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Abstract Background The presence of inter-limb asymmetry in the human body has traditionally been perceived to be detrimental for athletic performance. However, a systematic review addressing and comprehensively assessing the association of asymmetry between the lower limbs and middle- and long-distance running performance-related metrics is currently lacking. Objective The main purpose of this systematic review was to examine the relationship between lower inter-limb asymmetry and determinants of running performance in healthy middle- and long-distance runners. The secondary objective was to identify possible avenues for further research in this area. Methods PubMed, Web of Science and SPORTDiscus were systematically searched for studies investigating the relationship between lower inter-limb asymmetry and (determinants of) running performance in healthy and injury-free middle- and long-distance runners. The quality of studies eligible for inclusion was assessed using the Downs and Black Quality Index Tool. Results Out of 4817 articles screened, 8 studies were included in this review which assessed the association between functional, morphological, kinematic and kinetic asymmetry and running performance-related metrics. The quality score of the included research varied between 5/10 and 9/10. Our results revealed mixed findings, showing both significant negative (n = 16) and positive (n = 1) associations as well as no significant associations (n = 30) between inter-limb asymmetry and running performance-related metrics. Conclusions A high heterogeneity across study methods and outcomes was apparent, making it difficult to draw a straightforward conclusion. Our results indicate that the majority of metrics of functional, morphological, kinematic and kinetic inter-limb asymmetry are negatively or not associated with running performance (and/or its determinants). Thus, a more extensive high-quality body of research using standardised asymmetry magnitude metrics is essential to determine whether, and to what extent asymmetry between the lower limbs could affect middle- and long-distance running performance. Future studies should establish potential trade-off values to help practitioners develop evidence-based training programs. Key Points In the majority of the metrics, the magnitude of lower inter-limb asymmetry was negatively or not associated with middle- and long-distance running performance. Coaches, athletes and researchers should be attentive of the task, time- and metric-specificity as well as the inter- and intra- individual variability of magnitude outcomes, when assessing inter-limb asymmetries.

Abstract Background Mid-March 2020, Belgium went in lockdown to combat the COVID-19-pandemic. Having to provide school-based day care and adapt to online teaching, while all social, cultural and sports events and activities were cancelled, secondary school teachers’ physical activity (PA) and sedentary behaviour (SB) may have been affected considerably. This study investigates the impact of the first Belgian lockdown on PA and SB in Flemish secondary school teachers. Methods This prospective cohort study was conducted throughout the 2019–2020 school year. PA and SB measured in March/April 2020 were compared with a pre-lockdown measurement in January/February 2020. Other pre-lockdown measurements (September/October 2019 and November/December 2019) and one other during-lockdown measurement (May/June 2020) allowed us to control for confounding. Validated questionnaires were used to assess participants’ PA and SB. Generalized linear mixed models were applied in R. Results Among 624 participants (77·2% females, 43·3 ± 10·3 years), increases were observed for total PA (+ 108 min/week; p = 0·047), moderate PA (+ 217 min/week; p = 0·001), domestic and garden PA (+ 308 min/week; p

Abstract Teacher burnout and high recovery need are a topic of concern for educational institutions. This cross-sectional study assesses the association between lifestyle (including physical activity (PA), sedentary behavior (SB), dietary behavior and sleep), burnout risk and recovery need in 1878 secondary schoolteachers in Flanders. In September–October 2019, an online-questionnaire assessing burnout (i.e., emotional exhaustion, depersonalization, personal accomplishment), recovery need, PA-domains, SB-domains, dietary behavior (including fruit and vegetable intake and diet quality) and sleep during the week and the weekend was completed. Multiple linear regression models were applied. More emotional exhaustion was associated with more domestic and garden PA, work-related SB and sleep during the weekend, whereas higher scores of emotional exhaustion were associated with lower fruit intake, diet quality and less sleep during the week. More depersonalization was associated with more leisure-time PA and work-related SB and with lower fruit intake. Teachers showing more recovery need, showed more domestic and garden PA and work-related SB, but less leisure-time PA and sleep during the week. Future research should use longitudinal or experimental designs to get more insight into causality. Despite the low effect sizes, education networks and schools might benefit from promoting and facilitating a healthy lifestyle in secondary schoolteachers.

Introduction:Methyl salicylate, the main compound of wintergreen oil, is widely used in topical applications. However, its vascular and thermosensory effects are not fully understood. The primary aim was to investigate the effects of topical methyl salicylate on skin temperature (Tskin), skin microcirculation (MCskin) and muscle oxygen saturation (SmO2) compared to a placebo gel. The secondary aim was to assess thermosensory responses (thermal sensation, thermal comfort) and to explore to which extent these sensations correspond to the physiological responses over time.Methods:21 healthy women (22.2 ± 2.9 years) participated in this single-blind, randomized controlled trial. Custom-made natural wintergreen oil (12.9%), containing methyl salicylate (>99%) and a placebo gel, 1 g each, were applied simultaneously to two paravertebral skin areas (5 cm × 10 cm, Th4-Th7). Tskin (infrared thermal imaging), MCskin (laser speckle contrast imaging) and SmO2 (deep tissue oxygenation monitoring) and thermosensation (Likert scales) were assessed at baseline (BL) and at 5-min intervals during a 45 min post-application period (T0-T45).Results:Both gels caused an initial decrease in Tskin, with Tskin(min) at T5 for both methyl salicylate (BL-T5: Δ-3.36°C) and placebo (BL-T5: Δ-3.90°C), followed by a gradual increase (p < .001). Methyl salicylate gel resulted in significantly higher Tskin than placebo between T5 and T40 (p < .05). For methyl salicylate, MCskin increased, with MCskin(max) at T5 (BL-T5: Δ88.7%). For placebo, MCskin decreased (BL-T5: Δ-17.5%), with significantly lower values compared to methyl salicylate between T0 and T45 (p < .05). Both gels had minimal effects on SmO2, with no significant differences between methyl salicylate and placebo (p > .05). Thermal sensation responses to topical methyl salicylate ranged from “cool” to “hot”, with more intense sensations reported at T5.Discussion:The findings indicate that topical methyl salicylate induces short-term cutaneous vasodilation, but it may not enhance skeletal muscle blood flow. This study highlights the complex sensory responses to its application, which may be based on the short-term modulation of thermosensitive transient receptor potential channels.

IntroductionLittle is known on how diet, physical activity (PA) and sedentary behavior (SB) changes during pregnancy and after childbirth in primiparous couples. Moreover, it is unclear how potential behavioral changes are associated with changes in BMI. This study examined changes in diet, PA and SB, and their association with changes in BMI in couples transitioning to parenthood.MethodsDietary intake (FFQ), PA, SB (both Actigraph GT3X accelerometers) and BMI of women and men were assessed at 12 weeks of gestation, 6 weeks and 6 months postpartum. Data were analyzed using dyadic longitudinal data analyses techniques.ResultsIn women, a decrease in fruit intake, an increase in alcohol intake, an increase of light-intensity PA, and a decrease in SB were observed from the beginning of pregnancy up to 6 months postpartum. Decreases in fruit intake between 6 weeks and 6 months postpartum was associated with increases in BMI. Men did not show significant dietary changes, while an increase in light-intensity PA and a decrease in moderate-to-vigorous PA (MVPA) was observed at 6 months postpartum when compared to 12 weeks of gestation. Paternal increases in “avoidance food group” intake were associated with increases in BMI between baseline and 6 weeks postpartum. No associations of changes in BMI and changes in PA and SB were found.DiscussionNot only mothers but also fathers experienced unfavorable changes in lifestyle during the transition to parenthood, with impact on BMI changes. This highlights the need to monitor unhealthy changes in lifestyle and body weight in both parents when expecting a child and after childbirth.Clinical trial registrationClinicaltrials.gov, NCT03454958.

Abstract Background Decision makers want to know if there is a financial benefit in investing scarce resources in occupational health management (OHM). Economic evaluations (EEs) of OHM-strategies try to answer this question. However, EEs of OHM-strategies which are strongly marked by quantitative methods may be limited by contextual, qualitative residuals. Therefore, the objectives of this study were to (1) explore important economic dimensions of OHM and (2) to discuss the methods used in current EEs for measuring these dimensions. Methods In this explorative qualitative study, OHM-specialists were recruited via the Swiss organisation for health promotion. Thirteen semi-structured interviews were performed from November 2020 until May 2021. Videotapes were transcribed verbatim and organised by using an open coding strategy. Codes were clustered and synthesised as themes (i.e. the dimensions of EEs of OHM) through a mix of inductive and deductive content analysis. Member check with eight participants was accomplished to validate the results. Results The interviews had an average duration of 70.5 min and yielded 609 individual codes. These codes were merged into 28 subcategories which were finally categorised into five main themes: Understanding of OHM, costs, benefits, environmental aspects, and evaluation of OHM. Participants stated that the greater part of costs and benefits cannot be quantified or monetised and thus, considered in quantitative EEs. For example, they see a culture of health as key component for a successful OHM-strategy. However, the costs to establish such a culture as well as its benefits are hard to quantify. Participants were highly critical of the use of absenteeism as a linear measure of productivity. Furthermore, they explained that single, rare events, such as a change in leadership, can have significant impact on employee health. However, such external influence factors are difficult to control. Conclusions Participants perceived costs and benefits of OHM significantly different than how they are represented in current EEs. According to the OHM-specialists, most benefits cannot be quantified and thus, monetised. These intangible benefits as well as critical influencing factors during the process should be assessed qualitatively and considered in EEs when using them as a legitimation basis vis-à-vis decision makers.

BackgroundA healthy lifestyle during pregnancy is important for the health of mother and child. However, unfavorable physical activity (PA) and dietary changes are observed in pregnant women and their partner. Partner's influence on lifestyle has been reported by expectant women and men. The first aim was to analyze associations between perceived partner support on expectant parents own as well as their partner's moderate-to-vigorous intensity PA (MVPA) levels and dietary intake. Secondly, this study aimed to investigate intra-couple associations of MVPA, dietary intake and perceived support.MethodsA total of 152 heterosexual couples were recruited between week 8 and 10 of gestation by means of convenience sampling. Objective anthropometric and 7-day MVPA measurements were performed at 12 weeks of gestation. An online questionnaire was used to assess dietary intake, perceived partner support and socio-demographic characteristics. An Actor-Partner Interdependence Model for distinguishable dyads was constructed to examine the relationship between perceived partner support and both own's (i.e., actor-effect) and the partner's (i.e., partner-effect) MVPA levels, intake of fruits and vegetables, and an “avoidance food group.”ResultsFor pregnant women, perceived support from their partner was significantly associated with women's own MVPA levels (i.e., actor-effect; estimate = 0.344, SE = 0.168, p = 0.040) as well as the MVPA levels of the men (i.e., partner-effect; estimate = 0.717, SE = 0.255, p = 0.005). No significant actor- nor partner-effects were found for the expectant fathers. For none of the sexes significant actor-effects were found for fruit/vegetables and “avoidance food group” intake. For pregnant women, there was a positive partner-effect for fruit and vegetable intake (estimate = 7.822, SE = 1.842, p < 0.001) and a negative partner-effect for the “avoidance food group” intake (estimate = −16.115, SE = 3.629, p < 0.001). Positive correlations were found for perceived MVPA support (r = 0.40, p < 0.001), MVPA levels (r = 0.24, p = 0.007) and food intake from the “avoidance food group” (r = 0.28, p = 0.005) between partners.ConclusionThis study shows that male partners can act as significant facilitators for women. Partners may be an important target when promoting MVPA during pregnancy. Additionally, supportive couples seem to strengthen each other in keeping a healthy lifestyle in early pregnancy. These results justify couple-based interventions in the promotion of a healthy lifestyle during the transition to parenthood.Clinical trial registrationClinicaltrials.gov, identifier: NCT03454958.

Abstract Background During the pregnancy and postpartum period, both women and men experience physiological and psychological changes, which may negatively impact their eating behavior. A clear understanding of determinants of changes in eating behavior during this period is needed to facilitate the development of targeted family-based interventions countering unfavorable dietary changes during this critical life period. Methods Thirteen focus group discussions targeting determinants of changes in eating behavior during pregnancy and postpartum were conducted, involving a total of 74 expecting and first-time parents. A semi-structured question guide was used to facilitate the discussions. An inductive thematic approach was used to derive main and sub-categories of determinants from the data. The Determinants of Nutrition and Eating (DONE)-framework was employed to systematically organize and label the categories and determinants. Results Two frameworks were developed; one for the pregnancy and one for the postpartum period, comprising determinants of changes in eating behavior in both women and men. Three main levels of determinants were identified: (1) the individual level, including psychological (e.g., ‘health consciousness’), situational (e.g., ‘effort and convenience’) and biological (e.g., ‘discomfort’); (2) the interpersonal level (e.g., ‘social influence’) and (3) the environmental level, including micro- and meso/macro (e.g., ‘home/environment food availability’). Determinants acting as barriers (e.g., ‘time constraints’) or facilitators (e.g., ‘being a role model’) were identified. Many determinants were mentioned during both (e.g., ‘food knowledge’) or just one investigated period (e.g., ‘physiological changes’ during pregnancy, ‘influence of the baby’ postpartum). Finally, some were described by both parents (e.g., ‘self-regulation’), whereas others were mentioned by women (e.g., ‘(perceived) food safety’) or men (e.g., ‘other priorities’) only. Conclusion The developed frameworks set the foundation for the development of future family-based interventions and may be used already by healthcare providers to provide dietary guidance and support for women and men transitioning into parenthood. A focus on the interplay of individual factors at the biological and psychological level together with situational difficulties during pregnancy is recommended. Postpartum, focus should go to support first-time parents to obtain balance of both maintaining one’s own health and taking care of the baby, on improving self-regulation skills, and on coping with related situational constraints.

OBJECTIVE: The workplace is an ideal setting to implement public health strategies, but economic justification for such interventions is needed. Therefore, we performed a critical appraisal and synthesis of health economic evaluations (HEE) of workplace interventions aiming to increase physical activity (PA) and/or decrease sedentary behavior (SB). METHODS: A comprehensive search filter was developed using appropriate guidelines, such as the Peer Review of Electronic Search Strategies (PRESS) checklist, and published search algorithms. Six databases and hand searches were used to identify eligible studies. Full HEE of workplace interventions targeting PA/SB were included. Methodological quality was assessed using the Consensus Health Economic Criteria (CHEC) list. Two researchers independently performed all procedures. Hedges’ g was calculated to compare intervention effects. Outcomes from HEE were recalculated in 2017 euros and benefit-standardized. RESULTS: Eighteen HEE were identified that fulfilled on average 68% of the CHEC list criteria. Most studies showed improvements in PA/SB, but effects were small and thus, their relevance is questionable. Interventions were heterogeneous, no particular intervention type was found to be more effective. HEE were heterogeneous regarding methodological approaches and the selection of cost categories was inconsistent. Indirect costs were the main cost driver. In all studies, effects on costs were subject to substantial uncertainty. CONCLUSIONS: Due to small effects and uncertain impact on costs, the economic evidence of worksite PA/SB-interventions remains unclear. Future studies are needed to determine effective strategies. The HEE of such interventions should be developed using guidelines and validated measures for productivity costs. Additionally, studies should model the long-term costs and effects because of the long pay-back time of PA/SB interventions.

Abstract Background Physiotherapists often use thoracic spine mobilization (TSM) to reduce pain in patients with back disorders via a reduction of sympathetic activity. There is a “trade-off” in the activity of the sympathetic and parasympathetic nervous system activity. A sympathetic/parasympathetic balance (SPB) is needed to guarantee body homeostasis. However, body homeostasis is seldom considered as an aim of the treatment from the perspective of most physiotherapists. Strong empirical evidence for the effects of TSM on the SPB is still lacking. Some studies showed that spinal manipulation may yield beneficial effects on SPB. Therefore, it could be hypothesized that TSM is feasible and could influence SPB reactions. The primary aim was to describe the participants’ adherence to the intervention and to the measurement protocol, to identify unexpected adverse events (UAE) after TSM, to evaluate the best method to measure SPB parameters (heart rate variability (HRV), blood pressure (BP), heart rate (HR), skin perfusion and erythema) and to estimate the investigation procedure. The secondary aim was to assess the effects of TSM on SPB parameters in a small sample of healthy participants. Methods This crossover pilot study investigated TSM using posterior-anterior mobilization (PAM) and anterior-posterior mobilization (APM) on segments T6 to T12 in twelve healthy participants during two consecutive days. To evaluate feasibility, the following outcomes were assessed: adherence, UAE, data collection and data analysis. To evaluate the effect of TSM on SPB, HRV, BP, HR, skin perfusion and erythema were measured. Results The adherence was 100%. No UAE were reported. PAM showed larger effect sizes compared to APM in many secondary variables. Conclusions Although 100% maximal adherence was reached and no UAE were observed, data recording in future studies should be done during a second time interval while the data transfer from device to the computer software should occur immediately after completion of each participant’s measurement. The results of this pilot study suggest that PAM can reduce HRV HF and HRV ratio LF/HF and increase HR. Trial registration ClinicalTrail.gov (NCT02832141).

Abstract Background The transition to parenthood is a cornerstone event for both parents, potentially leading to relevant changes in lifestyle and behaviour. In women, the metabolic changes during and after pregnancy and the deleterious effects of excessive gestational weight gain and postpartum weight retention have been extensively described. However, there is no full understanding about which specific energy balance related behaviours (EBRB) contribute to unfavourable weight gain and weight retention. Furthermore, information on how transition to parenthood affects men is lacking. Therefore, this study aims to investigate changes in body weight, body composition and EBRB in couples transitioning to parenthood. Methods TRANSPARENTS is a multi-centre observational follow-up study that focuses on body weight, body composition and EBRB during the transition to parenthood. Couples (women and men) will be recruited during the first trimester of their first pregnancy. Study visits will occur at four occasions (12 weeks of pregnancy, 6 weeks postpartum, 6 months postpartum and 12 months postpartum). Anthropometrics of the parents and new-borns will be assessed including body weight, height/length, body composition (using bio-electrical impedance analysis and measurement of four skinfold thicknesses (biceps, triceps, subscapular and supraspinal/suprailiac)) and waist and hip circumference. Dietary intake, physical activity, sedentary behaviour, smoking habits, sleeping pattern, fatigue, diet and exercise related partner support, mental health, breastfeeding, contraception use, and socio-demographics will be assessed using a questionnaire. In addition, accelerometry will be used to assess physical activity and sedentary behaviour objectively. Also data from women’s medical record, such as pre-pregnancy weight and pregnancy outcomes, will be included. Multilevel modelling will be used to evaluate maternal and paternal changes in body weight, body composition and EBRB during and after pregnancy (primary outcomes). Multiple linear regression analyses will be performed to identify predictors of changes in body weight, body composition and EBRB. All analyses will be adjusted for possible confounders. Discussion TRANSPARENTS is a unique project identifying vulnerable parents and (un)favourable changes in EBRB throughout this potentially critical life period. Provided insights will facilitate the development of effective intervention strategies to help couples towards a healthy transition to parenthood. Trial registration Clinicaltrials.gov Identifier: NCT03454958. Registered March 2018.

Bio-electrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) are methods to estimate human body composition. This study aimed to compare sex-specific outcomes for estimating segmental and whole-body composition in 83 healthy participants (21.9 ± 1.5 years, 56% men) using Inbody S10 BIA and Norland Elite DXA devices. One-way repeated measures ANOVAs showed significantly lower whole-body fat% and whole-body fat mass values alongside higher whole-body lean mass values resulting from BIA when compared to DXA (both sexes: p < 0.001). In men, whole-body bone mineral content was significantly higher using BIA against DXA (p < 0.001). Regardless of sex, no significant BIA versus DXA difference was found in arm fat mass (men: p = 0.180, women: p = 0.233), whereas significantly lower leg fat mass values were found with BIA versus DXA (both sexes: p < 0.001). Additionally, significantly higher arm lean mass (both sexes: p < 0.001) and leg lean mass (only women: p < 0.001) were found in BIA versus DXA. Moderate to very strong positive associations (p < 0.05) between BIA and DXA outcome measures were found, except for arm fat mass (men: p = 0.904, women: p = 0.130) and leg fat mass (only men: p = 0.845). This study highlights (sex-dependent) differences in corresponding test outcomes between BIA and DXA both at the segmental and whole-body level.

Greenlandic traditional nutrition was unique in the arctic environment because it was an almost exclusive meat dietary pattern. Høygaard et al. left Copenhagen in August 1936, and stayed in East Greenland until August 1937. The four members of the expedition resided in Tasisaq and visited eight settlements around where nutritional intake was recorded by residing in families. However, the nutritional intake was analysed on a household level. The aim of the present study is to reanalyse the Høygaard et al. data according to modern scientific standards. In total, 21 males and 14 females participated. Median (IQR) energy consumption was 3881 (1568) kcal.day−1 for males and 2910 (882) kcal.day−1 for females. Without the five participants living near trading centres, this was 3268 (219) kcal.day−1 and 2634 (723) kcal.day−1, respectively. Expressed in energy-percent, the macronutrient consumptions were 34% for protein, 37% for fat and 29% for carbohydrates. Without imported food, this was 41%, 49% and 10%, respectively. The main findings of the present study are, as expected, that the food consumed came mainly from traditional hunting, was low in plant foods and extremely low in carbohydrates. The Inuit succeeded to stay in apparently healthy conditions with a traditional meat-based dietary pattern.

Greenlandic traditional nutrition was an almost exclusive meat dietary pattern. Høygaard et al. stayed in East-Greenland between August 1936 and August 1937. The four members of the expedition resided in Tasisaq and recorded nutritional intake by residing in families. However, data were analysed on a household level. The aim of the present study is to reanalyse the Høygaard et al. data according to modern scientific standards. In total 21 males and 14 females participated. Median (IQR) vitamin C intake was 79 (77) mg.day−1 for males and 59 (56) mg.day−1 for females. Consumption of meat and organs from seals gave 21 mg.d−1 vitamin C, comparable to vitamin C from algae. Narwhal skin and eyes had a marginal contribution to the vitamin C consumption. The number of adults consuming algae during the research days was 67% for males and 71% for females, this was 24% and 21% for narwhal skin. The main conclusions of the present study are the important role of algae consumption in Greenlandic traditional dietary pattern to avoid scurvy, and that foods traditionally seen as important sources of vitamin C like eyes from seals and narwhal skin, played a minor role in meeting the vitamin C requirements.

Abstract Background The objective evaluation of the physical environmental characteristics (e.g. speed limit, cycling infrastructure) along adolescents’ actual cycling routes remains understudied, although it may provide important insights into why adolescents prefer one cycling route over another. The present study aims to gain insight into the physical environmental characteristics determining the route choice of adolescent cyclists by comparing differences in physical environmental characteristics between their actual cycling routes and the shortest possible cycling routes. Methods Adolescents (n = 204; 46.5% boys; 14.4 ± 1.2 years) recruited at secondary schools in and around Ghent (city in Flanders, northern part of Belgium) were instructed to wear a Global Positioning System device in order to identify cycling trips. For all identified cycling trips, the shortest possible route that could have been taken was calculated. Actual cycling routes that were not the shortest possible cycling routes were divided into street segments. Segments were audited with a Google Street View-based tool to assess physical environmental characteristics along actual and shortest cycling routes. Results Out of 160 actual cycling trips, 73.1% did not differ from the shortest possible cycling route. For actual cycling routes that were not the shortest cycling route, a speed limit of 30 km/h, roads having few buildings with windows on the street side and roads without cycle lane were more frequently present compared to the shortest possible cycling routes. A mixed land use, roads with commercial destinations, arterial roads, cycle lanes separated from traffic by white lines, small cycle lanes and cycle lanes covered by lighting were less frequently present along actual cycling routes compared to the shortest possible cycling routes. Conclusions Results showed that distance mainly determines the route along which adolescents cycle. In addition, adolescents cycled more along residential streets (even if no cycle lane was present) and less along busy, arterial roads. Local authorities should provide shortcuts free from motorised traffic to meet adolescents’ preference to cycle along the shortest route and to avoid cycling along arterial roads.

Abstract Background One of the driving factors of dietary overconsumption throughout the last decennia is the increase of food portion sizes. Larger portions induce higher daily energy intake, so reducing portion size may reduce intake of excess calories. However, real-life studies about the effects of portion size reduction are lacking. Therefore, this study examined the effect of a French fries portion size reduction on French fries consumption, French fries plate waste, satiety and caloric intake during the subsequent afternoon among university students and employees in a Belgian on-campus restaurant setting. Moreover, this study evaluated consumers’ perception about the portion size reduction. Methods The study took place over a two-time (i.e. baseline and intervention week) 4-day period (Tuesday–Friday) in the on-campus restaurant where ±1200 meals are served every day. French fries’ portions were reduced by 20% by replacing the usual porcelain bowl served during the baseline week (±200 g) with smaller volume paper bags during the intervention week (±159 g) in a pre-post real-life experiment. French fries consumption and plate waste were measured in 2056 consumers at baseline and 2175 consumers at intervention. Additionally, interviews were conducted directly after lunch and again between 4 and 6 p.m. on the same day to assess satiety and caloric intake at pre and post in a small subsample of both French fries consumers (n = 19) and non-French fries consumers (n = 14). Post-intervention, the same subsample was interviewed about their perception of the portion size reduction (n = 28). Results Total French fries intake decreased by 9.1%, and total plate waste decreased by 66.4%. No differences were found in satiety or caloric intake between baseline and intervention week among the French fries’ consumers. The majority (n = 24, 86%) of French fries consumers noticed the reduction in portion size during the intervention. Although most participants (n = 19, 68%) perceived the reduced portion size as sufficient, only a minority of participants (n = 9, 32%) indicated post-intervention that they would agree with a permanent implementation. Conclusions Reducing portion size may lead to reduced caloric intake, without changing perceived levels of satiety.

Abstract Background Low physical activity levels and high levels of sedentary time among adolescents call for population wide interventions. Public open spaces can be important locations for adolescents’ physical activity. This study aimed to describe the prevalence, frequency and context of public open space visitation and to gain insight into the individual, social and physical environmental factors associated with public open space use among 12- to 16-year-old Flemish (Belgian) adolescents. Methods Global positioning system devices, accelerometers and one-on-one interviews were used to measure location-specific activity levels, time spent at, reasons for using and accompaniment at public open spaces among 173 adolescents. Multilevel hurdle and gamma models were used to estimate the associations between the independent variables (age, gender, ethnicity, education, sport club membership and accompaniment) and the amount of time, sedentary time, light-, moderate- to vigorous- and vigorous-intensity physical activity at public open spaces. Results Three out of four participants had visited a public open space (for recreational purposes) and participants were most often accompanied by friends/classmates. Mainly public transportation stops/stations were used, and subsequently the most reported reason for public open space use was “to wait for something or someone”. Furthermore, boys, younger adolescents, non-western-European adolescents and lower educated adolescents were more likely to use public open spaces. Additionally, boys and younger adolescents were more likely to accumulate physical activity at public open spaces. The only social environmental variable associated with time spent at public open spaces was accompaniment by siblings: adolescents spent more time at public open spaces when accompanied by their siblings. Conclusions Public open spaces may be effective areas to promote physical activity among groups at risk for physical inactivity (i.e. low educated and non-western-European adolescents). Additionally, girls and older adolescents were less likely to visit and be physically active at public open spaces. Therefore, urban planners should consider adding attractive features, in order to encourage physical activity among girls and older adolescents at public open spaces. Furthermore, creating public open spaces that are attractive for youth of all ages could contribute to adolescents visiting public open spaces accompanied by siblings.

Abstract Background Ecological models emphasize that cycling for transport is determined by an interplay between individual, physical and social environmental factors. The current study investigated (a) which physical and social environmental factors determine adolescents’ preferences towards cycling for transport and (b) which individual, physical and social environmental factors are associated with their intention to actually cycle for transport. Methods An online questionnaire consisting of questions on individual and social environmental variables, and 15 choice-based conjoint tasks with manipulated photographs was completed by 882 adolescents (55.3% male; 13.9 ± 1.6 years). Within the choice tasks, participants were asked to indicate which of two situations they would prefer to cycle to a friend’s house. The manipulated photographs were all modified versions of one semi-urban street which differed in the following physical micro-environmental attributes (separation of cycle path, evenness of cycle path, speed limit, speed bump, traffic density, amount of vegetation and maintenance). In addition, each photograph was accompanied by two sentences which described varying cycling distances and co-participation in cycling (i.e. cycling alone or with a friend). After each choice task participants were also asked if they would actually cycle in that situation in real life (i.e. intention). Hierarchical Bayes analyses were performed to calculate relative importances and part-worth utilities of environmental attributes. Logistic regression analyses were performed to investigate which individual, physical and social environmental factors were associated with adolescents’ intention to actually cycle for transport. Results Adolescents’ preference to cycle for transport was predominantly determined by separation of cycle path, followed by shorter cycling distance and co-participation in cycling. Higher preferences were observed for a separation between the cycle path and motorized traffic by means of a hedge versus a curb, versus a marked line. Similar findings were observed for intention to cycle. Furthermore, evenness of the cycle path and general maintenance of the street were also of considerable importance among adolescents, but to a lesser extent. Conclusions Results of this experimental study justify investment by local governments in well-separated cycling infrastructure, which seemed to be more important than cycling distance and the social environment.

Abstract Background In prospective studies, sugar-sweetened beverages (SSB) have been associated with weight increase. However, most prospective studies examine changes in body weight over time according to amounts of SSB intake at baseline, generally without considering changes over time in SSB, energy intake and physical activity. The objective of the present study was to examine how SSB intakes influence changes in weight, according to the way SSB intakes are analysed. Methods For a prospective cohort study with two nutritional assessments in time, 46 Flemish municipalities were selected by clustered random sampling. Within these municipalities, a random sample of men and women between 18 and 75 years of age was selected and invited to participate. In total, 562 middle-aged Belgian adults were tested in 2002 and 2012 for the same anthropometric, lifestyle, nutrition and physical activity parameters. The main outcome measured were weight changes from 2002 to 2012 were analysed according to various ways to parametrise SSB intakes in 2002 and changes in SSB, energy intake, and physical activity from 2002 to 2012. Results In a multivariable model including age, sex, the best predictors of weight changes were the weight at baseline (P

OBJECTIVES:The transition from high school to college or university has been shown to be a critical period for weight and fat gain. To date, no European data on weight and fat gain over the full trajectory of college or university are available. Therefore, the purpose of the present study was to investigate weight and fat gain among Belgian university students from freshman through senior year of university. METHODS:In this prospective observational study, a total of 340 university students were measured six times, i.e. at baseline (start of the first academic year) and at the start of the second semester of the first, second, third, fourth and fifth academic year. Objective measurements included body weight, height, body mass index (BMI), fat%, fat mass, fat free mass and waist circumference. Multilevel modelling was used to assess anthropometric changes over time according to sex. RESULTS:From freshman through senior year of university, individual weight changes ranged from -5.2 to +15.7kg, and respectively 77.4% and 69.3% of students showed increases in BMI and fat%. Stronger increases in weight and BMI were found for males (5.7kg; 1.6kg/m2; both p

BACKGROUND:This study aimed to examine potential differences in walking, cycling, public transport and passive transport (car/moped/motorcycle) to work and to other destinations between college and non-college educated working young adults. Secondly, we aimed to investigate which psychosocial and environmental factors are associated with the four transport modes and whether these associations differ between college and non-college educated working young adults. METHODS:In this cross-sectional study, 224 working young adults completed an online questionnaire assessing socio-demographic variables (8 items), psychosocial variables (6 items), environmental variables (10 items) and transport mode (4 types) and duration to work/other destinations. Zero-inflated negative binomial regression models were performed in R. RESULTS:A trend (p

BACKGROUND:Active transport is a convenient way to incorporate physical activity in adolescents' daily life. The present study aimed to investigate which psychosocial and environmental factors are associated with walking, cycling, public transport (train, tram, bus, metro) and passive transport (car, motorcycle, moped) over short distances (maximum eight kilometres) among older adolescents (17-18 years), to school and to other destinations. METHODS:562 older adolescents completed an online questionnaire assessing socio-demographic variables, psychosocial variables, environmental variables and transport to school/other destinations. Zero-inflated negative binomial regression models were performed. RESULTS:More social modelling and a higher residential density were positively associated with walking to school and walking to other destinations, respectively. Regarding cycling, higher self-efficacy and a higher social norm were positively associated with cycling to school and to other destinations. Regarding public transport, a higher social norm, more social modelling of siblings and/or friends, more social support and a higher land use mix access were positively related to public transport to school and to other destinations, whereas a greater distance to school only related positively to public transport to school. Regarding passive transport, more social support and more perceived benefits were positively associated with passive transport to school and to other destinations. Perceiving less walking and cycling facilities at school was positively related to passive transport to school only, and more social modelling was positively related to passive transport to other destinations. CONCLUSIONS:Overall, psychosocial variables seemed to be more important than environmental variables across the four transport modes. Social norm, social modelling and social support were the most consistent psychosocial factors which indicates that it is important to target both older adolescents and their social environment in interventions promoting active transport. Walking or cycling together with siblings or friends has the potential to increase social norm, social modelling and social support towards active transport.

Active transport has great potential to increase physical activity in older adolescents (17-18 years). Therefore, a theory- and evidence-based intervention was developed aiming to promote active transport among older adolescents. The intervention aimed to influence psychosocial factors of active transport since this is the first step in order to achieve a change in behaviour. The present study aimed to examine the effect of the intervention on the following psychosocial factors: intention to use active transport after obtaining a driving licence, perceived benefits, perceived barriers, subjective norm, self-efficacy, habit and awareness towards active transport.A matched control three-arm study was conducted and consisted of a pre-test post-test design with intervention and control schools in Flanders (northern part of Belgium). A lesson promoting active transport was implemented as the last lesson in the course 'Driving Licence at School' in intervention schools (intervention group 1). Individuals in intervention group 2 received this active transport lesson and, in addition, they were asked to become a member of a Facebook group on active transport. Individuals in the control group only attended the regular course 'Driving Licence at School'. Participants completed a questionnaire assessing socio-demographics and psychosocial variables at baseline, post (after one week) and follow-up (after eight weeks). To assess intervention effects, multilevel linear mixed models analyses were performed.A sample of 441 older adolescents (56.8% female; 17.4 (0.7) years) was analysed. For awareness regarding the existence of car sharing schemes, a significant increase in awareness from baseline to post measurement was found within intervention group 1 (p = 0.001) and intervention group 2 (p = 0.030) compared to the control group in which no change was found. In addition, a significant increase in awareness from baseline to follow-up measurement was found within intervention group 1 (p = 0.043) compared to a decrease in awareness from baseline to follow-up measurement within the control group.Overall, the intervention was not effective to increase psychosocial correlates of active transport. Future intervention studies should search for alternative strategies to motivate and involve this hard to reach target group.

This study examined the effect of a 10 and 20% meal price increase when choosing French fries and a 10 and 20% meal price reduction when choosing fruit for dessert on university students' purchasing behaviour in an on-campus restaurant. The moderating effect of gender was also investigated. Secondly, this study aimed at gaining further insight into reasons why these price manipulations did or did not change students' purchasing behaviour.This two-phased mixed-methods study was conducted in a Belgian on-campus university restaurant with approximately 1200 to 1300 student visitors per day. In a first phase (French fries experiment), data were collected during a control week (no price manipulation) and two separate intervention weeks (10 and 20% meal price increase when students chose French fries). In a second phase (fruit experiment), following the same protocol but carried out a few weeks later, meal prices were reduced by 10 and 20% when students chose fruit for dessert. French fries and fruit sale counts relative to the total number of items sold were used as outcome measure. Short interviews were conducted in convenient subsamples of student customers to assess influences on food choice.Increasing the meal price by 10 and 20% when choosing French fries was associated with respective 10.9 and 21.8% absolute reductions in French fries purchases, while reducing the meal price by 10 and 20% when choosing fruit for dessert was associated with absolute increases in fruit purchases of respectively 25.1 and 42.4% (all p

Increasing participation in transportation cycling represents a useful strategy for increasing children's physical activity levels. Knowledge on how to design environments to encourage adoption and maintenance of transportation cycling is limited and relies mainly on observational studies. The current study experimentally investigates the relative importance of micro-scale environmental factors for children's transportation cycling, as these micro-scale factors are easier to change within an existing neighborhood compared to macro-scale environmental factors (i.e. connectivity, land-use mix, …).Researchers recruited children and their parents (n = 1232) via 45 randomly selected schools across Flanders and completed an online questionnaire which consisted of 1) demographic questions; and 2) a choice-based conjoint (CBC) task. During this task, participants chose between two photographs which we had experimentally manipulated in seven micro-scale environmental factors: type of cycle path; evenness of cycle path; traffic speed; traffic density; presence of speed bumps; environmental maintenance; and vegetation. Participants indicated which route they preferred to (let their child) cycle along. To find the relative importance of these micro-scale environmental factors, we conducted Hierarchical Bayes analyses.Type of cycle path emerged as the most important factor by far among both children and their parents, followed by traffic density and maintenance, and evenness of the cycle path among children. Among parents, speed limits and maintenance emerged as second most important, followed by evenness of the cycle path, and traffic density.Findings indicate that improvements in micro-scale environmental factors might be effective for increasing children's transportation cycling, since they increase the perceived supportiveness of the physical environment for transportation cycling. Investments in creating a clearly designated space for the young cyclist, separated from motorized traffic, appears to be the most effective way to increase perceived supportiveness. Future research should confirm our laboratory findings with experimental on-site research.

The aim of this review and meta-analysis was to critically determine the possible effects of different cooling applications, compared to non-cooling, passive post-exercise strategies, on recovery characteristics after various, exhaustive exercise protocols up to 96 hours (hrs). A total of n = 36 articles were processed in this study. To establish the research question, the PICO-model, according to the PRISMA guidelines was used. The Cochrane's risk of bias tool, which was used for the quality assessment, demonstrated a high risk of performance bias and detection bias. Meta-analyses of subjective characteristics, such as delayed-onset muscle soreness (DOMS) and ratings of perceived exertion (RPE) and objective characteristics like blood plasma markers and blood plasma cytokines, were performed. Pooled data from 27 articles revealed, that cooling and especially cold water immersions affected the symptoms of DOMS significantly, compared to the control conditions after 24 hrs recovery, with a standardized mean difference (Hedges' g) of -0.75 with a 95% confidence interval (CI) of -1.20 to -0.30. This effect remained significant after 48 hrs (Hedges' g: -0.73, 95% CI: -1.20 to -0.26) and 96 hrs (Hedges' g: -0.71, 95% CI: -1.10 to -0.33). A significant difference in lowering the symptoms of RPE could only be observed after 24 hrs of recovery, favouring cooling compared to the control conditions (Hedges' g: -0.95, 95% CI: -1.89 to -0.00). There was no evidence, that cooling affects any objective recovery variable in a significant way during a 96 hrs recovery period.

A recommended field method to assess body composition in adolescent sprint athletes is currently lacking. Existing methods developed for non-athletic adolescents were not longitudinally validated and do not take maturation status into account. This longitudinal study compared two field methods, i.e., a Bio Impedance Analysis (BIA) and a skinfold based equation, with underwater densitometry to track body fat percentage relative to years from age at peak height velocity in adolescent sprint athletes. In this study, adolescent sprint athletes (34 girls, 35 boys) were measured every 6 months during 3 years (age at start = 14.8 ± 1.5 yrs in girls and 14.7 ± 1.9 yrs in boys). Body fat percentage was estimated in 3 different ways: 1) using BIA with the TANITA TBF 410; 2) using a skinfold based equation; 3) using underwater densitometry which was considered as the reference method. Height for age since birth was used to estimate age at peak height velocity. Cross-sectional analyses were performed using repeated measures ANOVA and Pearson correlations between measurement methods at each occasion. Data were analyzed longitudinally using a multilevel cross-classified model with the PROC Mixed procedure. In boys, compared to underwater densitometry, the skinfold based formula revealed comparable values for body fatness during the study period whereas BIA showed a different pattern leading to an overestimation of body fatness starting from 4 years after age at peak height velocity. In girls, both the skinfold based formula and BIA overestimated body fatness across the whole range of years from peak height velocity. The skinfold based method appears to give an acceptable estimation of body composition during growth as compared to underwater densitometry in male adolescent sprinters. In girls, caution is warranted when interpreting estimations of body fatness by both BIA and a skinfold based formula since both methods tend to give an overestimation.

BackgroundEnvironmental factors are found to influence transport-related physical activity, but have rarely been studied in relation with cycling for transport to various destinations in 10-12 yr old children. The current qualitative study used 'bike-along interviews' with children and parents to allow discussion of detailed environmental factors that may influence children's cycling for transport, while cycling in the participant's neighborhood.MethodsPurposeful convenience sampling was used to recruit 35 children and one of their parents residing in (semi-) urban areas. Bike-along interviews were conducted to and from a randomly chosen destination (e.g. library) within a 15 minutes' cycle trip in the participant's neighborhood. Participants wore a GoPro camera to objectively assess environmental elements, which were subsequently discussed with participants. Content analysis and arising themes were derived using a grounded theory approach.ResultsThe discussed environmental factors were categorized under traffic, urban design, cycling facilities, road design, facilities at destination, aesthetics, topography, weather, social control, stranger danger and familiar environment. Across these categories many environmental factors were (in)directly linked to road safety. This was illustrated by detailed discussions of the children's visibility, familiarity with specific traffic situations, and degree of separation, width and legibility of cycle facilities.ConclusionRoad safety is of major concern in this 10-12 yr old study population. Bike-along interviews were able to identify new, detailed and context-specific physical environmental factors which could inform policy makers to promote children's cycling for transport. However, future studies should investigate whether hypothetical changes to such micro environmental features influence perceptions of safety and if this in turn could lead to changes in children's cycling for transport.

Experimental evidence of environmental features important for physical activity is challenging to procure in real world settings. The current study aimed to investigate the causal effects of environmental modifications on a photographed street's appeal for older adults' walking for transport. Secondly, we examined whether these effects differed according to gender, functional limitations, and current level of walking for transport. Thirdly, we examined whether different environmental modifications interacted with each other. Qualitative responses were also reported to gain deeper insight into the observed quantitative relationships. Two sets of 16 panoramic photographs of a streetscape were created, in which six environmental factors were manipulated (sidewalk evenness, traffic level, general upkeep, vegetation, separation from traffic, and benches). Sixty older adults sorted these photographs on appeal for walking for transport on a 7-point scale and reported qualitative information on the reasons for their rankings. Sidewalk evenness appeared to have the strongest influence on a street's appeal for transport-related walking. The effect of sidewalk evenness was even stronger when the street's overall upkeep was good and when traffic was absent. Absence of traffic, presence of vegetation, and separation from traffic also increased a street's appeal for walking for transport. There were no moderating effects by gender or functional limitations. The presence of benches increased the streetscape's appeal among participants who already walked for transport at least an hour/week. The protocols and methods used in the current study carry the potential to further our understanding of environment-PA relationships. Our findings indicated sidewalk evenness as the most important environmental factor influencing a street's appeal for walking for transport among older adults. However, future research in larger samples and in real-life settings is needed to confirm current findings.