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PubMed1991

Long-term effects of a lifestyle modification exercise program on the fitness of sedentary, obese children.

We studied the effects of a lifestyle modification and exercise program on the fitness of 12 sedentary and obese children who were physician-referred into a 1-month YMCA lifestyle modification program. These variables were measured at entry, at the program's conclusion, and 1 and 4 months following conclusion: weight (lbs), sum of 2 skinfolds (mm), number of sit-ups, 9-minute run (total distance in yds), sit-and-reach for flexibility (cm). Total serum cholesterol (mg/dl) was measured only at entry and 4 months following conclusion. We found a NS decrease in weight (124 to 117 lbs) and sum of skinfolds (54 to 40 mm); a significant (p less than 0.01) increase in sit-ups (23 to 35); a significant (p less than 0.05) increase in 9 minute run distance (1201 to 1419 yds); no change in flexibility; and a NS decrease in total serum cholesterol (178 to 155 mg/dl). It was concluded that, while good changes were made, a longer period of time would be required to significantly reduce weight, sum of skinfolds, and total serum cholesterol.

Behavior Therapy↗

PubMed1996

Getting started--a review of physical activity adoption studies.

The aim of this paper has been to review methods that have been found to be effective in getting sedentary adults to adopt physical activity, to examine these methods within the multilevel framework conceptualised by Winett et al, and to provide recommendations for future research to test new methods and their effectiveness in leading to the adoption of physical activity in sedentary populations. Searches for relevant studies were conducted on the Medline computerised database. Additional studies were located in reference sections of these studies and other review papers. Surveys that specifically identified determinants of adoption of physical activity in adults were included. Reviewed articles were selected on the basis of quasi-experimental and experimental designs that specifically examined the question of how to get sedentary adults to adopt a programme of physical activity or exercise, had completely described methods, and evaluated the effectiveness of methods of increasing physical activity and/or exercise. While numerous reviews have been written on determinants on physical activity adoption and maintenance, only two prospective surveys have identified specifics of adoption of physical activity. Most of the evidence for techniques that help inactive people to adopt physical activity comes from quasi-experimental and experimental intervention studies examining various cognitive and behavioural strategies at the individual level. Fewer studies have examined techniques at the interpersonal, organisational, community, environmental, and policy level. More prospective observational studies aimed at homogeneous subgroups are needed to identify correlates of physical activity adoption to help tailor interventions. Continued clinical studies are needed to differentiate the necessary and sufficient strategies at the personal and interpersonal levels. Interventions aimed at environmental, institutional, and social levels remain largely unexplored and there is a need for more research that specifically targets inactive subgroups at these levels.

Adult↗

PubMed2006

Prevention of type 2 diabetes: a review.

One of the major public health challenges of the 21st century is type 2 diabetes. WHO estimates that by 2025 as many as 200-300 million people worldwide will have developed the disease. A distressing increase in children is perhaps the most alarming sign of something going wrong. Roughly half of the risk of type 2 diabetes can be attributed to environmental exposure and the other half to genetics. Central themes for prevention are the risk factors overweight, sedentary lifestyle, certain dietary components and perinatal factors. Overweight is the most critical risk factor, and should be targeted for prevention of type 2 diabetes especially among children and youths. Ethnicity and perinatal factors are also worth considering. Today we know that prevention helps. In the US Diabetes Prevention Programme for high risk individuals, there was a 58% relative reduction in the progression to diabetes in the lifestyle group compared with the controls. Within the lifestyle group, 50% achieved the goal of more than 7% weight reduction, and 74% maintained at least 150 min of moderately intense activity each week. This review discusses different forms of prevention, and proposes first of all to target people with Impaired Glucose Tolerance with increasing activity and altering dietary factors. And secondly, population-based measures to encourage increased physical activity and decreased consumption of energy-dense foods are important, and may target school children and young people, certain ethnic groups and women with gestational diabetes.

Adult↗

PubMed2004

Exercise improves biomarkers of health and stress in animals fed ad libitum.

Voluntary and forced exercise decrease morbidity and mortality in laboratory animals. Caloric restriction has similar effects on health and unique benefits on life span. Nonetheless, in most experiments, animals do not have access to physical activity and are fed ad libitum (AL). We hypothesized that with regular access to either unlimited running wheel exercise (EX) or limited physical activity (PA), key biomarkers of health would be enhanced enough to counter some consequences of a sedentary AL lifestyle. This 16-month study compared body weight, tumor number and size, tissue lesions, oxidative stress, and reactive stress in (1) sedentary animals with no access to physical activity (SED); (2) animals with access to hour-long, twice weekly activity in a large box (PA); and (3) animals with access every other day to a running wheel (EX). At the end of the study, EX body weight was 8-9% lower than PA and SED. In addition, EX had no kidney lesions versus 50% in PA and SED, and had smaller tumor size (10+/-2 vs. 14+/-4 and 30+/-4 mm). Exhaustive exercise lowered glutathione/oxidized glutathione ratio in EX and PA, but in SED, the ratio was depressed even in resting animals. In all treatments, prolactin (PRL) levels were lower in resting animals than in acutely exercised animals. In conclusion, EX had the most favorable health biomarkers while SED had the least. PA did not confer gross health benefits different than the SED group, but was biochemically more similar to EX animals.

Age Factors↗

PubMed1992

The effects of a university fitness programme on health-related variables in previously sedentary males.

This study reports on the effects of a 10-week university fitness programme on health-related fitness variables. Twenty-one male exercisers, aged 37.0(10.3) years (mean(s.d.); range 21-58), and 22 male controls, aged 38.6(7.9) years (mean(s.d.); range 17-54), volunteered to take part. Two sample t-tests and 95% confidence intervals were used to determine if the exercise group demonstrated a greater average improvement than the control group and the average improvement in both groups separately. The exercise group showed a greater average improvement over the controls from Test 1 (before fitness programme) to Test 2 (after) in the following: steady-state heart rate (beats min-1) 95% confidence intervals (-7.8, -16.2); predicted VO2max (ml kg-1 min-1): 95% confidence intervals (3.2, 6.6); sit-ups (repetitions): 95% confidence intervals (3.1, 7.0); flexibility (cm): 95% confidence intervals (3.3, 6.9). There was no significant difference between the exercise group and control group in body weight, percentage body fat, blood pressure, total plasma cholesterol, high-density lipoprotein and triglycerides. The exercise programme improved aerobic fitness, local muscular endurance and flexibility. However, the increase in aerobic fitness did not coincide with beneficial changes in the coronary risk profile.

Adolescent↗

PubMed2002

Carbohydrate dependence during hard-intensity exercise in trained cyclists in the competitive season: importance of training status.

To test the hypothesis that intensive endurance training increases CHO utilisation during hard-intensity exercise, seven competitive road cyclists (Cy) performed three 50-min steady-state exercise tests on a cycle ergometer above their ventilatory threshold (+ 15 %) over the course of a cycling season (January [ET1], May [ET2] and September [ET3]). We compared the data with the baseline values of seven sedentary controls (Sed). CHO oxidation in Cy was higher in ET2 and ET3 than in ET1 (p < 0.05), was lower in ET3 than in ET2 (p < 0.05) and was higher in Cy than in Sed only in ET2 (p < 0.05). Lactate kinematics were lower in Cy than in Sed in all conditions (p < 0.05), but in Cy they were lower in ET2 than in ET1 and higher in ET3 than in ET2 (p < 0.05). Race performance was impaired and the overtraining score was increased at ET3 in comparison with ET2 (p < 0.05). We conclude that competitive cyclists increase CHO oxidation during hard-intensity exercise over the course of a season, but show a decline by the end of the season in association with the appearance of an overtraining state. Thus, well-trained cyclists develop a CHO dependence, which is modified with training status.

Adult↗

PubMed2005

Brain size, innovative propensity and migratory behaviour in temperate Palaearctic birds.

The evolution of migration in birds remains an outstanding, unresolved question in evolutionary ecology. A particularly intriguing question is why individuals in some species have been selected to migrate, whereas in other species they have been selected to be sedentary. In this paper, we suggest that this diverging selection might partially result from differences among species in the behavioural flexibility of their responses to seasonal changes in the environment. This hypothesis is supported in a comparative analysis of Palaearctic passerines. First, resident species tend to rely more on innovative feeding behaviours in winter, when food is harder to find, than in other seasons. Second, species with larger brains, relative to their body size, and a higher propensity for innovative behaviours tend to be resident, while less flexible species tend to be migratory. Residence also appears to be less likely in species that occur in more northerly regions, exploit temporally available food sources, inhabit non-buffered habitats and have smaller bodies. Yet, the role of behavioural flexibility as a response to seasonal environments is largely independent of these other factors. Therefore, species with greater foraging flexibility seem to be able to cope with seasonal environments better, while less flexible species are forced to become migratory.

Analysis of Variance↗

PubMed2006

Compliance with the Australian national physical activity guidelines for children: relationship to overweight status.

Childhood obesity incidence has increased substantially and it has been argued that decreasing physical activity levels, coinciding with an increase in sedentary behaviours, are responsible. Australian guidelines were published in 2004, recommending that children participate in a minimum of 60 min of physical activity daily and spend no more than 2h a day using electronic media for entertainment. We aimed to compare compliance with these guidelines amongst children of differing weight status. The Childhood Injury Prevention Study (CHIPS) collected data from a randomly selected sample of Brisbane primary and preschool children aged 5-12 years. The following data were available for 518 participants: age, gender, measured height and weight and estimated time per week from a parent-completed 7 days diary in physical activity out of school and sedentary leisure activities including television viewing and computer use. Using age standardised body mass index estimates, approximately 20% of the cohort were overweight. Non-compliance with guidelines was 14.7% for out of school physical activity participation, and 30.9% for excess electronic media entertainment use. There was a 63% increase in the odds of overweight status amongst children who were non-compliant with the electronic entertainment recommendations than those who were compliant (adjusted odds ratio=1.63; 95% CI=1.05-2.54). Female gender and school level socioeconomic category were also independently associated with overweight status. Non-compliance with the minimal physical activity guideline increased the odds of being overweight by 28%, however this difference was not statistically significant. One in seven children from the Greater Brisbane area are at risk for being insufficiently active whilst a third overuse electronic media. Given that overuse of electronic entertainment was positively associated with childhood obesity, these children should be the target of public health campaigns to promote alternative leisure time activities.

Child↗

PubMed2002

[Relative role of physical inactivity and snacking between meals in weight gain].

BACKGROUND: Diet and life-styles are considered as the main factors that determine the high prevalence of obesity in Western societies. Although some countries have registered a decrease in fat intake, the percentage of overweight and obesity has increased. Therefore, it is thought that fat intake may not be the main factor that determines the current epidemic of obesity. The objective of this study was to determine the role of a sedentary life-style and eating between meals (snacking) as major determinants of a recent weight change (over last 5 years). METHOD: By using cross-sectionally baseline data of the SUN cohort, we adjusted non-conditional logistic regression models to estimate the odds ratio (OR) of gaining weight according to age, physical activity in leisure time, watching television, taking a nap, smoking, snacking and the intake of macronutrients. RESULTS: A statistically significant inverse association between leisure-time physical activity and the probability of gaining weight was found for men (OR = 0.93; CI 95%, 0.88-0.98) and a trend was also present among women. Snacking was positively associated with a higher probability of gaining weight among men (OR = 1.88; CI 95%, 1.40-2.53) and among women (OR = 1.38; CI 95%, 1.10-1.73). CONCLUSIONS: Our data suggest a direct association between snacking and weight gain in middle-aged people.

Adult↗

PubMed2003

Exercise behaviour change in 40 to 65-year-old women: The SWEAT Study (Sedentary Women Exercise Adherence Trial).

OBJECTIVE: The purpose of this study was to examine the relation between self-reported psychological processes and changes in exercise behaviour in an 18-month longitudinal stage-based intervention trial in 115 initially sedentary women aged 40-65 years. DESIGN: A two-way factorial design was used. METHODS: Participants were assigned randomly to either moderate or vigorous and either home or centre-based exercise. After six months, all participants exercised at home. Participants completed questionnaires at baseline, six, 12 and 18 months which assessed stage of exercise behaviour, self-efficacy, decisional balance and processes of change. RESULTS: 28 patterns of stage change were identified across the 18 months with 6.1% remaining sedentary and 45% demonstrating linear movement from contemplation to action to maintenance to continued maintenance. Two interpretable clusters were identified within both the contemplation (at baseline) and action (at six months) stages. Cluster membership, however, did not influence behaviour change. For participants demonstrating a linear pattern of change, self-efficacy for overcoming barriers and behavioural processes increased from contemplation to action. Self-efficacy for exercise competence increased from contemplation to action but was more pronounced for the vigorous exercise groups. Decisional balance showed a three-way interaction and there was no change for experimental processes. There was no change in any variable from action to maintenance. CONCLUSIONS: The intervention was seen to be effective regardless of location or intensity of exercise. The relevance of substages is questionable in stage-based interventions as women with a profile suggesting less readiness to change or sustain change were just as likely to adopt or maintain exercise.

Adult↗

PubMed1997

Doppler echocardiographic indexes and 24-h ambulatory blood pressure data in sedentary middle-aged men presenting exaggerated blood pressure response during dynamical exercise test.

Previous studies have pointed out that exaggerated blood pressure (BP) response during physical exercise could be an early marker of essential hypertension. Apparently some of the exaggerated BP responders present changes in the heart geometry and function that are usually found in the early course of the hypertensive disease. To evaluate the association between exaggerated BP response and these changes, we submitted 20 normotensive men presenting elevated BP response during bicycle exercise (hyperreactive group, systolic BP > or = 220 mmHg at maximal workload) to 24-h ambulatory blood pressure monitoring (ABPM) and to two-dimensionally guided M-mode echocardiography and pulsed Doppler. The results from this group were contrasted with those of a comparable group, which otherwise, presented normal BP response during the same procedure (control group, systolic BP < or = 210 mmHg at maximal workload). The ABPM measurements were normal and analogous between the two groups: the mean 24-h systolic blood pressure (SBP) was respectively 126 +/- 6 mmHg and 129 +/- 5 mmHg, diastolic blood pressure (DBP) 82 +/- 4 mmHg in both groups, and heart rate (HR), respectively 76 +/- 9 and 74 +/- 7 bpm. The univariate correlation (R) between the maximal BP response during bicycle exercise and BP measurements in the ABPM were in general weak, and as a whole, the hyperreactive group presented the weakest correlation coefficients. M-mode echocardiographic data such as the left ventricular mass index (LVMI, 80 +/- 10 vs. 81 +/- 11 g/m2), posterior wall and interventricular septal thickness (PWT, 8.8 +/- 0.6 vs. 8.6 +/- 0.7 mm; IVST, 9.0 +/- 0.4 vs. 8.8 +/- 0.6) were also normal and comparable between the groups. LV systolic functional indexes such as fractional shortening (LVFS, 39 +/- 2.8 vs. 40 +/- 3.5%) and ejection fraction (LVEF, 70 +/- 3.5 vs. 71 +/- 3.7%) were also normal and similar. Doppler-derived LV diastolic functional indexes such as the peak velocity of early flow divided by the peak velocity of late flow (RE/A) and isovolumetric relaxation time (IVRT) were also equivalent (RE/A, both 1.3 +/- 0.2, IVRT 79 +/- 7 vs. 81 +/- 6 msec). These results support the concept that an exaggerated BP elevation during physical activity, when not accompanied of higher levels of BP during daily activities are not associated with changes in the heart geometry or in the ventricular function, and might represent an hemodynamical behavior of limited pathological and clinical importance. These conclusions must be taken cautiously since personal characteristics such as life style, family history of hypertension, gender, race and also the levels of BP chosen to delimit a normal and an exaggerated BP response might be important factors determining the consequences of the hyperreactive behavior.

Adult↗

PubMed2002

How work-place conditions, environmental toxicants and lifestyle affect male reproductive function.

Major temporal and geographical shifts in male reproductive function is presently an issue worldwide. The hormonal disruption hypothesis has achieved considerable attention but epidemiological evidence in support of the theory is lacking. Several occupational hazards to male reproductive function are known but exposure prevalences are hardly sufficient to play a role for reduced sperm count in the general male population. Sedentary work may be an exception. Perhaps prolonged time in the sedentary position exhausts the testicular heat regulation. But so far studies addressing implications of the heat hypothesis in the general population are few. Neither change of sexual behaviour nor reduced period of sexual continence seems to be a likely explanation. Tobacco smoking and consumption of caffeine and alcoholic beverages in adulthood have a rather marginal impact on spermatogenesis and can hardly explain major shifts or regional differences in male reproductive health. However, prenatal effects following smoking during pregnancy might play a role because we have witnessed a smoking epidemic among fertile women in some countries during the second half of the twentieth century. Moreover, if genetic factors play more than a marginal role for testicular function and sperm count, pregnancy planning resulting in reduced family size during the past 100 years could possibly explain a decline in semen quality because the most fertile part of the population reproduce less while the subfertile probably continue to get a limited number of children.

Body Temperature Regulation↗

PubMed2006

The role of built environments in physical activity, eating, and obesity in childhood.

Over the past forty years various changes in the U.S. "built environment" have promoted sedentary lifestyles and less healthful diets. James Sallis and Karen Glanz investigate whether these changes have had a direct effect on childhood obesity and whether improvements to encourage more physical activity and more healthful diets are likely to lower rates of childhood obesity. Researchers, say Sallis and Glanz, have found many links between the built environment and children's physical activity, but they have yet to find conclusive evidence that aspects of the built environment promote obesity. For example, certain development patterns, such as a lack of sidewalks, long distances to schools, and the need to cross busy streets, discourage walking and biking to school. Eliminating such barriers can increase rates of active commuting. But researchers cannot yet prove that more active commuting would reduce rates of obesity. Sallis and Glanz note that recent changes in the nutrition environment, including greater reliance on convenience foods and fast foods, a lack of access to fruits and vegetables, and expanding portion sizes, are also widely believed to contribute to the epidemic of childhood obesity. But again, conclusive evidence that changes in the nutrition environment will reduce rates of obesity does not yet exist. Research into the link between the built environment and childhood obesity is still in its infancy. Analysts do not know whether changes in the built environment have increased rates of obesity or whether improvements to the built environment will decrease them. Nevertheless, say Sallis and Glanz, the policy implications are clear. People who have access to safe places to be active, neighborhoods that are walkable, and local markets that offer healthful food are likely to be more active and to eat more healthful food-two types of behavior that can lead to good health and may help avoid obesity.

Child↗

PubMed2006

Is love of nature in the US becoming love of electronic media? 16-year downtrend in national park visits explained by watching movies, playing video games, internet use, and oil prices.

After 50 years of steady increase, per capita visits to US national parks have declined since 1988. This decline, coincident with the rise in electronic entertainment media, may represent a shift in recreation choices with broader implications for the value placed on biodiversity conservation and environmentally responsible behavior. We compared the decline in per capita visits with a set of indicators representing alternate recreation choices and constraints. The Spearman correlation analyses found this decline in NPV to be significantly negatively correlated with several electronic entertainment indicators: hours of television, (rs=-0.743, P<0.001), video games (rs=-0.773, P<0.001), home movies (rs=-0.788, P<0.001), theatre attendance (rs=-0.587, P<0.025) and internet use (rs=-0.783, P<0.001). There were also significant negative correlations with oil prices (rs=-0.547, P<0.025), foreign travel (rs=-0.452, P<0.05), and Appalachian Trail hikers (rs=-0.785, P<0.001). Income was significantly positively correlated with foreign travel (rs=0.621, P<0.005) but negatively correlated with national park visits (rs=-0.697, P<0.005). There was no significant correlation of mean number of vacation days, indicating available vacation time is probably not a factor. Federal funding actually increased during this period, and so was rejected as a probable factor. Park capacity was rejected as limiting since both total overnight stays and visits at the seven most popular parks rose well into the mid-1990s. Aging of baby boomers was also rejected as they are only now reaching retirement age, and thus during the period of visitation decline were still of prime family vacation age. Multiple linear regression of four of the entertainment media variables as well as oil prices explains 97.5% of this recent decline (r=0.975, multiple r2=0.950, adjusted multiple r2=0.925, SE=0.015, F=37.800, P<0.0001). We may be seeing evidence of a fundamental shift away from people's appreciation of nature (biophilia, Wilson 1984) to 'videophilia,' which we here define as "the new human tendency to focus on sedentary activities involving electronic media." Such a shift would not bode well for the future of biodiversity conservation.

Ecology↗

PubMed1999

Factors underlying the increase in carotid intima-media thickness in borderline hypertensives.

To define the role played by various risk and behavioral factors in the increase of carotid intima-media thickness (IMT) observed in borderline hypertensives. Using B-mode ultrasonography, we compared 97 borderline hypertensives enrolled in the HARVEST study to 27 normotensive controls. Intima-media thickness was measured in the right and left common carotid artery, bulb, and internal carotid artery. Mean IMT (m-IMT), maximum IMT (M-IMT), the mean of M-IMT (M-MAX), and the prevalence of raised lesions (IMT>1 mm) were established. Compared to the controls, higher systolic BP, diastolic BP, mean arterial blood pressure levels and body mass index (BMI) were present in the borderline hypertensives, whereas age, smoking, physical activity, serum cholesterol, and triglycerides were similar. After adjusting for age, sex, heart rate, BMI, smoking, serum cholesterol, triglycerides, and physical activity, higher values of m-IMT and M-IMT were present in most carotid segments of borderline hypertensives compared with controls. After further adjustment for systolic BP and diastolic BP, differences were no longer significant. The adjusted M-MAX was 0.59+/-0.12 in borderline hypertensives compared with 0.50+/-0.10 in controls (P<0.001). After adjustment for systolic BP and diastolic BP it was 0.58+/-0.11 in borderline hypertensives compared with 0.50+/-0.12 in controls (P<0.005). In the various carotid segments, the prevalence of raised lesions was 1. 2% in borderline hypertensives compared with 0.3% in controls (P<0. 001). In the multivariate analysis m-IMT, M-IMT, and M-MAX were related to ambulatory mean arterial pressure, systolic BP and diastolic BP, serum cholesterol and triglycerides, BMI, age, and physical activity. Higher IMT values were found in subjects who were physically active than in those who were sedentary. In borderline hypertensives, an increase in IMT takes place not only in the common carotid artery but also in the bulb and the internal carotid segment. Blood pressure levels are a main determinant of m-IMT while the interaction of BP with other risk factors such as age and plasma lipids is more relevant for advanced intima-media thickening such as M-MAX.

Adult↗

PubMed2002

Prevention of type 2 diabetes.

The prevalence of diabetes is increasing worldwide. The World Health Organisation has estimated that there will be around 300 million diabetics by 2025. The largest increase will occur in Asia. The prevalence of type 2 diabetes is increasing due to a combination of factors: increasing lifespan, sedentary lifestyle, excessive intake of high energy foods, increasing prevalence of overweight/obese people. The Finnish Diabetes Prevention Study Group has clearly shown that changes in the lifestyle of both overweight men and women with impaired glucose tolerance can reduce the incidence of type 2 diabetes by 58%. This finding was confirmed by the Diabetes Prevention Programme which found that lifestyle intervention in individuals with impaired fasting glucose or impaired glucose tolerance reduced the risk of developing type 2 diabetes by 58%, whereas treatment with metformin reduced the risk of type 2 diabetes by only 31%. Both acarbose and troglitazone have also been shown to reduce the progression to diabetes in individuals who are at high risk of developing type 2 diabetes. Since the cure for diabetes remains some way off our concerted efforts should be directed at prevention of diabetes in order to curb the increasing prevalence of diabetes worldwide. Lifestyle changes are more beneficial than long term drug therapy in the prevention of diabetes and should be actively promoted.

Acarbose↗

PubMed2004

The obesity epidemic: prospects for prevention.

Some 20-25% of UK adults are obese according to the WHO criterion (BMI >/=30 kg/m(2)). Type 2 diabetes, increasingly recognized as a major complication of overweight and obesity, is beginning to appear in UK adolescents, following the trends in the US. Epidemiological data indicate that the prevalence of overweight and obesity has doubled or tripled in the past few decades in the US, in Europe, and even in many developing countries. Thus obesity is increasingly seen as a public health problem requiring concerted action by both governmental and non-governmental organizations. A sound understanding of the root causes is crucial, if strategies for the prevention and treatment of this epidemic are to be developed. Many epidemiological studies suggest that physical activity at work, school or at leisure has declined to minimal levels, and that sedentary behaviours such as television viewing and computer games have become major pastimes. Thus energy requirements are substantially less than those for recent generations. Further, the food industry produces high-calorie foods which children and adults consume as snack meals, giving a substantial surfeit to their daily energy requirement. In children, a few school-based, preventive intervention trials have shown some promising results. Many negative trials have also been reported, and practical difficulties remain in the widespread implementation of appropriate protocols. Initiatives have been introduced by the government to increase the physical education syllabus in school to a minimum of 2 h/week, and the promotion of fruit and vegetables. Further research is required on the physiological and psychological causes of overweight and obesity in children and adults, and randomized, controlled, school and community-based trials are required to pilot preventative initiatives. Monitoring of the progress in prevention at both organizational and outcome level is required, and also of adverse outcomes such as a rise in the prevalence of eating disorders.

Adolescent↗

PubMed2006

Clustering of behavioural risk factors and compliance with clinical preventive recommendations in Spain.

OBJECTIVE: To examine the relationship between the clustering of behavioural risk factors and compliance with clinical preventive practices. METHOD: Cross-sectional study using a telephone interview of a sample of 16043 persons, representative of the population aged 18-64 years in the Madrid Region (Spain). The criteria for providing clinical preventive services were based on recommendations issued by the Spanish Society for Family and Community Medicine. Analyses were performed using logistic regression with adjustment for age, education, social class and year of interview. RESULTS: A positive dose-response association was observed between the number of behavioural risk factors (tobacco smoking, hazardous alcohol drinking, leisure-time sedentariness and unbalanced diet) and non-compliance of recommendations for blood-pressure and cholesterol testing, and for cytology and mammography screening (P < 0.001). Compared to subjects with no behavioural risk factors, those with all four risk factors showed a higher frequency of non-compliance of blood pressure assessment: OR = 2.5 (95% CI: 1.6, 3.8) in men and 2.7 (1.5, 4.8) in women, and cholesterolaemia testing: OR = 2.6 (1.8, 3.9) in men and 2.7 (1.5, 5.1) in women. Furthermore, among women, the presence of these four risk factors was also associated with a higher frequency of non-performance of cytology: OR = 6.4 (2.8, 14.8) and mammography screening: OR = 10.2 (2.1, 49.8). However, as it is a cross-sectional study, we do not know the direction of this relationship, therefore, any causal inference should be made with caution. CONCLUSIONS: Clustering of behavioural risk factors is associated with greater non-compliance with recommendations for both blood pressure and cholesterolaemia testing, and for cytology and mammography screening.

Adolescent↗