

Published version of an article from the journal: International Journal of Behavioral Nutrition and Physical Activity. Also available from BMC: http://dx.doi.org/10.1186/1479-5868-9-136 Open Access Background To date, most research on obesogenic environments facing school children has focused on physical and socio-cultural environments. The role of economic factors has been investigated to a much lesser extent. Our objective was to explore the association of micro-level economic factors and incentives with sports activities and intake of soft drinks and fruit juice in 10-12 year-old school children across Europe, and to explore price sensitivity in children’s soft drink consumption and correlates of this price sensitivity. Methods Data for the study originate from a cross-sectional survey undertaken in seven European countries (Belgium, Greece, Hungary, Netherlands, Norway, Slovenia and Spain) in 2010 among 10-12 year-old school children and their parents. In total, 7234 child questionnaires and 6002 parent questionnaires were completed. The child questionnaire included questions addressing self-reported weekly intake of soft drinks and fruit juices and time spent on sports activities, perception of parental support for sports activities, use of pocket money for soft drinks and perceived price responsiveness. Parent questionnaires included questions addressing the role of budget and price considerations in decisions regarding children’s sports activities, soft drink consumption, home practices and rules and socio-demographic background variables. Data were analysed using multiple linear regression and discrete-choice (ordered probit) modelling. Results Economic factors were found to be associated with children’s sports participation and sugary drink consumption, explaining 27% of the variation in time for sports activities, and 27% and 12% of the variation in the children’s soft drink and juice consumption, respectively. Parents’ financial support was found to be an important correlate (Beta =0.419) of children’s sports activities. Children’s pocket money was a strong correlate (Beta =21.034) of soft drink consumption. The majority of the responding children reported to expect that significantly higher prices of soft drinks would lead them to buy less soft drinks with their own pocket money, but a majority of parents did not expect higher soft drink prices to reduce their children’s soft drink consumption. Conclusions We conclude that economic factors, especially parents’ financial support and amount of pocket money, appear to be of importance for children’s sports participation and soft drink consumption, respectively. Keywords: Children; Obesogenic environment; Economic incentives; Sports activity; Soft drinks; Price responsiveness

Background Obesity treatment is by large ineffective long term, and more emphasis on the prevention of excessive weight gain in childhood and adolescence is warranted. To inform energy balance related behaviour (EBRB) change interventions, insight in the potential personal, family and school environmental correlates of these behaviours is needed. Studies on such multilevel correlates of EBRB among schoolchildren in Europe are lacking. The ENERGY survey aims to (1) provide up-to-date prevalence rates of measured overweight, obesity, self-reported engagement in EBRBs, and objective accelerometer-based assessment of physical activity and sedentary behaviour and blood-sample biomarkers of metabolic function in countries in different regions of Europe, (2) to identify personal, family and school environmental correlates of these EBRBs. This paper describes the design, methodology and protocol of the survey. Method/Design A school-based cross-sectional survey was carried out in 2010 in seven different European countries; Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia, and Spain. The survey included measurements of anthropometrics, child, parent and school-staff questionnaires, and school observations to measure and assess outcomes (i.e. height, weight, and waist circumference), EBRBs and potential personal, family and school environmental correlates of these behaviours including the social-cultural, physical, political, and economic environmental factors. In addition, a selection of countries conducted accelerometer measurements to objectively assess physical activity and sedentary behaviour, and collected blood samples to assess several biomarkers of metabolic function. Discussion The ENERGY survey is a comprehensive cross-sectional study measuring anthropometrics and biomarkers as well as assessing a range of EBRBs and their potential correlates at the personal, family and school level, among 10-12 year old children in seven European countries. This study will result in a unique dataset, enabling cross country comparisons in overweight, obesity, risk behaviours for these conditions as well as the correlates of engagement in these risk behaviours.

Published version of an article in the journal: International Journal of Behavioral Nutrition and Physical Activity. Also available from the publihser:http://dx.doi.org/10.1186/1479-5868-8-136 BACKGROUND:Insight in children's energy balance-related behaviours (EBRBs) and their determinants is important to inform obesity prevention research. Therefore, reliable and valid tools to measure these variables in large-scale population research are needed.OBJECTIVE:To examine the test-retest reliability and construct validity of the child questionnaire used in the ENERGY-project, measuring EBRBs and their potential determinants among 10-12 year old children.METHODS:We collected data among 10-12 year old children (n = 730 in the test-retest reliability study; n = 96 in the construct validity study) in six European countries, i.e. Belgium, Greece, Hungary, the Netherlands, Norway, and Spain. Test-retest reliability was assessed using the intra-class correlation coefficient (ICC) and percentage agreement comparing scores from two measurements, administered one week apart. To assess construct validity, the agreement between questionnaire responses and a subsequent face-to-face interview was assessed using ICC and percentage agreement.RESULTS:Of the 150 questionnaire items, 115 (77%) showed good to excellent test-retest reliability as indicated by ICCs > .60 or percentage agreement [greater than or equal to] 75%. Test-retest reliability was moderate for 34 items (23%) and poor for one item. Construct validity appeared to be good to excellent for 70 (47%) of the 150 items, as indicated by ICCs > .60 or percentage agreement [greater than or equal to] 75%. From the other 80 items, construct validity was moderate for 40 (27%) and poor for 40 items (27%).CONCLUSIONS:Our results demonstrate that the ENERGY-child questionnaire, assessing EBRBs of the child as well as personal, family, and school-environmental determinants related to these EBRBs, has good test-retest reliability and moderate to good construct validity for the large majority of items.

ObjectiveThe Dutch Obesity Intervention in Teenagers (DOiT) is a school-based randomised controlled trial that was effective in decreasing the consumption of sugar-sweetened beverages among adolescents. The present study examined, using mediation analysis, whether this decrease in consumption of sugar-sweetened beverages could be explained by an increase in the consumption of water or diet drinks.DesignParticipants completed a questionnaire about their beverage consumption at baseline and at 8 months (immediately post-intervention), 12- and 20-month follow-ups. A series of multi-level linear regression analyses were performed to examine water and diet drink consumption as potential mediators of the intervention effect on the consumption of sugar-sweetened beverages.SettingEighteen Dutch secondary schools.SubjectsA total of 747 adolescents (mean age: 12·7 years).ResultsIn addition to the DoiT intervention effect of a reduction in the consumption of sugar-sweetened beverages at 8 months (−284 ml/d; 95 % CI −420, −148) and 12 months (−260 ml/d; 95 % CI −360, −160), there was also a significant reduction in diet drinks at 8 months (−52 ml/d; 95 % CI −89, −16). There was no significant difference in water consumption at any follow-up. The decrease in sugar-sweetened beverage consumption could not be explained by an increase in water or diet drink consumption at any time point.ConclusionsInterventions aimed at reducing sugar-sweetened beverage consumption may be effective without changing consumption of other beverages. Reducing sugar-sweetened beverages was, however, a main message of the DOiT intervention. It is possible that a concomitant promotion of water may have resulted in a greater increase in water intake and replacement of sugar-sweetened beverages with water.

Background There is an urgent need for more carefully developed public health measures in order to curb the obesity epidemic among youth. The overall aim of the "EuropeaN Energy balance Research to prevent excessive weight Gain among Youth" (ENERGY)-project is the development and formative evaluation of a theory-informed and evidence-based multi-component school-based and family-involved intervention program ready to be implemented and evaluated for effectiveness across Europe. This program aims at promoting the adoption or continuation of health behaviors that contribute to a healthy energy balance among school-aged children. Earlier studies have indicated that school and family environments are key determinants of energy-balance behaviors in schoolchildren. Schools are an important setting for health promotion in this age group, but school-based interventions mostly fail to target and involve the family environment. Methods Led by a multidisciplinary team of researchers from eleven European countries and supported by a team of Australian experts, the ENERGY-project is informed by the Environmental Research Framework for Weight gain Prevention, and comprises a comprehensive epidemiological analysis including 1) systematic reviews of the literature, 2) secondary analyses of existing data, 3) focus group research, and 4) a cross European school-based survey. Results and discussion The theoretical framework and the epidemiological analysis will subsequently inform stepwise intervention development targeting the most relevant energy balance-related behaviors and their personal, family-environmental and school-environmental determinants applying the Intervention Mapping protocol. The intervention scheme will undergo formative and pilot evaluation in five countries. The results of ENERGY will be disseminated among key stakeholders including researchers, policy makers and the general population. Conclusions The ENERGY-project is an international, multidisciplinary effort to develop and test an evidence-based and theory-informed intervention program for obesity prevention among school-aged children.

Objective. To examine dose-response associations between screen time and overweight, independent of physical activity and dietary intake. Methods. Participants were 580 Dutch youth (13 years; 48% boys). Body mass index, waist circumference and skinfold thickness at four sites determined weight status. Questionnaires examined television viewing and computer use, participation in organized sport and high caloric snack and sugar-containing beverage consumption. Results. There were no significant associations among boys. Compared with girls spending less than two hours/day in screen time, those who spent three to four hours/day were more likely to be classified as overweight by waist circumference (odds ratio [OR]=3.4; 95% confidence intervals [CI]=1.1–10.7; p=0.03), and this likelihood increased substantially among those spending more than four hours/day (OR=5.5; 95% CI=2.1–14.1; p≤0.0001). Conclusions. Girls who spend three or more hours/day in screen time are at increased risk of being classified as overwe...

Objectives This paper aims to identify the mediating mechanisms of a school-based obesity prevention program (DOiT). Methods The DOiT-program was implemented in Dutch prevocational secondary schools and evaluated using a controlled, cluster-randomised trial (September 2003 to May 2004). We examined mediators of effects regarding (1) consumption of sugar containing beverages (SCB); (2) consumption of high caloric snacks; (3) screen-viewing behaviour; and (4) active commuting to school. To improve these behaviours the DOiT-program tried to influence the following potentially mediating variables: attitude, subjective norm, perceived behavioural control, and habit-strength. Results Both in boys (n = 418) and girls (n = 436) the DOiT-intervention reduced SCB consumption (between group difference in boys = -303.5 ml/day, 95% CI: -502.4;-104.5, between group difference in girls = -222.3 ml/day, 95% CI: -371.3;-73.2). The intervention did not affect the other examined behaviours. In girls, no intervention effect on hypothetical mediators was found nor evidence of any mediating mechanisms. Boys in intervention schools improved their attitude towards decreasing SCB consumption, while this behaviour became less of a habit. Indeed, attitude and habit strength were significant mediators of the DOiT-intervention's effect (4.5 and 3.8%, respectively) on SCB consumption among boys. Conclusion Our findings imply that interventions aimed at EBRB-change should be gender-specific. Future studies aimed at reducing SCB consumption among boys should target attitude and habit strength as mediating mechanisms. Our study did not resolve the mediating mechanisms in girls. Trial registration International Standard Randomised Controlled Trial Number Register ISRCTN87127361

Background Only limited data are available on the development, implementation, and evaluation processes of weight gain prevention programs in adolescents. To be able to learn from successes and failures of such interventions, integral written and published reports are needed. Methods Applying the Intervention Mapping (IM) protocol, this paper describes the development, implementation, and evaluation of the Dutch Obesity Intervention in Teenagers (DOiT), a school-based intervention program aimed at the prevention of excessive weight gain. The intervention focussed on the following health behaviours: (1) reduction of the consumption of sugar-sweetened beverages, (2) reduction of energy intake derived from snacks, (3) decrease of levels of sedentary behaviour, and (4) increase of levels of physical activity (i.e. active transport behaviour and sports participation). The intervention program consisted of an individual classroom-based component (i.e. an educational program, covering 11 lessons of both biology and physical education classes), and an environmental component (i.e. encouraging and supporting changes at the school canteens, as well as offering additional physical education classes). We evaluated the effectiveness of the intervention program using a randomised controlled trial design. We assessed the effects of the intervention on body composition (primary outcome measure), as well as on behaviour, behavioural determinants, and aerobic fitness (secondary outcome measures). Furthermore, we conducted a process evaluation. Discussion The development of the DOiT-intervention resulted in a comprehensive school-based weight gain prevention program, tailored to the needs of Dutch adolescents from low socio-economic background.

Background: Few studies have differentiated between weekday and weekend day sleep duration in their association with indicators of weight status in children. Therefore, we examined the association of week and weekend day sleep duration with indicators of body composition in 10-12 year old European school children. Methods and Findings: Multi-level linear regression analysis was performed to examine the association between parent-reported week and weekend day sleep duration and objectively assessed child BMI and WC, adjusting for socio-demographic variables and energy balanced related behaviours EBRBs (i.e. dietary, physical and sedentary behaviour). Compared to sleeping 10 hrs/night or more, sleeping on average less than 10 hrs/night during weekdays was associated with higher BMI (for example, B = 0.86 and CI = [0.27;1.45] when sleeping ≤7 hrs) and WC (for example, B = 1.99 and CI = [0.32;3.65] when sleeping ≤7 hrs). Sleeping 9 hrs/night during weekend days, but not ≤8 hrs, was associated with higher WC (B = 0.66; CI = [0.04;1.28]) compared to sleeping more than 10 hrs/night. Average (week and weekend) sleep duration less than 10 hrs/night was associated with higher values for BMI (B = 0.98; CI = [0.24;1.73] and WC (B = 2.35; CI = [0.08;4.31]). Conclusions: Weekday sleep duration seems more strongly associated with body composition in European school children than weekend day sleep duration. Promoting adequate sleep duration may contribute to healthy weight in children. © 2013 Altenburg et al.

Published version of an article published in the journal: PLoS ONE. Also available from the publisher at: http://dx.doi.org/10.1371/journal.pone.0034742 Background: Current data on the prevalence of overweight and energy-balance behaviors among European children is necessary to inform overweight prevention interventions. Methodology/Principal Findings: A school-based survey among 10–12 year old children was conducted in seven European countries using a standardized protocol. Weight, height, and waist circumference were measured; Engagement in physical activity, sedentary and dietary behaviors, and sleep duration were self-reported. Descriptive analyses were conducted, looking at differences according to country, gender, and parental education. 7234 children (52%girls; 11.6±0.7 years) participated. 25.8% and 5.4% of boys, and 21.8% and 4.1% of girls were overweight (including obese) and obese (according to International Obesity Task Force criteria), respectively. Higher prevalence of overweight/obesity was observed in Greece, Hungary, Slovenia and Spain than in Belgium, Netherlands and Norway. Large differences between countries were found in intakes of sugar-sweetened beverages, breakfast, active transport, TV and computer time. More favorable overweight status and behavior patterns were found in girls than boys and in children of higher educated parents than in children of lower educated parents. Conclusions/Significance: High levels and striking differences in overweight status and potential risk behaviors were found among schoolchildren across Europe.

Background The age-related deterioration of physiological capacities such as muscle strength and balance is associated with increased dependence. Understanding the contribution of physical fitness components to functional performance facilitates the development of adequate exercise interventions aiming at preservation of function and independence of older people. The aim of the study was to investigate the relationship between physical fitness components and functional performance in older people living in long-term care facilities. Methods Design cross-sectional study Subjects 226 persons living in long-term care facilities (mean age: 81.6 ± 5.6). Outcome measures Physical fitness and functional performance were measured by performance-based tests. Results Knee and elbow extension strength were significantly higher in men (difference = 44.5 and 50.0 N, respectively), whereas women were more flexible (difference sit & reach test = 7.2 cm). Functional performance was not significantly different between the genders. In men, motor coordination (eye-hand coordination) and measures of strength were the main contributors to functional performance, whereas in women flexibility (sit and reach test) and motor coordination (tandem stance and eye-hand coordination) played a major role. Conclusion The results of this study show that besides muscle strength, fitness components such as coordination and flexibility are associated with functional performance of older people living in long-term care facilities. This suggests that men and women living in long-term care facilities, differ considerably concerning the fitness factors contributing to functional performance. Women and men may, therefore, need exercise programs emphasizing different fitness aspects in order to improve functional performance.

Background: Young adults face radical life changes regarding residence, marriage, family and work that may negatively impact their health behaviours. Therefore, we investigated the associations of the number of daily hassles and life events and their subjective appraisal with physical activity and screen time in young adulthood. Methods: Data came from participants of the Amsterdam Growth and Health Longitudinal Study (AGAHLS). Self-reported physical activity (min/wk) was used from wave 6 (1991; mean age 27), wave 7 (1993; mean age 29), wave 8 (1996/1997; mean age 32) and 9 (2000; mean age 36). Self-reported screen time (h/wk) was assessed in waves 8 and 9. The number and the appraisal of daily hassles and major life events were assessed with the Everyday Problem Checklist and Life Events List, respectively (including five life event domains, i.e.: health, work, home/family, personal/social relations, and finances). The final sample included 474 participants for the physical activity analyses and 475 participants for the screen time analyses. To test the longitudinal associations of daily hassles and life events with physical activity and screen time, univariable and multivariable Generalised Estimating Equations were performed. Effect modification by gender was tested. Results: Physical activity levels were higher in those who had experienced more daily hassles. People who reported higher subjective appraisal in the work and finances life event domains also had higher levels of physical activity, although only the subjective appraisal in the finances domain remained significant in the multivariable model. No significant associations between number and subjective appraisal of daily hassles and life events and screen time were observed. Conclusions: The occurrence of specific life events may be more influential for people's physical activity behaviour than their respective sum or emotional tone. Still, the assessment of daily hassles may be a relevant addition in this research field. Finally, we suggest that daily hassles and life events are less important for explaining screen time behaviour than for physical activity.

BackgroundThis study investigated the associations of physical characteristics and personality in adolescence with physical activity and sedentary behaviour in adulthood.FindingsPhysical characteristics (i.e. objectively measured BMI, sum of skin folds, MOPER test battery performance), and personality (i.e. self-reported inadequacy, social inadequacy, rigidity, self-sufficiency/recalcitrance, dominance, achievement motivation, facilitating anxiety, debilitating anxiety, and social desirability) were assessed in 217 adolescent boys (Mean 13.0, SD 0.6) and girls (Mean 12.9, SD 0.6). Twenty-nine years later, at the age of 42, their physical activity and sedentary behaviour were assessed by means of accelerometry. Boys who scored lower on self-sufficiency/recalcitrance and higher on facilitating anxiety spent more time sedentary in adulthood. Girls with a superior standing high jump performance, and a lower score on social desirability spent more time sedentary in adulthood. In contrast with sedentary behaviour, physical activity at age 42 year could not be predicted by physical characteristics or personality in adolescence.ConclusionsSedentary behaviour in adulthood was partly explained by physical characteristics and/or personality in adolescence. Thus, our results suggest that it may be possible to identify people who are at risk of becoming sedentary at a rather young age.