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Low(er) motor competence in obese children: towards a better understanding of the contributing factors
Full text linkMotor competence in overweight and obese children
No full textBackground: In the past decades, the prevalence as well as the degree of overweight and obesity in children has been rapidly increasing across the world. This is of particular concern due to the corresponding complications for psychosocial and physical health. Nowadays, research into the constraints imposed by excess body weight and fatness on children’s functional capacity is gaining increased attention. Within the existing literature, however, the focus is primarily on components contributing to the level of physical fitness. By contrast, the lower motor competence of overweight and obese children relative to normal-weight peers has not yet been thoroughly investigated. Motor competence refers to the performance as well as the underlying quality of movement when executing various motor tasks. Since an adequate level of motor skill is considered to be a prerequisite for everyday activities and an essential aspect underlying children’s engagement in physical activities, the scarcity of information on the motor (in)competence associated with childhood overweight and obesity contrasts with the potential importance of this factor in both development and treatment of the current epidemic.
Research: The overall objective of the present doctoral thesis was twofold. The first aim was to further map the movement-related difficulties in the overweight and obese childhood population across the continuum from gross to fine motor skills. The second aim was to gain greater insight into the specific nature of these difficulties. More specifically, the hypothesis of a decreased perceptual-motor function was examined. These aims were pursued by means of cross-sectional studies conducted both in field- and laboratory-based settings with a focus on motor skill performance (i.e., the product or outcome of a motor action) and movement execution and control (i.e., the process through which that particular outcome is obtained), respectively.
The first study investigated the relationship between children’s weight status (i.e., normal-weight, overweight or obese) and their performance on both gross and fine motor tasks. Level of motor skill was evaluated using the Movement Assessment Battery for Children (MABC), which consists of age-specific test items organized in clusters for balance, ball skills, and manual dexterity. It was shown that childhood obesity is associated with poorer overall motor skill performance. This finding was not solely restricted to tasks requiring whole body movement, but also tended to exist in tasks where only a limited part of body mass was involved in the action.
The subsequent two studies separately examined gross and fine motor skill performance with a common focus on the age-related impact of excess body weight or fatness on children’s motor coordination. In chapter two, BMI-related differences in gross motor coordination were explored by means of the Körperkoordinationstest für Kinder (KTK). Childhood overweight and - to a greater extent - obesity were found to result in poorer KTK performances, with the most apparent differences on test items relying on physical properties in addition to dynamic body coordination. Using a modified peg placing task in chapter three, it was demonstrated that being overweight or obese was also detrimental for fine motor skill coordination. Besides, results of both studies pointed to more pronounced BMI-related differences as children grow older. The reported deficiency in both gross and fine motor skill among overweight and particularly obese children appeared to decline relative to the performance of normal-weight peers across developmental time. With regard to the KTK, this finding was substantiated by a growing proportion of overweight and obese children that could be identified as being motor impaired according to the age- and gender-specific standards of the test battery.
Based on our findings in the field, it could be critically questioned to what extent the mechanical problem of moving excess mass exclusively accounts for the reported lower motor competence associated with childhood overweight and obesity. Hence, two laboratory-based studies were conducted to test the alternative hypothesis of perceptual-motor difficulties as a probable complementary underlying mechanism. In chapter four, the relative contribution of visual (i.e., eyes open or closed) and somatosensory information (i.e., normal or reduced plantar sensation) to postural balance control was explored during quiet bilateral stance in overweight children versus normal-weight peers using computerized posturography. No significantly different centre of pressure (COP) responses to the more challenging conditions were established between groups. Overweight children were not found to be less capable to compensate for the loss of normal sensory inputs in maintaining postural stability. The last study, in chapter five, provided details on the impact of visual deprivation on obese and normal-weight children’s gait control when walking over ground at self-selected speeds. The removal of vision resulted in a number of identical changes in spatiotemporal and kinematic gait characteristics in both groups of children. However, a different response in temporal phasing (i.e., a significantly greater percentage of the gait cycle spent in the stance phase due to a more pronounced increase in relative double support time) suggested an increased reliance on online visual information and a reduced capacity to reweight remaining sensory cues among obese children in order to produce their usual walking pattern.
Conclusions: The research presented in this thesis aimed to refine the picture of the motor (in)competence in overweight and obese children and to enhance the current understanding of its underlying mechanism(s). It can be concluded that overweight and obese children are less motor competent as compared to normal-weight peers. More specifically, excess body weight and fatness were found to impose significant constraints on both gross and fine motor skill performance. In the absence of targeted initiatives addressing this problem, the reported deficiencies even appeared to be increasing with age. Finally, preliminary evidence could be provided for difficulties in the perception and/or integration of (altered) sensory information needed to plan and control movement among obese children. A decreased perceptual-motor function might thus underlie their lower motor competence. In the end, future wide-ranging research is required because a more comprehensive view on the implications of being overweight or obese on children’s motor function can significantly contribute to prevention and treatment programs
Effectiveness and implementation practices of interventions promoting healthy energy balance-related behaviors in children and parents : two cases: school gardens and the Feel4Diabetes-project.
No full textNeighborhood-based physical and social environment as correlates of physical activity and sedentary time in community-dwelling older adults
No full textWorldwide, the proportion of older adults (65 years and older) will increase substantially during the forthcoming years. Because aging goes together with decreased mobility and declining health, a higher number of older adults is at risk of institutionalization, and this will inevitably result in a higher health care burden. Given that regular physical activity and the reduction of periods of prolonged sedentary time have proven to have beneficial results for a wide range of health outcomes, it is recommendable to develop public health interventions aimed at reaching sufficient levels of physical activity in older adults, and limiting their sitting time. However, before effective promotion programs can be developed, it is necessary to assess these health behaviors adequately, and to identify multidimensional factors that influence these behaviors. Socio-ecological models posit that health behaviors can be explained by analyzing the interaction of the individual and his or her environment.
The research undertaken for this doctoral thesis had three aims: First, it investigated the measurement properties of physical activity and sedentary behavior questionnaires, adapted for assessment in older adults. A second aim was to obtain a better understanding of the neighborhood physical and social environment in relation to older adults’ physical activity and sedentary behavior. Thirdly, it investigated the possible interplay between the neighborhood environment and multidimensional socio-ecological factors (health-related, psychological and social factors) to explain physical activity and sedentary behavior in community-dwelling older adults.
Regarding the first aim, study results suggested that physical activity and sedentary behavior of older adults should be assessed using ‘all-inclusive questionnaires’. Such questionnaires, querying a wide range of light-to-vigorous physical activities and sedentary behaviors relevant to older adults, might have the greatest potential to reduce reporting bias. Especially for physical activity assessment, questionnaires should include a higher number of items on light-intensity activities, accompanied by clear and unambiguous descriptions of such activities.
With regard to the second and third research question, findings showed that older adults living in neighborhoods with high, objectively-measured, ‘walkability’ also walked more for transport than their counterparts living in low-walkable neighborhoods. Increasing the accessibility of existing relevant destinations, for instance through the provision of shortcut alleyways for vulnerable road users or public transport opportunities to reach destinations located further away from one’s residence, seems to have been key in increasing older adults’ transport walking. In addition, study findings demonstrated that if both walkability and diversity in the social composition of the neighborhood were high, older adults walked even more for transport. Furthermore, the combination of high walkability and higher levels of neighboring (talking to neighbors and social interactions) was related to less sitting time. These findings suggest that destinations relevant for older adults should also incorporate social interaction opportunities where older adults can get in contact with older adults, as well as with other population subgroups living in their neighborhood.
Our study results identified two subgroups of older adults that warrant special attention in future research. In the first place, only in low-income neighborhoods was it the case that living in a highwalkable area was also related to higher levels of physical activity. This suggests that environmental interventions might be beneficial for low-income neighborhood residents, who are not always easy to reach through individual-oriented programs. Secondly, those older adults with better physical functioning levels could be targeted. Findings implied that both a good physical functioning level and high neighborhood walkability might be necessary to motivate older adults to engage in transport walking.
Given that the relation between physical functioning and transport walking may be reciprocal, these results suggest that living in a high-walkable neighborhood might attenuate the aging-related decrease in mobility for those with better functioning levels. Therefore, it could be advised that for transport walking, increasing neighborhood walkability may be beneficial, but only in those older adults who still have adequate levels of physical functioning. It could, therefore, be recommendable to persuade older adults to move into high-walkable neighborhoods while they can still benefit from such a neighborhood, namely when they still have adequate functioning levels to engage in transport walking. In general, for all older adults, objective neighborhood walkability was less relevant to recreational walking levels. To increase this type of physical activity in older adults, as well as to reduce sitting time, interventions aiming at enhancing psychosocial factors - such as perceived benefits for physical activity and social support to reduce sitting - may be effective promotion strategies.
Findings from this doctoral dissertation can inspire researchers, health promoters and policy makers to conduct more research on the importance of creating a physical and social environment that is conducive to higher physical activity, reduced sitting time, and hence, effective ‘aging in place’
Optimizing rehabilitation interventions in men with prostate cancer receiving androgen deprivation therapy
No full textEffects of interventions to promote daily physical activity in type 2 diabetes patients
No full textDespite the fact that physical activity is of major importance and has many health benefits in type 2 diabetes patients, most patients in this population are not sufficiently active. The overall aim of this thesis was to provide insight in and investigate ways to increase physical activity in a Belgian type 2 diabetes population. Worldwide many physical activity interventions for type 2 diabetes patients have been developed and most of them showed promising short-term results, but data on long-term effectiveness using objective physical activity measurements were often lacking. Therefore, the purpose of this thesis was to develop different physical activity lifestyle interventions for type 2 diabetes patients and to evaluate their short-, intermediate (≤ six months after the intervention) or long-term (> six months after the intervention) effectiveness by self-reported and objective physical activity measurements. Earlier studies showed promising results with regard to both feasibility and effectiveness of lifestyle physical activity interventions in a type 2 diabetes population. However, currently there is still vagueness about the optimal intensity, duration, delivery mode, and content of such interventions in order to obtain robust long-term effects. For the different physical activity interventions of this thesis, we developed an overall theory-based intervention framework. We made different adaptations of this framework and gave answers to the shortcomings of the current literature by means of those adaptations.
Our results showed no clear effects on health outcomes of our interventions. Only a subsample of participants, who succeeded in increasing their steps/day with ≥ 4000 above their baseline levels, had a better glucose control. Our findings demonstrate however the utility of pedometer-based cognitive-behavioural programmes to increase physical activity and decrease sedentary behaviour in this population. Most workable factors of our interventions were social support, modelling and norm from family, relapse prevention and self-efficacy towards overcoming physical activity barriers. When delivering physical activity interventions for type 2 diabetes patients it is thus important to help the participants to create a social support network in their home environment. Moreover, they have to be supported and trained in their self-efficacy towards overcoming physical activity barriers and thus mastering how to cope with relapse. When aiming for behavioural effects, the most optimal lifestyle physical activity intervention in this specific study population is a long lasting, intensive intervention given by a motivated behavioural expert. From a health point of view, further research is necessary
Cheers to Tournée Minérale : evaluation of a one-month-abstinence campaign to reduce alcohol consumption among adults
No full textSocial inequalities in adolescent health and health behaviours : trends and determinants
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