Impact of physical activity on healthcare costs: a systematic review

BACKGROUND

This systematic review aims to describe the relation between physical inactivity and healthcare costs, by taking into account healthcare costs of physical-inactivity-related diseases (common practice), including physical-activity-related injuries (new) and costs in life-years gained due to avoiding diseases (new), whenever available. Moreover, the association between physical inactivity and healthcare costs may both be negatively and positively impacted by increased physical activity.

METHODS

A systematic review was conducted, including records reporting on physical (in)activity in relation to healthcare costs for a general population. Studies were required to report sufficient information to calculate the percentage of total healthcare costs potentially attributable to physical inactivity.

RESULTS

Of the 264 records identified, 25 were included in this review. Included studies showed substantial variation in the assessment methods of physical activity and in type of costs included. Overall, studies showed that physical inactivity is related to higher healthcare costs. Only one study included costs of healthcare resources used in prolonged life when physical-inactivity-related diseases were averted, showing net higher healthcare costs. No study included healthcare costs for physical-activity-related injuries.

CONCLUSIONS

Physical inactivity is associated with higher healthcare costs in the general population in the short-term. However, in the long-term aversion of diseases related with physical inactivity may increase longevity and, as a consequence, healthcare costs in life-years gained. Future studies should use a broad definition of costs, including costs in life-years gained and costs related to physical-activity-related injuries.

Patient-Reported Mobility, Physical Activity, and Bicycle Use after Vulvar Carcinoma Surgery

Patients treated for vulvar carcinoma may experience losses in mobility and physical activity. In this study, we assess the prevalence and severity of mobility problems using patient-reported outcomes of three questionnaires: EQ-5D-5L to estimate QoL and perceived health; SQUASH to estimate habitual physical activity; and a problem-specific questionnaire on bicycling. Patients treated for vulvar carcinoma between 2018 and 2021 were recruited, and 84 (62.7%) responded. The mean age was 68 ± 12 years (mean ± standard deviation). Self-reported QoL and perceived health were 0.832 ± 0.224 and 75.6 ± 20.0, respectively. Dutch physical activity guidelines were met by 34.2% of participants. Compared to baseline values, the times spent walking, bicycling, and participating in sports were all reduced. During bicycling, patients experienced moderate or severe pain in the skin of the vulva (24.5%), pain in the sit bones (23.2%), chafing (25.5%), or itching (8.9%). Overall, 40.3% experienced moderate or severe bicycling problems or could not bicycle, 34.9% felt that their vulva impeded bicycling, and 57.1% wished to make more or longer bicycling journeys. To conclude, vulvar carcinoma and its treatment reduce self-reported health, mobility, and physical activity. This motivates us to investigate ways to reduce discomfort during physical activities, and help women regain their mobility and self-reliance.

20-year individual physical activity patterns and related characteristics

Background

This study aims to describe individual leisure-time physical activity patterns among Dutch adults over a 20-year period, and to compare baseline characteristics of participants with different patterns.

Methods

The study population consisted of 2,518 adults (53% women) aged 26–65 years at baseline, measured every 5 years over a 20-year period. Self-reported physical activity measurements (from 1994 to 2017) were used to compose five (predefined) patterns: stable active, becoming active, becoming inactive, stable inactive, and varying physical activity. Multivariate logistic regression analyses were used to compare baseline socio-demographic, lifestyle, and health-related characteristics of these patterns.

Results

The total population shows a stable percentage being active in each round (between 55 and 58%). However over a period of 20 years, 32.6% of the participants were stable active, 19.9% were stable inactive, 15.2% became active, 11.6% became inactive, and 20.8% had varying physical activity behaviour. Compared to participants who were stable active, becoming active was associated with being 46–55 years old, having an intermediate level of education, and smoking, at baseline. Participants who became inactive were less likely to be 46–55 years old and more likely to be obese. Stable inactivity was associated with an intermediate level of education, low adherence to dietary guidelines, smoking, low levels of alcohol use and a moderate/poor perceived health. Participants with a varying physical activity level were more likely to have low adherence to dietary guidelines and to smoke.

Conclusions

Almost half of the participants changed their physical activity behaviour over 20 years. Baseline age, level of education, smoking, alcohol consumption, adherence to dietary guidelines, weight status and perceived health were associated with different physical activity patterns.

Adhering to the 2017 Dutch Physical Activity Guidelines: A Trend over Time 2001-2018

Recently, new physical activity (PA) guidelines were adopted in the Netherlands consisting of two components: (1) addressing duration of moderate and vigorous PA, (2) bone and muscle strengthening activities. The aim of this study is to retrospectively assess the long-term trend in fulfilling the criteria of the new PA guidelines and to gain insight into which activities contribute to changes over time. Data were available for 2001-2018 of a nationally representative sample of approximately 7000 Dutch citizens aged 12 years and over using the Short Questionnaire to Assess Health-enhancing physical activity (SQUASH). Multiple logistic regression analysis was performed by age, sex, and level of education. Overall, a positive trend was found from 39.9% adherence in 2001 to 46.0% in 2018. Adherence levels among adolescents decreased and increased among adults and seniors. Intermediate and higher educated groups showed positive trends over time whereas a stable trend was observed among lower educated. Activities contributing most to changes over time were sports, leisure time walking, and strenuous occupational activities. In the period 2001-2018, though an increasing trend was found, less than half of the population was sufficiently active. Special effort is necessary to reach adolescents, seniors, and lower educated groups in PA promotion programs.

Perceived barriers and facilitators of the implementation of a combined lifestyle intervention with a financial incentive for chronically ill patients

BACKGROUND

This study aims to describe barriers and facilitators of the implementation of a combined lifestyle intervention (CLI) in primary care for patients with chronic disease. The aim of CLI to help patients to create a healthy lifestyle and to maintain this healthy lifestyle. During a CLI a patient receives advice and counselling to improve health-related behavior such as physical activity and diet. Special attention was given to the influence of adding a health promoting financial incentive (HPFI) for the participants to the CLI.

METHODS

Twenty-four semi-structured interviews within six care groups were performed between July and October 2017. The interviews were transcribed verbatim and coded by two researchers independently.

RESULTS

Respondents mentioned several preferred characteristics of the CLI such as easy accessibility of the intervention site and the presence of health care professionals during exercise sessions. Moreover, factors that could influence implementation (such as attitude of the health care professionals) and preconditions for a successful implementation of a CLI (such as structural funding and good infrastructure) were identified. Overall, positive HPFIs (e.g. a reward) were preferred over negative HPFIs (e.g. a fine). According to the respondents, HPFIs could positively influence the degree of participation, and break down barriers for participating in and finishing the CLI.

CONCLUSIONS

Multiple barriers and facilitators for successful implementation of a CLI were identified. For successful implementing CLIs, a positive attitude of all stakeholders is essential and specific preconditions should be fulfilled. With regard to adding a HPFI, more research is needed to identify the attitude of specific target groups towards an HPFI.

The 2017 Dutch Physical Activity Guidelines

Background

The objective of this study was to derive evidence-based physical activity guidelines for the general Dutch population.

Methods

Two systematic reviews were conducted of English language meta-analyses in PubMed summarizing separately randomized controlled trials and prospective cohort studies on the relation between physical activity and sedentary behaviour on the one hand and the risk of all-cause mortality and incidence of 15 major chronic diseases and conditions on the other hand. Other outcome measures were risk factors for cardiovascular disease and type 2 diabetes, physical functioning, and fitness. On the basis of these reviews, an expert committee derived physical activity guidelines. In deriving the guidelines, the committee first selected only experimental and observational prospective findings with a strong level of evidence and then integrated both lines of evidence.

Results

The evidence found for beneficial effects on a large number of the outcome measures was sufficiently strong to draw up guidelines to increase physical activity and reduce sedentary behaviour, respectively. At the same time, the current evidence did not provide a sufficient basis for quantifying how much physical activity is minimally needed to achieve beneficial health effects, or at what amount sedentary behaviour becomes detrimental. A general tenet was that at every level of current activity, further increases in physical activity provide additional health benefits, with relatively larger effects among those who are currently not active or active only at light intensity. Three specific guidelines on (1) moderate- and vigorous-intensity physical activity, (2) bone- and muscle-strengthening activities, and (3) sedentary behaviour were formulated separately for adults and children.

Conclusions

There is an unabated need for evidence-based physical activity guidelines that can guide public health policies. Research in which physical activity is measured both objectively (quantity) and subjectively (type and quality) is needed to provide better estimates of the type and actual amount of physical activity required for health.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0661-9) contains supplementary material, which is available to authorized users.

Non-occupational physical activity levels of shift workers compared with non-shift workers

OBJECTIVES

Lack of physical activity (PA) has been hypothesised as an underlying mechanism in the adverse health effects of shift work. Therefore, our aim was to compare non-occupational PA levels between shift workers and non-shift workers. Furthermore, exposure-response relationships for frequency of night shifts and years of shift work regarding non-occupational PA levels were studied.

METHODS

Data of 5980 non-shift workers and 532 shift workers from the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) were used in these cross-sectional analyses. Time spent (hours/week) in different PA types (walking/cycling/exercise/chores) and intensities (moderate/vigorous) were calculated based on self-reported PA. Furthermore, sports were operationalised as: playing sports (no/yes), individual versus non-individual sports, and non-vigorous-intensity versus vigorous-intensity sports. PA levels were compared between shift workers and non-shift workers using Generalized Estimating Equations and logistic regression.

RESULTS

Shift workers reported spending more time walking than non-shift workers (B=2.3 (95% CI 1.2 to 3.4)), but shift work was not associated with other PA types and any of the sports activities. Shift workers who worked 1-4 night shifts/month (B=2.4 (95% CI 0.6 to 4.3)) and ≥5 night shifts/month (B=3.7 (95% CI 1.8 to 5.6)) spent more time walking than non-shift workers. No exposure-response relationships were found between years of shift work and PA levels.

CONCLUSIONS

Shift workers spent more time walking than non-shift workers, but we observed no differences in other non-occupational PA levels. To better understand if and how PA plays a role in the negative health consequences of shift work, our findings need to be confirmed in future studies.

A Systematic Review of Financial Incentives for Physical Activity: The Effects on Physical Activity and Related Outcomes

The aim of this review is to give an overview of the available evidence on the effects of financial incentives to stimulate physical activity. Therefore, a systematic literature search was performed for randomized trials that investigate the effects of physical-activity-related financial incentives for individuals. Twelve studies with unconditional incentives (eg, free membership sport facility) and conditional incentives (ie, rewards for reaching physical-activity goals) related to physical activity were selected. Selected outcomes were physical activity, sedentary behavior, fitness, and weight. Results show that unconditional incentives do not affect physical activity or the other selected outcomes. For rewards, some positive effects were found and especially for rewards provided for physical-activity behavior instead of attendance. In conclusion, rewards seem to have positive effects on physical activity, while unconditional incentives seem to have no effect. However, it should be kept in mind that the long-term effects of financial incentives are still unclear.

A systematic review of financial incentives given in the healthcare setting; do they effectively improve physical activity levels?

Background

According to current physical activity guidelines, a substantial percentage of the population in high-income countries is inactive, and inactivity is an important risk factor for chronic conditions and mortality. Financial incentives may encourage people to become more active. The objective of this review was to provide insight in the effectiveness of financial incentives used for promoting physical activity in the healthcare setting.

Methods

A systematic literature search was performed in three databases: Medline, EMBASE and SciSearch. In total, 1395 papers published up until April 2015 were identified. Eleven of them were screened on in- and exclusion criteria based on the full-text publication.

Results

Three studies were included in the review. Two studies combined a financial incentive with nutrition classes or motivational interviewing. One of these provided a free membership to a sports facility and the other one provided vouchers for one episode of aerobic activities at a local leisure center or swimming pool. The third study provided a schedule for exercise sessions. None of the studies addressed the preferences of their target population with regard to financial incentives. Despite some short-term effects, neither of the studies showed significant long-term effects of the financial incentive.

Conclusions

Based on the limited number of studies and the diversity in findings, no solid conclusion can be drawn regarding the effectiveness of financial incentives on physical activity in the healthcare setting. Therefore, there is a need for more research on the effectiveness of financial incentives in changing physical activity behavior in this setting. There is possibly something to be gained by studying the preferred type and size of the financial incentive.

Insights into the concept of vitality: associations with participation and societal costs

BACKGROUND

In healthcare, the focus is currently shifting from someone's disabilities to someone's abilities, which is also evident from the increasing focus on vitality. Vitality (here defined as energy, motivation and resilience) is an often used concept, which also aims at someone's capabilities. However, little is known about vitality yet; in particular about its association with participation and societal costs.

METHODS

Within a cross-sectional design, information regarding vitality, participation and societal costs was collected among 8015 Dutch adults aged 20 years and over. Vitality was measured using the validated Dutch Vitality Questionnaire (Vita-16). Information on economic (i.e. want/able to work, work absenteeism, work performance), societal (i.e. voluntary work, informal care giving) and social participation (i.e. quantity and quality of social contacts) and societal costs (i.e. healthcare and work-related costs) was collected using an internet survey.

RESULTS

Significant associations were found between vitality and various economic (i.e.sustainable employability:want to work: β = 1.21, 95% CI: 0.99-1.43,able to work:β = 2.09, 95% CI: 1.79-2.38;work absenteeism: OR = 0.75, 95% CI: 0.71-0.79;work performance:β = 0.49, 95% CI: 0.46-0.52), societal (i.e.voluntary work, informal care) and social (i.e.quantity and quality of social contacts) participation measures, as well as between vitality and societal costs (i.e.healthcare costs:β = -213.73, 95% CI: €-311.13 to €-107.08),absenteeism costs: β = -338.57, 95% CI: €-465.36 to €-214.14 and presenteeism costs:β = -1293.31, 95% CI: €-1492.69 to €-1088.95).

CONCLUSION

This study showed significant positive associations between vitality and economic, societal and social participation and negative associations between vitality and societal costs. This may stimulate research on interventions enhancing and maintaining vitality and thereby contributing to improved participation and reduced costs.

Adopting an active lifestyle during adulthood and health-related quality of life: the Doetinchem Cohort Study

OBJECTIVES

We examined health-related quality of life in adults who became physically active at recommended levels over a 10-year period compared with adults with different physical activity patterns. Methods. We examined men and women aged 26 to 70 years (mean [SD] = 47.4 [10.1]) in the Doetinchem Cohort Study 3 times between 1995 and 2009. We distinguished participants who became physically active (n = 618), remained active (n = 1286), remained inactive (n = 727), became physically inactive (n = 535), or with varying activity levels (n = 455) over 10 years. We used multivariable linear regression analyses to determine differences in health-related quality of life (survey similar to the 36-Item Short-Form Health Survey) at 10-year follow-up. Results. Adults who became physically active reported better physical functioning, vitality, and general health after 10 years than did persistently inactive adults and adults who became inactive. They also reported less bodily pain and better social functioning than adults who became inactive. No differences were observed with adults who remained active or with varying activity levels. Conclusions. Adopting a physically active lifestyle may result in a better health-related quality of life, comparable to remaining physically active over 10 years.

Sitting Behaviors and Mental Health among Workers and Nonworkers: The Role of Weight Status

Objective. To explore the associations between sitting time in various domains and mental health for workers and nonworkers and the role of weight status. Design. Cross-sectional analyses were performed for 1064 respondents (47% men, mean age 59 years) from the Doetinchem Cohort Study 2008-2009. Sedentary behavior was measured by self-reported time spent sitting during transport, leisure time, and at work. Mental health was assessed by the Mental Health Inventory (MHI-5). BMI was calculated based on measured body height and weight. Results. Neither sitting time during transport nor at work was associated with mental health. In the working population, sitting during leisure time, and particularly TV viewing, was associated with poorer mental health. BMI was an effect modifier in this association with significant positive associations for healthy-weight non-workers and obese workers. Conclusion. Both BMI and working status were effect modifiers in the relation between TV viewing and mental health. More longitudinal research is needed to confirm the results and to gain insight into the causality and the underlying mechanisms for the complex relationships among sedentary behaviors, BMI, working status, and mental health.

Weight status, psychological health, suicidal thoughts, and suicide attempts in Dutch adolescents: results from the 2003 E-MOVO project

This study describes the association between weight status and psychological health, suicidal thoughts and suicide attempts in adolescents from a population-based study of 21,730 adolescents who responded to a classroom-based internet questionnaire. It demonstrated clear associations between weight status in adolescents and poor psychological health, suicidal thoughts and suicide attempts, especially in obese individuals. Obese boys and girls were more likely to be classified as "psychologically unhealthy" than were normal weight subjects. They also reported more suicidal thoughts and suicide attempts.

Lifestyle factors of a five-year community-intervention program: the Hartslag Limburg intervention

BACKGROUND

Community-based health promotion is a widely advocated strategy in public health to favorably alter lifestyle. The aim of this study was to investigate the net effect of a cardiovascular disease-prevention program (Hartslag Limburg) on lifestyle factors after 5 years of intervention (1998-2003).

METHODS

In a cohort study, 5-year mean changes in lifestyle factors (energy intake; fat intake; time spent on leisure-time physical activity; walking, bicycling, and sports; and smoking behavior) between subjects from the intervention area (n=2356) and the control area (n=758) were compared for men and women and for those with a low (less than intermediate secondary education) and a moderate (intermediate vocational or higher secondary education) or high (higher vocational education or university) educational level. Adjustments were made for age and the mean of the individual pre- and post-intervention measurement of the variable under study. When stratifying for gender, adjustments were made for educational level, and vice versa.

RESULTS

In general, lifestyle factors changed unfavorably in the control group, whereas changes were less pronounced or absent in the intervention group. The adjusted difference in mean change in lifestyle factors between the intervention group and the control group was significant (p<or=0.05) for energy intake (-0.2 megajoule per day among both women and those with a low educational level); fat intake (-2.5 grams per day [g/d] among women and -3 g/d among those with a low educational level); time spent walking (+2.2 hours per week [hrs/wk] among women and +2.3 hrs/wk among those with a low educational level); time spent on total leisure-time physical activity (+2.1 hrs/wk among women); and time spent bicycling (+0.6 hrs/wk among those with a low educational level).

CONCLUSIONS

The community intervention Hartslag Limburg succeeded in preventing age- and time-related unfavorable changes in energy intake, fat consumption, walking, and bicycling, particularly among women and those with low SES.

The impact of school-based prevention of overweight on psychosocial well-being of children

This review aimed to gain insight in the extent to which psychosocial effects of obesity prevention programmes have been studied, to give an overview of the methods used to measure the particular psychosocial aspects and - if possible - to quantify the effects found. Intervention studies (n = 267) covering the period 1990-October 2005 were derived from seven reviews about childhood obesity interventions. An additional search identified 2754 studies covering the period January 2005-February 2008. In total, 2901 papers (excluding 120 duplicates) were screened for inclusion. Sixty-nine papers covering 53 interventions were included and screened on measuring psychosocial variables. All original authors were contacted. Seven of the selected interventions measured psychosocial variables, five of which evaluated a net intervention effect as compared with a control condition. Only two interventions reported a statistically significant net intervention effect (a decrease in use of purging or diet pills and a decrease in peer ratings of aggression and observed verbal aggression). We conclude that a minority of childhood obesity interventions investigate the effects of their programmes on psychosocial well-being of children and adolescents. It is recommended that in the future, these programmes will be evaluated in a uniform way on a broad range of psychosocial aspects.

Environmental attributes related to walking and bicycling at the individual and contextual level

OBJECTIVE

The aim of the present paper was to give insight into the practical consequences of using either single-level or multilevel regression analyses on data from research on environmental determinants of physical activity.

METHODS

For this purpose, results from single-level and multilevel regression analyses on comparable attributes of the environment were compared using a combination of individual and aggregated data, merged at the neighbourhood level.

RESULTS

Using only individual level data, applying multilevel instead of single-level analyses did not substantially influence the results. However, ignoring the multilevel structure of our data by applying single-level in stead of multilevel analyses resulted in statistically significant associations for all the environmental attributes under study. Moreover, using information on environmental attributes at both the individual and the contextual level to adjust associations at one level for the other level showed that associated environmental attributes tend to be associated either at the individual or at the contextual level.

CONCLUSIONS

These results stress the importance for reviews and meta-analyses of recording type of measurement and type of analytical strategy used and incorporating them in the review process. Using advanced multilevel designs will still only partly solve the methodological issues involved in studying environmental attributes associated with physical activity, but it will help in disentangling this complex relationship. Therefore, it is recommended that, whenever there is a presumably relevant grouping (context; eg neighbourhoods) in a study, a multilevel approach should at least be considered.

Reliability and validity of the short questionnaire to assess health-enhancing physical activity (SQUASH) in patients after total hip arthroplasty

BACKGROUND

Despite recognized benefits of regular physical activity on musculoskeletal fitness as well as general health, little is known about the physical activity behavior of patients after Total Hip Arthroplasty (THA). So far, no physical activity questionnaire has been validated in this category of patients. As the Short Questionnaire to Assess Health-enhancing physical activity (SQUASH) has been shown to be a fairly reliable and valid tool to gauge the physical activity behavior of the general Dutch adult population, we measured the reliability and relative validity of this tool in patients after THA.

METHODS

44 patients (17 men and 27 women, mean age 71 +/- 8 years) completed the SQUASH twice with an in-between period of 2 to 6 weeks (mean 3.7). Reliability was determined by calculating the Spearman correlation coefficient between the activity scores of the separate questions as well as the total activity scores from both administrations. Additionally, a Bland & Altman analysis was performed for the total activity scores. Relative validity was determined using the Actigraphaccelerometer, worn by 39 patients (15 men and 24 women, mean age 70 +/- 8 years) for a 2-week period following the second questionnaire, as a criterion measure.

RESULTS

Spearman's correlation coefficient for overall reliability was 0.57. It varied between 0.45 and 0.90 for the separate questions. No systematic biases between readings were found. The Spearman correlation between Actigraph readings and total activity score was 0.67. It was 0.56 for total minutes of activity, 0.20 for time spent in light intensity activity, 0.40 for moderate activity and 0.35 for vigorous activity. Systematic bias was found between the SQUASH and the Actigraph.

CONCLUSION

The SQUASH can be considered to be a fairly reliable tool to assess the physical activity behavior of patients after THA. Validity was found to be comparable with those of other questionnaires, and as it is short and easy to fill in, it may prove to be a useful tool to assess physical activity in this particular subset of the population. However, the considerable systematic bias found in this study illustrates the need for further analysis of the validity of the SQUASH.

Exposure and effectiveness of phytosterol/-stanol-enriched margarines

BACKGROUND

Studies on effectiveness of phytosterol/-stanol-enriched margarines in the community have received low priority. For postlaunch monitoring purposes including risk-benefit analyses, it is needed to investigate both exposure and effectiveness of these margarines.

OBJECTIVE

To study the use and effectiveness of phytosterol/-stanol-enriched margarine.

DESIGN, SETTING AND SUBJECTS

The study population consisted of 2379 subjects that participated in a community intervention study ('Hartslag Limburg') aged 28-76 years. In 1998 and 2003, blood samples for total and high-density lipoprotein (HDL) cholesterol were obtained. A general questionnaire and food frequency questionnaire (FFQ) were administered. From 1999 onwards, phytosterol/-stanol-enriched margarines were introduced on the Dutch market. On the basis of 2003 data, subjects were classified in users of (a) phytosterol/-stanol-enriched margarine, (b) cholesterol-lowering drugs, (c) the combination (both enriched margarine and drugs) and (d) neither enriched margarines nor cholesterol-lowering drugs.

RESULTS

Mean (+/-s.d.) daily intake of phytosterol-enriched margarine (n=99) and phytostanol-enriched margarine (n=16) was 14+/-9 g. From 1998 to 2003, total serum cholesterol concentration changed significantly different among the four groups: in the combination users -2.04+/-1.50 mmol/l (-29%), in cholesterol-lowering drug users -1.09+/-1.17 mmol/l (-17%), in the enriched margarine users -0.24+/-0.75 mmol/l (-4%) and in non-users +0.10+/-0.72 mmol/l (+2%)(P<0.05).

CONCLUSION

Recommended doses are not consumed, but phytosterol/-stanol-enriched margarines can modestly reduce serum total cholesterol in the community. These margarines cannot equal the effect of cholesterol-lowering drugs, but may act additively. Further investigation of the health effects that may occur during simultaneous cholesterol lowering drugs and phytosterol-or -stanol-enriched margarines usage is important, as well as community education about the cholesterol lowering foods and drugs.

SPONSORSHIP

Netherlands Organization for Health Research and Development (ZonMW) (data collection of Hartslag Limburg and further data- analyses).

Intra-national variation in trends in overweight and leisure time physical activities in The Netherlands since 1980: stratification according to sex, age and urbanisation degree

OBJECTIVE

To investigate time trends in overweight and Leisure Time Physical Activities (LTPA) in The Netherlands since 1980. Intra-national differences were examined stratified for sex, age and urbanisation degree.

SUBJECTS AND METHODS

We used a random sample of about 140,000 respondents aged 20-69 years from the Health Interview Survey (Nethhis) and subsequent Permanent Survey on Living Conditions (POLS). Self-reported data on weight and height and demographic characteristics were gathered through interviews (every year) and data on LTPA were collected by self-administered questionnaires (1990-1997, 2001-2004). Linear regression analysis was performed for trend analyses.

RESULTS

During 1981-2004, mean body mass index (BMI) increased significantly by 1.0 kg/m(2) (average per year=0.05 kg/m(2)). Trends were similar across sex and different degrees of urbanisation, but varied across age groups. In 20-to 39-year-old women, mean BMI increased by 1.7 kg/m(2), which was more than in older age groups (P<or=0.05). With respect to LTPA, no clear trend was observed during 1990-1997 and 2001-2004. The (absence of) trends were similar across sex and urbanisation degrees, but varied across age groups. During 2001-2004, 20-to 39-year-old women spent approximately 150 min/week less on LTPA compared to older women, while this difference was smaller during 1990-1997.

CONCLUSIONS

Mean BMI increased more in younger women, which is consistent with the observation that this group spent less time on LTPA during recent years. Although the overall increase in overweight could not be explained by trends in LTPA, the younger women should be considered as a target group for future physical activity interventions. The influence of the 'obesogenic environment' seems to be similar across different degrees of urbanisation.

Physical activity and stroke. A meta-analysis of observational data

BACKGROUND

Based on studies published so far, the protective effect of physical activity on stroke remains controversial. Specifically, there is a lack of insight into the sources of heterogeneity between studies.

METHODS

Meta-analysis of observational studies was used to quantify the relationship between physical activity and stroke and to explore sources of heterogeneity. In total, 31 relevant publications were included. Risk estimates and study characteristics were extracted from original studies and converted to a standard format for use in a central database.

RESULTS

Moderately intense physical activity compared with inactivity, showed a protective effect on total stroke for both occupational (RR = 0.64, 95% CI: 0.48-0.87) and leisure time physical activity (RR = 0.85, 95% CI: 0.78-0.93). High level occupational physical activity protected against ischaemic stroke compared with both moderate (RR = 0.77, 95% CI: 0.60-0.98) and inactive occupational levels (RR = 0.57, 95% CI: 0.43-0.77). High level compared with low level leisure time physical activity protected against total stroke (RR = 0.78, 95% CI: 0.71-0.85), haemorrhagic stroke (RR = 0.74, 95% CI: 0.57-0.96) as well as ischaemic stroke (RR = 0.79, 95% CI: 0.69-0.91). Studies conducted in Europe showed a stronger protective effect (RR = 0.47, 95% CI: 0.33-0.66) than studies conducted in the US (RR = 0.82, 95% CI: 0.75-0.90).

CONCLUSIONS

Lack of physical activity is a modifiable risk factor for both total stroke and stroke subtypes. Moderately intense physical activity is sufficient to achieve risk reduction.

Factors of the physical environment associated with walking and bicycling

PURPOSE

The purpose of this study was to identify factors of the physical environment that may influence time spent on walking and bicycling.

METHODS

Demographic factors and time spent on walking and bicycling (during leisure time and for commuting purposes) were assessed with a self-administered questionnaire. GIS databases were used to objectively measure the total square area of green space and recreational space (woods, parks, sport grounds, allotments for vegetable gardens, and grounds for day trips) in a circle around the postal code of a respondent with a radius of 300 and 500 m. Multilevel regression analysis was used to study the association between walking and bicycling on the one hand, and green and recreational space on the other hand. Analyses were adjusted for gender, age, and educational level.

RESULTS

In a neighborhood defined as a circle with a 300-m radius, the square area of sport grounds was associated with bicycling in general and the square area of parks was associated with bicycling for commuting purposes. It is, however, very likely that these results reflect the association of living in the outskirts of town and time spent on bicycling.

CONCLUSION

The present study showed green and recreational space, specifically sport grounds and parks, to be associated with time spent on bicycling.

Leisure time physical activity and health-related quality of life: cross-sectional and longitudinal associations

Studies that relate change in physical activity to change in health-related quality of life in the general population are needed to confirm associations suggested by cross-sectional studies. In the present study, cross-sectional as well as longitudinal associations between leisure time physical activity and health-related quality of life were studied in an apparently healthy population. The present study showed cross-sectional associations between at least moderately intense leisure time physical activity and general health perceptions, vitality, physical functioning and role limitations due to physical health problems. No associations were present for total leisure time physical activity. Change in leisure time physical activity was associated with change in social functioning in men as well as in women, irrespective of the intensity of physical activity. Only in men, change in total leisure time physical activity was associated with change in vitality and general mental health. In our study, cross-sectional associations were not confirmed by longitudinal analyses. Cross-sectional associations were mainly found for physical components of health-related quality of life, whereas longitudinal associations were predominantly observed for mental components of health-related quality of life. Confirmation of our results by those of other studies is needed in order to quantify health promotion messages.

Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity

BACKGROUND/OBJECTIVES

The purpose of this study is to determine reproducibility and relative validity of the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH).

METHODS

Participants (36 men and 14 women, aged 27-58) were asked to complete the SQUASH twice with an inbetween period of approximately 5 weeks. In addition, participants wore the Computer Science and Applications (CSA) Activity Monitor for a 2-week period following the first questionnaire.

RESULTS

The Spearman correlation for overall reproducibility of the SQUASH was 0.58 (95%-CI 0.36-0.74). Correlations for the reproducibility of the separate questions varied between 0.44 and 0.96. Spearman's correlation coefficient between CSA readings and the total activity score was 0.45 (95%-CI 0.17-0.66).

CONCLUSIONS

In conclusion, the SQUASH is a fairly reliable and reasonably valid questionnaire and may be used to order subjects according to their level of physical activity in an adult population. Because the SQUASH is a short and simple questionnaire, it may proof to be a very useful tool for the evaluation of health enhancing physical activity in large populations.