Impact of the intervention program "JolinchenKids - fit and healthy in daycare" on energy balance related-behaviors: results of a cluster controlled trial.

BACKGROUND: The purpose of this study was to evaluate the multi-component health promotion program, JolinchenKids - fit and healthy in daycare, designed to promote physical activity (PA), healthy eating, and mental wellbeing among 3- to 6-year-old preschoolers. METHODS: For this cluster controlled trial, 62 daycare facilities (DFs) from thirteen different federal states in Germany were recruited (31 intervention, 31 control DFs). Outcome measures were children's habitual PA, fruits and vegetable consumption, consumption of unsweetened beverages and snacks with parents as raters. Study nurses assessed children's body composition and motor skills. Data was collected at baseline and 12 months later. To track adherence to the implementation of intervention modules at individual DF groups, an implementation calendar was used from baseline to follow-up. Linear mixed models were used to investigate effects for survey, group and their interaction at the individual level while accounting for clustering. RESULTS: Samples of 831 (baseline) and 641 (follow-up) children aged 4.3 ± 0.8 and 5.2 ± 0.8 years were analysed. More than half of the intervention DFs chose the nutrition or PA module for the first year of implementation while an implementation level of > 50% was only achieved in less than a third. A significant intervention effect (survey × group interaction) was found for the standing long jump favouring children at intervention DFs (ß = 3.08; 95% Confidence interval [CI]: (0.09; 6.07)). No significant intervention effects were found for time spent on PA, total screen time, dietary habits, and body composition, i.e. body-mass-index and percentage of body fat. CONCLUSIONS: Participation in JolinchenKids - fit and healthy in daycare led to improvements in some indicators for motor skills. However, other health outcomes and behaviours were not affected by program participation over the course of 1 year. TRIAL REGISTRATION: German Clinical Trials Register DRKS00011065 (Date of registration 16-09-2016).

Identifying Evidence-Informed Physical Activity Apps: Content Analysis.

BACKGROUND: Regular moderate to vigorous physical activity is essential for maintaining health and preventing the onset of chronic diseases. Both global rates of smartphone ownership and the market for physical activity and fitness apps have grown rapidly in recent years. The use of physical activity and fitness apps may assist the general population in reaching evidence-based physical activity recommendations. However, it remains unclear whether there are evidence-informed physical activity apps and whether behavior change techniques (BCTs) previously identified as effective for physical activity promotion are used in these apps. OBJECTIVE: This study aimed to identify English and German evidence-informed physical activity apps and BCT employment in those apps. METHODS: We identified apps in a systematic search using 25 predefined search terms in the Google Play Store. Two reviewers independently screened the descriptions of apps and screenshots applying predefined inclusion and exclusion criteria. Apps were included if (1) their description contained information about physical activity promotion; (2) they were in English or German; (3) physical activity recommendations of the World Health Organization or the American College of Sports Medicine were mentioned; and (4) any kind of objective physical activity measurement was included. Two researchers downloaded and tested apps matching the inclusion criteria for 2 weeks and coded their content using the Behavioral Change Technique Taxonomy v1 (BCTTv1). RESULTS: The initial screening in the Google Play Store yielded 6018 apps, 4108 of which were not focused on physical activity and were not in German or English. The descriptions of 1216 apps were further screened for eligibility. Duplicate apps and light versions (n=694) and those with no objective measurement of physical activity, requiring additional equipment, or not outlining any physical activity guideline in their description (n=1184) were excluded. Of the remaining 32 apps, 4 were no longer available at the time of the download. Hence, 28 apps were downloaded and tested; of these apps, 14 did not contain any physical activity guideline as an app feature, despite mentioning it in the description, 5 had technical problems, and 3 did not provide objective physical activity measurement. Thus, 6 were included in the final analyses. Of 93 individual BCTs of the BCTTv1, on average, 9 (SD 5) were identified in these apps. Of 16 hierarchical clusters, on average, 5 (SD 3) were addressed. Only BCTs of the 2 hierarchical clusters "goals and planning" and "feedback and monitoring" were identified in all apps. CONCLUSIONS: Despite the availability of several thousand physical activity and fitness apps for Android platforms, very few addressed evidence-based physical activity guidelines and provided objective physical activity measurement. Furthermore, available descriptions did not accurately reflect the app content and only a few evidence-informed physical activity apps incorporated several BCTs. Future apps should address evidence-based physical activity guidelines and a greater scope of BCTs to further increase their potential impact for physical activity promotion.

Energy Cost of Common Physical Activities in Preschoolers.

BACKGROUND: To determine the energy cost of common physical activities in preschoolers and to compare it with the Compendium of Energy Expenditure for Youth (CEEY). METHODS: In total, 42 children [age: 4.8 (0.8) y; body mass index: 15.3 (2.0) kg/m2; 22 boys] completed 13 common physical activities covering sedentary to vigorous intensities, while energy expenditure (EE) was measured continuously by indirect calorimetry. Activity-specific metabolic equivalents (AME) were calculated as the EE observed during each single activity divided by the EE during observed rest. Independent t tests were applied to analyze differences between boys and girls and between AME and CEEY. RESULTS: No significant differences in AME were observed between girls and boys. Except for playing hide-and-seek, all indoor activities revealed significantly higher energy costs compared with those stated in the compendium. Significant differences in outdoor activities were found for riding a tricycle [5.67 (95% confidence interval, 4.94-6.4) AME vs 6.2 metabolic equivalents, riding a bike, P < .05] and for fast walking [5.42 (95% confidence interval, 4.84-6.0) AME vs 4.6 metabolic equivalents, P < .05]. CONCLUSIONS: Applying the CEEY to preschoolers will lead to a substantial underestimation of EE. Therefore, we recommend that a CEEY for preschool children be developed if measurement of EE is not feasible.

Views of policy makers and health promotion professionals on factors facilitating implementation and maintenance of interventions and policies promoting physical activity and healthy eating: results of the DEDIPAC project.

BACKGROUND: The uptake, implementation, and maintenance of effective interventions promoting physical activity (PA) and a healthy diet and the implementation of policies targeting these behaviors are processes not well understood. We aimed to gain a better understanding of what health promotion professionals and policy makers think are important factors facilitating adoption, implementation, and maintenance of multi-level interventions and policies promoting healthy eating and PA in Belgium, Germany, Ireland, Norway, and Poland. METHODS: Six interventions and six policies were identified based on pre-defined criteria. Forty semi-structured interviews were conducted with stakeholders from various sectors to elicit information on factors impacting adoption, implementation, and maintenance of these interventions and policies. All interview transcripts were coded in NVivo, using a common categorization matrix. Coding in the respective countries was done by one researcher and validated by a second researcher. RESULTS: Active involvement of relevant stakeholders and good communication between coordinating organizations were described as important factors contributing to successful adoption and implementation of both interventions and policies. Additional facilitating factors included sufficient training of staff and tailoring of materials to match needs of various target groups. The respondents indicated that maintenance of implemented interventions/policies depended on whether they were embedded in existing or newly created organizational structures in different settings and whether continued funding was secured. CONCLUSIONS: Despite considerable heterogeneity of interventions and health policies in the five countries, stakeholders across these countries identify similar factors facilitating adoption, implementation, and maintenance of these interventions and policies.

[Promoting a balanced diet and physical activity among children : Conditions for the successful implementation and maintenance of multi-level interventions and policies: Results of two qualitative case studies]. / Förderung einer ausgewogenen Ernährung und körperlicher Aktivität von Kindern : Voraussetzungen für eine erfolgreiche Implementierung und Aufrechterhaltung von Mehrebeneninterventionen und politischen Maßnahmen: Ergebnisse aus zwei qualitativen Fallstudien.

BACKGROUND: To date, conditions for successfully implementing and maintaining multi-level interventions and policies for the promotion of a balanced diet and physical activity are not well understood from the perspective of stakeholders. OBJECTIVE: The aim of this article is to examine which factors are regarded as facilitating or impeding introduction, implementation and maintenance of multi-level interventions and policies from the standpoint of stakeholders. MATERIALS AND METHODS: Semi-structured face-to-face interviews with stakeholders of one multi-level intervention (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS [IDEFICS] for the prevention of childhood obesity, n = 4) and one policy (Federal state offices coordinating networks for the provision of healthy food options in schools, n = 3) were analysed using qualitative content analysis. RESULTS: In both cases, the use of existing structures facilitated introduction, implementation and maintenance. Additionally, training of staff for implementation according to standardised protocols or concepts and taking structures and work conditions of settings into account during implementation were considered essential. In both cases, conflicting interests in interdisciplinary stakeholder teams regarding intervention content and implementation were identified as a barrier. A lack of political support and insecure long-term funding only played a role in regard to the implementation and maintenance of policies. On the other hand, target groups of the multi-level intervention were not sufficiently involved in the development of intervention materials which resulted in a lack of tailoring and acceptance in the target groups. CONCLUSIONS: The results provide important insights into the long-term implementation of multi-level interventions and policies in different settings.

Design and methods for a cluster-controlled trial conducted at sixty-eight daycare facilities evaluating the impact of "JolinchenKids - Fit and Healthy in Daycare", a program for health promotion in 3- to 6-year-old children.

BACKGROUND: The prevention of overweight and obesity during infancy is a highly relevant public health topic given the significant impact of childhood obesity on acute and chronic diseases, general health, and well-being in later stages of life. Apart from the family setting, daycare facilities (DFs) represent a key setting for health promotion among children under the age of six years. "JolinchenKids - Fit and Healthy in Daycare" is a multi-component program promoting physical activity (PA), healthy eating, and mental well-being in 3- to 6-year-old preschoolers at DFs, originally designed by the German health insurance AOK. To evaluate program effectiveness, a cluster-controlled trial involving 68 DFs is currently conducted. The objective of this article is to describe the background, study design, and aims of this trial. METHODS/DESIGN: Sixty-eight DFs across Germany will be recruited to take part in the study, half of them serving as intervention DFs and half of them as delayed intervention control DFs (which receive the program upon completion of the study). At each DF, height, weight, and body composition, as well as motor skills, will be assessed in twenty 3- to 6-year-old children. Children's eating and PA habits, and mental well-being will be assessed via parental questionnaires. A subsample of children (i.e., at 24 DFs which are randomly selected within a geographic region) will be asked to wear accelerometers at their wrists to objectively measure PA over the course of seven days. To compare changes in body composition, motor skills, eating and PA habits, and mental well-being of children at intervention DFs with those observed among children at delayed intervention control DFs over one year, all measurements will take place at baseline and twelve months after the launch of the program at all DFs. DISCUSSION: This study investigates the influence of a health promotion program in the daycare setting on various outcomes, including body composition and objectively measured PA, in a nationwide sample of 3- to 6-year-old preschoolers. This study will provide evidence regarding the effectiveness of a multi-component program for health promotion in this setting and may provide insights into new strategies for preventing obesity in early life. TRIAL REGISTRATION: German Clinical Trials Register DRKS00011065 (Date of registration 16-09-2016).

What works in community-based interventions promoting physical activity and healthy eating? A review of reviews.

Chronic diseases, such as type II diabetes, are on the rise worldwide. There is consistent evidence that physical activity and healthy eating are important lifestyle factors which affect the risk for chronic diseases. Community-based interventions are of particular public health interest as they reach target groups in their natural living environment and may thus achieve high population-level impacts. We conducted a systematic literature search to assess the effectiveness of community-based interventions to promote physical activity and healthy eating. Specifically, we searched for promising intervention strategies in this setting. We narratively summarized the results of 18 systematic reviews. Among children and adolescents, we found moderate evidence for effects on weight change in primary school-aged children for interventions containing a school component. The evidence for interventions aimed at general adult populations was inconclusive. Self-monitoring, group-based components, and motivational signs to encourage stair use were identified as promising strategies to increase physical activity. Among adults at risk for type II diabetes, evidence was found for beneficial effects on weight change and diabetes incidence. However, interventions for this group were not integrated in more comprehensive community-based approaches.