Staff Publications

Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

    Full text documents are added when available. The database is updated daily and currently holds about 240,000 items, of which 72,000 in open access.

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    Exercise self-efficacy is weakly related to engagement in physical activity in persons with long-standing spinal cord injury
    Kooijmans, Hedwig ; Post, Marcel ; Motazedi, Ehsan ; Spijkerman, Dorien ; Bongers-Janssen, Helma ; Stam, Henk ; Bussman, Hans - \ 2019
    Disability & Rehabilitation (2019). - ISSN 0963-8288
    behavioural model - exercise - physical activity - self-efficacy - Spinal cord injury

    Aims: Many people with a long-standing spinal cord injury have an inactive lifestyle. Although exercise self-efficacy is considered a key determinant of engaging in exercise, the relationship between exercise self-efficacy and physical activity remains unclear. Therefore, this study examines the relationship between exercise self-efficacy and the amount of physical activity in persons with long-standing spinal cord injury. Methods: This cross-sectional study included 268 individuals (aged 28–65 years) with spinal cord injury ≥ 10 years and using a wheelchair. Physical activity was measured with the Physical Activity Scale for Individuals with Physical Disabilities. Exercise self-efficacy was assessed with the Spinal cord injury Exercise Self-Efficacy Scale. Univariate and multivariable regression analyses were performed to test for the association between exercise self-efficacy and physical activity, controlling for supposed confounders. Results: Univariate regression analysis revealed that exercise self-efficacy was significantly related to the level of daily physical activity (β = 0.05; 95% CI 0.04–0.07; 15% explained variance; p < 0.001). In multivariable regression analysis exercise self-efficacy remained, explaining a significant additional amount of the variance (2%; p < 0.001) of physical activity. Conclusion: Exercise-self efficacy is a weak but independent explanatory factor of the level of physical activity among persons with long-standing spinal cord injury. Longitudinal trials are needed to study the impact of interventions targeting an increase of exercise self-efficacy on the amount of physical activity performed.Implications for rehabilitation Pre-intervention levels of exercise-self-efficacy might mediate the effectiveness of interventions that aim at increasing physical activities in people with a long-standing spinal cord injury. Enhancing exercise-self efficacy may improve levels of physical activity, even in people with a long-standing spinal cord injury. When it comes to enhancing physical activity, efforts to enhance non-structured daily physical activities such as household activities and gardening might be as important as efforts to enhance sports and other physical exercise.

    Healthy Living After Cancer Treatment : Considerations for Clinical and Community Practice
    Bluethmann, Shirley M. ; Sciamanna, Christopher N. ; Winkels, Renate M. ; Sturgeon, Kathleen M. ; Schmitz, Kathryn H. - \ 2018
    American Journal of Lifestyle Medicine 12 (2018)3. - ISSN 1559-8276 - p. 215 - 219.
    cancer - energetics - healthy aging - physical activity - survivorship

    As the number of US cancer survivors now reaches almost 16 million, understanding how to care for survivors after cancer treatment has demanded national attention. Increasingly, compelling benefits of lifestyle behaviors for cancer prevention and control have been demonstrated. In particular, physical activity is recommended as a central component of healthy living after cancer treatment. However, survivors struggle to achieve recommended physical activity and other behaviors for reasons that are still not well understood. Further, as greater than 60% of cancer survivors are older than 65 years, there is a unique opportunity to increase engagement of older adults in health programs and clinical trials. This article considers evidence from two reviews: a review on epidemiology studies of lifestyle and cancer and a review on different behavioral intervention strategies to achieve positive behavioral changes in cancer survivors. Both reviews offer important evidence on the role of lifestyle in life after cancer treatment. However, more investigation is needed on the practice of lifestyle medicine for cancer survivors, including ways to extend the reach of health promotion beyond cancer clinics, to primary care and community settings.

    Groen en welbevinden : Hoe kan het groen in de directe woonomgeving bijdragen aan het welbevinden van verschillende bewoners?
    Vries, S. de - \ 2018
    Wageningen : Wageningen University & Research - 57 p.
    public green areas - health - ecosystem services - physical activity - social cooperation - study - youth - health indicators
    Molecular assessment of muscle health and function : The effect of age, nutrition and physical activity on the human muscle transcriptome and metabolom
    Hangelbroek, Roland W.J. - \ 2017
    Wageningen University. Promotor(en): A.H. Kersten; C.P.G.M. de Groot, co-promotor(en): M.V. Boekschoten. - Wageningen : Wageningen University - ISBN 9789463437103 - 205
    muscles - age - nutrition - physical activity - transcriptomes - metabolomes - elderly - creatine - phosphocreatine - vitamin d - atrophy - spieren - leeftijd - voeding - lichamelijke activiteit - transcriptomen - metabolomen - ouderen - creatine - fosfocreatine - vitamine d - atrofie

    Prolonged lifespan and decreased fertility will lead to an increased proportion of older adults in the world population (population aging). An important strategy to deal with population aging has been to promote healthy aging; not only to prevent mounting health care costs, but also to maintain independence and quality of life of older populations for as long as possible. Close to the opposite of the healthy aging is frailty. A major component of (physical) frailty is sarcopenia: age-related loss of muscle mass. Decreased muscle size and strength has been associated with a wide variety of negative health outcomes, including increased risk of hospitalization, physical disability and even death. Therefore, maintaining muscle size and strength is very important for healthy aging. Nutrition and physical activity are possible strategies to maintain or even improve muscle function with age.

    The effect of nutrition, age, frailty and physical activity on the function of skeletal muscle is complex. A better understanding of the molecular mechanisms involved can provide new insights in potential strategies to maintain muscle function over the life course. This thesis aims to investigate these mechanisms and processes that underlie the effects of age, frailty and physical activity by leveraging the sensitivity and comprehensiveness of transcriptomics and metabolomics.

    Chapter 2 and 3 describe the effects of age, frailty and resistance-type exercise training on the skeletal muscle transcriptome and metabolome. Both the transcriptome and metabolome show significant differences between frail and healthy older adults. These differences are similar to the differneces between healthy young men and healthy older adults, suggesting that frailty presents itself as a more pronounced form of aging, somewhat independent of chronological age. These age and frailty related differences in the transcriptome are partially reversed by resistance-type exercise training, in accordance with the observed improvement in muscle strength. Regression analysis revealed that the protocadherin gamma gene cluster may be important to skeletal muscle function. Protocadherin gamma is involved in axon guidance and may be upregulated due to the denervation-reinnervation cycles observed in skeletal muscle of older individuals. The metabolome suggested that resistance-type exercise training led to a decrease in branched-chain amino acid oxidation, as shown by a decrease in amino acid derived carnitines. Lastly, the blood metabolome showed little agreement with the metabolome in skeletal muscle, indicating that blood is a poor read-out of muscle metabolism.

    We assessed the effect of knee immobilization with creatine supplementation or placebo on the skeletal muscle transcriptome and metabolome in chapter 4. Knee immobilization caused muscle mass loss and strength loss in all participants, with no differences between creatine and placebo groups. Knee immobilization appeared to induce the HDAC4-myogenin axis, which is primarily associated with denervation and motor neuron diseases. The metabolome showed changes consistent with the decreased expression of energy metabolism genes. While acyl-carnitine levels tended to decrease with knee immobilization, one branched-chain amino acid-derived acyl carnitine was increased after knee immobilization, suggesting increased amino acid oxidation.

    Vitamin D deficiency is common among older adults and has been linked to muscle weakness. Vitamin D supplementation has been proposed as a strategy to improve muscle function among older populations. In chapter 5, supplementation with vitamin D (calcifediol, 25(OH)D) is investigated as nutritional strategy to improve muscle function among frail older adults. However, we observed no effect of vitamin D on the muscle transcriptome. These findings indicate the effects of vitamin D supplementation on skeletal muscle may be either absent, weak, or limited to a small subset of muscle cells.

    Transcriptomic changes due to different forms of muscle disuse are compared in chapter 6 (primarily knee immobilization and bed rest). The goal was to determine the similarities and differences among various causes of muscle atrophy in humans (primarily muscle disuse). Both knee immobilization and bed rest led to significant changes in the muscle transcriptome. However, the overlap in significantly changed genes was relatively small. Knee immobilization was characterized by ubiquitin-mediated proteolysis and induction of the HDAC4/Myogenin axis, whereas bed rest revealed increased expression of genes of the immune system and increased expression of lysosomal genes. Knee immobilization showed the highest similarity with age and frailty-related transcriptomic changes. This finding suggests that knee immobilization may be the most suitable form of disuse atrophy to assess the effectiveness of strategies to prevent age-related muscle loss in humans.

    The transcriptome and metabolome are incredibly useful tools in describing the wide array of biological systems within skeletal muscle. These systems can be modulated using physical activity (or lack thereof) as well as nutrition. This thesis describes some of these processes and highlights several unexplored genes and metabolites that may be important for maintaining or even optimizing muscle function. In the future, it may be possible to optimize both exercise and nutrition for each individual using these techniques; or even better, cheaper and less invasive alternatives.

    The Care Sport Connector in the Netherlands
    Leenaars, Karlijn - \ 2017
    Wageningen University. Promotor(en): M.A. Koelen, co-promotor(en): M.A.E. Wagemakers; G.R.M. Molleman. - Wageningen : Wageningen University - ISBN 9789463436106 - 261
    sport - sport policy - health care workers - physical activity - public health services - health promotion - primary health care - netherlands - case studies - physical education - sport - sportbeleid - gezondheidswerkers - lichamelijke activiteit - voorzieningen ten behoeve van de volksgezondheid - gezondheidsbevordering - eerstelijnsgezondheidszorg - nederland - gevalsanalyse - lichamelijke opvoeding

    Introduction
    To stimulate physical activity (PA) and guide primary care patients towards local PA facilities, Care Sport Connectors (CSC) (in Dutch Buurtsportcoach), to whom a broker role has been ascribed, were introduced in 2012. This function is new, and to our knowledge no study has yet explored a broker role and its impact on improving intersectoral collaboration between both sectors. The aim of this thesis was to explore CSCs’ role and impact in connecting the primary care and the PA sector.
    Method
    This thesis employed a multiple case study design in which 15 CSCs from nine municipalities spread over the Netherlands were followed in their work from 2014 to the end of 2016. Different data collection methods were used (literature review, interviews, focus groups, document analysis, and questionnaires), and perspectives of different stakeholders (policymakers, professionals, CSCs) on different levels (policy and community) were taken into account (Chapter 2).

    Results
    The connection between the primary care and the PA sector: a chain approach
    The connection between both sectors can be characterised as a chain in which CSCs guide the target group towards PA facilities after referral by primary care professionals or their own recruitment. In this connection CSCs fulfilled three roles - broker, referral, and organiser – which did not change over time (Chapter 4 and 5).

    Barriers at system and sector level hinder the established connection

    Barriers related to the primary care (lack of time, money and knowledge) and the PA sector (lack of suitable PA activities and adequate instructors) are currently hindering the connection between both sectors (Chapter 4 and 6). Barriers related to the collaboration between both sectors, like cultural differences and different interests as identified in our literature review (Chapter 3) were not identified.

    The importance of an integral approach for CSCs and the connection between both sectors
    An integral approach to structural embed CSCs (Chapter 7) seemed to influence CSCs’ work and subsequently their impact. CSCs working in municipalities who structurally embedded CSCs only at the PA sector, connected both sectors mostly by jointly organising activities. CSCs working in municipalities who adopted an integral approach connected both sectors by a variety of activities targeting different audiences, and primary care professionals fulfilled mostly a role in the referral of their patients. The structural imbedding of the CSC according an integral approach seems the most promising in reaching the desired outcomes (Chapter 8).

    Conclusion
    CSC’ role is promising for establishing a connection between the primary care and the PA sector. However, to make a success of the connection changes are needed at system and sector level. Further research should focus on CSCs’ impact on stimulating PA among primary care patients, and the development of CSC’ role and the connection between both sectors over time.

    Monitoringsonderzoek Gezonde Schoolpleinen : monitor van het proces Gezonde Schoolpleinen van 70 Icoonscholen, inspiratie voor een gezond schoolplein en landelijke bekendheid van het proces Gezonde Schoolpleinen
    Goossen, Martin ; Pleijte, Marcel ; Langers, Fransje ; Donders, Josine ; Vries, Sjerp de - \ 2017
    Wageningen : Wageningen Environmental Research (Wageningen Environmental Research rapport 2814) - 89
    basisscholen - kinderen - gebiedsontwikkeling - campus - gezondheid van kinderen - architectuur - ontwerp - sociale gevolgen - cognitieve ontwikkeling - lichamelijke activiteit - gezondheid - elementary schools - children - area development - campus - child health - architecture - design - social impact - cognitive development - physical activity - health
    Groen en leren : de meerwaarde van groen voor het welbevinden in de leeromgeving samengevat
    Spijker, J.H. - \ 2017
    Wageningen : Wageningen Environmental Research - 7
    beplantingen - onderwijs - leren - schoolterrein - leerprestaties - openbaar groen - klimaat - temperatuur - gezondheid - sociaal welzijn - luchtkwaliteit - lichamelijke activiteit - lichamelijke fitheid - stressfactoren - kinderen - plantations - education - learning - school site - educational performance - public green areas - climate - temperature - health - social welfare - air quality - physical activity - physical fitness - stress factors - children
    de meerwaarde van groen voor het welbevinden in de leeromgeving samengevat
    Promoting physical activity in socially vulnerable groups : a mixed method evaluation in multiple community-based physical activity programs
    Herens, M.C. - \ 2016
    Wageningen University. Promotor(en): Maria Koelen, co-promotor(en): Annemarie Wagemakers; Johan van Ophem; Lenneke Vaandrager. - Wageningen : Wageningen University - ISBN 9789462578081 - 276
    physical activity - community health - community health services - community programs - netherlands - program development - quality of life - socioeconomic status - lichamelijke activiteit - gezondheid op regionaal niveau - voorzieningen tbv de gezondheid op regionaal niveau - gemeenschapsprogramma's - nederland - programmaontwikkeling - kwaliteit van het leven - sociaal-economische positie

    Background: In the Netherlands, inequalities in physical activity behaviour go hand in hand with socioeconomic inequalities in health. To promote physical activity effectively and equitably, participatory community-based physical activity interventions seem promising and are supported by the Dutch government’s policy. Although many strategies have been developed to increase physical activity levels in general and in socially vulnerable groups in particular, most evaluations show only small to moderate effects. To date, the evidence base rests mainly on correlational, cross-sectional studies at participant level, lacking insight into causal relationships and interaction patterns between factors influencing physical activity. In addition, in line with Dutch health promotion policy, there is a general demand for community-based health-enhancing physical activity (CBHEPA) programs to be evaluated for impacts and (cost)effectiveness.

    Aim: The aim of this PhD research was to assess the effectiveness of these community-based physical activity programs at different impact levels (individual, group, and program), including the mechanisms generating outcomes. This study aims to contribute to the evidence base of programs targeting socially vulnerable groups, by applying systematically a multilevel and realist perspective in order to generate recommendations about how to evaluate physical activity promotion interventions targeting socioeconomic inequalities in health and physical activity.

    Methods: The research used a mixed methods design, grounded in an ecological perspective on human health, enabling the identification of underlying mechanisms at multiple levels which explain what works and why. A total of 268 participants in 19 groups in seven ongoing CBHEPA programs were monitored between 2012 and 2015. At individual level, a sequential cohort design was used to acquire longitudinal data on developments in physical activity behaviour and health-related indicators, and to assess participants’ willingness to pay for sport and physical activity. At group and program level, qualitative techniques of measurement and analyses were used, thus linking outcomes at multiple impact levels from different datasets over a period of time, adding contextual and time-related value to our findings building a realist synthesis protocol.

    Results: Based on a multilevel analysis, our findings showed that the CBHEPA programs reach socially vulnerable, but not necessarily inactive, groups in terms of socioeconomic and health-related quality of life outcomes. No increase in physical activity levels over time were found, but the findings suggest that ongoing programs contributed to physical activity maintenance in the target population. Significant positive associations were found between leisure-time physical activity, and health-related quality of life, self-efficacy, and enjoyment.

    Furthermore, participants’ willingness to pay (WTP) for sports and physical activity was explored in terms of money and time in relation to WTP predictors. The average monetary WTP amounted to €9.60/month, exceeding the average monthly program fees actually paid by €2.64, and was positively associated with income and sport and physical activity experiences. The average WTP in travel time was close to18 minutes and was positively associated with income and age. Indications are that short-term program satisfaction is probably more decisive for willingness to pay than long-term perspectives of improving health-related quality of life.

    At group level, fostering group processes was found as an overarching principle, conditional for spin-offs in terms of enjoyment and active participation, which, in turn, lead to a sense of ownership among participants, who take up responsibility for the exercise group as well as for their individual activity behaviour. CBHEPA programs thrive on participants having fun together and on exercise trainers’ leadership skills.

    The issue of physical activity maintenance was explored in the case of women of non-Western origin. The factors influencing physical activity maintenance at individual level were: perceived (health) benefits, self-regulation, and learning outcomes regarding physical activity and social participation. At group level, mutual support, security, sharing stories, and trust were important factors. At program level program, quality, staff responsiveness, continuity, and accessibility were important factors. Individual perceived benefits and factors at group and program level, aimed at an appropriate mix of exercise and social activities, contributed significantly to physical activity maintenance by women of non-Western origin.

    At program level, outcomes of interest, identified by local stakeholders, related to community outreach, program sustainability, intersectoral collaboration, and enhancing participants’ active lifestyles. Supportive contexts were municipal policies in support of community-based programs, established collaborative structures and community networks, and alignment with other health and welfare projects. Stakeholders’ past experiences with sport and physical activity projects and commitment to the target group were strong additional supportive contextual factors. Supportive mechanisms were entrepreneurship, leadership, responsiveness, deployment of professional exercise trainers, and ensuring the implementation of tailored and accessible program activities. Local governance structures, however, appeared often to lack adaptive capacity to accommodate multilevel processes to realise the sustainment of CBHEPA programs. Policy volatility often results in discontinuity of project funding and collaborative processes, and a reduction in the availability of professional expertise, thus hampering program development and sustainability.

    Conclusions: CBHEPA programs, if supported in their performance and sustainability, succeed in generating physical activity maintenance in socially vulnerable groups. Two parallel tracks of value co-creation were identified, reflecting value-in-social-context shaped by social forces and reproduced in social structures through interaction and dialogue: the institutional track, involving the collaborative processes at institutional level, and the exercise group track, involving the collaborative processes in the exercise groups. The exercise trainer is usually the only linchpin responsible for connecting these parallel tracks. Strong evidence was found on how contextual dynamics shape local CBHEPA initiatives and on the need for responsiveness and adaptive mechanisms in the institutional track as well as in the exercise group track, in order to realise sustained CBHEPA programs.

    We suggest future research on physical activity behaviour and maintenance to focus not only on how individuals act, but also on how individuals, groups, and environments interact. This calls for evaluation strategies which align accountability with learning through evaluation.

    Targeting persons with low socioeconomic status of different ethnic origins with lifestyle interventions : opportunities and effectiveness
    Bukman, A.J. - \ 2016
    Wageningen University. Promotor(en): Edith Feskens, co-promotor(en): Reint-Jan Renes. - Wageningen : Wageningen University - ISBN 9789462577022 - 169
    socioeconomic status - lifestyle - ethnic groups - intervention - cardiovascular diseases - type 2 diabetes - diabetes - obesity - dutch - turkish - glucose tolerance - morocco - physical activity - prevention - sociaal-economische positie - levensstijl - etnische groepen - interventie - hart- en vaatziekten - diabetes type 2 - suikerziekte - obesitas - nederlands - turks - glucosetolerantie - marokko - lichamelijke activiteit - preventie

    Lifestyle intervention studies have shown that the development of cardiometabolic diseases can be partly prevented or postponed by the combination of a healthy diet and physical activity. Cardiometabolic diseases and their risk factors are particularly prevalent among individuals with low socioeconomic status and some ethnic minorities, and therefore these groups especially may benefit from participating in lifestyle interventions. Although individuals with low socioeconomic status and ethnic minorities could potentially benefit from lifestyle interventions, it seems that these groups are often not successfully reached for such interventions. Moreover, when they do participate in these interventions, they seem more likely to quit. The overall aim of this thesis was therefore to study opportunities for, and the effectiveness of, lifestyle interventions to reduce the risk of cardiometabolic diseases, targeting individuals with low socioeconomic status of different ethnic origins. To this end, this thesis reports two studies that identified opportunities for adapting lifestyle interventions to the target group’s needs, one study describing the process of adapting an effective lifestyle intervention (SLIM) into a new lifestyle intervention targeting individuals with low SES of different ethnic origins (MetSLIM) and two studies that determined the effectiveness of lifestyle interventions among the target group.

    The aim of the study described in chapter 2 was to identify opportunities for adapting lifestyle interventions in such a way as to be more appealing for individuals with low socioeconomic status. The study provided insight into perspectives of groups with different socioeconomic positions regarding their current eating and physical activity behaviour; triggers for lifestyle change; and preferred ways to support lifestyle change. Data were gathered in semi-structured focus group interviews with adults with low socioeconomic status (four groups) and with adults with high socioeconomic status (five groups). In general, three key topics were identified, namely: current lifestyle is logical for participants given their personal situation; lifestyle change is prompted by feedback from their body; and support for lifestyle change should include individually tailored advice and could profit from involving others. The perceptions of the participants with low socioeconomic status were generally comparable to the perceptions shared by the participants with high socioeconomic status. Some perceptions were, however, especially mentioned in the low socioeconomic status groups. Participants with low socioeconomic status indicated that their current eating behaviour was sometimes affected by cost concerns. They seemed to be especially motivated to change their lifestyle when they experienced health complaints but were rather hesitant to change their lifestyle for preventive purposes. Regarding support for lifestyle change, participants with low socioeconomic status preferred to receive advice in a group rather than on their own. For physical activities, groups should preferably consist of persons of the same age, gender or physical condition.

    The aim of the study described in chapter 3 was to identify how Turkish and Moroccan adults living in the Netherlands, aged 45 years and older, could be reached to participate in health checks for cardiometabolic diseases and follow-up (lifestyle) advice. In this study, questionnaire data were combined with interview data. This was done in order to use the narratives from the interviews to get a better understanding of the numbers that resulted from the questionnaire data. It turned out that both ethnic groups preferred an invitation from their general practitioner (GP) for a health check and preferred to fill out the health check questionnaire at the GP’s office or at home, on paper. They preferred to receive advice at individual level in relation to personal matters via either a physician or a specialised healthcare professional. Sixty-one percent of the Turkish respondents preferred to receive information in their native language, compared to 37% of the Moroccan respondents. Several participants mentioned a low proficiency in the local language as an explanation for their preference to fill out the health check questionnaire at home, to receive advice from an ethnicity-matched professional and to receive information in their native language. The results of this study suggested that the GP would be a promising contact to reach adults of Turkish and Moroccan origin for health checks or (lifestyle) advice. Furthermore, the findings suggested that it would be necessary to provide information in individuals’ native language to overcome language barriers and that (lifestyle) advice should be tailored towards the needs of the targeted individuals.

    The insights gained into the needs and preferences of the target group – as described in chapter 2 and chapter 3 – were taken into account in the design of the MetSLIM intervention study. The MetSLIM study targeted individuals with low socioeconomic status of Dutch, Turkish and Moroccan origin. The MetSLIM study protocol was based on the SLIM study protocol. The SLIM study showed the beneficial effects of nutrition advice and physical activity promotion on the prevention type 2 diabetes, but drop-out was relatively high among low SES participants. Chapter 4 provides a detailed description of the development from the SLIM study protocol to the MetSLIM study protocol. Furthermore, this chapter gives insight into the obstacles encountered in developing the MetSLIM study to target individuals with low socioeconomic status of different ethnic origins. The new elements regarding the lifestyle intervention programme were: 1) additional group meetings about price concerns and social occasions with regard to a healthy diet; 2) ethnicity-matched dieticians; 3) gender-matched sports instructors; 4) all activities in the participants’ own neighbourhood; and 5) activities for women and men separately. The new elements regarding the study design, in order to study the effectiveness of the MetSLIM intervention programme, included: 1) from an university stetting to a community setting; 2) from a randomised controlled trial to a quasi-experimental study; 3) waist circumference – as a visible cardiometabolic risk factor – as main study outcome; 4) recruitment via GPs and in community centres; 5) translated study materials and ethnicity-matched research assistants involved in measuring; and 6) fewer measurements and measurements that could take place at different locations. Adaptations to the original SLIM study protocol were considered necessary in order to overcome practical barriers that hinder the target group’s participation; to suit the target group’s (cultural) needs; and to make it feasible to perform the study in a local (community) setting.

    MetSLIM was not the only study set up based on the SLIM study. The SLIMMER study translated SLIM from a university setting to a real-world setting. The intervention was implemented in the public health and primary healthcare setting involving local GPs, practice nurses, dieticians, physiotherapists and sports clubs. The SLIMMER study did not target individuals with low socioeconomic status in particular; however, 52% of the study participants did have a low socioeconomic status, as determined by highest completed educational level. Chapter 5 describes how we explored the role of socioeconomic status in willingness to participate, programme attendance, programme acceptability, adherence to lifestyle guidelines, drop-out and effectiveness in the SLIMMER diabetes prevention intervention. The SLIMMER study was a randomised controlled trial, targeting 40- to 70-year-old adults at increased risk of type 2 diabetes, carried out in Apeldoorn and Doetinchem. The intervention group participated in a 10-month lifestyle programme: weekly training sessions were guided by a physiotherapist, and dietary advice was given by a dietician during 5–8 individual consultations and one group session. Measurements were carried out at baseline, after 12 months and six months after the active intervention period ended. The study showed that participation, attendance, acceptability, adherence, drop-out and effect of the SLIMMER study were mostly not affected by socioeconomic status. The SLIMMER study was able to reach the low socioeconomic status group as effectively as the higher socioeconomic status group, resulting in at least similar health benefits. The SLIMMER sample size was too small to study differences within the low socioeconomic status group, e.g. comparing the low vs. the least educated or comparing ethnic groups. Only 10% of the 316 SLIMMER participants had the lowest educational levels (no education or primary education) and only 11% had a foreign background.

    The aim of the study described in chapter 6 was to measure the effectiveness of the MetSLIM intervention on waist circumference and other cardiometabolic risk factors, lifestyle and quality of life among 30- to 70-year-old adults with an elevated waist-to-height ratio. In the MetSLIM study, 220 individuals participated, of whom 40% had no education or only primary education and of whom 64% had a foreign background. MetSLIM had a quasi-experimental design with measurements at baseline and after 12 months. Participants were recruited in deprived neighbourhoods of Arnhem and Eindhoven via either their GP or in community centres. The intervention group participated in a 12-month lifestyle programme: an introductory group meeting was guided by the researcher, weekly physical activity lessons were guided by a sports instructor and dietary advice was given by an ethnicity-matched dietician (in total four hours of individual consultations and three group sessions). The study showed that the MetSLIM lifestyle intervention was effective in reducing waist circumference, other measures of obesity, total and LDL cholesterol, and quality of life. MetSLIM had a drop-out of 31%, which was higher than at 12 months in the SLIM study (10%) and SLIMMER study (13%), but comparable to drop-out in similar studies among ethnic minorities or low socioeconomic status populations.

    Finally, in chapter 7, the main results of this thesis are described, followed by a discussion of methodological considerations, public health implications, suggestions for future research and the general conclusion. The adaptation process from SLIM to MetSLIM is discussed, including a reflection on the decision to use SLIM as a starting point and the decision to target three different ethnic groups at the same time. Moreover, difficulties in defining and selecting persons with low socioeconomic status and specific ethnic groups within research are addressed. As SLIMMER and MetSLIM proved that low socioeconomic status populations can be reached, and that their health can be improved when they participate in lifestyle interventions, it is suggested that further implementation should be considered. Insight should be gained into the ‘black box’ of lifestyle interventions; i.e. we should get to know what works for whom. Planned future research includes a process and economic evaluation of MetSLIM.

    This thesis has shown that intensive combined lifestyle interventions can be effective in low socioeconomic status populations and identified possible adaptations to make lifestyle interventions more suitable for individuals with low socioeconomic status of Dutch, Turkish and Moroccan origin. The question is not whether a lifestyle intervention can be effective, but how diverse groups can be reached and benefit from it. For this purpose, further insight into the success of different adaptations for different target groups should be obtained to reveal the effective elements to reach, inspire and retain different low socioeconomic status populations and ethnic minorities with lifestyle interventions.

    Blijven Bewegen na de BeweegKuur : De rol van groen in de woonomgeving
    Vries, S. de; Langers, F. ; Meis, Jessie ; Berendsen, B. ; Kremers, Stef - \ 2016
    Wageningen : Alterra, Wageningen-UR (Alterra-rapport 2701) - 25
    voeding en gezondheid - lichamelijke activiteit - levensstijl - openbaar groen - herstellen - gezondheid - voeding - beweging - welzijn - nutrition and health - physical activity - lifestyle - public green areas - reconditioning - health - nutrition - movement - well-being
    De BeweegKuur is een leefstijlinterventie die beoogt blijvend gezonder voedings- en beweeggedrag te
    realiseren. Qua beweging is het de bedoeling dat de deelnemers op het eind van de BeweegKuur
    uitstromen naar het reguliere beweegaanbod in hun leefomgeving. In deze studie is gekeken of groen
    in de woonomgeving een rol speelt bij het volhouden van het beweegniveau tot een jaar na afloop van
    de BeweegKuur. Specifiek is gekeken naar a) de rol van groen bij de keuze voor uitstroomactiviteit en
    b) die van uitstroomactiviteit op de kans op uitval. Daarnaast is, min of meer los van de activiteit,
    gekeken naar c) het volhouden van de mate van lichamelijke activiteit in termen van beweegminuten,
    zoals die op het eind van de BeweegKuur bestond.
    Groen voor gezondheid: wat hebben gezondheidsprofessionals nodig? : Achtergronddocument
    Hermans, C.M.L. ; Lemmens, L. ; Postma, A. - \ 2015
    Wageningen : Alterra, Wageningen-UR (Alterra-rapport 2665) - 49
    natuur - openbaar groen - gezondheid - volksgezondheid - omgevingspsychologie - perceptie - welzijn - stress - lichamelijke activiteit - beweging - nature - public green areas - health - public health - environmental psychology - perception - well-being - stress - physical activity - movement
    Natuur werkt positief op gezondheid en welbevinden van mensen. De werkingsmechanismen achter deze positieve relatie zijn bekend: stress vermindert, lichamelijke activiteit neemt toe, de sociale cohesie in de buurt verbetert. Toch wordt natuur nauwelijks ingezet door professionals uit de eerste lijn of publieke gezondheid. Wat belemmert hen en wat zijn de oplossingen?
    Groen en gebruik ADHD-medicatie door kinderen : de relatie tussen de hoeveelheid groen in de woonomgeving en de prevalentie van AD(H)D-medicatiegebruik bij 5- tot 12-jarigen
    Vries, S. de; Verheij, R. ; Smeets, H. - \ 2015
    Wageningen : Alterra, Wageningen-UR (Alterra 2672) - 23
    kinderen - gezondheid van kinderen - aandachtstekort hyperactiviteitstoornis - natuur - omgevingspsychologie - milieu - lichamelijke activiteit - welzijn - gezondheid - beweging - children - child health - attention deficit hyperactivity disorder - nature - environmental psychology - environment - physical activity - well-being - health - movement
    In deze studie is gekeken naar de relatie tussen de hoeveelheid groen in de woonomgeving en het gebruik van ADHD-medicatie door kinderen. De gegevens over het medicijngebruik zijn afkomstig uit de Achmea Health Database. Uit deze database zijn kinderen die in 2011 tussen de 5 en 12 jaar waren, geselecteerd, ongeacht of ze ADHD-medicatie gebruikten of niet. Hieraan zijn middels de 6-positie postcode van het woonadres gegevens over het groen in de woonomgeving (250 m en 500 m) gekoppeld alsmede enkele buurtkenmerken. Van de 274.698 kinderen in de database waren voor 248.270 kinderen alle gegevens beschikbaar. De uitval werd voornamelijk veroorzaakt door tussentijdse verhuizingen. Middels multilevel logistische regressieanalyse is de relatie tussen de hoeveelheid groen in de woonomgeving en het al dan niet gebruiken van een ADHD-medicijn geanalyseerd.
    Overweight and obesity in primary-school children: a surveillance system for policy-making in Europe from 2007 onwards
    Wijnhoven, T.M.A. - \ 2015
    Wageningen University. Promotor(en): Pieter van 't Veer, co-promotor(en): Joop van Raaij. - Wageningen - ISBN 9789462574656 - 265
    overgewicht - obesitas - quetelet index - lichaamsgewicht - schoolkinderen - kinderen - kwantitatieve analyse - who - gezondheid van kinderen - risicoschatting - kindervoeding - lichamelijke activiteit - kleding - overweight - obesity - body mass index - body weight - school children - children - quantitative analysis - who - child health - risk assessment - child nutrition - physical activity - clothing

    Trudy M.A. Wijnhoven

    Overweight and obesity in primary-school children: a surveillance system for policy-making in Europe from 2007 onwards.

    Background

    As a follow-up to the European Ministerial Conference on Counteracting Obesity convened in 2006 in Turkey, the European Childhood Obesity Surveillance Initiative (COSI) was launched by the Regional Office for Europe of the World Health Organization (WHO). COSI, a collaboration between WHO and interested Member States, aims to monitor the magnitude of overweight and obesity among primary-school children in European countries, to allow intercountry comparisons and to identify regional differences for informed policy-making. It collects at regular intervals data on weight and height of primary-school children and on their nutrition and physical activity behaviours, as well as on school environmental characteristics supportive to healthy nutrition and physical activity.

    Methods

    The research described in this PhD thesis is based on the data collected in the first two COSI rounds by 12 European countries in school year 2007/2008 and by 13 European countries in school year 2009/2010. Nationally representative samples of children aged 6–9 years were drawn, whereby a majority of the countries applied a two-stage school-based cluster sampling approach.

    A total of 168 832 children in school year 2007/2008 and 224 920 children in school year 2009/2010 were included in the anthropometric intercountry data analyses. Children's weight and height were measured by trained examiners using standardized procedures. Participating countries were allowed to adhere to their local legal requirements by specified deviations from standardized procedures, such as in types of clothing worn by the children during weight and height measurements. For each country, the prevalence of overweight and obesity, as well as mean Z-scores of anthropometric indices of height, weight and body mass index (BMI) were computed.

    The characteristics included in the analyses on the school environment referred to the frequency of physical education lessons, the availability of school playgrounds, the possibility to obtain food items and beverages on the school premises, and the organization of school initiatives to promote a healthy lifestyle. The school form was usually completed by the school principal or the teachers involved with the sampled classes. Data from 1831 schools in school year 2007/2008 and from 2045 schools in school year 2009/2010 were used. For each school, a school nutrition environment score (range: 0–1) was determined whereby higher scores correspond to higher support for a healthy school nutrition environment and the mean of the children's BMI-for-age Z-scores calculated.

    Five countries in school year 2007/2008 provided children's data on 13 health-risk behaviours related to breakfast and food consumption frequency, physical activity, screen time and sleep duration (n = 15 643). These data were reported by the caregivers alone or jointly with their child. For each country, the prevalence of the risk behaviours was estimated, and associations between them and overweight and obesity examined by multilevel logistic regression analyses.

    Results

    In both school years, a wide range in overweight and obesity prevalence estimates was found that differed significantly by country, as well as by European region. In all countries, the percentage of overweight children was about 20% or more (range: 18–57%), and the percentage of obese children was 5% or more (range: 5–31%). The findings suggest the presence of a north–south gradient with the highest overweight and obesity prevalence estimates found in southern European countries. Furthermore, changes in mean BMI-for-age Z-scores (range: from –0.21 to +0.14) and prevalence of overweight (range: from –9.0% to +6.2%) from school year 2007/2008 to school year 2009/2010 varied significantly among countries, whereas a period of two years is considered too short to identify these developments. The clothes-adjusted overweight prevalence estimates were lower by as much as 12% than the unadjusted estimates. Monthly BMI-for-age Z-score values within countries did not show systematic seasonal effects.

    Large between-country differences were observed in both school years in the availability of food items or beverages on the school premises (e.g., fresh fruit could be obtained in 12–95% of schools) and in the organization of initiatives to promote a healthy lifestyle in the selected classes (range: 42–97%). The provision of physical education lessons and the availability of school playgrounds were more uniformly present across the countries (range: 76–100%). A large variation was also seen in school nutrition environment scores (range: 0.30–0.93) whereby countries with a low score (< 0.70) graded less than three out of five characteristics as supportive. High-score countries showed more often than low-score countries a combined absence of cold drinks containing sugar, sweet snacks and salted snacks on the school premises.

    The prevalence of all 13 health-risk behaviours differed significantly across countries. For instance, the percentage of children who ate ‘foods like candy bars or chocolate’ > 3 days/week ranged from 2.2% to 63.4%; this figure ranged from 1.1% to 46.5% for those who ate ‘foods like potato chips (crisps), corn chips, popcorn or peanuts’ > 3 days/week. The range for children who did not have breakfast every day was between 4.4% and 32.5%, and from 4.8% to 35.0% for those who did not play outside ≥ 1 hour/day. Not having breakfast daily and spending screen time ≥ 2 hours/day were clearly positively associated with obesity. The same was true for eating ‘foods like pizza, French fries, hamburgers, sausages or meat pies’ > 3 days/week and playing outside < 1 hour/day. While a combination of multiple less favourable physical activity behaviours was clearly positively associated with obesity, a combination of the presence of multiple unhealthy eating behaviours did not lead to higher odds of obesity.

    Conclusions

    The results found in both COSI school years show that overweight and obesity among 6–9-year-old children are a serious public health concern, especially in southern European countries, and show the need for accelerated efforts to prevent excess body weight early in life by all participating countries. It was possible to detect relevant changes within a period of two years but to identify clear trends within countries, a longer time interval is necessary. The data on the school nutrition environment and the children's health-risk behaviours may assist policy-makers in monitoring their national policies targeting school settings and childhood obesity. In particular, promoting physical activity-related and discouraging sedentary behaviours among schoolchildren in the context of obesity preventive interventions seem to be essential.

    Prof. Ben Witteman over Patiënt meer baas in eigen buik
    Witteman, B.J.M. - \ 2015
    Wageningen UR
    voeding en gezondheid - lichaamsbeweging - lichamelijke activiteit - patiënten - gezondheidsbevordering - nutrition and health - exercise - physical activity - patients - health promotion
    Interview Ben Witteman ter gelegenheid van zijn inauguaratie op 21 mei 2015. Meer aandacht voor voeding en bewegen bij patiënten met chronische aandoeningen en rond operaties. Daar pleit maag-lever-darmarts prof. Ben Witteman voor.
    Lifestyle factors and risk of cardiovascular diseases
    Hoevenaar-Blom, M.P. - \ 2013
    Wageningen University. Promotor(en): Daan Kromhout, co-promotor(en): W.M.M. Verschuren; A.M.W. Spijkerman. - S.l. : s.n. - ISBN 9789461735072 - 119
    hart- en vaatziekten - levensstijl - risicofactoren - dieet - lichamelijke activiteit - slaap - cardiovascular diseases - lifestyle - risk factors - diet - physical activity - sleep

    Background

    Evidence is accumulating that lifestyle factors influence the incidence of fatal and non-fatal cardiovascular diseases (CVD). A healthy diet, being physically active, moderate alcohol consumption and not smoking are associated with a lower CVD risk. In addition to these lifestyle factors, recent research suggests that poor sleep may also be a risk factor of CVD. In this thesis, we focussed on a Mediterranean style diet, specific leisure time physical activities, and sleep duration and quality as risk factors for CVD.

    Methods

    Our analyses are based on the prospective Doetinchem Cohort Study (N ~ 3 400), the Monitoring Project on Risk Factors for Chronic Diseases (MORGEN) Study (N ~ 20 400) and the Dutch contribution to the European Prospective Investigation into Cancer and Nutrition (EPIC-NL) (N ~ 34 700). These studies included men and women aged 20-65 years when examined between 1993 and 1997. Diet was assessed with the validated EPIC food frequency questionnaire and operationalized with the Mediterranean Diet Score (MDS, range: 0-9). Physical activity was estimated with the validated EPIC physical activity questionnaire, with an emphasis on different leisure time activities. In addition, information was collected on duration and quality of sleep by two questions. Cardiovascular morbidity and mortality were ascertained through linkage with national registers. Multivariable Cox models were used to estimate the strength of the associations and 95% confidence intervals.

    Results

    During 12 years of follow-up, 206 CVD cases occurred in the Doetinchem Cohort Study, 1 486 cases in the MORGEN Study and 4 881 cases in the EPIC-NL Study. In the study on diet, a two unit increment in MDS was associated with a 22% lower risk of fatal CVD, and a 5% lower risk of total CVD. For specific CVDs, a 14% lower risk of myocardial infarction, a 12% lower risk of stroke, and a 26% lower risk of pulmonary embolism was observed. The MDS was not related to incident angina pectoris, transient ischemic attack and peripheral arterial disease. The use of multiple measurements of the MDS increased the strength of the associations with CVD and narrowed the confidence intervals. For leisure time physical activity, we showed that cycling was associated with an 18% lower risk of total CVD, sports with a 26% lower risk, and those who both cycled and performed sports had a 34% lower risk. Walking and gardening were not associated with CVD risk. Short sleep duration was associated with a 15% higher risk of total CVD, whereas long sleep duration and sleep quality separately were not associated. Short sleepers with a poor sleep quality had a 63% higher risk of total CVD compared to those with a normal sleep duration and good sleep quality. Finally, the combination of a healthy diet, sufficient physical activity, moderate alcohol consumption and non-smoking was associated with a 57% lower risk of composite CVD and a 67% lower risk of fatal CVD. The addition of sufficient sleep duration to these four traditional healthy lifestyle factors resulted in a 65% lower risk of composite CVD and an 83% lower risk of fatal CVD.

    Conclusions

    In this thesis, we showed that the strength of the association between dietary patterns and CVD incidence is likely underestimated because most studies used only the baseline measurement of diet. Furthermore, leisure time physical activities should be of at least moderate intensity to contribute to lower CVD risk. We also observed that sufficient sleep is a factor that should be taken into consideration in the prevention of CVD, in combination with a healthy diet, sufficient physical activity, moderate alcohol consumption and not smoking. Our results underscore the importance of a healthy lifestyle for CVD prevention.


    Zorgkosten van ongezond gedrag en preventie
    Polder, J.J. ; Hoogenveen, R. ; Luijben, G. ; Berg, M. van den; Boshuizen, H.C. ; Slobbe, L. - \ 2012
    Bilthoven : Rijksinstituut voor Volksgezondheid en Milieu (Kosten van ziekten notities 2012-2) - 22
    gezondheidszorg - voeding en gezondheid - volksgezondheid - gezondheidsgedrag - kosten van de gezondheidszorg - roken - lichamelijke activiteit - preventie - health care - nutrition and health - public health - health behaviour - health care costs - smoking - physical activity - prevention
    In deze notitie staan de zorgkosten van ongezond gedrag centraal, en hierbij ligt de nadruk op roken, overgewicht en lichamelijke activiteit. Er wordt niet alleen naar de huidige zorgkosten gekeken, maar ook naar de invloed van ongezond gedrag op de zorgkosten op lange termijn. De berekeningen in deze notitie zijn uitgevoerd met behulp van het RIVM Chronisch Ziekten Model (CZM).
    Beweging wordt efficiënter met juiste voeding
    Tieland, Michael - \ 2012
    elderly - nutrition and health - exercise - physical activity - proteins - dietary protein - elderly nutrition
    Een gedeelde passie voor gezonder leven. Evaluatieonderzoek naar netwerken rondom de beweegkuur en gecombineerde leefstijl interventies
    Hartog-van den Esker, F.G. den; Wagemakers, A. ; Vaandrager, L. ; Koelen, M. - \ 2012
    Wageningen : Wageningen University - 69
    gezondheidsbevordering - gezondheidsbeleid - levensstijl - lichamelijke activiteit - lichaamsbeweging - voeding en gezondheid - overgewicht - netwerken - health promotion - health policy - lifestyle - physical activity - exercise - nutrition and health - overweight - networks
    NISB (Nederlands Instituut voor Sport en Bewegen), projectleider van de BeweegKuur, is in 2010 gestart met het project 'Netwerken bouwen in de BeweegKuur'. In dit project gaat het om het opbouwen van regionale en lokale netwerken voor de afstemming tussen preventie, curatie en sport en voor de borging in gezondheidsbeleid. NISB heeft de Leerstoelgroep Gezondheid en Maatschappij van Wageningen University gevraagd onderzoek te doen naar de netwerkvorming rondom de BeweegKuur. Het doel van het onderzoek is inzicht te krijgen in de factoren van belang voor duurzame netwerken, de resultaten die de netwerken boeken en de wijze waarop netwerken gefaciliteerd kunnen worden. Een tweede doel is het leveren van direct bruikbare kennis voor de netwerken.
    'Voedingsindustrie denkt nog onvoldoende na over gezondheid'
    Kok, F.J. - \ 2011
    Kennis Online 8 (2011)okt. - p. 3 - 5.
    voeding en gezondheid - voedselindustrie - gezondheidsbevordering - overgewicht - gezondheidsvoedsel - voedselconsumptie - consumenten - lichamelijke activiteit - nutrition and health - food industry - health promotion - overweight - health foods - food consumption - consumers - physical activity
    We eten te zout, te zoet, te vet en vooral ook te veel. Al jaren horen we dat we gezond moeten eten en voldoende bewegen, maar toch wordt Nederland alsmaar dikker. Om echt een slag te maken, zouden voedingsmiddelenbedrijven meer hun best mogen doen hun producten gezonder te maken. 'Anders krijgen ze straks ongewild nog de schuld van de obesitasepidemie.'
    Van vonkjes naar vuurtjes. Pilot evaluatie netwerkvorming rondom de BeweegKuur
    Wagemakers, A. ; Hartog-van den Esker, F.G. den; Vaandrager, L. - \ 2011
    Wageningen : Leerstoelgroep Gezondheid en Maatschappij. Wageningen Universiteit. - 68
    gezondheidsbevordering - gezondheidsbescherming - lichamelijke activiteit - lichaamsbeweging - netwerken - levensstijl - voeding en gezondheid - health promotion - health protection - physical activity - exercise - networks - lifestyle - nutrition and health
    NISB heeft de leerstoelgroep Gezondheid en Maatschappij van de Wageningen Universiteit gevraagd onderzoek te doen naar de netwerkvorming rondom de BeweegKuur. Het doel van het onderzoek is het evalueren van de lokale en regionale netwerkvorming rondom de BeweegKuur. Hiertoe is onderzocht hoe de netwerkvorming vorm is gegeven, wat de successen en knelpunten zijn en welke werkwijzen geschikt zijn voor het evalueren van de netwerkvorming. Dit verslag beschrijft het pilot onderzoek.
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