Explore the vast range of titles available.

Background Aging-related cognitive decline and cognitive impairment greatly impacts older adults’ daily life. The worldwide ageing of the population and associated wave of dementia urgently calls for prevention strategies to reduce the risk of cognitive decline. Physical activity (PA) is known to improve cognitive function at older age through processes of neuroplasticity. Yet, emerging studies suggest that larger cognitive gains may be induced when PA interventions are combined with cognitive activity (CA). This meta-analysis evaluates these potential synergistic effects by comparing cognitive effects following combined PA + CA interventions to PA interventions (PA only), CA interventions (CA only) and control groups. Methods Pubmed, Embase, PsycInfo, CINAHL and Sportdiscus were searched for English peer-reviewed papers until April 2018. Data were extracted on cognition and factors potentially influencing the cognitive effects: mode of PA + CA combination (sequential or simultaneous), session frequency and duration, intervention length and study quality. Differences between older adults with and without mild cognitive impairments were also explored. Results Forty-one studies were included. Relative to the control group, combined PA + CA intervention showed significantly larger gains in cognition ( g  = 0.316; 95% CI 0.188–0.443; p  < .001). Studies that compared combined PA + CA with PA only, showed small but significantly greater cognitive improvement in favor of combined interventions ( g  = 0.160; 95% CI 0.041–0.279; p  = .008). No significant difference was found between combined PA + CA and CA only interventions. Furthermore, cognitive effects tended to be more pronounced for studies using simultaneous designs ( g  = 0.385; 95%CI 0.214–0.555; p  < .001) versus sequential designs ( g  = 0.114; 95%CI -0.102- 0.331, p  = .301). Effects were not moderated by session frequency, session duration, intervention length or study quality. Also, no differences in effects were found between older adults with and without mild cognitive impairments. Conclusion Findings of the current meta-analysis suggest that PA programs for older adults could integrate challenging cognitive exercises to improve cognitive health. Combined PA + CA programs should be promoted as a modality for preventing as well as treating cognitive decline in older adults. Sufficient cognitive challenge seems more important to obtain cognitive effects than high doses of intervention sessions.

[...]we often need to turn to quasi-experimental and observational studies to gain insight into these causal effects. [...]policies based on these incorrect causal interpretations were implemented, which potentially increased the risk for COVID-19 among vulnerable populations. Because the unobserved potential outcome of an individual cannot be known, researchers often compare the average outcomes of exposed and unexposed groups. [...]the estimate for smoking only takes into account the direct effect of smoking on death from COVID-19 and dismisses the indirect effect via chronic respiratory disease, leading to an underestimation of the total causal effect of smoking on death from COVID-19. [...]the effect estimate is also biased by a spurious pathway via unmeasured confounders (U), which could, for example, include a gene or air pollution that are influencing both risk for chronic respiratory disease and death from COVID-19.

Background E- and m-health interventions are promising to change health behaviour. Many of these interventions use a large variety of behaviour change techniques (BCTs), but it’s not known which BCTs or which combination of BCTs contribute to their efficacy. Therefore, this experimental study investigated the efficacy of three BCTs (i.e. action planning, coping planning and self-monitoring) and their combinations on physical activity (PA) and sedentary behaviour (SB) against a background set of other BCTs. Methods In a 2 (action planning: present vs absent) × 2 (coping planning: present vs absent) × 2 (self-monitoring: present vs absent) factorial trial, 473 adults from the general population used the self-regulation based e- and m-health intervention ‘MyPlan2.0’ for five weeks. All combinations of BCTs were considered, resulting in eight groups. Participants selected their preferred target behaviour, either PA ( n  = 335, age = 35.8, 28.1% men) or SB ( n  = 138, age = 37.8, 37.7% men), and were then randomly allocated to the experimental groups. Levels of PA (MVPA in minutes/week) or SB (total sedentary time in hours/day) were assessed at baseline and post-intervention using self-reported questionnaires. Linear mixed-effect models were fitted to assess the impact of the different combinations of the BCTs on PA and SB. Results First, overall efficacy of each BCT was examined. The delivery of self-monitoring increased PA (t = 2.735,  p  = 0.007) and reduced SB (t = − 2.573,  p  = 0.012) compared with no delivery of self-monitoring. Also, the delivery of coping planning increased PA (t = 2.302,  p  = 0.022) compared with no delivery of coping planning. Second, we investigated to what extent adding BCTs increased efficacy . Using the combination of the three BCTs was most effective to increase PA (x 2  = 8849,  p  = 0.003) whereas the combination of action planning and self-monitoring was most effective to decrease SB (x 2  = 3.918,  p  = 0.048). To increase PA, action planning was always more effective in combination with coping planning (x 2  = 5.590,  p  = 0.014; x 2  = 17.722,  p  < 0.001; x 2  = 4.552,  p  = 0.033) compared with using action planning without coping planning. Of note, the use of action planning alone reduced PA compared with using coping planning alone (x 2  = 4.389,  p  = 0.031) and self-monitoring alone (x 2  = 8.858,  p  = 003), respectively. Conclusions This study provides indications that different (combinations of) BCTs may be effective to promote PA and reduce SB. More experimental research to investigate the effectiveness of BCTs is needed, which can contribute to improved design and more effective e- and m-health interventions in the future. Trial registration This study was preregistered as a clinical trial (ID number: NCT03274271 ). Release date: 20 October 2017.

Background Sedentary behavior occurs largely subconsciously, and thus specific behavior change techniques are needed to increase conscious awareness of sedentary behavior. Chief amongst these behavior change techniques is self-monitoring of sedentary behavior. The aim of this systematic review and meta-analysis was to evaluate the short-term effectiveness of existing interventions using self-monitoring to reduce sedentary behavior in adults. Methods Four electronic databases (PubMed, Embase, Web of Science, and The Cochrane Library) and grey literature (Google Scholar and the International Clinical Trials Registry Platform) were searched to identify appropriate intervention studies. Only (cluster-)randomized controlled trials that 1) assessed the short-term effectiveness of an intervention aimed at the reduction of sedentary behavior, 2) used self-monitoring as a behavior change technique, and 3) were conducted in a sample of adults with an average age ≥ 18 years, were eligible for inclusion. Relevant data were extracted, and Hedge’s g was used as the measure of effect sizes. Random effects models were performed to conduct the meta-analysis. Results Nineteen intervention studies with a total of 2800 participants met the inclusion criteria. Results of the meta-analyses showed that interventions using self-monitoring significantly reduced total sedentary time (Hedges g = 0,32; 95% CI = 0,14 − 0,50; p  = 0,001) and occupational sedentary time (Hedge’s g = 0,56; 95% CI = 0,07 − 0,90; p  = 0,02) on the short term. Subgroup analyses showed that significant intervention effects were only found if objective self-monitoring tools were used (g = 0,40; 95% CI = 0,19 − 0,60; p  < 0,001), and if the intervention only targeted sedentary behavior (g = 0,45; 95% CI = 0,15-0,75; p  = 0,004). No significant intervention effects were found on the number of breaks in sedentary behavior. Conclusions Despite the small sample sizes, and the large heterogeneity, results of the current meta-analysis suggested that interventions using self-monitoring as a behavior change technique have the potential to reduce sedentary behavior in adults. If future – preferably large-scale studies – can prove that the reductions in sedentary behavior are attributable to self-monitoring and can confirm the sustainability of this behavior change, multi-level interventions including self-monitoring may impact public health by reducing sedentary behavior.

Background Dental caries in young children is a severe public health problem. Children depend on their parents and care professionals for their oral health. The aim of this study is to gain in-depth insight into the factors influencing oral health care for young children. Methods A qualitative explorative research design, within a constructivist research paradigm, was used. Eight individual and three focus group interviews were conducted with parents of children aged 6 months to 6 years. Particular emphasis was dedicated to the inclusion of parents from minority groups. Individual interviews were conducted with eight professionals from different health and welfare sectors working with young children and families. Data were analysed using reflexive thematic analysis. Results Several factors influence young children’s oral health, including time issues, children’s uncooperative behaviour, parents’ own oral health habits, family and cultural norms, and lack of knowledge. Parents from minority groups experience more barriers. Non-dental professionals report different barriers for taking responsibility about the topic including lack of time, lack of knowledge, and considering oral health as a taboo subject. Conclusion Care guidelines for young children and training in initiating conversations regarding oral health with parents are needed for professionals.

Background While there is increasing evidence for negative physical health consequences of high volumes of sedentary time and prolonged sedentary time in adolescents, the association with cognition is less clear. This study investigated the association of volumes of habitual sedentary time and prolonged sedentary time with executive functions and short-term memory in adolescents. Methods This study has a cross-sectional observational study design. Volumes of sedentary time and prolonged sedentary time (accumulated sedentary time spent in bouts of  ≥ 30 min) were measured using the Axivity AX3 accelerometer. Six cognitive functions (spatial and verbal short-term memory; and working memory, visuospatial working memory, response inhibition and planning as executive functions) were measured using six validated cognitive assessments. Data were analysed using generalised linear models. Results Data of 119 adolescents were analysed (49% boys, 13.4 ± 0.6 year). No evidence for an association of volumes of sedentary time and prolonged sedentary time with spatial and verbal short-term memory, working memory, and visuospatial working memory was found. Volumes of sedentary time and prolonged sedentary time were significantly related to planning. One hour more sedentary time or prolonged sedentary time per day was associated with respectively on average 17.7% (95% C.I.: 3.5–29.7%) and 12.1% (95% C.I.: 3.9–19.6%) lower scores on the planning task. Conclusions No evidence was found for an association of volumes of habitual sedentary time and prolonged sedentary time with short-term memory and executive functions, except for planning. Furthermore, the context of sedentary activities could be an important confounder in the association of sedentary time and prolonged sedentary time with cognition among adolescents. Future research should therefore collect data on the context of sedentary activities. Trial registration This study was registered at ClinicalTrials.gov in January 2020 (NCT04327414; released on March 11, 2020).

Background Most oral diseases benefit from early detection by dental professionals. However, in the older population, regular dental attendance is low. This trial investigates whether a low-threshold check-up by a dental professional in a non-dental setting can motivate older persons to seek professional oral care. Methods A total of 194 community-dwelling persons aged 65 years and older, without a dental check-up over the last 12 months, will be recruited for this randomized, controlled, two-arm, single-blinded, superiority trial with a 1:1 allocation ratio. The intervention group will receive an oral examination including tailored oral health information. They will also be informed about the importance of regular dental visits and will be provided with referral letters for the dental professional and the family physician and a list of nearby dentists. In the control group, the oral examination including tailored information will not be performed. This group will only receive flyers with general oral hygiene information and a list of nearby dentists. The primary outcome is whether or not the participants will contact a dental professional within four months after the intervention. Discussion This study examines the efficacy of a low-threshold dental check-up intervention to motivate older adults to contact a dental professional and reactivate them into primary oral care, addressing barriers to oral care such as low health literacy, subjective treatment need, and dental anxiety. Key strategies include enhancing oral health knowledge, identifying existing oral issues, and involving family physicians. The study, set to run from April 2024 to March 2025, aims to inform future evidence-based oral health promotion strategies for community-dwelling older adults. Trial registration ClinicalTrials.gov NCT06341959. Registered on 25 April 2024.

Background Parks are valuable resources to promote physical activity (PA) among all ages. However, studies investigating the longer-term effect of park renewal on park-based PA are scarce and have not been conducted in Europe. This study builds upon prior research investigating the immediate effects of a total park renewal in Belgium on park-based PA. Specifically, it examines the overall and age-specific effects of the renewal one year and two years after its completion, providing insights into the longer-term impact on park-based PA. Methods A natural experiment was conducted by observing the behaviour of the park visitors in two urban public parks (i.e., intervention and control park). The intervention involved extensive park renewal, including increased size, adding outdoor fitness equipment, a multi-use sports cage, six playgrounds targeting children of different ages, various benches, wheelchair-accessible picnic tables, wide concrete pathways, and removal of low vegetation. Observations were performed before, immediately after, and one and two years after the renewal using the System for Observing Play and Recreation in Communities. The number of visitors observed sedentary, walking or vigorously active were recorded according to age group and mean PA intensity levels were calculated. General(ized) linear models were fitted to assess the effect of the renewal on visitors’ PA in the park. Results Overall, an increase was observed in the total number of visitors engaged in sedentary and vigorous activities one and two years after the renewal. However, no evidence for effects were found for the total number of visitors observed walking or for the mean PA intensity levels of the visitors. There were some age-specific differences: the number of adults and older adults observed sedentary increased, whereas no such effect was found for children or adolescents. Positive effects were observed for the number of adolescents, adults and older adults observed walking. Additionally, the number of children, adolescents and older adults engaging in vigorous PA increased in the intervention park compared to the control park. Conclusion Extensive urban park renewal can increase both sedentary and active visitor numbers one and two years post-renewal, although effects vary across age groups.

Background The aim of this study was to investigate bidirectional associations between (prolonged) sitting time and sleep duration in 12- to 14-year-old adolescents using a between-subjects and within-subjects analyses approach. Methods Observational data were used from 108 adolescents (53% girls; mean age 12.9 (SD 0.7) years) from six schools in Flanders, Belgium. The Axivity AX3 triaxial accelerometer, worn on the thigh, was used to assess daily total sitting time and daily time spent in sedentary bouts of ≥30 min (as a proxy for prolonged sitting time). The Fitbit Charge 3 was used to assess nightly sleep duration. Both monitors were worn on schooldays only (ranging from 4 to 5 days). Linear mixed models were conducted to analyse the associations, resulting in four models. In each model, the independent variable (sleep duration, sitting time or prolonged sitting time) was included as within- as well as between-subjects factor. Results Within-subjects analyses showed that when the adolescents sat more and when the adolescents spent more time sitting in bouts of ≥30 min than they usually did on a given day, they slept less during the following night ( p  = 0.01 and p  = 0.05 (borderline significant), respectively). These associations were not significant in the other direction. Between-subjects analyses showed that adolescents who slept more on average, spent less time sitting ( p  = 0.006) and less time sitting in bouts of ≥30 min ( p  = 0.004) compared with adolescents who slept less on average. Conversely, adolescents who spent more time sitting on average and adolescents who spent more time sitting in bouts of ≥30 min on average, slept less ( p  = 0.02 and p  = 0.003, respectively). Conclusions Based on the between-subjects analyses, interventions focusing on reducing or regularly breaking up sitting time could improve adolescents’ sleep duration on a population level, and vice versa. However, the within-subjects association was only found in one direction and suggests that to sleep sufficiently during the night, adolescents might limit and regularly break up their sitting time the preceding day. Trial registration Data have been used from our trial registered at ClinicalTrials.gov ( NCT04327414 ; registered on March 11, 2020).

Background The experience sampling method (ESM), also known as ecological momentary assessment, is gaining popularity in physical activity research. This method involves assessing participants’ behaviors and experiences repeatedly over time. One key advantage of ESM is its ability to temporally separate the dependent and independent variable of interest, reducing the risk of reverse causality. However, temporal separation alone is insufficient for establishing causality. This methodology paper illustrates the importance of the identification phase in drawing causal conclusions from ESM data. In the identification phase the causal effect of interest (or estimand) is specified and the assumptions under which a statistical association can be considered as causal are visualized using causal directed acyclic graphs (DAGs). Methods We demonstrate how to define a causal estimand and construct a DAG for a specific ESM research question. The example focuses on the causal effect of physical activity performed in real-life on subsequent executive functioning among older adults. The DAG development process combines literature review and expert consultations to identify time-varying and time-invariant confounders. Results The developed DAG shows multiple open backdoor paths causing confounding bias, even with temporal separation of the exposure (physical activity) and outcome (executive functioning). Two approaches to address this confounding bias are illustrated: (1) physical control using the within-person encouragement design, where participants receive randomized prompts to perform physical activity in their natural environment, and (2) analytic control, involving assessing all confounding variables and adjusting for these variables in the analysis phase. Conclusions Implementing the identification phase enables ESM researchers to make more informed decisions, thereby enhancing the validity of causal inferences in studies aimed at answering causal questions.