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Webster-Dekker KE, Zhou W, Woo S, Son JY, Ploutz-Snyder R, Larson JL. Prolonged bouts of sedentary behavior in people with chronic obstructive pulmonary disease and associated factors. Heart Lung 2023; 62:129-134. [PMID: 37499548 DOI: 10.1016/j.hrtlng.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/22/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Increased sedentary behavior (SB), especially in prolonged bouts, is associated with adverse health outcomes, but little is known about patterns of SB in people with chronic obstructive pulmonary disease (COPD). OBJECTIVES The purpose of this study was to describe SB and patterns of SB and to examine factors associated with prolonged bouts of SB in inactive community-dwelling adults with COPD. METHODS This cross-sectional analysis used data from inactive adults with COPD who were enrolled in an exercise program but had not started exercising. Participants were ≥ 50 years old with a diagnosis of COPD, had a forced expiratory volume in one second < 80% predicted, and were inactive. Participants wore an activPAL device for seven days to measure their SB and completed surveys and physical measures. Data were analyzed with multiple regression. RESULTS The sample included 160 participants with a mean age (± SD) of 69 ± 8, and a mean total sedentary time of 742 ± 150 min/day, with 254 ± 146 min/day in SB bouts ≥ 60 min. DURATION Time spent in bouts of SB ≥ 60-min. was negatively associated with self-efficacy for overcoming barriers to light physical activity (P<0.05), balance (P<0.05), chair stand test (P<0.05), FEV1% predicted (P<0.05) and positively associated with BMI (P<0.001). CONCLUSIONS Inactive people with COPD engage in extensive SB, much of it in prolonged bouts. Self-efficacy, balance, and lower body strength are modifiable variables associated with SB and potential targets for future interventions to reduce time in prolonged sedentary behavior.
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Affiliation(s)
- Katelyn E Webster-Dekker
- University of Michigan School of Nursing, Ann Arbor, 400 North Ingalls Building, Ann Arbor, MI 48109, USA; Indiana University School of Nursing, 600 Barnhill Dr, Indianapolis, IN 46202, USA.
| | - Weijiao Zhou
- University of Michigan School of Nursing, Ann Arbor, 400 North Ingalls Building, Ann Arbor, MI 48109, USA; Peking University School of Nursing, 38 Xueyuan Rd, Haidian District, Beijing 100191, China.
| | - Seoyoon Woo
- University of Michigan School of Nursing, Ann Arbor, 400 North Ingalls Building, Ann Arbor, MI 48109, USA; University of North Carolina Wilmington School of Nursing, McNeill Hall 3089, Wilmington, NC 28403, USA.
| | - Jung Yoen Son
- University of Michigan School of Nursing, Ann Arbor, 400 North Ingalls Building, Ann Arbor, MI 48109, USA.
| | - Robert Ploutz-Snyder
- University of Michigan School of Nursing, Ann Arbor, 400 North Ingalls Building, Ann Arbor, MI 48109, USA.
| | - Janet L Larson
- University of Michigan School of Nursing, Ann Arbor, 400 North Ingalls Building, Ann Arbor, MI 48109, USA.
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Perchoux C, Brondeel R, Klein S, Klein O, Thierry B, Kestens Y, Chaix B, Gerber P. Does the built environment influence location- and trip-based sedentary behaviors? Evidence from a GPS-based activity space approach of neighborhood effects on older adults. Environ Int 2023; 180:108184. [PMID: 37783123 DOI: 10.1016/j.envint.2023.108184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 08/18/2023] [Accepted: 09/02/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE Evidence on the influence of built environments on sedentary behaviors remains unclear and is often contradictory. The main limitations encompass the use of self-reported proxies of sedentary time (ST), the scarce consideration of the plurality of sedentary behaviors, and environmental exposures limited to the residential neighborhood. We investigated the relationships between GPS-based activity space measures of environmental exposures and accelerometer-based ST measured in total, at the place of residence, at all locations, and during trips. METHODS This study is part of the CURHA project, based on 471 older adults residing in Luxembourg, who wore a GPS receiver and a tri-axial accelerometer during 7 days. Daily ST was computed in total, at the residence, at all locations and during trips. Environmental exposures included exposure to green spaces, walking, biking, and motorized transportation infrastructures. Associations between environments and ST were examined using linear and negative binomial mixed models, adjusted for demographics, self-rated health, residential self-selection, weather conditions and wear time. RESULTS Participants accumulated, on average, 8 h and 14 min of ST per day excluding sleep time. ST spent at locations accounted for 83 % of the total ST. ST spent at the residence accounted for 87 % of the location-based ST and 71 % of the total ST. Trip-based ST represents 13 % of total ST, and 4 % remained unclassified. Higher street connectivity was negatively associated with total ST, while the density of parking areas correlated positively with total and location-based ST. Stronger associations were observed for sedentary bouts (uninterrupted ST over 20 and 30 min). CONCLUSION Improving street connectivity and controlling the construction of new parking, while avoiding the spatial segregation of populations with limited access to public transport, may contribute to limit ST. Such urban planning interventions may be especially efficient in limiting the harmful uninterrupted bouts of ST among older adults.
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Affiliation(s)
- C Perchoux
- Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research (LISER), Esch-sur-Alzette, Luxembourg.
| | - R Brondeel
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - S Klein
- Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research (LISER), Esch-sur-Alzette, Luxembourg
| | - O Klein
- Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research (LISER), Esch-sur-Alzette, Luxembourg
| | - B Thierry
- Université de Montréal/Centre de Recherche du CHUM, Pavillon S, 850 rue St-Denis, Montréal, QC H2X 0A9, Canada
| | - Y Kestens
- Université de Montréal/Centre de Recherche du CHUM, Pavillon S, 850 rue St-Denis, Montréal, QC H2X 0A9, Canada
| | - B Chaix
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Nemesis Team, Faculté de Médecine Saint-Antoine, Paris, France
| | - P Gerber
- Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research (LISER), Esch-sur-Alzette, Luxembourg
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Verloigne M, Van Oeckel V, Brondeel R, Poppe L. Bidirectional associations between sedentary time and sleep duration among 12- to 14-year-old adolescents. BMC Public Health 2021; 21:1673. [PMID: 34521376 PMCID: PMC8440143 DOI: 10.1186/s12889-021-11694-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/29/2021] [Indexed: 11/14/2022] Open
Abstract
Background The aim of this study was to investigate bidirectional associations between (prolonged) sitting time and sleep duration in 12- to 14-year-old adolescents using a between-subjects and within-subjects analyses approach. Methods Observational data were used from 108 adolescents (53% girls; mean age 12.9 (SD 0.7) years) from six schools in Flanders, Belgium. The Axivity AX3 triaxial accelerometer, worn on the thigh, was used to assess daily total sitting time and daily time spent in sedentary bouts of ≥30 min (as a proxy for prolonged sitting time). The Fitbit Charge 3 was used to assess nightly sleep duration. Both monitors were worn on schooldays only (ranging from 4 to 5 days). Linear mixed models were conducted to analyse the associations, resulting in four models. In each model, the independent variable (sleep duration, sitting time or prolonged sitting time) was included as within- as well as between-subjects factor. Results Within-subjects analyses showed that when the adolescents sat more and when the adolescents spent more time sitting in bouts of ≥30 min than they usually did on a given day, they slept less during the following night (p = 0.01 and p = 0.05 (borderline significant), respectively). These associations were not significant in the other direction. Between-subjects analyses showed that adolescents who slept more on average, spent less time sitting (p = 0.006) and less time sitting in bouts of ≥30 min (p = 0.004) compared with adolescents who slept less on average. Conversely, adolescents who spent more time sitting on average and adolescents who spent more time sitting in bouts of ≥30 min on average, slept less (p = 0.02 and p = 0.003, respectively). Conclusions Based on the between-subjects analyses, interventions focusing on reducing or regularly breaking up sitting time could improve adolescents’ sleep duration on a population level, and vice versa. However, the within-subjects association was only found in one direction and suggests that to sleep sufficiently during the night, adolescents might limit and regularly break up their sitting time the preceding day. Trial registration Data have been used from our trial registered at ClinicalTrials.gov (NCT04327414; registered on March 11, 2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11694-9.
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Affiliation(s)
- Maïté Verloigne
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Veerle Van Oeckel
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Ruben Brondeel
- Department of Movement and Sports Sciences, Ghent University, Watersportlaan 10, 9000, Ghent, Belgium
| | - Louise Poppe
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Júdice PB, Magalhães JP, Hetherington-Rauth M, Correia IR, Sardinha LB. Sedentary patterns are associated with BDNF in patients with type 2 diabetes mellitus. Eur J Appl Physiol 2021; 121:871-879. [PMID: 33389140 DOI: 10.1007/s00421-020-04568-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Exercise is beneficial to type-2 diabetes-mellitus (T2DM), and there is evidence showing that one of those benefits include a higher expression of brain-derived neurotrophic factor (BDNF), which has been implicated in improving fat oxidation and cognitive development. The deleterious effect of prolonged sedentary time (ST) on BDNF levels has never been examined in patients with T2DM. Our goal was to analyse the associations for sedentary patterns [i.e. breaks in ST per sedentary hour (BST-ST) and bouts of sedentary time (BSB) of different length] with BDNF in patients with T2DM, independent of moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness (CRF). METHODS Sample included 80 patients (38 women) with T2DM (58.3 ± 7.8 years). ST and MVPA were assessed by accelerometry (ActiGraph, GT3X + model), BDNF by blood collection and plasma quantification using commercial enzyme-linked immunosorbent assay kits, and CRF was determined using a Bruce protocol to exhaustion, on a motorized treadmill. RESULTS Positive associations for BST-ST (β = 0.155; p = 0.007) with BDNF, and negative associations for BSB longer than 15 min with BDNF were found (β = - 0.118; p = 0.049). Neither MVPA nor cardiorespiratory fitness eliminated the associations for BST-ST with BDNF, but MVPA eradicated the associations between BSB > 15 min and BDNF. CONCLUSIONS Our findings suggest that interrupting ST and especially avoiding longer sedentary periods (> 15 min) may be beneficial for BDNF plasma abundance that may influence metabolic and cognitive functioning of patients with T2DM, especially for the ones presenting lower MVPA levels. TRIAL REGISTRATION May 5, 2017, ClinicalTrials.govID:NCT03144505.
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Affiliation(s)
- Pedro B Júdice
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal.
- CIDEFES-Centro de Investigação em Desporto, Educação Física e Exercício e Saúde, Universidade Lusófona, Lisbon, Portugal.
| | - João P Magalhães
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
| | - Megan Hetherington-Rauth
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
| | - Inês R Correia
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
| | - Luís B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
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Verloigne M, Ridgers ND, Chinapaw M, Altenburg TM, Bere E, Van Lippevelde W, Cardon G, Brug J, De Bourdeaudhuij I. Patterns of objectively measured sedentary time in 10- to 12-year-old Belgian children: an observational study within the ENERGY-project. BMC Pediatr 2017; 17:147. [PMID: 28615079 PMCID: PMC5471712 DOI: 10.1186/s12887-017-0894-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 05/31/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study examined the frequency of and differences in sedentary bouts of different durations and the total time spent in sedentary bouts on a weekday, a weekend day, during school hours, during after-school hours and in the evening period in a sample of 10- to 12-year-old Belgian children. METHODS Accelerometer data were collected as part of the ENERGY-project in Belgium (n = 577, 10.9 ± 0.7 years, 53% girls) in 2011. Differences in total sedentary time, sedentary bouts of 2-5, 5-10, 10-20, 20-30 and ≥30 min and total time accumulated in those bouts were examined on a weekday, a weekend day, during school hours, during after-school hours and in the evening period, using multilevel analyses in MLwiN 2.22. RESULTS More than 60% of the participants' waking time was spent sedentary. Children typically engaged in short sedentary bouts of 2-5 and 5-10 min, which contributed almost 50% towards their total daily sedentary time. Although the differences were very small, children engaged in significantly fewer sedentary bouts of nearly all durations during after-school hours compared to during school hours and in the evening period. Children also engaged in significantly fewer sedentary bouts of 5-10, 10-20, and 20-30 min per hour on a weekend day than on a weekday. CONCLUSIONS Although primary school children spend more than 60% of their waking time sedentary, they generally engaged in short sedentary bouts. Children's sedentary bouts were slightly longer on weekdays, particularly during school hours and in the evening period, although the differences were very small. These results suggest that in this age group, interventions focusing on reducing total sedentary time rather than interrupting prolonged sedentary time are needed.
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Affiliation(s)
- Maïté Verloigne
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium. .,Research Foundation Flanders (FWO), Egmontstraat 5, 1000, Brussel, Belgium.
| | - Nicola D Ridgers
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Burwood, Australia
| | - Mai Chinapaw
- Department of Public and Occupational Health and the EMGO Institute for Health & Care Research, VU Medical Center, Amsterdam, the Netherlands
| | - Teatske M Altenburg
- Department of Public and Occupational Health and the EMGO Institute for Health & Care Research, VU Medical Center, Amsterdam, the Netherlands
| | - Elling Bere
- Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway
| | | | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Johannes Brug
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health & Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
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Hartman SJ, Marinac CR, Bellettiere J, Godbole S, Natarajan L, Patterson RE, Kerr J. Objectively measured sedentary behavior and quality of life among survivors of early stage breast cancer. Support Care Cancer 2017; 25:2495-503. [PMID: 28326507 DOI: 10.1007/s00520-017-3657-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 02/27/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE This study examined relationships between sedentary behavior accumulated in different bout durations and quality of life (QoL) among breast cancer survivors. METHODS Postmenopausal breast cancer survivors completed the Short Form Health Survey to assess QoL and wore an accelerometer to measure sedentary behavior and physical activity between August 2011 and May 2013. RESULTS Participants (n = 134) averaged 509.7 min/day in sedentary time with 285.2 min/day in short bouts (<20 min) and 224.5 min/day long bouts (≥20 min). Linear regression models indicated that greater total sedentary time was significantly associated with worse physical QoL (b = -0.70, p = 0.02) but not mental QoL (p = 0.92). Models that examined the accumulation of sedentary time in short bouts and long bouts together showed that time in long sedentary bouts was significantly related to physical QoL (b = -0.72, p = 0.02), while time in short bouts was not (p = 0.63). Moderate-to-vigorous intensity physical activity (MVPA) was a significant effect modifier of the relation between time spent in long sedentary bouts and physical QoL (p = 0.028) such that greater time in long bouts was associated with worse physical QoL only among women with lower levels of MVPA. CONCLUSIONS Findings indicate that time spent in long sedentary bouts is associated with worse physical QoL among breast cancer survivors who do not engage in high levels of MVPA. Future research should examine reducing sedentary time as a potential strategy to improve physical QoL.
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van der Berg JD, Stehouwer CDA, Bosma H, van der Velde JHPM, Willems PJB, Savelberg HHCM, Schram MT, Sep SJS, van der Kallen CJH, Henry RMA, Dagnelie PC, Schaper NC, Koster A. Associations of total amount and patterns of sedentary behaviour with type 2 diabetes and the metabolic syndrome: The Maastricht Study. Diabetologia 2016; 59:709-18. [PMID: 26831300 PMCID: PMC4779127 DOI: 10.1007/s00125-015-3861-8] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/14/2015] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS The study investigated cross-sectional associations of total amount and patterns of sedentary behaviour with glucose metabolism status and the metabolic syndrome. METHODS We included 2,497 participants (mean age 60.0 ± 8.1 years, 52% men) from The Maastricht Study who were asked to wear an activPAL accelerometer 24 h/day for 8 consecutive days. We calculated the daily amount of sedentary time, daily number of sedentary breaks and prolonged sedentary bouts (≥30 min), and the average duration of the sedentary bouts. To determine glucose metabolism status, participants underwent an oral glucose tolerance test. Associations of sedentary behaviour variables with glucose metabolism status and the metabolic syndrome were examined using multinomial logistic regression analyses. RESULTS Overall, 1,395 (55.9%) participants had normal glucose metabolism, 388 (15.5%) had impaired glucose metabolism and 714 (28.6%) had type 2 diabetes. The odds ratio per additional hour of sedentary time was 1.22 (95% CI 1.13, 1.32) for type 2 diabetes and 1.39 (1.27, 1.53) for the metabolic syndrome. No significant or only weak associations were seen for the number of sedentary breaks, number of prolonged sedentary bouts or average bout duration with either glucose metabolism status or the metabolic syndrome. CONCLUSIONS/INTERPRETATION An extra hour of sedentary time was associated with a 22% increased odds for type 2 diabetes and a 39% increased odds for the metabolic syndrome. The pattern in which sedentary time was accumulated was weakly associated with the presence of the metabolic syndrome. These results suggest that sedentary behaviour may play a significant role in the development and prevention of type 2 diabetes, although longitudinal studies are needed to confirm our findings.
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Affiliation(s)
- Julianne D van der Berg
- Department of Social Medicine, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Jeroen H P M van der Velde
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Department of Human Movement Sciences, Maastricht University, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Paul J B Willems
- Department of Human Movement Sciences, Maastricht University, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Hans H C M Savelberg
- Department of Human Movement Sciences, Maastricht University, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Simone J S Sep
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Pieter C Dagnelie
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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