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This study was supported by a research Grant from the Czech Science Foundation under Reg. No. 17-12579S and a governmental project under Reg. No. CZ.02.1.01/0.0/0.0/16_025/0007294. Objectives: The aim of the study was to determine secular trends in vigorous physical activity (VPA) among adolescents in relation to family affluence across 34 countries. Methods: This study used data from the Health Behaviour in School-aged Children (HBSC) study from 34 countries in Europe and North America. Adolescents (N = 501,647) aged 11, 13 and 15 years across three survey cycles (2006, 2010, 2014) self-reported data on VPA and a family affluence scale (FAS) using standardized questionnaires. Results: A significant increase in VPA was found in low-FAS boys (girls) in four (10) countries and a decrease in four (three) countries. In high-FAS boys (girls), a significant increase was observed in nine (11) countries and a decrease in two(three) countries. An overall significant increase in meeting the VPA recommendations was found in high-FAS boys (OR 1.11; 95% CI 1.06–1.16) and in all FAS groups in girls, with the largest effect being found among high-FAS girls (OR 1.24; 95% CI 1.18–1.30). Conclusions: A country-specific increase in VPA was observed primarily in the medium- and high-FAS categories. This study suggests a need to focus on increasing VPA efforts, especially in low- and medium-FAS boys. Publisher PDF

It is widely proven that being physically active and avoiding sedentary behaviour help to improve adolescents&rsquo, well-being and keep them in better health in general. We aimed to investigate the relationship between modes of transport to school and subjective complaints among schoolchildren. Analyses were based on the HBSC (Health Behaviour in School-aged Children) surveys conducted in 2017/18 in nine countries (N = 55,607, mean age 13.43 &plusmn, 1.64 yrs.). The main outcome showed that health complaints consisted of somatic and psychological complaints. Transport to school was characterized by mode of getting there (walking, biking, or another passive mode). A total of 46.1% of students walked and 7.3% cycled to school, 46.6% commuted by passive means. Biking to school was more frequent in Denmark (37.9%), Norway (26.5%), and Germany (26.6%). The multivariate generalized linear model adjusted for age, gender, country, and school proximity showed that biking to school is protective against reports of health complaints. The beta parameters were equal to &minus, 0.498 (p &lt, 0.001) for the general HBSC-SCL index, &minus, 0.208 (p &lt, 0.001) for the somatic complaint index, and &minus, 0.285 (p &lt, 0.001) for the psychological complaints index. Young people who actively commute to school are less likely to report health complaints, especially psychological symptoms.

Zusammenfassung Hintergrund Sitzendes Verhalten wird zunehmend als ein eigenständiger gesundheitlicher Risikofaktor eingeschätzt. Ein wesentliches Handlungsfeld für Interventionen zur Reduzierung sitzenden Verhaltens stellt deshalb der Büroarbeitsplatz dar. Dieses systematische Review untersucht, ob sitz- und/oder bewegungsspezifische Interventionen die Sitzzeiten von Büroangestellten am Arbeitsplatz reduzieren. Methoden Von April bis Mai 2016 wurde in den Datenbanken „PubMed“, „PsycINFO“ und „SPORTDiscus“ eine systematische Literaturrecherche durchgeführt. Insgesamt ließen sich 17 Studien identifizieren, welche die Sitzzeiten von Büroangestellten untersuchten. Die relevanten Studien wurden in einer „Best Evidence Synthesis“ zusammengefasst. Zusätzlich wurde eine Moderatoranalyse (u. a. Interventionsmethoden) durchgeführt. Ergebnisse Multikomponenten-Interventionen und Sitz-Steh-Arbeitsstationen sind vielversprechend zur Reduzierung der Sitzzeiten von Büroangestellten. In der Moderatoranalyse fiel der Anteil signifikant positiver Interventionsergebnisse für die Interventionsmethoden „Umweltveränderungen“, „Hinzufügen von Objekten zur Umgebung“ und „Anleitungen, um ein Verhalten auszuführen“ am höchsten aus. Interventionen mit spezifischem Fokus auf das Sitzen sowie Studien mit objektiver Messmethodik zur Erhebung der Sitzzeit zeigten sich erfolgversprechender. Schlussfolgerung Es existieren verschiedene erfolgversprechende Interventionen zur Reduzierung der Sitzzeiten am Büroarbeitsplatz. Hier sind Mehrkomponenten-Interventionen und die Installation von Sitz-Steh-Arbeitsstationen hervorzuheben. Wenig Evidenz liegt für die Langzeitwirkung vor. Die Heterogenität der Studien schränkt zudem allgemeingültige Wirksamkeitsaussagen ein. Zukünftige Studien sollten Interventionen stärker theoriebasiert planen und die Sitzzeiten mithilfe subjektiver und objektiver Messinstrumente erfassen.

Background: The increasing prevalence of childhood obesity is a global concern. Although childhood obesity has grown as a result of a complex array of interactions among multiple behavioural, biological, and environmental factors, excessive screen time (ST) and low levels of physical activity (PA) are often discussed as causal factors. Therefore, it is beneficial to identify risky family behavioural patterns contributing to the increasing prevalence of obesity even in pre-schoolers. Objective: The main aim of the study was to assess whether parental obesity and parent-child behavioural patterns (PA and ST) affect the odds of overweight/obesity in 4-to-7-year-old preschool children. Methods: We analysed seven-day PA and ST behaviour among families with pre-schoolers that included 194 preschool children (88 girls and 106 boys) and their parents (165 mothers and 111 fathers). PA was monitored by means of unsealed Yamax pedometers for at least eight hours a day over seven consecutive days during spring (April/May) and autumn (September/October) of 2015. ST was recorded by parents on family log book sheets. To assess the odds of parents' obesity and PA/ST variables in relation to child overweight/obesity, a logistic regression (backward method) was used. Results: Most children (n = 157) reported normal weight (87 boys, 70 girls), 37 children were overweight or obese (19 boys, 18 girls). Children's excessive ST (> 1 hour/day) (OR: 5.65/33.19 on weekdays/weekends), mothers' obesity (OR: 13.80/28.84 on weekdays/weekends), mothers' excessive ST (> 2 hours/ day) (OR: 32.46 at weekends), and children's male gender (OR: 38.69 at weekends) were significantly (p < .05) associated with higher odds of overweight/obesity in the preschool children. Conclusions: Uncovering parent-child behavioural patterns provides insight into the lifestyle of families with pre-schoolers and is a source of valuable information for designing and implementing family-based intervention programmes aimed at reducing obesity. Especially, weekends provide a suitable space for the implementation of joint family programmes aimed at reducing sedentary behaviour.

Objectives: To develop a road map towards a harmonized pan-European surveillance system for children and adolescents. Methods: Representatives of five European surveillance systems and the German Health Interview and Examination Survey for Children and Adolescents contributed to the road map through a structured workshop in 2016. Results: A conceptual framework for this road map was developed with seven action points (APs) guiding the successive cross-country harmonization. First, key indicators of health behaviour and their determinants in children and adolescents will be identified (AP1, 2); short screening instruments will be developed and implemented to assess and monitor key indicators (AP3, 4). In parallel, optional supplementary modules could be implemented to provide objective data (AP5). This would allow mutual calibration and improvement of existing instruments before their progressive replacement by more comparable measurement tools (AP6). The establishment of a competence platform is envisaged for guiding the harmonization process (AP7). Conclusions: This approach builds on existing systems, provides comparable key health indicators across European regions, helps to assess temporal trends and—once in place—will facilitate health reporting and monitoring of national and international health targets.

This study assessed the associations between these factors in a random sample of Czech families with preschool and school-aged children. A nationally representative sample comprised 185 families with preschool children and 649 families with school-aged children (dyads; both parents and child n = 365, mother and child n = 730, and father and child n = 469). The participants wore Yamax Digiwalker SW-200 pedometers at least four weekdays and both weekend days and completed family logbooks (anthropometric parameters, daily step counts (SC), and screen time (ST)). When a parent (fathers at weekends and mothers both on weekdays and at weekends) achieved 10,000 SC per day, their children were also significantly (OR = 2.93-6.06, 95% CI = 2.02-9.26) more likely to meet the daily SC recommendation. On the contrary, the involvement of fathers in organized leisure-time PA reduced their children's odds of meeting the SC recommendation on weekdays (OR = 0.53, 95% CI = 0.31-0.89) and at weekends (OR = 0.41, 95% CI = 0.24-0.72). The excessive ST of parents at weekends reduced the odds of their children meeting the SC recommendation (mother-child dyads: OR = 0.44, 95% CI = 0.26-0.72; father-child dyads: OR = 0.63, 95% CI = 0.37-1.06). High levels of parents' PA contribute to the achievement of the recommended daily PA in children on weekdays and at weekends. Excessive weekend ST of parents reduces their odds of their children achieving the recommended daily PA; however, the influence of parents' PA on their children's achieving the recommended daily PA is stronger than the inhibitory effect of ST.

Zusammenfassung: Lange Sitzzeiten und zu wenig Bewegung stellen zentrale Public Health-Probleme dar. Die epidemiologische Studienlage unterstreicht, dass bei einem vorwiegend sitzend geprägten Lebensstil eine Reduzierung und Unterbrechung von Sitzzeiten durch eine Förderung alltäglicher Ativitäten (z.B. Stehen am Arbeitsplatz), präventiv und eigenständig auf viele chronisch-degenerative Erkrankungen und lebensverlängernd wirkt. Public Health Initiativen sollten dies verstärkt berücksichtigen.

Background Neighborhood walkability has consistently been associated with utilitarian walking and total physical activity in non-European studies. However, evidence on environmental correlates of physical activity in Europe is still scarce and little is known about potential interactions between neighborhood walkability, active travel, and individual or household related characteristics including available means of transport. Methods The study examined the association of neighborhood walkability with self-reported active travel in Bielefeld, Germany. Travel survey data from 2867 adult residents and geographic information for 88 neighborhoods were analyzed in multilevel Poisson regression models including relevant interaction terms to assess potential effect modifications by age, gender, household members, available means of transport, and neighborhood socio-economic status. Results Active travel frequencies increased with female gender, available bicycles, neighborhood walkability and decreased with more household members, motorcars, and public transport passes within households. In the final model, a one standard deviation change in neighborhood walkability was associated with an estimated 27.5% increase in active travel trips. Stronger effects were found at younger ages and in participants with greater motorcar availability. No evidence was found for an effect modification by neighborhood socioeconomic status, household members, available public transport passes, or gender. Conclusions The positive association between neighborhood walkability and active travel shown in other urban contexts was confirmed in a historically evolved city in Germany. The observed effect varied with respondents’ age and available motorcars, which is in line with recent findings and suggests that public health advocacy in urban planning could promote physical activity on a population level, including those with motorcar access.

We present the 7-year follow-up analysis in overweight children and adolescents, who had participated originally in a randomized control trial of a lifestyle intervention. We compared them to an untreated population-based control group to demonstrate the effectiveness of the intervention.Degree of overweight (BMI-SDS) was determined in 32 overweight children (mean age 11.5 ± 1.5yrs, 65.6% females, mean BMI 23.7 ± 1.5 kg/mThe participants in the intervention group reduced significantly their BMI-SDS between T0-T1 (mean ± standard deviation -0.28 ± 0.28, p 0.001) and demonstrated no significant changes between T1-T2 (mean ± standard deviation -0.10 ± 0.34) and between T2-T3 (median +0.07; interquartile range: -0.54-0.62). BMI-SDS at T3 was significantly (p = 0.015) lower compared to T0. At T3, 46.8% of the participants in the intervention were normal-weight. The reduction in BMI-SDS between T0-T3 was significantly (p = 0.043) greater in the intervention group (median -0.26; interquartile range -0.87-0.23 BMI-SDS) compared to the control group (mean ± standard deviation -0.05 ± 0.77).The lifestyle intervention led to a significant reduction of overweight in the 7-year follow-up period. This decrease in BMI-SDS was significantly greater than the changes in BMI-SDS in a control group. This study is registered at clinicaltrials.gov (NCT00422916).

Hintergrund Sitzendes Verhalten dominiert bereits im Kindes- und Jugendalter den Alltag. Die gesundheitswissenschaftliche Forschung hat in den letzten Jahren vermehrt sitzende Verhaltensweisen untersucht und es deutet sich an, dass es sich um eine von der Bewegung unabhangige Verhaltensweise handelt.

Hintergrund Der Erhalt bzw. die Steigerung von korperlicher Aktivitat sowie die Reduktion von sitzenden Tatigkeiten stellen zentrale Elemente in der Gesundheitsforderung und Pravention lebensstilbedingter Erkrankungen im Kindes- und Jugendalter dar. Wie viel allerdings fur wen und unter welchen Lebensumstanden notwendig ist, wird bislang (noch) diskutiert.

OBJECTIVE: Screen-based behaviours such as watching television or computer use are among the most prevalent sedentary behaviours adolescents spend time on. There is a lack of recent estimates on prevalence and changes in the amount of time spent on screen-based behaviour across Central and Eastern Europe. The main aim is to assess the trends in the prevalence of current recommendations for the screen time (≤2 hours per day) of school-aged children in the Czech Republic between 2002 and 2014.METHODS: We used an internationally established methodology based on the Health Behaviour in School-aged Children (HSBC) study. Data was derived from Czech national representative samples of 11-, 13- and 15-year-olds collected in the years 2002 (N=4,065), 2006 (N=4,170), 2010 (N=3,962) and 2014 (N=4,338).RESULTS: The results indicated that the boys and girl surveyed in 2014 are up to two times more likely to meet the current recommendations for watching television in comparison with groups of schoolchildren of the same age surveyed in 2002. In contrast, computer use by adolescents increased markedly between 2006 and 2014. Taking total screen time into account, spending two hours per day or less on it decreased significantly among boys (OR=0.74, 95% CI=0.62-0.89) and girls (OR=0.80, 95% CI=0.70-0.92) between 2006 and 2014.CONCLUSIONS: As screen time is an important indicator of time spent in a sedentary way, our findings call for more interventions to reduce the time that school-aged children spend in front of screens.

Background: The aim of this study is to explore if perception of an activity-friendly environment is associated with more physical activity and fewer screen-based activities among adolescents. Methods: We collected self-reported data in 2014 via the Health Behavior in School-aged Children cross-sectional study from four European countries (n = 13,800, mean age = 14.4, 49.4% boys). We explored the association of perceived environment (e.g., "There are other children nearby home to go out and play with") with physical activity and screen-based activities using a binary logistic regression model adjusted for age, gender, family affluence and country. Results: An environment perceived as activity-friendly was associated with higher odds that adolescents meet recommendations for physical activity (odds ratio (OR) for one standard deviation (SD) change = 1.11, 95% confidence interval (CI) 1.05-1.18) and lower odds for excessive screen-based activities (OR for 1 SD better = 0.93, 95% CI 0.88-0.98). Conclusions: Investment into an activity-friendly environment may support the promotion of active life styles in adolescence.

Background This study focuses on the comparison of weekday/weekend parent-child behavioural patterns (step count (SC) and screen time (ST)) and answers the question of whether achieving the recommendations for daily SC (10,000) in parents also helps their preschool children achieve the recommended daily SC (11,500). Methods The participants (278 parents aged 30–45 and their 194 children aged 4–7) were randomly recruited from 10 Czech public kindergartens. The participants recorded SC (pedometer Yamax Digiwalker SW-200) and ST duration (proxy-report) for seven consecutive days (≥8 h/day) during September–October 2014 and April–May 2015. Differences between weekdays/weekends SC or ST were tested using a paired t-test. The odds of achieving the recommended daily SC for children were estimated using general logistic regression separately for weekdays and weekends. Results Only the mothers were found to have a significantly lower SC at weekends than on weekdays. All of the participants showed significantly more ST at weekends than on weekdays (daughters: 78.6 vs. 45.7 min/day, p

Gesundheitsriskantes Verhalten ist nach wie vor ein wichtiges Thema der Pravention und Gesundheitsforderung. Insbesondere soziale Variationen gesundheitsbezogenen Verhaltens geben Hinweise fur die Gestaltung und Umsetzung von Interventionen. Die Ergebnisse der HBSC-Studie („health beaviour in school-aged children“; 2009/2010), in deren Rahmen 5005 Schuler/-innen allgemeinbildender Schulen aus allen Bundeslandern (mit Ausnahme Baden-Wurttembergs) im Alter zwischen 11 und 15 Jahren mit Hilfe eines standardisierten Fragebogens befragt wurden, werden berichtet. Die Studie fokussierte auf gesundheitsrelevantes Verhalten, subjektive Gesundheit und soziale Determinanten. 6,4% der 11- bis 15-jahrigen Madchen und 5,9% der gleichaltrigen Jungen gaben an, mindestens 1-mal/Woche zu rauchen. Der Alkoholkonsum nahm mit dem Alter zu und war in wohlhabenden Familien haufiger: 15,3% der 15-jahrigen Madchen und 28,1% der gleichaltrigen Jungen gaben an, mindestens 1-mal/Woche Alkohol zu trinken. Jeder 10. Jugendliche hat Erfahrung mit Cannabis. Obwohl gesundheitsriskantes Verhalten insgesamt rucklaufig ist, verdienen Alkohol, Tabak und illegale Drogen weiterhin Aufmerksamkeit, v. a. unter Berucksichtigung der sozialen Variationen.

Background:\ud The use of electronic media has been found to be a risk factor for higher BMI and for being overweight. Physical activity has been found to be associated with lower BMI and lower risk for being overweight. Little is known about whether the associations between physical activity and electronic media use are additive or interactive in predicting BMI and risk for overweight among adolescents.\ud \ud Methods:\ud The data used in this study stem from the 2009/2010 survey of “Health Behaviour in School-aged Children (HBSC) study: A WHO Cross-National Survey. The sample consisted of 107184 13 and 15 year students from 30 different countries. Multilevel regression models were used to produce the presented estimates.\ud \ud Results:\ud Overall, 18% of boys and 11% of girls were classified as overweight. EM use was found to be associated with increased BMI z-scores and odds for overweight among both boys and girls who did not comply with physical activity guidelines. Among physically active adolescents, EM was found to be significantly associated with BMI or odds for overweight among girls, but not among boys.\ud \ud Conclusion:\ud While the usage of EM appear to be inconsequential for BMI and the risk of overweight among physically active boys, we find evidence indicating that EM use is associated with BMI and risk for overweight among girls, including those who report complying with MVPA guidelines.

Current data and available studies suggest that regular physical activity decreases overall mortality. In Germany corresponding findings are scarce. The aim of this data analysis was to clarify this issue for a German sample in men and women. A total of 3,742 males and 3,445 females aged 30–69, who participated in a baseline questionnaire in 1984–1986, were followed-up to the year 1998. During the follow-up period, 300 women and 643 men died. The multivariate rate ratios (RR) for accumulated hours of leisure time sports activities (LTSA) per week and with an LTSA-index based on METs per week with the reference of sedentary lifestyle, showed a clearly protective impact in a dose-response relationship (p for trend

Background: The present study was designed to analyse Web pages of German gynaecologists with regard to postmenopausal hormone therapy ( HT). There is a growing body of evidence, that the overall health risks of HT exceed the benefits. Making one's own informed choice has become a central concern for menopausal women. The Internet is an important source of health information, but the quality is often dubious. The study focused on the analysis of basic criteria such as last modi. cation date and quality of the HT information content. The results of the Women's Health Initiative Study (WHI) were used as a benchmark. Methods: We searched for relevant Web pages by entering a combination of key words (9 x 13 = 117) into the search engine www.google.de. Each Web page was analysed using a standardized questionnaire. The basic criteria and the quality of content on each Web page were separately categorized by two evaluators. Disagreements were resolved by discussion. Main Findings: Of the 97 websites identified, basic criteria were not met by the majority. For example, the modi. cation date was displayed by only 23 (23.7%) Web pages. The quality of content of most Web pages regarding HT was inaccurate and incomplete. Whilst only nine (9.3%) took up a balanced position, 66 (68%) recommended HT without any restrictions. In 22 cases the recommendation was indistinct and none of the sites refused HT. With regard to basic criteria, there was no difference between HT-recommending Web pages and sites with balanced position. Conclusion: Evidence-based information resulting from the WHI trial was insufficiently represented on gynaecologists' Web pages. Because of the growing number of consumers looking online for health information, the danger of obtaining harmful information has to be minimized. Web pages of gynaecologists do not appear to be recommendable for women because they do not provide recent evidence-based findings about HT.

Increasing physical activity and reduction of sedentary behaviour play important roles in health promotion and prevention of lifestyle-related diseases in children and adolescents. However, the question of how much physical activity is useful for which target group is still a matter of debate. International guidelines (World Health Organization; European Association for the Study of Obesity), which are mainly based on expert opinions, recommend 60 min of physical activity every day. Age- and sex-specific features and regional differences are not taken into account. Therefore, expert consensus recommendations for promoting physical activity of children and adolescents in Germany were developed with special respect to national data, but also with respect to aspects of specific target groups, e.g., children with a lower socio-economic status (SES) or with migration background. They propose 90 min/day of physical activity, or at least 12,000 steps daily. Additionally, lifestyle factors, especially restriction of media consumption, were integrated. The recommendations provide orientation for parents and caregivers, for institutions such as schools and kindergartens as well as for communities and stakeholders. © 2014 S. Karger GmbH, Freiburg.

Background: Sedentary behaviour in general and sitting time in particular is an emerging global health concern. The aim of this study was to provide data on the prevalence of sitting time in German adults and to examine socio-demographic and environmental correlates of sitting time. Methods. A representative sample of German adults (n = 2000; 967 men, 1033 women; 49.3 ±17.6 years of age) filled in the Global Physical Activity Questionnaire, including one question on overall sitting time and answered questions about the neighbourhood environment, as well as concerning demographics. Daily sitting time was stratified by gender, age group, BMI, educational and income level, as well as physical activity (PA). To identify socio-demographic and environmental correlates of sitting time, we used a series of linear regressions. Results: The overall median was 5 hours (299 minutes) of sitting time/day and men sat longer than women (5 vs. 4 hours/day; p < 0.05). In both genders age and PA were negatively and the educational level positively associated with sitting time. The level of income was not a correlate of sitting time in multivariate analyses. Sitting time was significantly positively associated with higher neighbourhood safety for women. The variance of the multivariate model ranged from 16.5% for men to 8.9% for women. Conclusions: The overall sitting time was unequally distributed in the German adult population. Our findings suggest implementing specific interventions to reduce sitting time for subgroups such as men, younger aged adults and adults with a higher education and lower PA. Future studies should enhance our understanding of the specific correlates of different types and domains of sitting in order to guide the development of effective public health strategies. :doi 10.1186/1471-2458-13-196

Aim: The aim of this study was to examine whether the correlates of physical activity (PA) differed as a function of two different PA recommendations: (1) the Fitness Recommendation, i.e., the improvement of cardiovascular fitness by 3 × 20 min/week of vigorously intense PA and (2) the health-enhancing PA (HEPA) concept such as the emphasis on the important benefits to health and fitness by performing 5 × 60 min/week of moderately intense PA. Subjects and Methods: A cross-sectional design was used. In a sample of 524 adolescents (50.2% males, mean age = 15.0), we quantified different (demographic/biological, psychological, behavioural) self-reported correlates of PA as well as compliance with the PA recommendations. Sex-specific multivariate logistic regression models were used to identify correlates of fulfiling the two PA recommendations. Results: Multivariate analyses revealed differences between the correlates and PA-specific Recommendations. For boys, only the Fitness Recommendation was significantly associated with psychosocial variables (self-efficacy and behavioural change strategies) and membership in a sports club. For girls, membership in a sports club was significantly associated with both PA recommendations. However, this association was positive with respect to the Fitness Recommendation and negative with respect to the HEPA Recommendation. Conclusion: Our results provided some preliminary indication that correlates differ depending on specific recommendations in 14–16-year-old boys and girls. Moreover some variability with regard to sex was observed.

Purpose Engaging in prolonged screen-time behaviors (STBs) is detrimental for health. The objective of the present analyses was to examine temporal trends in TV viewing and computer use among adolescents across 30 countries. Methods Data were derived from the cross-national Health Behaviour in School-aged Children study. Data on TV viewing and computer use for gaming and nongaming purposes were collected in 2002 (n = 139,725 [51.4% girls]), 2006 (n = 149,251 [51.3% girls]), and 2010 (n = 154,845 [51.2% girls]). The temporal trends in TV viewing and computer use were each tested for all countries combined and for each individual country by sex-specific univariate analysis of variance. Results Between 2002 and 2010, TV viewing decreased slightly in most of the 30 countries among both boys and girls. This decrease was more than offset by a sharp increase in computer use, which was consistent across all countries. Overall, boys reported more hours of STBs. They also reported a slightly larger decrease in TV viewing and slightly larger increase in computer use. STBs were generally more frequent on weekend days. Conclusions The overall cross-national increases in STBs should be a call to action for public health practitioners, policy-makers, and researchers that interventions specifically focused on reducing STBs in youth are sorely needed. Because all countries experienced a trend in the same direction, it might be fruitful to learn more about the determinants of STBs among those countries in which hours of STBs are generally low as compared with other countries.

To review the epidemiological evidence on the health-enhancing physical activity recommendation of the Centers for Disease Control and Prevention (CDC) and the American College for Sports Medicine (ACSM). Review of papers written in English and German, issued after the release of the CDC/ACSM recommendation (i. e. after 1995), restricted to adults and to their physical health. Due to the large body of published data, no systematic review was performed. Instead, a representative cross-section of the published studies is presented. The international epidemiological evidence supports the CDC/ACSM recommendation as a reasonable public health message. According to this recommendation, the daily accumulation of 30 minutes of physical activity of moderate intensity — independent of the context of physical activity (e. g. transport, leisure) — provides substantial benefits across a broad range of health outcomes for sedentary men and women. Nevertheless some controversial issues need further address.

BACKGROUND: There are conflicting data about the health benefits of moderately intense physical activity. OBJECTIVES: To examine the effect of such activity on all cause mortality in a German sample of men and women. METHODS: Physical activity during leisure time of 3742 men and 3445 women aged 30 to 69 was assessed in a baseline questionnaire from 1984 to 1986. The participants were observed during the follow up period until 1998 when a mortality follow up was conducted. RESULTS: During the follow up period, 300 women and 643 men had died. The multivariate rate ratios (RR) for the volume of lifestyle activities of moderate intensity (for example, gardening, walking, cycling) compared with sedentary lifestyle showed a clearly protective dose-response relation (p for trend