The 2017 Dutch Physical Activity Guidelines

Energy Expenditure and Changes in Body Composition during Submarine Deployment-An Observational Study "DasBoost 2-2017"

The present study was designed to objectively assess the effects of 3-months submarine deployment on behavioural and metabolic determinants of metabolic health. In 13 healthy, non-obese volunteers, we using stable isotope dilution, and plasma and urinary biochemistry to characterize metabolic health before and after a 3-month submarine deployment. Volunteers worked in 6-h shifts. After deployment, we observed reduced fat-free mass (mean ± SD, -4.1 ± 3.3 kg, p = 0.003) and increased adiposity (21.9 ± 3.2% fat mass to 24.4 ± 4.7%, p = 0.01). Changes in fat-free mass were positively associated with physical activity (+0.8 kg per 0.1 increase in PAL, p = 0.03). The average physical activity level was 1.64 ± 0.26 and total energy expenditure during deployment was 2937 ± 498 kcal/d, while energy intake was 3158 ± 786 kcal/d. Fasting glucose (p = 0.03), and triglycerides (p = 0.01) declined, whereas fasting free fatty acids increased (p = 0.04). Plasma vitamin D and B12 concentrations decreased (-14%, p = 0.04, and -44%, p = 0.001, respectively), and plasma calcium, and magnesium increased (+51%, p = 0.01, and +5%, p = 0.02). Haemoglobin was unchanged, but haematocrit decreased (-2.2 ± 2.1%, p = 0.005). In conclusion, submarine deployment impairs fat-free mass maintenance and promotes adiposity. High physical activity may prevent the decline in fat-free mass. Our study confirms the need to counteract Vitamin D and B12 deficiencies, and suggests impairments in erythrocyte metabolism.

Energy Expenditure and Changes in Body Composition during Submarine Deployment-An Observational Study "DasBoost 2-2017"

The present study was designed to objectively assess the effects of 3-months submarine deployment on behavioural and metabolic determinants of metabolic health. In 13 healthy, non-obese volunteers, we using stable isotope dilution, and plasma and urinary biochemistry to characterize metabolic health before and after a 3-month submarine deployment. Volunteers worked in 6-h shifts. After deployment, we observed reduced fat-free mass (mean ± SD, −4.1 ± 3.3 kg, p = 0.003) and increased adiposity (21.9 ± 3.2% fat mass to 24.4 ± 4.7%, p = 0.01). Changes in fat-free mass were positively associated with physical activity (+0.8 kg per 0.1 increase in PAL, p = 0.03). The average physical activity level was 1.64 ± 0.26 and total energy expenditure during deployment was 2937 ± 498 kcal/d, while energy intake was 3158 ± 786 kcal/d. Fasting glucose (p = 0.03), and triglycerides (p = 0.01) declined, whereas fasting free fatty acids increased (p = 0.04). Plasma vitamin D and B12 concentrations decreased (−14%, p = 0.04, and −44%, p = 0.001, respectively), and plasma calcium, and magnesium increased (+51%, p = 0.01, and +5%, p = 0.02). Haemoglobin was unchanged, but haematocrit decreased (−2.2 ± 2.1%, p = 0.005). In conclusion, submarine deployment impairs fat-free mass maintenance and promotes adiposity. High physical activity may prevent the decline in fat-free mass. Our study confirms the need to counteract Vitamin D and B12 deficiencies, and suggests impairments in erythrocyte metabolism.

Extended steep ramp test normative values for 19-24-year-old healthy active young adults

PURPOSE

To extend currently available sex and age-specific normative values in children and adolescents for the peak work rate (WRpeak) attained at the steep ramp test (SRT) to healthy active young adults.

METHODS

Healthy male and female participants aged between 19 and 24 years were recruited. After screening and anthropometric measurements, participants performed a SRT on a cycle ergometer (increments of 25 W/10 s), monitoring and recording SRT-WRpeak, heart rate (HR), and blood pressure (BP) at rest and directly after peak exercise.

RESULTS

Fifty-seven participants (31 males and 26 females; median age of 21.3 years) volunteered and were tested. Anthropometrics, resting BP and lung function were all within normal ranges. Ninety-three percent of the participants attained a peak HR (HRpeak) > 80% of predicted (mean HRpeak 87 ± 5% of predicted). No differences were found in resting and peak exercise variables between females and males, except for absolute SRT-WRpeak (350 W [Q1: 306; Q3: 371] and 487 W [Q1: 450; Q3: 517], respectively) and SRT-WRpeak normalized for body mass (relative SRT-WRpeak; 5.4 ± 0.5 and 6.2 ± 0.6 W/kg, respectively). Low-to-moderate correlations (ρ [0.02-0.71]) were observed between SRT-WRpeak and anthropometric variables for females and males separately. Extended reference curves (8-24-year-old subjects) for SRT performance show different trends between male and female subjects when modelled against age, body height, and body mass.

CONCLUSIONS

The present study provides sex-, age-, body height-, and body mass-related normative values (presented as reference centiles) for absolute and relative SRT performance throughout childhood and early adulthood.

Self-Care in Adults with Type 2 Diabetes Mellitus: A Systematic Review

BACKGROUND

Self-care is essential for the prevention of complications in patients with diabetes, but several authors report that even with health education programs, the incidence of complications in patients with diabetes continues to increase.

OBJECTIVE

We aimed to examine adherence to self-care strategies and the repercussions of adherence on the clinical profiles of individuals with type 2 diabetes.

METHODS

We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We searched for related studies in 4 databases: PubMed, Web of Science, Scopus, and Latin American and Caribbean Health Science Literature (LILACS). We included observational studies in English and Portuguese that evaluated the effects of selfcare in individuals with type 2 diabetes.

RESULTS

The search resulted in the identification of 615 articles, of which 34 met all the inclusion criteria. General self-care was considered unsatisfactory. Physical exercise was classified as the self-care activity that was performed less frequently by individuals with type 2 diabetes mellitus; adherence to medication was the most frequent behavior among volunteers.

CONCLUSION

The studies indicated poor adherence of the population to good self-care practices, reflected by the increase in complications related to DM.

Cardiometabolic Risk Factors and Physical Activity Patterns Maximizing Fitness and Minimizing Fatness Variation in Malaysian Adolescents: A Novel Application of Reduced Rank Regression

Patterns of physical activity (PA) that optimize both fitness and fatness may better predict cardiometabolic health. Reduced rank regression (RRR) was applied to identify combinations of the type (e.g., football vs. skipping), location and timing of activity, explaining variation in cardiorespiratory fitness (CRF) and Body Mass Index (BMI). Multivariable regressions estimated longitudinal associations of PA pattern scores with cardiometabolic health in n = 579 adolescents aged 13–17 years from the Malaysian Health and Adolescent Longitudinal Research Team study. PA pattern scores in boys were associated with higher fitness (r = 0.3) and lower fatness (r = −0.3); however, in girls, pattern scores were only associated with higher fitness (r = 0.4) (fatness, r = −0.1). Pattern scores changed by β = −0.01 (95% confidence interval (CI) −0.04, 0.03) and β = −0.08 (95% CI −0.1, −0.06) per year from 13 to 17 years in boys and girls respectively. Higher CRF and lower BMI were associated with better cardiometabolic health at 17 years, but PA pattern scores were not in either cross-sectional or longitudinal models. RRR identified sex-specific PA patterns associated with fitness and fatness but the total variation they explained was small. PA pattern scores changed little through adolescence, which may explain the limited evidence on health associations. Objective PA measurement may improve RRR for identifying optimal PA patterns for cardiometabolic health.

Predictors of exoskeleton motor learning in spinal cord injured patients

PURPOSE OF THE ARTICLE

Learning to use an exoskeleton is time consuming and diverse between users. Knowledge about trainability of exoskeleton skills is relevant for planning and expectation management. The objective was to assess predictors of exoskeleton skill performance during and after exoskeleton training.

MATERIALS AND METHODS

Twenty-four participants with a motor complete spinal cord injury were given 24 training sessions in 8 weeks. Nine potential predictors were identified: lesion level, age, gender, age at injury, time since injury, BMI, sport, active lifestyle, and anxiety. Univariate and multivariate linear regression analyses were performed to examine predictors of skill performance after 2, 4, 6, and 8 weeks.

RESULTS AND CONCLUSIONS

Twenty participants completed the training. Univariate analysis revealed that positive predictors were: low lesion level and more active lifestyle after 2 weeks, whereas low age at injury, low BMI, and more active lifestyle were positive predictors after 6 weeks. Multivariate regression model explained 65% of the performance after 2 weeks (predictors: lesion level, anxiety, active lifestyle) and 66% after 6 weeks (predictors: BMI, active lifestyle, age). Lesion level was a predictor during the first 4 weeks, but did not influence participants' final skill level. BMI, age, and active lifestyle were predictors toward the end of the training period.Implications for rehabilitationWith the help of wearable exoskeletons people with a complete spinal cord injury can regain their standing and walking mobility.Learning to use an exoskeleton is time consuming and the number of training sessions required to walk independently differs greatly between users.This study shows that lesion level was an important predictor of exoskeleton motor learning in the first 4 weeks of training.BMI, age, and active lifestyle were predictors of exoskeleton skill performance toward the end of the 8 week training period.

The effect of Active Plus, a computer-tailored physical activity intervention, on cognitive functioning of elderly people with chronic illness(es) - study protocol for a randomized controlled trial

BACKGROUND

Physical activity not only is beneficial to a person's health, but can also have a positive influence on cognitive functioning. However, elderly people with chronic illness(es) often do not meet the physical activity guidelines. Physical activity programs for the elderly exist, but these are often expensive and not easily accessible to the elderly with chronic illness(es). In addition, the beneficial effects of these physical activity programs on cognitive functioning have never been specifically tested in this target group. Hence, this randomized controlled trial aims to test whether Active Plus, a proven effective physical activity intervention, is able to improve the cognitive functioning of elderly people with chronic illness(es) or to slow down cognitive decline. In addition, it studies what kind of activity, intensity, duration and frequency of physical activity most strongly influence cognitive functioning.

METHODS

A randomized controlled trial is performed, comparing the Active Plus intervention group to a waiting list control group. In total 540 older adults (≥65 years) with at least one chronic illness that limits mobility are recruited from 7 municipalities. Comparable neighborhoods within a municipality are randomly allocated to the intervention or control group. Baseline and follow-up measurements after 6 and 12 months assess cognitive functioning and physical activity behavior, measured both objectively with an accelerometer and subjectively with a self-report questionnaire. Multilevel analyses are conducted to assess effects on cognitive functioning, including analyses on moderation effects for physical activity type, frequency, duration and intensity.

DISCUSSION

To our knowledge this is the first study to investigate effectiveness of a physical activity program on cognitive functioning in elderly people suffering from a broad range of chronic illnesses. If proven effective Active Plus would be a very cost effective intervention not only to increase physical activity, but also to improve cognitive functioning or slow down cognitive decline. Up till now clear evidence is lacking on the kind of physical activity, intensity, duration and frequency needed to achieve cognitive benefits. By measuring both with accelerometers and self-report questionnaires we hope to gain insight in these processes.

TRIAL REGISTRATION

Nederlands Trial Register NL6005 ; Date of Registration 21-03-2017.

Protocol for a cluster randomised controlled trial of a Peer-Led physical Activity iNtervention for Adolescent girls (PLAN-A)

Background

Adolescent girls are less physically active than recommended for health, and levels decline further as they approach adulthood. Peers can influence adolescent girls’ physical activity. Interventions capitalising on peer support could positively impact physical activity behaviour in this group. Building on promising feasibility work, the purpose of this cluster randomised controlled trial is to assess whether the Peer-Led physical Activity iNtervention for Adolescent girls (PLAN-A) increases adolescent girls’ physical activity and is cost effective.

Methods

PLAN-A is a two-arm secondary school-based cluster randomised controlled trial, conducted with girls aged 13–14 years from twenty schools in the south west of England. The intervention requires participants to nominate influential girls within their year group to become peer supporters. The top 15% of girls nominated in each school receive three days of training designed to prepare them to support their peers to be more physically active during a ten-week intervention period. Data will be collected at two time points, at baseline (T0) and 5–6 months post-intervention (T1). Schools will be randomly allocated to the intervention (n = 10) or control (n = 10) arm after T0. At each time point, all consenting participants will wear an accelerometer for seven days to assess the primary outcome of mean weekday minutes of moderate-to-vigorous physical activity. Multivariable mixed effects linear regression will be used to estimate differences in the primary outcome between the two arms and will be examined on an Intention-to-Treat (ITT) basis. A self-report psychosocial questionnaire will be completed by participants to assess self-esteem and physical activity motivation. Resource use and quality of life will be measured for the purposes of an economic evaluation. A mixed-methods process evaluation will be conducted to explore intervention fidelity, acceptability and sustainability. Analysis of quantitative process evaluation data will be descriptive, and the framework method will be used to analyse qualitative data.

Discussion

This paper describes the protocol for the PLAN-A cluster randomised controlled trial, a novel approach to increasing adolescent girls’ physical activity levels through peer support.

Trial registration

ISRCTN14539759–31 May, 2018.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7012-x) contains supplementary material, which is available to authorized users.

Physical activity levels of women with breast cancer during and after treatment, a comparison with the Dutch female population

Background: Physical activity has been shown to reduce side-effects of breast cancer and its treatment. As physical activity levels of patients with breast cancer are largely unknown, we investigated these levels and compared them to women from the general population. Methods: In this prospective cohort study, physical activity levels of women with breast cancer participating in the UMBRELLA cohort were assessed at radiotherapy intake and thereafter every 6 months up to 3 years with the SQUASH questionnaire, which was also used in a random sample of the Dutch population. We compared physical activity levels (no activity, low, moderate or high levels of sports, leisure time or total activity) between patients and the Dutch female population using multinomial logistic regression. Standardized Prevalence Ratios (SPR) were calculated to compare adherence to Dutch physical activity guidelines. Results: Women with breast cancer (n_baseline = 1655, n_{6 months} = 1414, n_{12 months} = 1186, n_{18 months} = 957, n_{24 months} = 744, n_{30 months} = 555, and n_{36 months} = 377) were less likely to spend time in physical activity compared to the general population (n = 11,710) until 3 years post-diagnosis, especially after 6 months (OR_{high-vs.-no activity} = 0.34, 95% CI: 0.28-0.41). From 12 months onwards, patients were more likely to perform sports compared to the general population, especially patients who underwent systemic therapy. Guideline adherence was significantly lower in patients at baseline and 6 months (SPR_baseline = 89, 95% CI: 82-97; SPR_{6 months} = 88, 95% CI: 81-96), and comparable to the general population at 12-36 months, especially in older women. Conclusions: Physical activity levels in women with breast cancer during and after treatment were lower compared to the Dutch female population. Three years post-treatment, they were still less physically active, although they spend more time in sport activities. As about half of the patients did not perform any sports, physical activity needs to be stimulated during and after treatment.

Investigating Motor Competence in Association with Sedentary Behavior and Physical Activity in 7- to 11-Year-Old Children

Children's motor competence (MC) has declined in the past decades, while sedentary behavior (SB) has increased. This study examined the association between MC and physical activity (PA) levels among primary schoolchildren. Demographics, body height and weight, MC (Athletic Skills Track), and PA levels (ActiGraph, GT3X+) were assessed among 595 children (291 boys, mean age = 9.1 years, SD = 1.1). MC was standardized into five categories: from very low to very high. PA levels were classified into SB, light PA (LPA), and moderate-to-vigorous PA (MVPA). Mixed-model analyses were conducted with PA levels as dependent variables and MC as the independent variable, while adjusting for age, gender, and body mass index (BMI) z-score on the individual level. A negative association between MC and SB and a positive association between MC and MVPA were found. The strength of both associations increased as children expressed lower or higher levels of MC. MC is an important correlate of both SB and MVPA, particularly for children with very high or low MC. Developing and improving children's MC may contribute to spending less time in SB and more time in MVPA, particularly for high-risk groups, i.e., children with low MC. Moreover, addressing MC development and PA promotion simultaneously might create positive feedback loops for both children's MC and PA levels.