Background: Following the publication of the 2018 World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) Third Expert Report, a collaborative group was formed to develop a standardized scoring system and provide guidance for research applications. Methods: The 2018 WCRF/AICR Cancer Prevention Recommendations, goals, and statements of advice were examined to define components of the new Score. Cut-points for scoring were based on quantitative guidance in the 2018 Recommendations and other guidelines, past research that operationalized 2007 WCRF/AICR Recommendations, and advice from the Continuous Update Project Expert Panel. Results: Eight of the ten 2018 WCRF/AICR Recommendations concerning weight, physical activity, diet, and breastfeeding (optional), were selected for inclusion. Each component is worth one point: 1, 0.5, and 0 points for fully, partially, and not meeting each recommendation, respectively (Score: 0 to 7–8 points). Two recommendations on dietary supplement use and for cancer survivors are not included due to operational redundancy. Additional guidance stresses the importance of accounting for other risk factors (e.g., smoking) in relevant models. Conclusions: The proposed 2018 WCRF/AICR Score is a practical tool for researchers to examine how adherence to the 2018 WCRF/AICR Recommendations relates to cancer risk and mortality in various adult populations. Full article

Few studies on older populations consider several energy balance-related behaviors together. This cross-sectional study compared subjectively and objectively measured physical activity (PA) and sedentary behavior (SB) patterns between older adults with and without a healthy diet. We recruited 127 community-dwelling older Taiwanese adults (69.9 ± 5.0 years); data were collected during April and September 2018. Objectively measured total PA, moderate-to-vigorous PA, light PA, step count, total sedentary time, duration of sedentary bouts, number of sedentary bouts, and number of sedentary breaks were assessed using activity monitors. Subjectively measured PA and SB were measured using the International Physical Activity Questionnaire and Sedentary Behavior Questionnaire for Older Adults. Chi-square tests and independent sample t-tests were performed. For subjective measures, older adults without a healthy diet spent significantly less total leisure time on PA and more leisure sitting time than those with a healthy diet. For objective measures, older adults without a healthy diet spent less time on light PA and had a higher total sedentary time, duration of sedentary bouts, times of sedentary bouts, and times of sedentary breaks than those with a healthy diet. Regardless of the use of objective or subjective measurements, older adults without a healthy diet engaged in a more inactive and sedentary lifestyle. These findings have implications for health promotion practitioners in designing tailored interventions. Full article

We aimed to investigate the effects of a wide range of daily physical activity (PA) levels on energy balance (EB), energy intake (EI), and appetite. Nine young men completed three different PA levels in a metabolic chamber in a random order: (1) no exercise (Low-PA); (2) 25 min walking seven times (Mid-PA); and (3) 25 min running seven times (High-PA) within a 24 h period. Interval exercise (25 min exercise and 35 min rest) was performed three times in the morning and four times in the afternoon. The exercise intensities were 21.6% and 53.7% $\dot{\mathrm{V}}$ O₂ peak for the Mid-PA and High-PA days, respectively. Participants were served three standardized meals and a buffet for dinner. The 24 h EB was calculated as 24 h energy expenditure (EE) minus 24 h EI. The 24 h EEs for the Low-PA, Mid-PA, and High-PA days were 1907 ± 200, 2232 ± 240, and 3224 ± 426 kcal, respectively, with significant differences observed among the three conditions (p < 0.01 for Low-PA vs. Mid-PA, Low-PA vs. High-PA, and Mid-PA vs. High-PA, respectively). The 24 h EIs for the Low-PA, Mid-PA, and High-PA days were 3232 ± 528, 2991 ± 617, and 3337 ± 684 kcal, and were unaffected by PA levels (p = 0.115). The 24 h EBs were 1324 ± 441 kcal (Low-PA), 759 ± 543 kcal (Mid-PA), and 113 ± 430 kcal (High-PA), with significant differences observed between Low-PA vs. Mid-PA (p = 0.0496), Low-PA vs. High-PA (p ≤ 0.01), and Mid-PA vs. High-PA (p = 0.017) conditions. The EB in the Low-PA group was the highest of the three conditions. Appetite perception did not differ among the study days, however there was an interaction trend (p = 0.078, time × condition). Thus, significantly different daily PA did not affect 24 h EI, however markedly affected 24 h EB, implying that EB is not automatically matched during a single day. Full article

Schools can help to improve children’s health. The ‘Healthy Primary School of the Future’ (HPSF) aims to sustainably integrate health and well-being into the school system. This study examined the effects of HPSF on children’s dietary and physical activity (PA) behaviours after 1 and 2 years’ follow-up. The study (n = 1676 children) has a quasi-experimental design with four intervention schools, i.e., two full HPSF (focus: nutrition and PA) and two partial HPSF (focus: PA), and four control schools. Accelerometers and child- and parent-reported questionnaires were used at baseline, after 1 (T1) and 2 (T2) years. Mixed-model analyses showed significant favourable effects for the full HPSF versus control schools for, among others, school water consumption (effect size (ES) = 1.03 (T1), 1.14 (T2)), lunch intake of vegetables (odds ratio (OR) = 3.17 (T1), 4.39 (T2)) and dairy products (OR = 4.43 (T1), 4.52 (T2)), sedentary time (ES = −0.23 (T2)) and light PA (ES = 0.22 (T2)). Almost no significant favourable effects were found for partial HPSF compared to control schools. We conclude that the full HPSF is effective in promoting children’s health behaviours at T1 and T2 compared with control schools. Focusing on both nutrition and PA components seems to be more effective in promoting healthy behaviours than focusing exclusively on PA. Full article

Background: Since the beginning of the 20th century, the importance of creating healthy work environments and promoting the health of workers in the healthcare sector to create Healthy and Resilient Organizations has been emphasized. In this context, self-esteem is an essential construct which influences health and healthy life styles, and, therefore, the general wellbeing of nurses. The objective of this study was to analyze the mediating role of reasons for exercising in the effect that self-esteem has on uncontrolled eating by nursing professionals. Methods: The sample was made up of 1094 nurses who were administered the Rosenberg General Self-Esteem Scale, the Goal Content for Exercise Questionnaire, and the Three-Factor Eating Questionnaire-R18. Results: Bivariate correlation analysis and multiple mediation analysis showed that self-esteem has direct and indirect effects on uncontrolled eating. Moreover, self-esteem determines whether one does physical exercise to improve one’s image, recognition, or social affiliation—although the effects on uncontrolled eating were only significant in the case of image. Conclusions: The results have important practical implications in the framework of Positive Occupational Health Psychology (POHP) as they emphasize self-esteem, physical exercise and eating as essential aspects of the health and wellbeing of employees in the healthcare sector, highlighting the importance of creating organizations committed to promoting the psychosocial health of their workers. Full article

Background: Evidence shows that diet is associated with physical activity. However, there has been a lack of studies addressing it in a population of older adults. Therefore, the main purpose of this study was to explore associations between various frequencies of dietary intake and physical activity in older adults. Methods: In this cross-sectional study, the participants were 810 older adults aged ≥85. Frequency of dietary intake and the level of physical activity were assessed using the Elderly Diet Index score and International Physical Activity questionnaire. Mutual associations were examined using generalized estimating equations with a logistic regression model. Results: ”Optimal” intake of fish and seafood (OR (odds ratio) = 1.40; 95% CI (95 percent confidence interval) 1.01 to 2.00), fruits (OR = 2.10; 95% CI 1.45 to 3.02), legumes (OR = 1.73; 95% CI 1.19 to 2.50), olive oil (OR = 1.83; 95% CI 1.09 to 3.08) and bread (OR = 4.62; 95% CI 3.05 to 6.99) and the total Elderly Diet Index score (OR = 4.99; 95% CI 3.20 to 7.70) were associated with ”sufficient” physical activity. When all dietary components were entered simultaneously into the model, ”optimal” intakes of meat (OR = 1.73; 95% CI 1.10 to 2.71), fish and seafood (OR = 2.26; 95% CI 1.46 to 3.51), cereals (OR = 1.75; 95% CI 1.02 to 3.25), fruits (OR = 1.52; 95% CI 1.02 to 2.26), legumes (OR = 1.48; 95% CI 1.10 to 1.93), and bread (OR = 5.14; 95% CI 3.24 to 8.15) were associated with ”sufficient” physical activity. Conclusions: Our study shows that the total Elderly Diet Index score is the strongest predictor associated with ”sufficient” physical activity in a population of older adults. Thus, policies aiming to improve overall diet in order to achieve higher levels of physical activity are warranted. Full article

There is evidence that individuals’ compensatory health beliefs may be an important psychological driver of health behavior. Only recently, however, have researchers begun to develop and seek to validate instruments that are suited to measuring specific pairings of the diverse compensatory health beliefs that exist. The aim of this study was to provide support for key aspects of validity associated with the Exercise-Snacking Licensing Scale (ESLS), an instrument that was designed to assess individuals’ endorsement (or licensing) of unhealthy snacking behaviors around exercise. Participants (N = 1095) responded to a version of the ESLS that was designed to assess their licensing responses following either “light” or “tiring” physical activity, and completed additional instruments assessing dispositional, exercise-related, and diet-related constructs. Analyses indicated that scores derived from both versions of the ESLS (“light” and “tiring” physical activity) displayed a relatively consistent factor structure, favorable alpha coefficients, and meaningful correlations with variables that are theoretically aligned with licensing. Factor analytic procedures did, however, indicate that researchers may wish, in future, to consider the use (or not) of reverse-scored items within the ESLS. Together, these findings provide important insight into the structural, external, and generalizability aspects of validity for scores derived from the ESLS, and indicate that the ESLS may be a valuable instrument for the brief assessment of unhealthy licensing beliefs around exercise. Further use of the ESLS is encouraged to determine if and how these licensing beliefs actually influence subsequent snacking behaviors, and the potential downstream effects these beliefs may have in shaping health outcomes associated with exercise participation. Full article

Background: It is unclear how rural occupations and lifestyles may play a role in shaping physical activity and diet behaviors that contribute to the rural–urban obesity disparity. Methods: Data come from the prospective and observational South Dakota Rural Bone Health Study, which included adults aged 20–66 years in three groups: (1) non-rural non-Hutterite, (2) rural non-Hutterite, and (3) rural Hutterite. Physical activity data were collected using 7-day physical activity questionnaires, and hours per day in physical activity categories are reported. Diet data were collected using food frequency questionnaires, and food group servings per day (svg/day) are reported. Mixed models were generated to determine group differences in physical activity and diet outcomes, and marginal group means are presented. Results: Among females, both rural groups spent more time in moderate activity (4.8 ± 0.13 h/day and 4.7 ± 0.09 h/day vs. 3.5 ± 0.11 h/day, both p < 0.001) and vigorous activity (0.58 ± 0.03 h/day and 0.53 ± 0.02 h/day vs. 0.43 ± 0.03 h/day, both p < 0.01) and less time sitting (4.4 ± 0.13 h/day and 4.3 ± 0.09 h/day vs. 5.0 ± 0.11 h/day, both p < 0.001) on weekdays than non-rural groups. Hutterite females spent fewer hours in moderate activity (2.6 ± 0.08 h/day vs. 4.5 ± 0.11 h/day, p < 0.001) and vigorous activity (0.18 ± 0.02 h/day vs. 0.46 ± 0.02 h/day, p < 0.001) on weekend days compared to rural females. Hutterite females consumed more fruits (2.2 ± 0.06 svg/day vs. 1.7 ± 0.10 svg/day, p < 0.001) and vegetables (3.6 ± 0.08 svg/day vs. 2.7 ± 0.12 svg/day, p < 0.001) than rural females. Among males, both rural groups spent more time in moderate activity (4.9 ± 0.13 h/day and 6.1 ± 0.12 h/day vs. 3.0 ± 0.16 h/day, both p < 0.001) and less time sitting (4.1 ± 0.13 h/day and 3.4 ± 0.12 h/day vs. 6.0 ± 0.15 h/day, both p < 0.001) on weekdays compared to non-rural groups. Hutterite males spent less time in moderate activity (2.1 ± 0.10 h/day vs. 4.1 ± 0.11 h/day, p < 0.001) and vigorous activity (0.15 ± 0.04 h/day vs. 0.74 ± 0.04 h/day, p < 0.001) on weekend days compared to rural males. Hutterite males consumed more vegetables (3.0 ± 0.10 svg/day vs. 2.0 ± 0.11 svg/day, p < 0.001) than rural males. Conclusions: A rural occupation and lifestyle appear to contribute to differences in physical activity, while traditional rural lifestyle practices contribute to differences in diet. Full article

The aim of this study was to evaluate the feasibility and preliminary efficacy of an intervention comprised of regular exercise alongside educational and motivational support for participants’ avoidance of unhealthy compensatory eating. Forty-five sedentary individuals were randomized to an 8-week exercise plus compensatory eating avoidance program (CEAP; n = 24), or an 8-week exercise intervention only (control; n = 21). The feasibility and preliminary efficacy of the intervention were assessed using quantitative measures and supplemented with written responses to open-ended questions. The CEAP workshop was well-received; however, self-reported use of some of the included behavior change strategies was lower than expected. Post-intervention, there was evidence of reduced self-reported compensatory eating for participants in the CEAP group but not controls, with CEAP participants also reporting greater use of coping plans relative to controls post-intervention. The exercise program had benefits for waist circumference, body fat percentage, blood pressure, and cardiovascular fitness; however, improvements were similar between groups. Taken together, the results of this study indicate that the CEAP is feasible and may reduce compensatory eating around exercise; however, this effect is small. Potential modifications to the CEAP are discussed within the paper. Full article