Youth-centred participatory action approach towards co-created implementation of socially and physically activating environmental interventions in Africa and Europe: the YoPA project study protocol.

INTRODUCTION: The majority of adolescents do not meet guidelines for healthy behaviours, posing major risks for developing multiple non-communicable diseases. Unhealthy lifestyles seem more prevalent in urban than rural areas, with the neighbourhood environment as a mediating pathway. How to develop and implement sustainable and effective interventions focused on adolescent health and well-being in urban vulnerable life situations is a key challenge. This paper describes the protocol of a Youth-centred Participatory Action (YoPA) project aiming to tailor, implement, and evaluate social and physical environmental interventions. METHODS AND ANALYSIS: In diverse urban environments in Denmark, the Netherlands, Nigeria and South Africa, we will engage a dynamic group of 15-20 adolescents (12-19 years) growing up in vulnerable life situations and other key stakeholders (eg, policy makers, urban planners, community leaders) in local co-creation communities. Together with academic researchers and local stakeholders, adolescents will take a leading role in mapping the local system; tailoring; implementing and evaluating interventions during participatory meetings over the course of 3 years. YoPA applies a participatory mixed methods design guided by a novel Systems, User perspectives, Participatory co-creation process, Effects, Reach, Adoption, Implementation and Maintenance framework assessing: (i) the local systems, (ii) user perspectives, (iii) the participatory co-creation process, (iv) effects, (v) reach, (vi) adoption, (vii) implementation and (viii) maintenance of interventions. Through a realist evaluation, YoPA will explore why and how specific outcomes were reached (or not) in each setting (n=800-1000 adolescents in total). ETHICS AND DISSEMINATION: This study received approval from the ethics committees in Denmark, the Netherlands, Nigeria and South Africa and will be disseminated via various collaborative dissemination activities targeting multiple audiences. We will obtain informed consent from all participants. We envision that our YoPA co-creation approach will serve as a guide for participation of adolescents in vulnerable life situations in implementation of health promotion and urban planning in Europe, Africa and globally. TRIAL REGISTRATION NUMBER: NCT06181162.

Development and content validity of an application to assess 24-hour movement behaviors in 0-4-year-old children involving end-users and key stakeholders: the My Little Moves app.

BACKGROUND: Recently, research focus has shifted to the combination of all 24-h movement behaviors (physical activity, sedentary behavior and sleep) instead of each behavior separately. Yet, no reliable and valid proxy-report tools exist to assess all these behaviors in 0-4-year-old children. By involving end-users (parents) and key stakeholders (researchers, professionals working with young children), this mixed-methods study aimed to 1) develop a mobile application (app)-based proxy-report tool to assess 24-h movement behaviors in 0-4-year-olds, and 2) examine its content validity. METHODS: First, we used concept mapping to identify activities 0-4-year-olds engage in. Parents (n = 58) and professionals working with young children (n = 21) generated a list of activities, sorted related activities, and rated the frequency children perform these activities. Second, using multidimensional scaling and cluster analysis, we created activity categories based on the sorted activities of the participants. Third, we developed the My Little Moves app in collaboration with a software developer. Finally, we examined the content validity of the app with parents (n = 14) and researchers (n = 6) using focus groups and individual interviews. RESULTS: The app has a time-use format in which parents proxy-report the activities of their child, using eight activity categories: personal care, eating/drinking, active transport, passive transport, playing, screen use, sitting/lying calmly, and sleeping. Categories are clarified by providing examples of children's activities. Additionally, 1-4 follow-up questions collect information on intensity (e.g., active or calm), posture, and/or context (e.g., location) of the activity. Parents and researchers considered filling in the app as feasible, taking 10-30 min per day. The activity categories were considered comprehensive, but alternative examples for several activity categories were suggested to increase the comprehensibility and relevance. Some follow-up questions were considered less relevant. These suggestions were adopted in the second version of the My Little Moves app. CONCLUSIONS: Involving end-users and key stakeholders in the development of the My Little Moves app resulted in a tailored tool to assess 24-h movement behaviors in 0-4-year-olds with adequate content validity. Future studies are needed to evaluate other measurement properties of the app.

Systematic Review of Contemporary Theories Used for Co-creation, Co-design and Co-production in Public Health.

BACKGROUND: There is a need to systematically identify and summarize the contemporary theories and theoretical frameworks used for co-creation, co-design and co-production in public health research. METHODS: The reporting of this systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Given substantial interest in and application of co-creation, co-design and co-production, we searched PubMed, CINAHL, Scopus and APA PsycINFO from 2012 to March-April 2022. A quality assessment and data extraction for theory content was performed. RESULTS: Of the 3763 unique references identified through the comprehensive search strategy, 10 articles were included in the review: four articles named co-creation, two articles named co-creation and co-design, two articles named co-production and co-design, and two articles named co-design. Empowerment Theory was employed by two articles, whereas other theories (n = 5) or frameworks (n = 3) were employed by one article each. For the quality assessment, eight articles received a strong rating and two articles received a moderate rating. CONCLUSION: There is little indication of theory applications for the approaches of co-creation, co-design and co-production in public health since 2012, given 10 articles were included in this review. Yet, the theories described in these 10 articles can be useful for developing such co-approaches in future public health research.

How to Evaluate the Effectiveness of Health Promotion Actions Developed Through Youth-Centered Participatory Action Research.

Most actions targeting children's health behaviors have limited involvement of children in the development, potentially contributing to disappointing effectiveness. Therefore, in the 3-year "Kids in Action" study, 9- to 12-year-old children from a lower-socioeconomic neighborhood were involved as coresearchers in the development, implementation, and evaluation of actions targeting health behaviors. The current study describes the controlled trial that evaluated the effects on children's energy balance-related behaviors, physical fitness, and self-rated health, as well as experienced challenges and recommendations for future evaluations. Primary school children from the three highest grades of four intervention and four control schools were eligible for participation. Outcome measures assessed at baseline, and at 1- and 2-year follow-up were as follows: motor fitness by the MOPER test (N = 656, N = 485, N = 608, respectively), physical activity and sedentary behavior by accelerometry (N = 223, N = 149, N = 164, respectively), and consumption of sugar sweetened beverages and snacks and self-rated health by a questionnaire (N = 322, N = 281, N = 275, respectively). Mixed-model analyses were performed adjusted for clustering within schools and relevant confounders. Significant beneficial intervention effects were found on self-reported consumption of energy/sports drinks at T2 versus T0, and on total time and ≥5-minute bouts of moderate-to-vigorous physical activity at T1 versus T0. Significant adverse effects were found on "speed and agility" and "coordination and upper-limb speed." No other significant effects were found. The inconsistent intervention effects may be explained by the dynamic cohort and suboptimal outcome measures. We advise future studies with a similar approach to apply alternative evaluation designs, such as the delayed baseline design.

Correlates of Physical Activity in 0- to 5-year-olds: A Systematic Umbrella Review and Consultation of International Researchers.

BACKGROUND: Many children aged 0-5 years do not meet the WHO physical activity guidelines. To develop effective, evidence-based interventions, it is necessary to understand which factors are associated with physical activity in early childhood. OBJECTIVE: To summarize the current evidence on correlates of physical activity in 0- to 5-year-old children. METHODS: First, a systematic umbrella review was conducted following PRISMA guidelines. PubMed, Embase, PsycINFO, and SPORTDiscus were searched up to May 2020 for systematic reviews examining the association between potential correlates and quantitatively measured physical activity in children aged 0-5.9 years. Included reviews were assessed on methodological quality, and results were categorized according to the socio-ecological model. Second, 31 international researchers of physical activity in young children participated in an expert panel to reflect on the outcomes of the umbrella review and propose directions for future research. RESULTS: Twenty-one reviews were included that examined a total of 98 potential correlates. When synthesizing all reviews, 23 correlates were found with consistent evidence for an association with a physical activity outcome. For most other potential correlates there was inconsistent evidence across reviews for associations with physical activity in young children. Although there was little overlap between the correlates identified in the umbrella review and determinants suggested by the expert panel, both confirmed the importance of socio-cultural, policy, and physical environmental factors in general. CONCLUSION: Multiple correlates of young children's physical activity were identified. However, various methodological challenges (e.g., measurement instruments) and the large heterogeneity (e.g., study samples, correlates, and outcome measures) hindered formulating definitive conclusions. Moreover, none of the reviews reported on the interrelatedness between correlates, which would align with more holistic understandings of behavior. Our findings indicate the urgent need for establishing a common ground in definitions, assessment methods, and analytical methods to further the field of physical activity research in this tremendously important age group. PROSPERO REGISTRATION NUMBER: CRD42020184159.

Combining participatory action research with intervention mapping to develop and plan the implementation and evaluation of a healthy sleep intervention for adolescents.

Background: Adolescents' sleep deteriorated over the last decades, urging the need to develop effective interventions. Using participatory action research (PAR) is a promising and unique approach to target adolescents' sleep. This study aims to describe the process and results of combining PAR and intervention mapping (IM) to guide future researchers on developing and planning of the implementation and evaluation of interventions promoting healthy sleep in adolescents. Methods: In each of three intervention schools (two with general and technical education and one with technical and vocational education), an action team including adolescents (age 13- 15 years, n=max. 12) and a researcher was composed to develop and plan the intervention. During weekly sessions (n=ranging from 23 to 34 per school), the action team went through the six steps of IM. A short PAR was performed with parents (n=7) to develop parental intervention components. Results: Combining PAR and IM resulted in interventions focusing on the importance of healthy sleep, regular sleep patterns and associated behaviors: screen behaviors, physical activity, dietary behavior and relaxation. Several differences in the participatory process (i.e. more guidance needed during brainstorms in the vocational/technical school) and developed intervention (i.e. less intrusive intervention components in the vocational/technical school) were observed between schools. Conclusion: Combining PAR with IM resulted in more extensive interventions than other existing school-based sleep interventions. Future studies should investigate whether a participatory developed sleep intervention could be transferred to another setting using a shorter participatory process.

Systematic review of accelerometer-based methods for 24-h physical behavior assessment in young children (0-5 years old).

BACKGROUND: Accurate accelerometer-based methods are required for assessment of 24-h physical behavior in young children. We aimed to summarize evidence on measurement properties of accelerometer-based methods for assessing 24-h physical behavior in young children. METHODS: We searched PubMed (MEDLINE) up to June 2021 for studies evaluating reliability or validity of accelerometer-based methods for assessing physical activity (PA), sedentary behavior (SB), or sleep in 0-5-year-olds. Studies using a subjective comparison measure or an accelerometer-based device that did not directly output time series data were excluded. We developed a Checklist for Assessing the Methodological Quality of studies using Accelerometer-based Methods (CAMQAM) inspired by COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). RESULTS: Sixty-two studies were included, examining conventional cut-point-based methods or multi-parameter methods. For infants (0-12 months), several multi-parameter methods proved valid for classifying SB and PA. From three months of age, methods were valid for identifying sleep. In toddlers (1-3 years), cut-points appeared valid for distinguishing SB and light PA (LPA) from moderate-to-vigorous PA (MVPA). One multi-parameter method distinguished toddler specific SB. For sleep, no studies were found in toddlers. In preschoolers (3-5 years), valid hip and wrist cut-points for assessing SB, LPA, MVPA, and wrist cut-points for sleep were identified. Several multi-parameter methods proved valid for identifying SB, LPA, and MVPA, and sleep. Despite promising results of multi-parameter methods, few models were open-source. While most studies used a single device or axis to measure physical behavior, more promising results were found when combining data derived from different sensor placements or multiple axes. CONCLUSIONS: Up to age three, valid cut-points to assess 24-h physical behavior were lacking, while multi-parameter methods proved valid for distinguishing some waking behaviors. For preschoolers, valid cut-points and algorithms were identified for all physical behaviors. Overall, we recommend more high-quality studies evaluating 24-h accelerometer data from multiple sensor placements and axes for physical behavior assessment. Standardized protocols focusing on including well-defined physical behaviors in different settings representative for children's developmental stage are required. Using our CAMQAM checklist may further improve methodological study quality. PROSPERO REGISTRATION NUMBER: CRD42020184751.

Development of a core outcome set for school-based intervention studies on preventing childhood overweight and obesity: study protocol.

INTRODUCTION: Prevention of childhood overweight is an important health priority. Evidence synthesis from studies evaluating school-based overweight preventive interventions is hampered by the wealth of different outcomes across studies. Therefore, consensus on a core set of outcomes for school-based overweight prevention studies is needed. This paper presents the protocol for the development of a core outcome set (COS) for school-based intervention studies aimed at childhood overweight prevention. METHODS AND ANALYSIS: First, a scoping review will be performed to identify outcomes included in studies evaluating school-based overweight prevention interventions in 6-12 year-old children. Additionally, child focus groups will be organised in three countries to list the outcomes children consider important in school-based interventions. Next, an expert panel will identify all unique outcomes (eg, body composition) from the results of the scoping review and focus groups, ruling out how outcomes were defined and measured (eg, body mass index, body fat). In the next phase, a group of international stakeholders will participate in a Delphi study in which they will rate all unique outcomes on a 9-point Likert scale over three rounds to reach consensus on a COS. Participants will include healthcare professionals, policymakers, teachers, school leaders and parents of 6-12 year-olds. All rated outcomes will be presented to stakeholders in two online consensus meetings. ETHICS AND DISSEMINATION: The Medical Ethics Committee of the VU Medical Center approved the child focus group study in the Netherlands (nr. 2020.071) and the Delphi study-including the consensus meeting (nr. 2022.0295). Other sites will obtain ethics approval for focus groups in their country. The University of Strathclyde School of Psychological Sciences ethics committee approved the Delphi study-including consensus meeting (nr. 72.27.04.2022 .A). The final COS will be disseminated through the diverse networks of all authors and participants. TRIAL REGISTRATION NUMBER: This COS initiative is registered with the Core Outcome Measures in Effectiveness initiative (registration nr. 971).

A systematic review of proxy-report questionnaires assessing physical activity, sedentary behavior and/or sleep in young children (aged 0-5 years).

BACKGROUND: Accurate proxy-report questionnaires, adapted to the child's developmental stage, are required to monitor 24-h movement behaviors in young children, especially for large samples and low-resource settings. OBJECTIVES: This review aimed to summarize available studies evaluating measurement properties of proxy-report questionnaires assessing physical activity, sedentary behavior and/or sleep in children aged 0-5 years. METHODS: Systematic literature searches were carried out in the PubMed, Embase and SPORTDiscus databases, up to January 2021. For physical activity and sedentary behavior questionnaires this is a review update, whereas for sleep questionnaires we included all relevant studies published up to now. Studies had to evaluate at least one of the measurement properties of a proxy-report questionnaire assessing at least duration and/or frequency of physical activity, sedentary behavior and/or sleep in 0- to 5-year-old children. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline was used to evaluate the quality of evidence. RESULTS: Thirty-three studies were included, examining a total of 37 questionnaires. Ten questionnaires were designed for infants, two for toddlers, 11 for preschoolers, and 14 for a broader age range targeting multiple of these age groups. Twenty questionnaires assessed constructs of sleep, four assessed constructs of physical activity, two assessed screen behavior, five assessed constructs of both physical activity and sedentary behavior, and six assessed constructs of all 24-h movement behaviors. Content validity was evaluated for six questionnaires, structural validity for two, internal consistency for three, test-retest reliability for 16, measurement error for one, criterion validity for one, and construct validity for 26 questionnaires. None of the questionnaires were considered sufficiently valid and/or reliable for assessing one or more movement behaviors in 0- to 5-year-old children, and the quality of evidence was mostly low or very low. CONCLUSIONS: Valid and/or reliable questionnaires assessing 24-h movement behaviors in 0- to 5-year-olds are lacking. High-quality studies are therefore required, to develop proxy-report questionnaires and evaluate their measurement properties. PROSPERO REGISTRATION NUMBER: CRD42020169268.

Cross-validation of cut-points in preschool children using different accelerometer placements and data axes.

The present study cross-validated various cut-points to assess physical activity and sedentary behaviour in preschoolers, using hip- and wrist-worn accelerometers and both vertical axis and vector magnitude data. Secondly, we examined the influence of epoch length on time estimates of physical activity and sedentary behaviour. Sixty-four preschoolers (34 girls) wore two accelerometers, on their right hip and dominant wrist, during 1 hour of free play. Preschoolers' activities were observed by two trained researchers. Area under the curve (AUC) was calculated for the receiving operating characteristic (ROC) curves as a measure of precision. AUC ranges were 0.603-0.723 for sedentary behaviour, 0.472-0.545 for light physical activity and 0.503-0.661 for moderate-to-vigorous physical activity (MVPA), indicating poor to fair precision. Percentage of time classified as sedentary behaviour, light or MVPA according to observation and accelerometer data varied largely between cut-points, accelerometer placements and axes. The influence of epoch length on time estimates was minimal across cut-points, except for one hip-based vector magnitude cut-point. Across all accelerometer placements and data axes, no set of cut-points demonstrated adequate precision for sedentary behaviour, light physical activity and MVPA. The highly variable and omnidirectional activity pattern of preschoolers may explain the lack of adequate cut-points.

Start with reducing sedentary behavior: A stepwise approach to physical activity counseling in clinical practice.

Recently, sedentary behavior recommendations have been included in the public health guidelines of multiple countries, pointing to new opportunities for prevention of chronic disease as well as a potential strategy for initiating long-term behavior change. OBJECTIVE: To propose an evidence-informed approach to physical activity counseling that starts with a focus on reducing sedentary time. METHODS: We put forward a case for addressing changes in sedentary behavior in clinical practice using a narrative review. We also propose a new approach for the assessment and counselling of patients with respect to movement behaviors. RESULTS: There is evidence to support a stepwise approach to physical activity counseling that starts with targeting sedentary behavior, particularly in those who are highly sedentary, or those who have chronic disease, or physical impairments. CONCLUSIONS: Our approach encourages clinicians to consider sedentary behavior counseling as a critical first step to physical activity counseling. For many patients, this initial step of reducing sedentary behavior could build a pathway to an active lifestyle. PRACTICAL IMPLICATIONS: A shift from long periods of sedentary time to daily routines incorporating more light intensity physical activity could result in meaningful health improvements. Importantly, this approach may be more feasible for highly inactive patients.

The consequences of using different epoch lengths on the classification of accelerometer based sedentary behaviour and physical activity.

We examined the influence of using different epoch lengths on the classification accuracy of laboratory-controlled sedentary behaviour (SB), and free-living total time and time spent in bouts of SB and moderate-to-vigorous physical activity (MVPA), in children and adolescents. We used two studies including accelerometer-derived data of: 1) controlled activities, i.e. seven sedentary, one standing and one dancing (n = 90); 2) free-living activities (n = 902). For the controlled-activity data, we calculated percentages of time classified as SB and MVPA. For the free-living data, we calculated medians (25th-75th percentiles) of total time and time spent in bouts of SB and MVPA. Applying 8counts/5seconds, 25counts/15seconds and 100counts/60seconds for SB on controlled-activity data revealed respectively (1) 92-96%, 89-99% and 98-100% of sedentary time accurately classified as SB (activity- and age-dependent); (2) 91-98%, 88-99% and 97-100% of standing time classified as SB (age-dependent); (3) 25-37%, 20-25% and 25-38% of dancing time classified as SB (age-dependent). Using longer epochs, children's total time in SB and MVPA decreased while time accumulated in bouts of SB and MVPA accumulated in bouts increased. We conclude that a 60-second epoch seems preferable when the aim is to classify sedentary behaviour, while a shorter epoch length is needed to capture children's short bursts of MPVA. Furthermore, we should be aware that a longer epoch results in averaging of intensities to the middle category.

Effects of physical exercise on natural killer cell activity during (neo)adjuvant chemotherapy: A randomized pilot study.

Natural killer (NK) cells are a population of innate immune cells known to play a pivotal role against tumor spread. In multiple murine models, it was shown that physical exercise had the potential to increase NK cell antitumor activity through their mobilization and tissue redistribution in an interleukin (IL)-6 and epinephrine-dependent manner. The translation of this finding to patients is unclear. In this randomized pilot trial, we analyzed blood samples of patients with resectable breast or colon cancer who were randomized into an evidence-based moderate-high intensity resistance and aerobic exercise intervention (n = 8) or a control group (n = 6) during the first 9-12 weeks of (neo)adjuvant chemotherapy. In this pilot, we did not solely focus on statistical significance, but also explored whether average between-group differences reached 10%. NK cell degranulation was preserved in the exercise group whereas it decreased in the control group resulting in a between-group difference of 11.4% CD107a+ degranulated NK cells (95%CI = 0.57;22.3, p = 0.04) in the presence and 13.8% (95%CI = -2.5;30.0, p = 0.09) in the absence of an anti-epidermal growth factor receptor monoclonal antibody (EGFR-mAb). In line, the between-group difference of tumor cell lysis was 7.4% (95%CI = -9.1;23.9, p = 0.34), and 13.7% (95%CI = -10.1;37.5, p = 0.23) in favor of the exercise group in the presence or absence of EGFR mAb, respectively. Current explorative analyses showed that exercise during (neo)adjuvant chemotherapy may benefit NK cell activity. Future studies with a larger sample size are needed to confirm this finding and to establish its clinical potential. Trial registration: Dutch trial register number NTR4105.

Physical activity and prospective associations with indicators of health and development in children aged <5 years: a systematic review.

BACKGROUND: Early childhood is a critical period for growth and development, yet the association with physical activity during this important period is unknown. The aim of this review is to critically summarize the evidence on the prospective associations between physical activity and health and development in children aged < 5 years. METHODS: A systematic search in three electronic databases (Pubmed, PsycINFO, and Sportdiscus) was conducted to identify prospective studies examining the associations between physical activity (all types; specified by quantity) and health indicators (body composition, cardiometabolic health, bone health and risks/harm) or development (motor, cognitive and social-emotional development) in young children (mean age < 5 years at baseline). Two independent researchers assessed the methodological quality using the 'Quality Assessment Tool for Quantitative Studies' (EPHPP). This tool covers eight quality criteria: selection bias, study design, confounders, blinding, data collection methods, withdrawals and drop-outs, intervention integrity and data-analysis. RESULTS: Thirty-nine studies, predominantly conducted in preschoolers (ages 3-5 years), were included of which nine were rated as high methodological quality. There was moderate evidence for a positive association between physical activity and motor (n = 11 studies) and cognitive development (n = 10 studies) based on consistent findings from studies having low-to-moderate methodological quality. There was insufficient evidence for an association between physical activity and body composition (n = 15 studies), cardiometabolic health indicators (n = 7 studies), social-emotional development (n = 2 studies) and bone health (n = 2 studies) based on inconsistent findings from studies having weak-to-high methodological quality. CONCLUSIONS: There is a need for more high-quality research in order to determine the dose-response relationship between physical activity and health and development in early childhood. Special attention should be paid to studies in children below the age of 3 years.

Strategies and effects of school-based interventions to promote active school transportation by bicycle among children and adolescents: a systematic review.

BACKGROUND: Promoting cycling to school may benefit establishing a lifelong physical activity routine. This systematic review aimed to summarize the evidence on strategies and effects of school-based interventions focusing on increasing active school transport by bicycle. METHODS: A literature search based on "PICo" was conducted in eight electronic databases. Randomized and non-randomized controlled trials with primary/secondary school students of all ages were included that conducted pre-post measurements of a school-based intervention aimed at promoting active school travel by bicycle and were published in English between 2000 and 2019. The methodological quality was assessed using the "Effective Public Health Practice Project" tool for quantitative studies. Applied behavior change techniques were identified using the "BCT Taxonomy v1". Two independent researchers undertook the screening, data extraction, appraisal of study quality, and behavior change techniques. RESULTS: Nine studies investigating seven unique interventions performed between 2012 and 2018 were included. All studies were rated as weak quality. The narrative synthesis identified 19 applied behavior change techniques clustered in eleven main groups according to their similarities and a variety of 35 different outcome variables classified into seven main groups. Most outcomes were related to active school travel and psychosocial factors, followed by physical fitness, physical activity levels, weight status, active travel and cycling skills. Four studies, examining in total nine different outcomes, found a significant effect in favor of the intervention group on bicycle trips to school (boys only), percentage of daily cycling trips to school, parental/child self-efficacy, parental outcome expectations, moderate-to-vigorous intensity physical activity (total, from cycling, before/after school), and total basic cycling skills. Seven of these outcomes were only examined in two studies conducting the same intervention in children, a voluntary bicycle train to/from school accompanied by adults, including the following clustered main groups of behavior change techniques: shaping knowledge, comparison of behavior, repetition and substitution as well as antecedents. CONCLUSIONS: The applied strategies in a bicycle train intervention among children indicated great potential to increase cycling to school. Our findings provide relevant insights for the design and implementation of future school-based interventions targeting active school transport by bicycle. TRIAL REGISTRATION: This systematic review has been registered in the international prospective register of systematic reviews "PROSPERO" at (registration number: CRD42019125192 ).

Trends in Neuromotor Fitness in 10-to-12-Year-Old Dutch Children: A Comparison Between 2006 and 2015/2017.

Children with a low level of neuromotor fitness are less skilled to participate in sports activities. Moreover, lower levels of neuromotor fitness are related to adiposity, lower cardiovascular health, and poor self-esteem in children. The aim of this paper was to determine neuromotor fitness in 10-12-year-old Dutch children over a 10-year period. Test scores measured in 2015/2017 (N = 533 in 2015, N = 941 in 2017) were compared with scores of same-aged children measured in 2006 (N = 1986). Neuromotor fitness was assessed using the MOPER fitness test battery, including speed and agility, strength, flexibility, and coordination and upper-limb speed. Data were analyzed using multilevel linear regression models and tobit regression analyses in case of skewed distributions with an excess of zeros. Analyses were stratified by age and gender, and adjusted for level of urbanization. Children in 2015/2017 performed significantly worse on speed and agility (ß = 0.8 to 1.1 s), significantly better on coordination/upper-limb speed (ß = -1.0 to -0.6 s), and-except for 12-year-old girls-significantly worse on flexibility vs. children in 2006 (ß = -3.4 to -1.8 cm). Additionally, upper-body strength was significantly worse among 10-year olds (ß = -3.2 to -2.5 s) while leg strength was significantly worse among 11-year-olds in 2015/2017 vs. 2006 (ß = -1.8 to -1.7 cm). Trunk strength was worse among 11- and 12-year old boys (ß = 1.1 to 1.2 s). In line with a previously observed downward trend in neuromotor fitness among children (1980-2006), we found worse scores on speed and agility, and flexibility in 2015/2017 vs. 2006, stressing the need for interventions aimed at improving neuromotor fitness in order to promote physical activity and future health.

Effectiveness and promising behavior change techniques of interventions targeting energy balance related behaviors in children from lower socioeconomic environments: A systematic review.

This systematic review aims to summarize the evidence regarding the effectiveness of interventions targeting energy balance-related behaviors in children from lower socioeconomic environments and the applied behavior change techniques. The literature search was conducted in Cochrane, Embase, Psycinfo and Pubmed. Articles had to be published between January 2000 and September 2019. Studies were included that i) targeted dietary behavior, physical activity and/or sedentary behavior; ii) had a controlled trial design; iii) included children aged 9-12 years old; iv) focused on lower socioeconomic environments; and v) took place in upper-middle or high income countries. Two independent researchers extracted data, identified behavior change techniques using the Behavior Change Technique Taxonomy v1, and performed a methodological quality assessment using the quality assessment tool of the Effective Public Health Practice Project. We included 24 studies, of which one received a high and three a moderate quality rating. Demonstration, practice and providing instructions on how to perform a behavior were the most commonly applied behavior change techniques. Seven studies reported significant beneficial intervention effects: five on physical activity, one on physical activity and sedentary behavior and one on dietary behavior. When comparing effective versus non-effective interventions, and comparing our review to previous reviews focusing on children from the general population, similar behavior change techniques were applied. More high quality research is needed to evaluate the effectiveness of interventions and their behavior change techniques targeting children of low socioeconomic environments. PROSPERO registration number: CRD42016052599.

Gender Influence on Students, Parents, and Teachers' Perceptions of What Children and Adolescents in Germany Need to Cycle to School: A Concept Mapping Study.

Active commuting to school is highly recommended for several reasons, and in the decision-making process for doing so, a child interacts with parents and teachers. Until now, these three interactors' gender-specific perspectives on children and adolescents' need for cycling to school have been unavailable. Thus, our concept mapping study analyzed the needs of 12- to 15-year-olds in Germany for cycling to and from school daily, as perceived by students, parents, and teachers stratified by gender. From November 2019 to February 2020, 136 students, 58 parents, and 29 teachers participated. Although 87.8% of girls and 100% of boys owned a bicycle, only 44.4% of girls and 72.9% of boys cycled to school. On average, girls cycled to school on 1.6 ± 2.0 days a week and boys on 2.7 ± 2.0 days a week. A "bicycle and related equipment," the "way to school," and "personal factors" were reported needs, perceived by students and teachers of both genders and by mothers. Girls reported the additional gender-specific need for "social behavior in road traffic," mothers and female teachers reported "role of parents," and female teachers reported a "sense of safety." This study's findings could inspire the development of school-based bicycle interventions.

Muscle contractile properties of cancer patients receiving chemotherapy: Assessment of feasibility and exercise effects.

BACKGROUND: This pilot trial explores the feasibility of measuring muscle contractile properties in patients with cancer, effects of exercise during chemotherapy on muscle contractile properties and the association between changes in contractile muscle properties and perceived fatigue. METHOD: Patients who received (neo)adjuvant chemotherapy for breast or colon cancer were randomized to a 9-12 week exercise intervention or a waitlist-control group. At baseline and follow-up, we measured knee extensor strength using maximal voluntary contraction (MVC), contractile muscle properties of the quadriceps muscle using electrical stimulation, and perceived fatigue using the Multidimensional Fatigue Inventory. Feasibility was assessed by the proportion of patients who successfully completed measurements of contractile muscle properties. Exercise effects on muscle contractile properties were explored using linear regression analyses. Between-group differences >10% were considered potentially relevant. Pearson correlation (rp ) of changes in contractile muscle properties and changes in perceived fatigue was calculated. RESULTS: Twenty two of 30 patients completed baseline and follow-up assessments. Measurements of contractile properties were feasible except for muscle fatigability. We found a potentially relevant between-group difference in the rate of force development favoring the intervention group (1192 N/s, 95% CI = -335; 2739). Change in rate of force development was negatively correlated with change in perceived general (rp  = -0.54, P = .04) and physical (rp  = -0.59, P = .02) fatigue. CONCLUSION: Chemotherapy induces a decrease in the rate of force development, which may reflect a larger loss in type II muscle fibers. This may be attenuated with (resistance) exercise. The increase in the rate of force development was related to a decrease in perceived fatigue.