The contribution of general and cancer-related variables in explaining physical activity in a breast cancer population 3 weeks to 6 months post-treatment.

OBJECTIVE: Physical activity determinants are subject to change when confronted with the diagnosis of 'cancer' and new cancer-related determinants appear. The aim of the present study is to compare the contribution of cancer-related determinants with more general ones in explaining physical activity 3 weeks to 6 months post-treatment. METHODS: A theory-based and validated questionnaire was used to identify physical activity levels (total and domain-specific) and associated determinants among 464 breast cancer survivors (aged 18 to 65 years) 3 weeks to 6 months post-treatment. RESULTS: Descriptive analyses showed higher scores for general determinants in comparison with cancer-related determinants. Nevertheless, regression analyses showed that both general and cancer-related determinants explained total and domain-specific physical activity. Self-efficacy, enjoyment, social support, lack of time and lack of company were important general determinants. The perception of returning to normal life, cancer-related barriers (fatigue, lack of energy and physical side effects) and self-efficacy in overcoming these barriers were important cancer-related determinants. Although results differed according to the women's working status and the physical activity domain, general self-efficacy explained most physical activity types in both groups. CONCLUSION: Comparable with the general population, enhancing breast cancer survivors' self-efficacy in being sufficiently physically active seems to be important in physical activity interventions post-treatment. However, interventions should be tailored to the experienced symptoms and working status of the women.

Children's cycling skills: Development of a test and determination of individual and environmental correlates.

INTRODUCTION: Children's ability to perform cycling skills was found to play an important role in cycling accidents. Therefore, this study developed a test to gain a detailed insight into the cycling skills of 9-10 year old children and evaluated individual and physical environmental correlates of cycling skills. METHODS: Children (n=93) took a cycling test consisting of 13 test stations. In addition, parents completed a questionnaire on school commuting behavior. An exploratory factor analysis was conducted to investigate the factor structure of the cycling test and ICC's were calculated to examine interrater reliability. Descriptive statistics were executed on children's cycling skill scores. Regression analyses were conducted to evaluate individual and environmental correlates of cycling skills. RESULTS: Three factors were extracted: the 'during-cycling skills', the 'before/after-cycling skills' and a 'transitional-cycling skills' factor. These factors accounted for 56.74% of the total variance. Furthermore, intraclass correlation coefficients ranged from 0.75 to 0.98. For all cycling skill, except two, 50% of children scored higher than 7.5/10. Additionally, 18.4% of children scored lower than 3/10 on at least two cycling skills. Parental perceived motor competence of the child explained 10% of the variance in cycling skills (ß=0.33), residential density explained 12% of the variance (ß=-0.37). CONCLUSIONS: In order to get an overall picture of the cycling skills of children, the 'during-cycling skills', the 'before/after-cycling skills' and the 'transitional-cycling skills' need to be examined. Furthermore, Flemish children of the 4th grade scored well on cycling skills. However, cycle training programs should focus more on one-handed skills and those children scoring lower than 3/10 on one or more cycling skills.

Individual, social and physical environmental correlates of 'never' and 'always' cycling to school among 10 to 12 year old children living within a 3.0 km distance from school.

BACKGROUND: Cycling to school has been identified as an important target for increasing physical activity levels in children. However, knowledge about correlates of cycling to school is scarce as many studies did not make a distinction between walking and cycling to school. Moreover, correlates of cycling to school for those who live within a distance, that in theory would allow cycling to school, stay undiscovered. Therefore, this study examined individual, social and physical environmental correlates of never and always cycling to/from school among 10 to 12 year old Belgian children living within a 3.0 km distance from school. METHODS: 850 parents completed a questionnaire to assess personal, family, behavioral, cognitive, social and physical environmental factors related to the cycling behavior of their children. Parents indicated on a question matrix how many days a week their child (1) walked, (2) cycled, was (3) driven by car or (4) public transport to and from school during fall, winter and spring. Multivariate logistic regression analyses were conducted to examine the correlates. RESULTS: Overall, 39.3% of children never cycled to school and 16.5% of children always cycled to school. Children with high levels of independent mobility and good cycling skills perceived by their parents were more likely to always cycle to school (resp. OR 1.06; 95% CI 1.04-1.15 and OR 1.08; 95% CI 1.01-1.16) and less likely to never cycle to school (resp. OR 0.84; 95% CI 0.78-0.91 and OR 0.77; 95% CI 0.7-0.84). Children with friends who encourage them to cycle to school were more likely to always cycle to school (OR 1.08; 95% CI 1.01-1.15) and less likely to never cycle to school (OR 0.9; 95% CI 0.83-1.0). In addition, children with parents who encourage them to cycle to school were less likely to never cycle to school (OR 0.78; 95% CI 0.7-0.87). Regarding the physical environmental factors, only neighborhood traffic safety was significantly associated with cycling: i.e., children were more likely to always cycle to school if neighborhood traffic was perceived as safe by their parents (OR 1.18; 95% CI 1.07-1.31). CONCLUSION: Individual, social and physical environmental factors were associated with children's cycling behavior to/from school. However, the contribution of the physical environment is limited and highlights the fact that interventions for increasing cycling to school should not focus solely on the physical environment.

Objectively measured sedentary time and physical activity time across the lifespan: a cross-sectional study in four age groups.

BACKGROUND: From a health perspective it is suggested to promote a positive balance between time spent in light intensity physical activity (LIPA) and sedentary behaviour (SB) (i.e. spending more time in LIPA than time spent in SB). However, no studies have reported prevalence rates of the LIPA-SB balance yet. The aim of this study was to objectively investigate the time spent in SB, in LIPA and moderate-to-vigorous intensity physical activity (MVPA) in four Belgian age groups and to explore which proportion of the population had a favorable balance between LIPA and SB and combined this with recommended amount of MVPA. METHODS: Accelerometer data from 7 cross-sectional studies (N=2083) in four age groups (preschoolers, primary schoolchildren, secondary schoolchildren and adults) were aggregated. Differences in SB and PA between age groups and between men and women were determined by two-way MANCOVA. LIPA-SB balance was calculated and participants were categorized into one of four groups: (1) positive LIPA-SB balance (LIPA> SB) & sufficient MVPA (2) negative LIPA-SB balance & sufficient MVPA (3) positive LIPA-SB balance & insufficient MVPA (4) negative LIPA-SB balance & insufficient MVPA. RESULTS: For the total sample, 55% of the waking time was spent in SB, 39% in LIPA and 6% in MVPA. Differences in SB between age groups was dependent from gender (p<0.001). Further, a positive LIPA-SB balance was assessed in 18% of the total sample and only 10% combined this positive balance with recommended amount of MVPA. Secondary schoolgirls were most at risk, with only 1% of the sample combining a positive LIPA-SB balance with sufficient MVPA. Another risk group was the large proportion (43%) of adult men who combined sufficient MVPA with a negative LIPA-SB balance. CONCLUSION: A high proportion of the Belgian population is at risk if taking into account both SB and PA levels. Secondary schoolgirls have the unhealthiest SB and PA profile and are therefore an important target group for interventions both increasing MVPA and decreasing SB. In men more attention should be given in promoting a positive LIPA-SB balance independently from their compliance with the MVPA guidelines.

Treatment-related and psychosocial variables in explaining physical activity in women three weeks to six months post-treatment of breast cancer.

OBJECTIVE: This study examined treatment-related and psychosocial variables in explaining total and leisure time physical activity in breast cancer survivors three weeks to six months post-treatment. METHODS: A questionnaire was used to measure total and leisure time physical activity and relevant determinants among 464 breast cancer survivors (aged 18-65 years). RESULTS: Personal control was an important overall determinant in explaining physical activity in breast cancer survivors. The impact of treatment-related variables and psychological functioning depended on the working status of the women. Fatigue and poor body image prevented non-working women from being sufficiently physically active. In working women, chemotherapy and arm problems negatively influenced physical activity, whereas therapy side-effects (headaches, hot flashes, feeling unwell) and poor body image positively influenced physical activity. Social support and coping strategies could not explain post-treatment physical activity levels. CONCLUSION: Personal control, treatment-related variables and psychological functioning influenced physical activity after cancer treatment. Relations depended on the working status of the women. PRACTICE IMPLICATIONS: Incorporating self-control methods in physical activity interventions after breast cancer could be helpful. Furthermore, interventions should be tailored to the experienced symptoms (fatigue, arm-problems, body image) and working status of women.

Web-based, computer-tailored, pedometer-based physical activity advice: development, dissemination through general practice, acceptability, and preliminary efficacy in a randomized controlled trial.

BACKGROUND: Computer tailoring is a relatively innovative and promising physical activity intervention approach. However, few computer-tailored physical activity interventions in adults have provided feedback based on pedometer use. OBJECTIVES: To (1) describe the development of a Web-based, pedometer-based, computer-tailored step advice intervention, (2) report on the dissemination of this tool through general practice, (3) report on its perceived acceptability, and (4) evaluate the preliminary efficacy of this tool in comparison with a standard intervention. METHODS: We recruited 92 participants through general practitioners and randomly assigned them to a standard condition (receiving a pedometer-only intervention, n = 47) and a tailored condition (receiving a pedometer plus newly developed, automated, computer-tailored step advice intervention, n = 45). Step counts, self-reported data obtained via telephone interview on physical activity, time spent sitting, and body mass index were assessed at baseline and postintervention. The present sample was mostly female (54/92, 59%), highly educated (59/92, 64%), employed (65/92, 71%), and in good health (62/92, 67%). RESULTS: Recruitment through general practitioners was poor (n = 107, initial response rate 107/1737, 6.2%); however, the majority of participants (50/69, 73%) believed it is useful that general practitioners help patients find ways to increase physical activity. In the tailored condition, 30/43 (70%) participants requested the computer-tailored step advice and the majority found it understandable (21/21, 100%), credible (17/18, 94%), relevant (15/18, 83%), not too long (13/18, 72%), instructive (13/18, 72%), and encouraging to increase steps (16/24, 67%). Daily step counts increased from baseline (mean 9237, SD 3749 steps/day) to postintervention (mean 11,876, SD 4574 steps/day) in the total sample (change of 2639, 95% confidence interval 105-5172; F(1 )= 5.0, P = .04). No interaction or other time effects were found. CONCLUSIONS: The majority of participants in the tailored condition accepted the step advice and indicated it was useful. However, in this selected sample of adults, the tailored condition did not show superior effects compared with the standard condition.

The perception of the neighborhood environment changes after participation in a pedometer based community intervention.

BACKGROUND: The aim of this study was to investigate whether the perception of the neighbourhood environment alters when changing the physical activity behaviour through a pedometer intervention. FINDINGS: The intervention was implemented for 15 weeks in a small village in Germany, and was based on the individual baseline activity level. Eighty-two inhabitants participated in the study and completed an environmental questionnaire before and after the intervention. Results showed that after the intervention the participants perceived a lower distance to local facilities, a higher availability of bike lanes and infrastructures, a better maintenance of infrastructure, a better network and a safer traffic situation. CONCLUSION: This suggests that a change in the levels of physical activity merges the levels of exposure to the environment which results in different environmental perceptions.

Effectiveness of workplace interventions in Europe promoting healthy eating: a systematic review.

BACKGROUND: The worksite is a promising setting for health promotion. This review summarizes the evidence of effect of intervention studies in European countries promoting a healthy diet solely and in combination with increasing physical activity at the workplace. METHODS: A systematic review of published literature was carried out. Inclusion criteria were: studies conducted in European countries; papers published from 1 January 1990 to 1 October 2010; worksite-based interventions promoting a healthy diet solely or in combination with physical activity; primary prevention; measurement of anthropometrical or behavioural change and adults (≥18 years old). Levels of evidence for intervention effectiveness on behavioural determinants, nutrition and physical activity behaviours and body composition and the quality of the included interventions were assessed. RESULTS: Seventeen studies solely focusing on promotion of a healthy diet were identified. Eight were educational, one used worksite environmental change strategies, and eight used a combination of both (multi-component). None of the interventions were rated as 'strong'; seven met the criteria for 'moderate' quality. The reviewed studies show moderately evidence for effects on diet. Thirteen studies focusing both on nutrition and physical activity (nine educational and four multi-component studies) were identified. Ten were rated as having 'weak' and three as having 'moderate' methodological quality, providing inconclusive evidence for effects. CONCLUSION: Limited to moderate evidence was found for positive effects of nutrition interventions implemented at the workplace. Effects of workplace health promotion interventions may be improved if stronger adherence to established quality criteria for such interventions is realized.

Measuring physical activity-related environmental factors: reliability and predictive validity of the European environmental questionnaire ALPHA.

BACKGROUND: A questionnaire to assess physical activity related environmental factors in the European population (a 49-item and an 11-item version) was created as part of the framework of the EU-funded project "Instruments for Assessing Levels of PHysical Activity and fitness (ALPHA)". This paper reports on the development and assessment of the questionnaire's test-retest stability, predictive validity, and applicability to European adults. METHODS: The first pilot test was conducted in Belgium, France and the UK. In total 190 adults completed both forms of the ALPHA questionnaire twice with a one-week interval. Physical activity was concurrently measured (i) by administration of the long version of the International Physical Activity Questionnaire (IPAQ) by interview and (ii) by accelerometry (Actigraph device). After adaptations, the second field test took place in Belgium, the UK and Austria; 166 adults completed the adapted questionnaire at two time points, with minimum one-week interval. In both field studies intraclass correlation coefficients (ICC) and proportion of agreement were computed to assess the stability of the two test scores. Predictive validity was examined in the first field test by correlating the results of the questionnaires with physical activity data from accelerometry and long IPAQ-last 7 days. RESULTS: The reliability scores of the ALPHA questionnaire were moderate-to good in the first field testing (ICC range 0.66 - 0.86) and good in the second field testing (ICC range 0.71 - 0.87). The proportion of agreement for the ALPHA short increased significantly from the first (range 50 - 83%) to the second field testing (range 85 - 95%). Environmental scales from both versions of the ALPHA questionnaire were significantly associated with self-reported minutes of transport-related walking, and objectively measured low intensity physical activity levels, particularly in women. Both versions were easily administered with an average completion time of six minutes for the 49-item version and less than two minutes for the short version. CONCLUSION: The ALPHA questionnaire is an instrument to measure environmental perceptions in relation to physical activity. It appears to have good reliability and predictive validity. The questionnaire is now available to other researchers to investigate its usefulness and applicability across Europe.

Effectiveness of school-based interventions in Europe to promote healthy nutrition in children and adolescents: systematic review of published and 'grey' literature.

The objective of the present review was to summarise the existing European published and 'grey' literature on the effectiveness of school-based interventions to promote a healthy diet in children (6-12 years old) and adolescents (13-18 years old). Eight electronic databases, websites and contents of key journals were systematically searched, reference lists were screened, and authors and experts in the field were contacted for studies evaluating school-based interventions promoting a healthy diet and aiming at primary prevention of obesity. The studies were included if they were published between 1 January 1990 and 31 December 2007 and reported effects on dietary behaviour or on anthropometrics. Finally, forty-two studies met the inclusion criteria: twenty-nine in children and thirteen in adolescents. In children, strong evidence of effect was found for multicomponent interventions on fruit and vegetable intakes. Limited evidence of effect was found for educational interventions on behaviour, and for environmental interventions on fruit and vegetable intakes. Interventions that specifically targeted children from lower socio-economic status groups showed limited evidence of effect on behaviour. In adolescents, moderate evidence of effect was found for educational interventions on behaviour and limited evidence of effect for multicomponent programmes on behaviour. In children and adolescents, effects on anthropometrics were often not measured, and therefore evidence was lacking or delivered inconclusive evidence. To conclude, evidence was found for the effectiveness of especially multicomponent interventions promoting a healthy diet in school-aged children in European Union countries on self-reported dietary behaviour. Evidence for effectiveness on anthropometrical obesity-related measures is lacking.

Interventions for promoting physical activity among European teenagers: a systematic review.

BACKGROUND: Although physical activity is considered to yield substantial health benefits, the level of physical activity among European teenagers is not sufficient. Adolescence is characterized by a decline in physical activity level. Many studies investigated the effectiveness of interventions promoting physical activity among young people, but none dealt with the available evidence specific for Europe. This review was conducted to summarize the effectiveness of interventions to promote physical activity among European teenagers. METHODS: A systematic review was conducted to identify European intervention studies published in the scientific literature since 1995. Four databases were searched, reference lists were scanned and the publication lists of the authors of the retrieved articles were checked. The ANGELO framework was used to categorise the included studies by setting and by intervention components. RESULTS: The literature search identified 20 relevant studies. Fifteen interventions were delivered through the school setting, of which three included a family component and another three a family and community component. One intervention was conducted within a community setting, three were delivered in primary care and one was delivered through the internet. Ten interventions included only an individual component, whereas the other ten used a multi-component approach. None of the interventions included only an environmental component.Main findings of the review were: (1) school-based interventions generally lead to short term improvements in physical activity levels; (2) improvements in physical activity levels by school-based interventions were limited to school related physical activity with no conclusive transfer to leisure time physical activity; (3) including parents appeared to enhance school-based interventions; (4) the support of peers and the influence of direct environmental changes increased the physical activity level of secondary school children; (5) the assumption that a multi-component approach should produce synergistic results can not be confirmed; (6) when interventions aimed to affect more than one health behaviour the intervention appeared to be less effective in favour of physical activity. CONCLUSION: Overall, the current European literature supports the short-term effectiveness of school-based physical activity promotion programmes. The available evidence for the effectiveness in other settings is rather limited and underscores the need for further research.

Assessment of environmental correlates of physical activity: development of a European questionnaire.

BACKGROUND: Research on the influence of the physical environment on physical activity is rapidly expanding and different measures of environmental perceptions have been developed, mostly in the US and Australia. The purpose of this paper is to (i) provide a literature review of measures of environmental perceptions recently used in European studies and (ii) develop a questionnaire for population monitoring purposes in the European countries. METHODS: This study was done within the framework of the EU-funded project 'Instruments for Assessing Levels of Physical Activity and Fitness (ALPHA)', which aims to propose standardised instruments for physical activity and fitness monitoring across Europe. Quantitative studies published from 1990 up to November 2007 were systematically searched in Pubmed, Web of Science, TRIS and Geobase. In addition a survey was conducted among members of the European network for the promotion of Health-Enhancing Physical Activity (HEPA Europe) and European members of the International Physical Activity and Environment Network (IPEN) to identify published or ongoing studies. Studies were included if they were conducted among European general adult population (18+y) and used a questionnaire to assess perceptions of the physical environment. A consensus meeting with an international expert group was organised to discuss the development of a European environmental questionnaire. RESULTS: The literature search resulted in 23 European studies, 15 published and 8 unpublished. In these studies, 13 different environmental questionnaires were used. Most of these studies used adapted versions of questionnaires that were developed outside Europe and that focused only on the walkability construct: The Neighborhood Environment Walkability Scale (NEWS), the abbreviated version of the NEWS (ANEWS) and the Neighborhood Quality of Life Study (NQLS) questionnaire have been most commonly used. Based on the results of the literature review and the output of the meeting with international experts, a European environmental questionnaire with 49 items was developed. CONCLUSION: There is need for a greater degree of standardization in instruments/methods used to assess environmental correlates of physical activity, taking into account the European-specific situation. A first step in this process is taken by the development of a European environmental questionnaire.

Who participates in a computer-tailored physical activity program delivered through the Internet? A comparison of participants' and non-participants' characteristics.

BACKGROUND: Today, more and more health professionals use the Internet to deliver behavioral change interventions, because of its advantage to reach a wide variety of people at low costs. However, little is known about who is interested in and actually participates in such website-delivered programs. Therefore, the purpose of this manuscript was to examine the characteristics of participants and non-participants (parents recruited through schools) in a computer-tailored physical activity intervention delivered through the Internet. METHODS: Data was collected in two ways. First, 5706 brochures with a call to participate in a physical activity program, with as key element a website-delivered tailored physical activity advice, were distributed indirectly (through their children) to parents of all pupils in 14 primary and secondary schools in Belgium. Parents were asked to return the reply card mentioning if they wanted to participate or not. Second, characteristics of participating and non-participating parents were collected by distributing 2000 short questionnaires to pupils between 10-18 years of age, in 12 of the 14 schools. Chi-square analysis and binary logistic regressions were used to compare characteristics of those parents who showed interest (i.e. positive response on reply card) or actually participated (completed online assessment) in a website-delivered physical activity intervention with the characteristics of those parents who showed no interest or did not participate. RESULTS: In total 1730 pupils (87% respondents), completed the short questionnaire concerning their parents' age, occupation (to derive the socio-economic status) and physical activity habits. The results of the binary logistic regression showed that mothers were more likely to show interest (Odds Ratio (OR) = 1.68, p < 0.001) and participate (OR = 2.27, p < 0.005) in the program than fathers. High socioeconomic status (OR = 3.42, p < 0.001) and being employed (OR = 3.03, p < 0.001) were also significant predictors for showing interest but not for participation. Age and physical activity level did neither predict interest nor participation. CONCLUSION: Both younger and older adults as well as physically active and inactive people participated in our online computer-tailored physical activity program when recruitment was done through schools. However, other health-education programs are still needed to reach all segments of the population equally.

Evaluation of a website-delivered computer-tailored intervention for increasing physical activity in the general population.

OBJECTIVE: To examine if a website-delivered physical activity intervention, that provides participants with computer-tailored feedback, can improve physical activity in the general population. METHODS: Healthy adults (n=434), recruited from parents and staff of 14 primary and secondary schools in Belgium in the spring of 2005, were allocated into one of two intervention groups (receiving intervention with or without repeated feedback) or a no-intervention control group. Physical activity-levels were self-reported at baseline and at 6 months (n=285), using a computerized long version of the International Physical Activity Questionnaire online. Repeated measures analysis of co-variances were used to examine differences between the three groups. RESULTS: Intent-to-treat analysis showed significant time by group interaction effects in favor of both intervention groups compared with the control group. Significant increases were found for active transportation (+20, +24, +11 min/week respectively) and leisure-time physical activity (+26, +19, -4 min/week respectively); a significant decrease for minutes sitting on weekdays (-22, -34, +4 min/day respectively). No significant differences were found between both intervention groups. CONCLUSION: A website-delivered intervention, including computer-tailoring, was able to increase physical activity when compared to a no-intervention control group. High drop-out rate and the low number of participants who received repeated feedback indicated that engagement and retention are important challenges in e-health studies.

Effectiveness of an online computer-tailored physical activity intervention in a real-life setting.

The aim of this study was to evaluate the effectiveness of a computer-tailored physical activity intervention delivered through the Internet in a real-life setting. Healthy adults (n=526), recruited in six worksites, between 25 and 55 years of age were randomized to one of three conditions receiving, respectively, (i) online-tailored physical activity advice + stage-based reinforcement e-mails, (ii) online-tailored physical activity advice only, (iii) online non-tailored standard physical activity advice. At 6-month follow-up, no differences in physical activity between study conditions were found; total physical activity, physical activity at moderate intensity and physical activity in leisure time significantly increased in all study conditions between baseline and follow-up. Further evaluation of the intervention materials showed that the tailored advice was more read, printed and discussed with others than the standard advice. Most of the respondents in the e-mail group indicated to be satisfied about the number, frequency and usefulness of the stage-based e-mails. In conclusion, although tailored advice was appreciated more than standard advice, no evidence was found that an online-tailored physical activity intervention program outperformed online standard information.

Implementation of an online tailored physical activity intervention for adults in Belgium.

It has been argued that the Internet is a promising channel for distribution of health promoting programs, because of its advantage to reach a wide variety of people at once, at any time and location. However, little research is done to study how we could prompt people to use these online health promoting programs. Therefore the main objective of the present study was to assess if a face-to-face contact stimulates adults to visit a recently developed tailored physical activity website to promote more physical activity in the general Belgian population. The second objective was to test the website under real-life conditions in a small sample. Therefore, 200 flyers, with a call for evaluating the new tailored physical activity website, were distributed to hospital visitors in two different ways. One group of visitors were personally approached by a research assistant and handed over a flyer. Another 100 visitors could simply take a flyer home, without initial personal contact. After two months, telephone interviews were done to make a qualitative evaluation of the website. The results showed that obviously more participants with an initial face-to-face contact (46%) registered on the website in comparison with the participants without personal contact (6%). The used strategy reaches participants of both sexes as well as regular and irregular Internet users. Secondly, the telephone interviews indicated that the website was accepted well, without major problems. We could conclude that distributing flyers combined with a short face-to-face contact, increased the number of visitors compared with distributed flyers without contact and that the tailored physical activity website could be used in real-life situations to promote an active lifestyle in Belgium. However, a controlled study with a larger sample size should be done to test the effectiveness of the tailored intervention in increasing physical activity.

Efficacy of sequential or simultaneous interactive computer-tailored interventions for increasing physical activity and decreasing fat intake.

BACKGROUND: Little evidence exists about the effectiveness of "interactive" computer-tailored interventions and about the combined effectiveness of tailored interventions on physical activity and diet. Furthermore, it is unknown whether they should be executed sequentially or simultaneously. PURPOSE: The purpose of this study was to examine (a) the effectiveness of interactive computer-tailored interventions for increasing physical activity and decreasing fat intake and (b) which intervening mode, sequential or simultaneous, is most effective in behavior change. METHODS: Participants (N = 771) were randomly assigned to receive (a) the physical activity and fat intake interventions simultaneously at baseline, (b) the physical activity intervention at baseline and the fat intake intervention 3 months later, (c) the fat intake intervention at baseline and the physical activity intervention 3 months later, or (d) a place in the control group. RESULTS: Six months postbaseline, the results showed that the tailored interventions produced significantly higher physical activity scores, F(2, 573) = 11.4, p < .001, and lower fat intake scores, F(2, 565) = 31.4, p < .001, in the experimental groups when compared to the control group. CONCLUSIONS: For both behaviors, the sequential and simultaneous intervening modes showed to be effective; however, for the fat intake intervention and for the participants who did not meet the recommendation in the physical activity intervention, the simultaneous mode appeared to work better than the sequential mode.