Dutch obesity intervention in teenagers: effectiveness of a school-based program on body composition and behavior.

OBJECTIVE: 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. DESIGN: Randomized controlled trial. SETTING: Ten intervention and 8 control prevocational secondary schools. PARTICIPANTS: 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. MAIN OUTCOME MEASURES: Body height and weight, waist circumference, 4 skinfold thickness measurements, and dietary and physical activity behavior data. RESULTS: 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. CONCLUSION: 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.

The effects of exercise on cognition in older adults with and without cognitive decline: a systematic review.

OBJECTIVE: To systematically review the effect of physical exercise on cognition in older adults with and without cognitive decline. DATA SOURCES: : Randomized controlled trials were identified by literature searches in PubMed, EMBASE, CENTRAL, PsycINFO, and AgeLine. STUDY SELECTION: Papers were included on the basis of predefined inclusion criteria. DATA EXTRACTION: Data on study population, exercise intervention, and effectiveness were extracted. Two independent reviewers assessed methodological quality. DATA SYNTHESIS: Twenty-three studies were included-15 among cognitively healthy subjects and 8 among subjects with cognitive decline. Seven studies were qualified as high-quality studies, 2 in cognitively healthy subjects and 5 in subjects with cognitive decline. In cognitively healthy subjects, significant beneficial intervention effects were observed in 5 studies on information processing, executive function, or memory. Interventions in these studies included aerobic exercise only (n = 2); strength exercise (n = 1); strength and balance exercise (n = 1); or all-round exercise including aerobic, strength, balance and flexibility training (n = 1). In subjects with cognitive decline, 5 studies observed beneficial effects on general cognition, executive functions, and memory. Interventions included aerobic (n = 3) or strength exercise combined with flexibility or balance exercise (n = 2). CONCLUSIONS: Beneficial effects of various exercise programs on aspects of cognition have been observed in studies among subjects with and without cognitive decline. The majority of the studies, however, did not find any effect. The small number of included studies; lack of high-quality studies; and the large variability in study populations, exercise protocols, and outcome measures complicate interpretation of the results. More high-quality trials are needed to assess the effects of different types of exercise on cognitive function in older adults with and without cognitive decline.

The functional effects of physical exercise training in frail older people : a systematic review.

This systematic review describes the effect of exercise training on physical performance in frail older people. Randomized controlled trials were identified from searches in PubMed, EMBASE and CENTRAL from January 1995 through August 2007. Two reviewers independently screened the trials for eligibility, rated their quality, and extracted data. Randomized controlled trials that examined the effects on performance-based measures of physical function among frail older adults were included. The systematic search identified 20 studies, examining 23 different exercise programmes. The methodological quality score (0-9) of the trials ranged from 2 to 7 points. Sixteen of the studies were scored as high quality. There was a large variety in the studies concerning sample size, degree of frailty, types of interventions and types of assessments. The majority of the programmes were facility-based, group-exercise programmes that were performed three times a week for 45-60 minutes. The intervention programmes comprised resistance training (n = 9), Tai Chi training (n = 2), or multi-component training (n = 12). Six of the total selected 20 studies did not find a beneficial exercise effect on functional performance. This systematic review suggests that older adults with different levels of abilities can improve their functional performance by regular exercise training. To determine the most appropriate design of the exercise programme (type, intensity, frequency and duration of exercise) for functional improvement or prevention of loss of function, more high-quality trials are needed in which different training protocols are compared.

Acute physical activity and sports injuries in children.

An increase in the physical activity of individuals has many health benefits, but a drawback of an increase in physical activity is the risk of related injuries. To reduce the short- and long-term effects in terms of social and economic consequences, prevention of physical activity injuries is an important challenge. A sequence of prevention model has been proposed that aims to prevent physical activity injuries in different steps. The model includes (i) identification of the problem in terms of incidence and severity of physical activity injuries, (ii) identification of the risk factors and injury mechanisms that play a role in the occurrence of physical activity injuries, (iii) introduction of measures that are likely to reduce the future risk and (or) severity of physical activity injuries, and (iv) evaluation of the effectiveness of the measures by conducting a randomized controlled trial (RCT). This review describes what is currently known about all of the various aspects of the sequence of prevention in children (steps i-iv).

The motivation of children to play an active video game.

The purpose of this pilot study was to evaluate the effect of a weekly multiplayer class on the motivation of children aged 9-12 years to play an interactive dance simulation video game (IDSVG) at home over a period of 12 weeks. A sample of 27 children was randomly assigned to (1) a home group instructed to play the IDSVG at home; (2) a multiplayer group instructed to play the IDSVG at home and to participate in a weekly IDSVG multiplayer class. Participants were asked to play the IDSVG as often as they liked and report the playing time daily on a calendar for a 12-week period. Motivation to play was assessed by the playing duration of IDSVG in minutes and the dropout during the study. Mean age of the 16 children who completed the study was 10.6+/-0.8 years. During the 12-week intervention period, the multiplayer group played approximately twice as many minutes (901min) as the home group (376min, p=0.13). Dropout was significantly (p=0.02) lower in the multiplayer group (15%) than in the home group (64%). Our findings suggest that multiplayer classes may increase children's motivation to play interactive dance simulation video games.

The effect of walking and vitamin B supplementation on quality of life in community-dwelling adults with mild cognitive impairment: a randomized, controlled trial.

OBJECTIVES: To examine the effect of walking and vitamin B supplementation on quality-of-life (QoL) in community-dwelling adults with mild cognitive impairment. METHODS: One year, double-blind, placebo-controlled trial. Participants were randomized to: (1) twice-weekly, group-based, moderate-intensity walking program (n = 77) or a light-intensity placebo activity program (n = 75); and (2) daily vitamin B pills containing 5 mg folic acid, 0.4 mg B12, 50 mg B6 (n = 78) or placebo pills (n = 74). QoL was measured at baseline, after six and 12 months using the population-specific Dementia Quality-of-Life (D-QoL) to assess overall QoL and the generic Short-Form 12 mental and physical component scales (SF12-MCS and SF12-PCS) to assess health-related QoL. RESULTS: Baseline levels of QoL were relatively high. Modified intention-to-treat analyses revealed no positive main intervention effect of walking or vitamin supplementation. In both men and women, ratings of D-QoL-belonging and D-QoL-positive affect subscales improved with 0.003 (P = 0.04) and 0.002 points (P = 0.06) with each percent increase in attendance to the walking program. Only in men, SF12-MCS increased with 0.03 points with each percent increase in attendance (P = 0.08). CONCLUSION: Several small but significant improvements in QoL were observed with increasing attendance to the walking program. No effect of vitamin B supplementation was observed. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number Register, 19227688, http://www.controlled-trials.com/isrctn/.

Detection of memory impairment in the general population: screening by questionnaire and telephone compared to subsequent face-to-face assessment.

BACKGROUND: Development of efficient methods for identifying subjects with Mild Cognitive Impairment (MCI) from the general population is warranted, because these subjects represent an important group for (epidemiological) research purposes. OBJECTIVES: (1) To describe a two-step population screening for identifying adults with MCI from the general population for research purposes, by questionnaire and telephone; (2) to compare screening by telephone (method 1) to a subsequent face-to-face assessment (method 2). METHODS: In method 1, subjects with memory complaints were identified from the general population (n = 5491) by a postal questionnaire. Subsequently, cognitive status and memory were assessed in a telephone interview using the Telephone Interview for Cognitive Status and the Ten Word Learning Test. Next, subjects with MCI according to method 1 were subjected to a face-to-face assessment for method 2, in which cognitive status and memory were assessed using the Mini Mental State Examination (MMSE) and the Auditory Verbal Learning Test (AVLT). RESULTS: Two hundred and twenty-seven subjects completed both the telephone interview and the face-to-face assessment. Ninety-three subjects (41%) had MCI according to both methods. Seven subjects (3%) failed to meet MCI criteria according to method two because of an MMSE score <24; 127 subjects (56%) failed because of normal AVLT scores. CONCLUSION: (1) The two-step population screening was able to detect a considerable number of MCI-subjects in the general population; (2) agreement between both methods was moderate. Therefore, the method of recruiting subjects for (epidemiological) studies has to be taken into consideration when interpreting results of these studies.

Design of the Dutch Obesity Intervention in Teenagers (NRG-DOiT): systematic development, implementation and evaluation of a school-based intervention aimed at the prevention of excessive weight gain in adolescents.

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.

Effects of resistance and functional-skills training on habitual activity and constipation among older adults living in long-term care facilities: a randomized controlled trial.

BACKGROUND: Large-scale RCTs comparing different types of exercise training in institutionalised older people are scarce, especially regarding effects on habitual physical activity and constipation. This study investigated the effects of different training protocols on habitual physical activity and constipation of older adults living in long-term care facilities. METHODS: A randomized controlled trial with 157 participants, aged 64 to 94 years, who were randomly assigned to 1) resistance training; 2) all-round functional-skills training; 3) both; or 4) an 'educational' control condition. Habitual physical activity was assessed with a physical activity questionnaire and accelerometers. Constipation was assessed by a questionnaire. Measurements were performed at baseline and after six months of training. RESULTS: At baseline the median time spent sitting was 8.2 hr/d, the median time spent on activity of at least moderate intensity was 32 min/d. At baseline, about 22% of the subjects were diagnosed with constipation and 23% were taking laxatives. There were no between-group differences for changes in habitual physical activity or constipation over 6-months. CONCLUSION: Six months of moderate intensity exercise training neither enhances habitual physical activity nor affects complaints of constipation among older people living in long-term care facilities.

Promoting physical activity with people in different places--a Dutch perspective.

This paper describes five recent Dutch studies of the effectiveness of physical activity interventions carried out in diverse settings: general practice (GP), aged care facilities, and workplaces. The stage-based physical activity counselling carried out in the GP setting demonstrated a beneficial effect on the determinants of physical activity, but did not show any additional effect on physical activity behaviour, compared with standard physical activity advice. In contrast, the stage-based intervention through the workplace was effective in increasing physical activity, due mostly to an increase in vigorous-intensity activities. In the aged care setting, functional-skills training alone or in combination with resistance training showed functional improvement only in participants with high participation rates. Functional-skills training appeared to be more feasible than resistance training in this population of frail elderly. The two studies which aimed to promote earlier return-to-work among workers with sick leave due to non-specific low back pain also showed promising results. As a result, it was recommended that occupational physicians (OP) should refer workers with low back pain in the subacute phase of their sick leave to a low intensity intervention consisting of short meetings and exercises aimed at changing behaviour, and that the OPs contact other health care providers (GPs and physiotherapists) about the treatment strategy. Together, the results of these five Dutch studies suggest that it is feasible to successfully promote physical activity to groups of people in diverse places, with benefits in terms of both prevention and management of chronic disease and injury.

Cross-sectional relationship between physical fitness components and functional performance in older persons living in long-term care facilities.

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.

Once a week not enough, twice a week not feasible? A randomised controlled exercise trial in long-term care facilities [ISRCTN87177281].

OBJECTIVE: To evaluate the effectiveness of three different training protocols on physical function of older adults living in long-term care facilities. Emphasis was placed on feasibility in real-life situations. METHODS: Subjects (N=224) were randomised to 6 months of twice weekly (1) resistance training; (2) all-round functional-skills training; (3) a combination of both; or (4) a control program. Fitness and performance measures and self-reported disability were measured at baseline and after 24 weeks intervention. RESULTS: Attendance to the strength training was 76%, to the functional-skills training 70% and to the combined training 73%. In those who attended at least 75% of all classes (n=97) the functional-skills and combined training program improved several fitness and performance measures compared to the control group. CONCLUSION: Twice weekly functional-skills training, or a combination of resistance and functional-skills training can improve several fitness and performance measures of institutionalised older people. PRACTICE IMPLICATIONS: An important finding from our study was that less than twice a week exercise training is not enough for functional improvement, while it proved difficult for the elderly subjects to exercise twice weekly. Education on the health benefits of regular exercise, and a larger availability of classes in long-term care facilities may improve attendance.

Promoting physical activity using an activity monitor and a tailored web-based advice: design of a randomized controlled trial [ISRCTN93896459].

BACKGROUND: Ageing is associated with a decrease in physical activity. This decrease particularly occurs during specific transitional life stages. Especially during adolescence and young adulthood a steep decrease in physical activity is observed. Inactive people are often not aware of their inactivity. Providing feedback on the actual physical activity level by an activity monitor can increase awareness and may in combination with an individually tailored physical activity advice stimulate a physically active lifestyle. METHODS: In a randomized controlled trial the effectiveness of providing an activity monitor in combination with a personal physical activity advice through the Internet will be examined. Outcome measures are level of physical activity, determinants of physical activity, quality of life, empowerment, aerobic fitness and body composition. Participants are relatively inactive adolescents and young adults who are measured at baseline, after 3 months intervention and 5 months after the end of the intervention. In addition, facilitating and hindering factors for implementation of the intervention will be investigated. DISCUSSION: The use of a personal activity monitor in combination with web-based assisted individually tailored health promotion offers a good opportunity to work interactively with large groups of adolescents and young adults and provide them with advice based on their actual activity level. It has great potential to motivate people to change their behaviour and to our knowledge has not been evaluated before.

Protocol for Project FACT: a randomised controlled trial on the effect of a walking program and vitamin B supplementation on the rate of cognitive decline and psychosocial wellbeing in older adults with mild cognitive impairment [ISRCTN19227688].

BACKGROUND: The prevalence of individuals with cognitive decline is increasing since the number of elderly adults is growing considerably. The literature provides promising results on the beneficial effect of exercise and vitamin supplementation on cognitive function both in cognitively healthy as well as in the demented elderly. METHODS/DESIGN: The design is a two-by-two factorial randomised controlled trial. The study population consists of independently living elderly, between 70 and 80 years old, with mild cognitive impairment (MCI). In the RCT the effect of two interventions, a walking program and vitamin supplementation, is examined. The walking program (WP) is a group-based program aimed at improving cardiovascular endurance; frequency two lessons a week; lesson duration one hour; program duration one year. Non-walking groups receive a placebo activity program (PAP) (i.e. low intensive non-aerobic group exercises, like stretching) with the same frequency, lesson and program duration. Vitamin supplementation consists of a single daily vitamin supplement containing 50 mg B6, 5 mg folic acid and 0,4 mg B12 for one year. Subjects not receiving vitamin supplements are daily taking an identically looking placebo pill, also for a year. Participants are randomised to four groups 1) WP and vitamin supplements; 2) WP and placebo supplements; 3) PAP and vitamin supplements; 4) PAP and placebo supplements. Primary outcome measures are measures of cognitive function. Secondary outcomes include psychosocial wellbeing, physical activity, cardiovascular endurance and blood vitamin levels. DISCUSSION: No large intervention study has been conducted yet on the effect of physical activity and vitamin supplementation in a population-based sample of adults with MCI. The objective of the present article is to describe the design of a randomised controlled trial examining the effect of a walking program and vitamin B supplementation on the rate of cognitive decline in older adults with MCI.

Worksite health promotion programs with environmental changes: a systematic review.

BACKGROUND: It is now widely believed that health promotion strategies should go beyond education or communication to achieve significant behavioral changes among the target population. Environmental modifications are thought to be an important addition to a worksite health promotion program (WHPP). This review aimed to systematically assess the effectiveness of WHPPs with environmental modifications, on physical activity, dietary intake, and health risk indicators. METHODS: Online searches were performed for articles published up to January 2004 using the following inclusion criteria: (1) (randomized) controlled trial (RCT/CT); (2) intervention should include environmental modifications; (3) main outcome must include physical activity, dietary intake, and health risk indicators; and (4) healthy working population. Methodologic quality was assessed using a checklist derived from the methodologic guidelines for systematic reviews (Cochrane Back Review Group), and conclusions on the effectiveness were based on a rating system of five levels of evidence. RESULTS: Thirteen relevant, mostly multicenter, trials were included. All studies aimed to stimulate healthy dietary intake, and three trials focused on physical activity. Follow-up measurements of most studies took place after an average 1-year period. Methodologic quality of most included trials was rated as poor. However, strong evidence was found for an effect on dietary intake, inconclusive evidence for an effect on physical activity, and no evidence for an effect on health risk indicators. CONCLUSIONS: It is difficult to draw general conclusions based on the small number of studies included in this review. However, evidence exists that WHPPs that include environmental modifications can influence dietary intake. More controlled studies of high methodologic quality need to be initiated that investigate the effects of environmental interventions on dietary intake and especially on physical activity in an occupational setting.

Effects of resistance and all-round, functional training on quality of life, vitality and depression of older adults living in long-term care facilities: a 'randomized' controlled trial [ISRCTN87177281].

BACKGROUND: Regular physical activity may improve different aspects of wellbeing in older people, such as quality of life, vitality and depression. However, there is little experimental evidence to support this assumption. Therefore, we examined the effect of different training protocols on quality of life, vitality and depression of older adults living in long-term care facilities. METHODS: Subjects (n = 173, aged 64 to 94 years, living in long-term care facilities), were randomized to six months of three different moderate-intensity group exercise training protocols, or to an 'educational' control condition. Exercise consisted of two 45-60-minute training sessions per week of 1) resistance training; 2) all-round, functional training; or 3) a combination of both. Perceived health, the Geriatric Depression Scale (GDS), the Vitality Plus Scale (VPS) and the Dementia Quality of Life questionnaire (DQoL) were administered at baseline and after six months. RESULTS: In the combined training group a small but significant decline was seen in perceived health, DQoL and VPS score compared to the control group. CONCLUSIONS: We conclude that neither strength training nor all-round, functional training of moderate intensity is effective in improving quality of life, vitality or depression of older people living in long-term care facilities.

Vitamin B-12 status is associated with bone mineral content and bone mineral density in frail elderly women but not in men.

Subclinical vitamin B-12 deficiency is common in the elderly. Encouraged by early indications, we investigated the plasma vitamin B-12 status in association with bone mineral content (BMC) and bone mineral density (BMD) in frail elderly people. Data of 194 free-living Dutch frail elderly (143 women and 51 men) were available. BMC and BMD were measured by dual energy X-ray analysis. Biochemical analyses were performed on plasma or serum including vitamin B-12, methylmalonic acid, homocysteine, 25-hydroxy vitamin D and parathyroid hormone. Women had higher plasma vitamin B-12 (288 and 238 pmol/L, respectively) and lower plasma homocysteine levels (15.8 and 21.3 micro mol/L, respectively) than men. Of the total explained variance of BMC and BMD in women (46 and 22%, respectively), 1.3-3.1% was explained by plasma vitamin B-12, in addition to weight and height or energy intake. In men, the variance of BMC and BMD was explained by weight, smoking and/or height (total R(2) was 53 and 25%, respectively), but not by plasma vitamin B-12. Osteoporosis occurred more often among women whose vitamin B-12 status was considered marginal or deficient than in women with a normal status, i.e., the prevalence odds ratios (after adjustment for weight, age and calcium intake) (95% confidence intervals) were 4.5 (0.8;24.8) and 6.9 (1.2;39.4), respectively. These results suggest that vitamin B-12 status is associated with bone health in elderly women. Future studies on bone health should take into account a possible role of vitamin B-12 status in different populations.