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Abstract Background Electronic health (eHealth) and mobile health (mHealth) interventions have the potential to tackle the worldwide problem of physical inactivity. However, they often suffer from large attrition rates. Consequently, feasibility and acceptability of interventions have become important matters in the creation of e- and mHealth interventions. The aim of this study was to evaluate participants’ opinions regarding acceptability and feasibility of a self-regulation, app-based intervention called ‘MyDayPlan’. ‘MyDayPlan’ provides an innovative daily cycle providing several self-regulation techniques throughout the day that guide users towards an active lifestyle via various self-regulation techniques. Methods Semi-structured interviews were conducted with 20 adults after using the app for 2 weeks. A directed content analysis was performed using NVivo Software. Results ‘MyDayPlan’ was well-received and seems to be feasible and acceptable with inactive adults. The straightforward lay out and ease of use of the app were appreciated. Furthermore, the incorporation of the techniques ‘action planning’, and ‘prompting review of behavioral goals’ was positively evaluated. However, the users gave some recommendations: implementation of activity trackers to self-monitor physical activity could be of added value. Furthermore, increasing intuitiveness by minimizing text input and providing more preprogrammed options could further increase the ease of use. Finally, users indicated that they would benefit from more guidance during the “coping planning” component (barrier identification/problem solving), for example by receiving more tailored examples. Conclusions Based on these findings, adaptations will be made to the ‘MyDayPlan’ app before evaluating its effectiveness. Furthermore, involving potential end users and evaluating acceptability and feasibility during the development of an e- and mHealth intervention is key. Also, creating interventions with a large ease of use and straightforward layout that provides tailored support during action and coping planning is key.

Food insecurity is a global public health issue associated with noncommunicable diseases. Individual factors are strongly associated with food insecurity, but there is limited literature on the broader impact of both the social and food environments on food insecurity in non-English speaking European countries, given that the research was predominantly conducted in Anglophone settings. In addition, these studies have mostly been conducted in urban areas. Therefore, this study aimed to identify the main determinants of food insecurity among adults living in peri-urban areas in Flanders, Belgium. Data on socio-demographics, neighborhood social cohesion, social isolation, and perceived food environments were collected from 567 adults through a self-administered questionnaire, and objective data on the food environment were obtained through (commercial) databases on food outlets. Food insecurity was measured using the USDA Household Food Security Survey Module. Multivariable logistic regression models revealed that lower socioeconomic status (OR14.11,95%CI:4.72;61.11), reasonable (OR4.16,95%CI: 2.11;8.47) to poor and very poor (OR6.54,95%CI: 2.11;8.47) subjective health status, and living in private (OR7.01, 95% CI:3.0;17.0) or government-assisted (OR6.32,95%CI: 3.13;13.26) rental housing significantly increased the odds of food insecurity. Additionally, residing in a neighborhood with low (OR2.64, 95% CI:1.13;6.26) to medium (OR2.45,95% CI:1.21;5.11) social cohesion, having a neutral opinion (OR4.12,95%CI:1.51;11.54) about the availability of fruit and vegetables in one's neighborhood, and having an opinion that fruit and vegetable prices are too expensive (OR5.43,95% CI 2.26;14.4) significantly increased the odds of experiencing food insecurity. This study underscores the need for policies that consider factors related to social and food environments, in addition to individual factors, to effectively address food insecurity., (© 2024. The Author(s).)

Background: The growing number of patients with type 2 diabetes and prediabetes is a major public health concern. Physical activity is a cornerstone of diabetes management and may prevent its onset in prediabetes patients. Despite this, many patients with (pre)diabetes remain physically inactive. Primary care physicians are well-situated to deliver interventions to increase their patients' physical activity levels. However, effective and sustainable physical activity interventions for (pre)diabetes patients that can be translated into routine primary care are lacking., Methods: We describe the rationale and protocol for a 12-month pragmatic, multicentre, randomised, controlled trial assessing the effectiveness of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED). Twenty-one general practices will recruit 340 patients with (pre)diabetes during routine health check-ups. Patients allocated to the active control arm will receive a Fitbit activity tracker to self-monitor their daily steps and try to achieve the recommended step goal. Patients allocated to the intervention arm will additionally receive the mHealth intervention, including the delivery of several text messages per week, with some of them delivered just in time, based on data continuously collected by the Fitbit tracker. The trial consists of two phases, each lasting six months: the lead-in phase, when the mHealth intervention will be supported with human phone counselling, and the maintenance phase, when the intervention will be fully automated. The primary outcome, average ambulatory activity (steps/day) measured by a wrist-worn accelerometer, will be assessed at the end of the maintenance phase at 12 months., Discussion: The trial has several strengths, such as the choice of active control to isolate the net effect of the intervention beyond simple self-monitoring with an activity tracker, broad eligibility criteria allowing for the inclusion of patients without a smartphone, procedures to minimise selection bias, and involvement of a relatively large number of general practices. These design choices contribute to the trial's pragmatic character and ensure that the intervention, if effective, can be translated into routine primary care practice, allowing important public health benefits., Trial Registration: ClinicalTrials.gov (NCT05351359, 28/04/2022)., (© 2023. The Author(s).)

Background: Despite effectiveness of action and coping planning in digital health interventions to promote physical activity (PA), attrition rates remain high. Indeed, support to make plans is often abstract and similar for each individual. Nevertheless, people are different, and context varies. Tailored support at the content level, involving suggestions of specific plans that are personalized to the individual, may reduce attrition and improve outcomes in digital health interventions. The aim of this study was to investigate whether user information relates toward specific action and coping plans using a clustering method. In doing so, we demonstrate how knowledge can be acquired in order to develop a knowledge-base, which might provide personalized suggestions in a later phase., Methods: To establish proof-of-concept for this approach, data of 65 healthy adults, including 222 action plans and 204 coping plans, were used and were collected as part of the digital health intervention MyPlan 2.0 to promote PA. As a first step, clusters of action plans, clusters of coping plans and clusters of combinations of action plans and barriers of coping plans were identified using hierarchical clustering. As a second step, relations with user information (i.e. gender, motivational stage, ...) were examined using anova's and chi 2 -tests., Results: First, three clusters of action plans, eight clusters of coping plans and eight clusters of the combination of action and coping plans were identified. Second, relating these clusters to user information was possible for action plans: 1) Users with a higher BMI related more to outdoor leisure activities (F = 13.40, P < .001), 2) Women, users that didn't perform PA regularly yet, or users with a job related more to household activities (X 2  = 16.92, P < .001; X 2  = 20.34, P < .001; X 2  = 10.79, P = .004; respectively), 3) Younger users related more to active transport and different sports activities (F = 14.40, P < .001). However, relating clusters to user information proved difficult for the coping plans and combination of action and coping plans., Conclusions: The approach used in this study might be a feasible approach to acquire input for a knowledge-base, however more data (i.e. contextual and dynamic user information) from possible end users should be acquired in future research. This might result in a first type of context-aware personalized suggestions on the content level., Trial Registration: The digital health intervention MyPlan 2.0 was preregistered as a clinical trial (ID:NCT03274271). Release date: 6-September-2017., (© 2022. The Author(s).)

Background: The Occupational Sitting and Physical Activity Questionnaire (OSPAQ) was developed as an easy-to-use instrument for self-reported assessment of percentage sitting, standing, walking, and performing heavy labour in a workplace setting. This study aimed to evaluate the concurrent validity of all dimensions of the OSPAQ compared to accelerometer-assessed measures of occupational physical activities in a mixed sample of sedentary and physically active professions., Methods: Data from the Flemish Employees' Physical Activity (FEPA) study were used, including employees from the service and production sector. All participants filled in a questionnaire, underwent clinical measurements, and wore two Axivity AX3 accelerometers for at least 2 consecutive working days. Intraclass (ICC) and Spearman rho correlations (r) were analyzed to assess concurrent validity., Results: The sample included 401 workers (16% sedentary profession) with a mean age of 39.2 (± 11) years. Concurrent validity was good and moderate for assessing percentage of sitting (ICC = 0.84; r = 0.53), and standing (ICC = 0.64; r = 0.53), respectively. The concurrent validity for walking was weak to moderate (ICC = 0.50; r = 0.49), and weak for performing heavy labour (ICC = 0.28; r = 0.35). Stronger validity scores were found in sedentary professions for occupational sitting and standing. In physically active professions, an underestimation of self-reported sitting and standing was found, and an overestimation of self-reported walking and heavy labour. No significant self-reported over- or underestimation was found for sitting and heavy labour in sedentary professions, but an underestimation of self-reported standing and an overestimation of self-reported walking was observed., Conclusions: The OSPAQ has acceptable measurement properties for assessing occupational sitting and standing. Accelerometer-assessed measures of occupational walking and heavy labour are recommended, since a poor concurrent validity was found for both.

Background: The start of retirement is an important stage in an (older) adult's life and can affect physical activity (PA) and/or sedentary behaviors, making it an ideal period to implement health interventions. To identify the most optimal timing of such interventions it is important to determine how PA and sedentary behaviors change not only when making the transition to retirement, but also during the first years of retirement. The main study aim was to examine whether PA and sedentary behaviors change differently in retiring adults compared with recently retired adults. A second aim was to examine potential moderating effects of gender and educational level., Methods: A longitudinal study was conducted in Ghent, Belgium. Baseline measurements took place in 2012-2013 and follow-up data were collected 2 years later. In total, 446 adults provided complete data at both time points. Of the participants 105 adults were not retired at baseline but retired between baseline and follow-up (i.e. retiring) and 341 were already retired at baseline (i.e. recently retired). All participants completed a questionnaire on PA, sedentary behaviors, socio-demographic factors and physical functioning. Repeated measures MANOVAs were conducted in SPSS 22.0. to analyze the data., Results: Leisure-time cycling increased over time in retiring adults, but decreased in recently retired adults (p < 0.01). (Voluntary) work-related walking and moderate-to-vigorous PA decreased strongly in retiring adults, while slight increases were found in recently retired adults (p < 0.001 and p < 0.01). Passive transport decreased more strongly in recently retired than in retiring adults (p < 0.05), and computer use increased more in retiring adults than in the recently retired group (p < 0.001). Low-educated recently retired adults had the strongest decrease in walking for transport (p < 0.05) and strongest increase in TV viewing time (p < 0.01) and computer use (p < 0.10). For gender, almost no moderating effects were found., Conclusions: Future interventions should focus on PA and/or specific sedentary behaviors in retiring adults, but should definitely include long-term follow-up, as recently retired adults seem to be prone to lapse into an unhealthy lifestyle. Specific attention should be paid to low-educated adults as they are particularly susceptible to a decrease in PA and increased TV viewing time and computer use.

Background: Increasing cycling for transport can contribute to improve public health among adults. Micro-environmental factors (i.e. small-scaled street-setting features) may play an important role in affecting the street's appeal to cycle for transport. Understanding about the interplay between individuals and their physical environment is important to establish tailored environmental interventions. Therefore, the current study aimed to examine whether specific subgroups exist based on similarities in micro-environmental preferences to cycle for transport., Methods: Responses of 1950 middle-aged adults (45-65 years) on a series of choice tasks depicting potential cycling routes with manipulated photographs yielded three subgroups with different micro-environmental preferences using latent class analysis., Results: Although latent class analysis revealed three different subgroups in the middle-aged adult population based on their environmental preferences, results indicated that cycle path type (i.e. a good separated cycle path) is the most important environmental factor for all participants and certainly for individuals who did not cycle for transport. Furthermore, only negligible differences were found between the importances of the other micro-environmental factors (i.e. traffic density, evenness of the cycle path, maintenance, vegetation and speed limits) regarding the two at risk subgroups and that providing a speed bump obviously has the least impact on the street's appeal to cycle for transport., Conclusions: Results from the current study indicate that only negligible differences were found between the three subgroups. Therefore, it might be suggested that tailored environmental interventions are not required in this research context.

Background: The relationship between children's physical neighborhood environment and their physical activity, has been largely investigated. However in recent reviews, only a few significant and consistent direct associations between children's physical neighborhood environment and their physical activity were found. This is possibly due to the fact that the location where children's physical activity took place, is insufficiently specified. Therefore, this study aimed to investigate the association between parental perceived neighborhood characteristics and children's physical activity in clearly defined environments., Methods: Children (9-12 years; n = 606) wore an Actigraph accelerometer for 7 days. Parents completed the parental version of the Neighborhood Environmental Walkability Scale questionnaire and reported on children's physical activity in specific locations: physical activity in nearby streets and on sidewalks, physical activity in public recreation spaces and physical activity in the garden. Multilevel logistic regression analyses were conducted in MLwiN 2.30., Results: Children were more likely to be active in nearby streets and on sidewalks, if their parents perceived lower street connectivity (OR = 0.479; 95% CI = 0.33 and 0.70), higher land use mix accessibility (OR = 1.704; 95% CI = 1.25 and 2.33) and more crime safety (OR = 1.879; 95% CI = 1.29 and 2.74). Children whose parents perceived higher presence of recreation facilities (OR = 1.618; CI = 1.23; 2.12) were more likely to be active in public recreation spaces. No environmental neighborhood variables were related to physical activity in the garden and overall moderate- to vigorous-intensity physical activity., Conclusions: The parental perceived physical neighborhood environment relates differently to physical activity in different locations. In order to develop effective interventions, it seems promising to further investigate the association between location-specific physical activity and specific neighborhood environmental correlates.

Background: Adequate monitoring of older adults' physical activity (PA) is essential to develop effective health promotion programs. The present study examined criterion validity and test-retest reliability of the long International Physical Activity Questionnaire (IPAQ-L), adapted for Belgian, community-dwelling older adults (65 y and older)., Methods: Participants (n = 434) completed the last seven days version of IPAQ-L, modified for the Belgian population of community-dwelling older adults. This elderly-adapted version of IPAQ-L combined vigorous and moderate activities, and questions on gait speed and recreational cycling were added. Furthermore, participants wore an ActiGraph GT3X(+) accelerometer for at least five days. Criterion validity was determined by comparing self-reported weekly minutes of moderate-to-vigorous physical activity (MVPA) and weekly minutes of total PA with accelerometer data, defined by two different cut points (Freedson vs. Copeland). To examine test-retest reliability, a subsample of 29 participants completed IPAQ-L for a second time within a ten day interval., Results: IPAQ-L showed moderate criterion validity for measuring weekly minutes of MVPA and total PA (Spearman's ρ range 0.33-0.40). However, plots on agreement between self-reported and accelerometer PA showed a systematic over-reporting of IPAQ-L for MVPA. In contrast, plots indicated that IPAQ-L under-estimated levels of total PA, however, this under-estimation of total PA was substantially lower than the observed over-reporting of MVPA. Test-retest reliability was moderate-to-good for work-related PA, domestic PA, MVPA and total PA (ICC range 0.52-0.81), but poorer for transportation and recreational PA (ICC 0.44 and 0.43, respectively)., Conclusions: Criterion validity results suggest that IPAQ-L is more valid to measure older adults' weekly minutes of total PA than weekly MVPA minutes. Moreover, results might imply that content validity of IPAQ-L can be improved if specific light-intensity PA items are incorporated into IPAQ-L. Test-retest reliability of IPAQ-L was moderate to good, except for weekly minutes of transportation and recreational PA, probably due to week-to-week variability of these behaviors.

Background: During the last decades, the use of active travel modes declined in all age groups. Childhood is a critical time to establish lifelong healthy patterns. To develop effective interventions in this age group, insight in the correlates of health behaviors and the possible mediating factors is necessary. Among children, the role of parents may not be overlooked. Therefore, this study aimed to examine the associations of parental perceptions of neighborhood environmental attributes with active transport and total physical activity in 10-12 year old Belgian boys and girls. Furthermore, this study examined the potential mediating effect of independent mobility on these associations., Methods: In the present study, 736 10-12 year old children and their parents from 44 elementary schools in Flanders, Belgium, participated. The children were asked to wear an activity monitor and to fill in a survey questioning demographic factors and the Flemish Physical Activity Questionnaire. The parents filled in a survey concerning demographic factors, the child's level of independent mobility and environmental perceptions (Neighborhood Environmental Walkability Scale)., Results: Overall, boys reported more active transport when parents perceived more land use mix diversity, shorter distances to school, good land use mix access, higher residential density and less pleasing neighborhood aesthetics. Higher total physical activity levels were reported when parents perceived shorter distances to school and availability of walking/cycling infrastructure. None of the associations was mediated by independent mobility in boys. Girls reported more active transport when parents perceived higher residential density, more land use mix diversity, shorter distances to school, good land use mix access, available walking/cycling infrastructure and convenient recreational facilities. Girls reported higher total physical activity levels when parents perceived high residential density, good land use mix access, well-maintained and high quality walking/cycling infrastructures and more traffic safety. Independent mobility was found to be an important mediator of these associations in girls., Conclusions: Neighborhood environmental interventions to increase children's active transport and physical activity can be effective when combined with awareness raising programs for parents. Furthermore, among girls encouraging independent mobility may contribute to behavior change.

Background: Key life periods have been associated with changes in physical activity (PA). This study investigated (1) how PA changes when primary school children transfer to secondary school, (2) if school environmental characteristics differ between primary and secondary schools and (3) if changes in school environmental characteristics can predict changes in PA in Belgian schoolchildren. Moderating effects of gender and the baseline level of PA were investigated for the first and third research question., Methods: In total, 736 children (10-13 years) of the last year of primary school participated in the first phase of this longitudinal study. Two years later, 502 of these children (68.2%) agreed to participate in the second phase. Accelerometers, pedometers and the Flemish Physical Activity Questionnaire were used to measure PA. School environmental characteristics were reported by the school principals. Cross-classified regression models were conducted to analyze the data., Results: Self-reported active transport to school and accelerometer weekday moderate to vigorous PA (MVPA) increased after the transition to secondary school while self-reported extracurricular PA and total PA decreased. Pedometer weekday step counts decreased, but this decrease was only apparent among those who achieved the PA guidelines in primary school.Secondary schools scored higher on the school environmental characteristics: provision of sports and PA during lunch break, active schoolyards and playgrounds and health education policy but lower on sports and PA after-school than primary schools. Changes in the school environmental characteristics: active commuting to school, active schoolyards and playgrounds and health education policy resulted in changes in self-reported extracurricular PA, total PA , pedometer/accelerometer determined step counts and accelerometer determined MVPA. Moderating effects were found for baseline PA and gender., Conclusion: PA changed after the transition to secondary school. In general, secondary schools seem more likely to foster strategies to promote PA during school hours than primary schools who seem more likely to foster strategies to promote PA after school. Changes in school environmental characteristics may contribute to changes in PA. Thus, if confirmed in future studies, efforts are needed to implement these components in schools as early as possible to positively affect the change in PA.

Background: This pilot study aimed at investigating the effectiveness of lowering playground density on increasing children's physical activity and decreasing sedentary time. Also the feasibility of this intervention was tested., Methods: Data were collected in September and October 2012 in three Belgian schools in 187, 9-12 year old children. During the intervention, playground density was decreased by splitting up recesses and decreasing the number of children sharing the playground. A within-subject design was used. Children wore accelerometers during the study week. Three-level (class - participant - measurement (baseline or intervention)) linear regression models were used to determine intervention effects. After the intervention week the school principals filled out a questionnaire concerning the feasibility of the intervention., Results: The available play space was 12.18 ± 4.19 m²/child at baseline and increased to 24.24 ± 8.51 m²/child during intervention. During the intervention sedentary time decreased (-0.58 min/recess; -3.21%/recess) and moderate-to-vigorous physical activity (+1.04 min/recess; +5.9%/recess) increased during recess and during the entire school day (sedentary time: -3.29%/school day; moderate-to-vigorous physical activity +1.16%/school day). All principals agreed that children enjoyed the intervention; but some difficulties were reported., Conclusions: Lowering playground density can be an effective intervention for decreasing children's sedentary time and increasing their physical activity levels during recess; especially in least active children.

Background: Streetscape (microscale) features of the built environment can influence people's perceptions of their neighborhoods' suitability for physical activity. Many microscale audit tools have been developed, but few have published systematic scoring methods. We present the development, scoring, and reliability of the Microscale Audit of Pedestrian Streetscapes (MAPS) tool and its theoretically-based subscales., Methods: MAPS was based on prior instruments and was developed to assess details of streetscapes considered relevant for physical activity. MAPS sections (route, segments, crossings, and cul-de-sacs) were scored by two independent raters for reliability analyses. There were 290 route pairs, 516 segment pairs, 319 crossing pairs, and 53 cul-de-sac pairs in the reliability sample. Individual inter-rater item reliability analyses were computed using Kappa, intra-class correlation coefficient (ICC), and percent agreement. A conceptual framework for subscale creation was developed using theory, expert consensus, and policy relevance. Items were grouped into subscales, and subscales were analyzed for inter-rater reliability at tiered levels of aggregation., Results: There were 160 items included in the subscales (out of 201 items total). Of those included in the subscales, 80 items (50.0%) had good/excellent reliability, 41 items (25.6%) had moderate reliability, and 18 items (11.3%) had low reliability, with limited variability in the remaining 21 items (13.1%). Seventeen of the 20 route section subscales, valence (positive/negative) scores, and overall scores (85.0%) demonstrated good/excellent reliability and 3 demonstrated moderate reliability. Of the 16 segment subscales, valence scores, and overall scores, 12 (75.0%) demonstrated good/excellent reliability, three demonstrated moderate reliability, and one demonstrated poor reliability. Of the 8 crossing subscales, valence scores, and overall scores, 6 (75.0%) demonstrated good/excellent reliability, and 2 demonstrated moderate reliability. The cul-de-sac subscale demonstrated good/excellent reliability., Conclusions: MAPS items and subscales predominantly demonstrated moderate to excellent reliability. The subscales and scoring system represent a theoretically based framework for using these complex microscale data and may be applicable to other similar instruments.

Background: In adult research, neighborhood walkability has been acknowledged as an important construct among the built environmental correlates of physical activity. Research into this association has only recently been extended to adolescents and the current empirical evidence is not consistent. This study investigated whether neighborhood walkability and neighborhood socioeconomic status (SES) are associated with physical activity among Belgian adolescents and whether the association between neighborhood walkability and physical activity is moderated by neighborhood SES and gender., Methods: In Ghent (Belgium), 32 neighborhoods were selected based on GIS-based walkability and SES derived from census data. In total, 637 adolescents (aged 13-15 year, 49.6% male) participated in the study. Physical activity was assessed using accelerometers and the Flemish Physical Activity Questionnaire. To analyze the associations between neighborhood walkability, neighborhood SES and individual physical activity, multivariate multi-level regression analyses were conducted., Results: Only in low-SES neighborhoods, neighborhood walkability was positively associated with accelerometer-based moderate to vigorous physical activity and the average activity level expressed in counts/minute. For active transport to and from school, cycling for transport during leisure time and sport during leisure time no association with neighborhood walkability nor, with neighborhood SES was found. For walking for transport during leisure time a negative association with neighborhood SES was found. Gender did not moderate the associations of neighborhood walkability and SES with adolescent physical activity., Conclusions: Neighborhood walkability was related to accelerometer-based physical activity only among adolescent boys and girls living in low-SES neighborhoods. The relation of built environment to adolescent physical activity may depend on the context.

Background: Sedentary behaviors (involving prolonged sitting time) are associated with deleterious health consequences, independent of (lack of) physical activity. To inform interventions, correlates of prevalent sedentary behaviors need to be identified. We examined associations of socio-demographic, home-environmental and psychosocial factors with adults' TV viewing time and leisure-time Internet use; and whether psychosocial and environmental correlates differed according to gender, age and educational attainment., Methods: This cross-sectional study was conducted in Ghent, Belgium, between March and May 2010. Respondents to a mail-out survey (n = 419; 20-65 years; mean age 48.5 [12.1] years; 47.3% men) completed a questionnaire on sedentary behaviors and their potential socio-demographic, psychosocial and home environmental correlates. Statistical analyses were performed using multiple linear regression models., Results: The independent variables explained 31% of the variance in TV viewing time and 38% of the variance in leisure-time Internet use. Higher education, greater perceived pros of and confidence about reducing TV time were negatively associated with TV viewing time; older age, higher body mass index, larger TV set size and greater perceived cons of reducing TV time showed positive associations. Perceived pros of and confidence about reducing Internet use were negatively associated with leisure-time Internet use; higher education, number of computers in the home, positive family social norms about Internet use and perceived cons of reducing Internet use showed positive associations. None of the socio-demographic factors moderated these associations., Conclusions: Educational level, age, self-efficacy and pros/cons were the most important correlates identified in this study. If further cross-sectional and longitudinal research can confirm these findings, tailored interventions focusing on both psychosocial and environmental factors in specific population subgroups might be most effective to reduce domestic screen time.