Introduction: Addressing the demands of an ageing population requires a shift from individualised to collective prevention. Collective prevention adopts a socio-ecological approach, mobilising communities to improve population health. This study explores community nurses’ (CNs) perceptions of their role as health promoters. Methods: A qualitative study using participatory action research was conducted among 58 CNs from 18 community nursing care teams over 3 years. Data collection included 11 focus groups, a World Café session, and participant observations. Data were analysed through iterative thematic content analysis. Findings: From the analysis, 3 themes emerged: (1) CNs understanding of prevention, (2) their views on their roles and competencies, and (3)what are the facilitating and hindering factors to implement collective prevention. CNs’ understanding of prevention evolved from individual “aversion” of disease to a community-based vision centred on social connection. Four key roles for CNs were identified: detector, motivator, facilitator, and organiser. While a shared vision within teams facilitated progress, significant barriers included time pressure, productivity-based funding, and a lack of training in nursing curricula. Conclusion: CNs role in collective prevention is important, transitioning from task-oriented nursing care to community empowerment. However, sustainable implementation requires integrating collective prevention into national policy funding, and nursing education.

Abstract Background Insomnia symptoms are common in older adults. While observational studies suggest physical activity (PA) timing affects health outcomes, its effect on sleep remains unclear. We compared morning versus evening PA effects on insomnia severity and sleep quality in older adults with insomnia symptoms. Methods Eligible participants were aged 60–80 years with (sub)clinical insomnia (Insomnia Severity Index [ISI] score ≥10). In a randomized cross-over trial, participants engaged in coached PA in the morning (10:00–11:00) or evening (19:30–20:30) for 14 days each. ISI scores were assessed post-intervention. Objective sleep parameters—duration, latency, efficiency, and timing—were assessed with a Withings Sleep Analyzer under the mattress. Subjective sleep quality was reported daily via smartphone app. Salivary dim light melatonin onset (DLMO) was measured on the final day of each intervention. Results Of 37 participants (mean ISI 14.3 ± 3.3), 27 completed the study (mean age 69.8 ± 5; 63% women). ISI scores improved after both morning (Δ -2.5; 95% CI: -1.14, -3.83) and evening (Δ -2.0; 95% CI: -0.63, -3.38) activity relative to baseline, but were not different between interventions. Compared to evening activity, sleep midpoint occurred earlier with morning activity (03:40 vs 04:00; Δ -20 min; 95% CI: -31, -8). No differences in subjective sleep quality or DLMO were found. Exploratory analyses suggested insomnia scores improved specifically in late chronotypes following morning activity. Conclusions While morning vs. evening PA timing did not impact most sleep quality measures, it influenced sleep timing. Larger studies are needed to define optimal and personalized PA timing for improving sleep.

Adolescent nicotine use has increased recently. Detailed insights on nicotine use remain limited but are essential for effective prevention and intervention strategies. This study provides recent school-based data to enhance understanding of nicotine use among Dutch secondary school students. A cross-sectional survey was conducted among students from five Dutch secondary schools participating in a prevention programme (Vaping #yourchoice). Self-reported data were collected via a school-wide survey and a targeted survey among students identified by school staff as likely nicotine users. Results presented here combine data from both recruitment strategies. Measures included demographics, nicotine use patterns (e.g. age at first use, product type and frequency), perceived parental awareness, perceived addiction, quit attempts, and self-reported health complaints. Of all 978 respondents (mean age 14.5 years), 457 reported ever using nicotine of whom 90

Background and aim:Sustained lifestyle changes are crucial for the remission of type 2 diabetes (T2D) but remain challenging. Citizen initiatives using peer coaching and self-management may offer a promising alternative to professional medical care. This study evaluated Your Lifestyle As Medicine (YLAM), a Dutch citizen initiative for people with T2D. We aimed to assess its impact on metabolic parameters and to examine participants' engagement. Methods:This observational study analysed self-reported data on weight, waist circumference, fasting glucose and glycated haemoglobin (HbA1c) from participants in YLAM's online community. Participants could report their self-measured data on a weekly basis. Linear mixed-model analyses, stratified by sex, were used to assess changes in metabolic parameters over time. Additionally, we evaluated participants' engagement through reporting duration and weekly reporting rates. Results:We assessed all 232 people with T2D who reported multiple measurements for at least 3 months. The median reporting duration was 11.2 months (IQR 4.6-26.5). Weekly reporting rates were 59% for weight, 55% for waist circumference and 52% for fasting glucose, and 12-weekly reporting rates were 49% for HbA1c. Overall, mean weight, waist circumference, fasting glucose and HbA1c improved in the first year in both women and men. More specifically, weight decreased by 7.2 kg in women (95% CI -7.6 to -6.8) and by 7.4 kg in men (95% CI -8.0 to -6.8). This represented a mean relative weight loss of 9.0% (SD 7.7) and 8.6% (SD 6.5), respectively. Waist circumference decreased by 8.9 cm in women (95% CI -9.4 to -8.5) and by 8.5 cm in men (95% CI -9.1 to -7.8). Fasting glucose decreased by 1.15 mmol/L in women (95% CI -1.32 to -0.98) and by 0.49 mmol/L in men (95% CI -0.75 to -0.23). HbA1c decreased by 14.5 mmol/mol in women (95% CI -17.4 to -11.6) and by 9.1 mmol/mol in men (95% CI -13.2 to -5.0). Of all participants, 44% reported data for longer than a year and demonstrated sustained improvements in weight and waist circumference in the long term. Conclusion:This study provides evidence for substantial and sustained improvements in self-reported metabolic parameters in people with T2D engaged in a citizen initiative without medical supervision. Initiatives like YLAM offer a promising, accessible and scalable strategy to address the growing burden of lifestyle-related diseases.

Introduction Physical activity (PA) decreases the risk of mental diseases. Although PA timing has been hypothesised to affect mental health outcomes, no large-scale epidemiological cohort studies have been performed. We investigated the association between PA timing and incident depression in the general population.Methods A total of 89 934 European participants (62.4±7.9 years, age range: 43–79 years, 44.8% men) without a history of depression were analysed. Hourly PA levels were derived from accelerometry data and standardised for the total daily amount of PA. Participants were followed for a maximum of 8.5 years. Risks of incident depression dependent on individually standardised hourly PA level were assessed using Cox proportional-hazards models adjusted for potential confounders.Results During follow-up, 1748 participants developed depression. Using the hourly standardised PA levels, we observed higher risks for incident depression with higher night-time PA (eg, at 4:00 HR 1.35; 95% CI 1.28, 1.41), and lower depression risks with higher morning-time PA (eg, at 9:00 HR 0.85; 95% CI 0.81, 0.89). Also in the subgroup analysis, compared with participants who were most active during midday, participants with most PA in the early morning had a lower risk for incident depression (HR 0.80; 95% CI 0.68, 0.95). No differences were observed when analyses were stratified for sex, chronotype or for the overall objective PA level.Conclusions Morning PA was associated with lower risk and night-time PA was associated with increased risk of depression. These findings may suggest that future intervention studies should include timing as an additional dimension of PA as a possible treatment and prevention strategy for depression.

There are increased indications that physical activity timing, irrespective of intensity, impacts insomnia and circadian clock function. Here, we describe the rationale and design of a randomized cross-over study, called ON TIME, to examine the effects of (changing) physical activity timing on insomnia severity and on multiple exploratory outcomes that are linked to circadian clock function. We will conduct a randomized cross-over trial in 40 healthy older adults (aged 65 to 75 years) with subclinical or clinical insomnia (Insomnia Severity Index (ISI) scores of ≥ 10) from the Dutch municipality of Leiden and surroundings. Participants will undergo 3 intervention periods (14 days each) consecutively: one sedentary period and two periods of increased physical activity (one period with morning activity and one period with evening activity). The intervention periods are separated by a wash-out period of 1 week. In both active intervention arms, participants will follow coached or uncoached outdoor physical exercise sessions comprising endurance, strength, and flexibility exercises for 14 days. The primary outcome is change in insomnia severity as measured by the ISI. Additional exploratory outcomes include multiple components of objective sleep quality measured with tri-axial accelerometry and subjective sleep quality assessed by questionnaires as well as dim light melatonin onset and 24-h rhythms in heart rate, heart rate variability, breathing rate, oxygen saturation, mood, and objective emotional arousal and stress. Additionally, we will collect diary data on eating patterns (timing and composition). Finally, fasting blood samples will be collected at baseline and after each intervention period for measurements of biomarkers of metabolic and physiological functioning and expression of genes involved in regulation of the biological clock. We anticipate that this study will make a significant contribution to the limited knowledge on the effect of physical activity timing. Optimizing physical activity timing has the potential to augment the health benefits of increased physical exercise in the aging population. Trial was approved by the Medical Ethics Committee Leiden, The Hague, Delft, The Netherlands (June, 2023). The trial was registered in the CCMO-register https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm under study ID NL82335.058.22 and named (“Ouderen op tijd in beweging” or in English “Older adults exercising on time”). At time of manuscript submission, the trial was additionally registered at ClinicalTrials.gov under study ID: NL82335.058.22 and is awaiting approval.

The Dutch population is rapidly ageing, and a growing number of people are suffering from age-related health problems such as obesity, cardiovascular diseases and diabetes. These diseases can be prevented or delayed by adapting healthy behaviours. However, making long-lasting lifestyle changes has proven to be challenging and most individual-based lifestyle interventions have not been effective on the long-term. Prevention programs focused on lifestyle should involve the physical and social context of individuals, because the (social) environment plays a large role in both conscious and unconscious lifestyle choices. Collective prevention programmes are promising strategies to mobilize the potential of the (social) environment. However, little is known about how such collective prevention programs could work in practice. Together with community care organization Buurtzorg, we have started a 5 year evaluation project to study how collective prevention can be practised in communities. In this paper, we discuss the potential of collective prevention and explain the methods and goals of our study.

AIMS Little is known about the impact of daily physical activity timing (here referred to as 'chronoactivity') on cardiovascular disease (CVD) risk. We aimed to examined the associations between chronoactivity and multiple CVD outcomes in the UK Biobank. METHODS AND RESULTS physical activity data were collected in the UK-Biobank through triaxial accelerometer over a 7-day measurement period. We used K-means clustering to create clusters of participants with similar chronoactivity irrespective of the mean daily intensity of the physical activity. Multivariable-adjusted Cox-proportional hazard models were used to estimate hazard ratios (HRs) comparing the different clusters adjusted for age and sex (model 1), and baseline cardiovascular risk factors (model 2). Additional stratified analyses were done by sex, mean activity level, and self-reported sleep chronotype. We included 86 657 individuals (58% female, mean age: 61.6 [SD: 7.8] years, mean BMI: 26.6 [4.5] kg/m2). Over a follow-up period of 6 years, 3707 incident CVD events were reported. Overall, participants with a tendency of late morning physical activity had a lower risk of incident coronary artery disease (HR: 0.84, 95%CI: 0.77, 0.92) and stroke (HR: 0.83, 95%CI: 0.70, 0.98) compared to participants with a midday pattern of physical activity. These effects were more pronounced in women (P-value for interaction = 0.001). We did not find evidence favouring effect modification by total activity level and sleep chronotype. CONCLUSION Irrespective of total physical activity, morning physical activity was associated with lower risks of incident cardiovascular diseases, highlighting the potential importance of chronoactivity in CVD prevention.

Veroudering is het oplopen van schade aan cellen in het lichaam, wat een negatief effect heeft op de functie van organen en de kans op sterfte verhoogt. De stijging van de jaarlijkse sterftekans is een maat om veroudering te meten. Om gezond oud te worden is een gezonde leefstijl met een gematigd en gebalanceerde dieet voeding het belangrijkste. Dit hoofdstuk gaat in op het verouderingsproces en de rol van voeding daarbij, alsmede de voedingsbehoefte en lichaamssamenstelling bij ouderdom.

Background Physical inactivity has contributed to the current prevalence of many age-related diseases, including type 2 diabetes and cardiovascular disease. Peer coach physical activity intervention are effective in increasing long term physical activity in community dwelling older adults. Linking peer coach physical activity interventions to formal care could therefore be a promising novel method to improve health in inactive older adults to a successful long-term physical activity intervention. Methods We evaluated the effects of linking a peer coach physical activity intervention in Leiden, The Netherlands to primary care through an exercise referral scheme from July 2018 to April 2020. Primary care practices in the neighborhoods of three existing peer coach physical activity groups were invited to refer patients to the exercise groups. Referrals were registered at the primary care practice and participation in the peer coach groups was registered by the peer coaches of the exercise groups. Results During the study, a total of 106 patients were referred to the peer coach groups. 5.7% of patients participated at the peer coach groups and 66.7% remained participating during the 1 year follow up. The number needed to refer for 1 long term participant was 26.5. The mean frequency of participation of the referred participants was 1.2 times a week. Conclusion Linking a peer coach physical activity intervention for older adults to a primary care referral scheme reached only a small fraction of the estimated target population. However, of the people that came to the peer coach intervention a large portion continued to participate during the entire study period. The number needed to refer to engage one older person in long term physical activity was similar to other referral schemes for lifestyle interventions. The potential benefits could be regarded proportional to the small effort needed to refer.

Older people are often affected by impaired organ and bodily functions resulting in multimorbidity and polypharmacy, turning them into the main user group of many medicines. Very often, medicines have not specifically been developed for older people, causing practical medication problems for them like limited availability of easy to swallow formulations, easy to open packaging and dosing instructions for enteral administration. In 2020, the European Medicines Agency (EMA) published a reflection paper ‘Pharmaceutical development of medicines for use in the older population’, which discusses how the emerging needs of an ageing European population can be addressed by medicines regulation. The paper intends to help industry to better consider the needs of older people during pharmaceutical/clinical medicines development by summarising data on the most relevant topics, providing early suggestions on how to move forward and prompting expert discussions and studies into knowledge gaps. Topics include patient acceptability, (dis)advantages of an administration route, formulation, dosage form, packaging, dosing device and user instruction. While the paper is directed at older people and the pharmaceutical industry, the reflections are also relevant to younger patients with similar disease‐related needs and of value to other stakeholders parties, e.g., healthcare professionals, academics, patients and caregivers, as the paper makes clear what can be expected from industry and where collaborative work is needed. This commentary provides an overview of the different steps in the development of the reflection paper, discusses points considered most controversial and/or subject to (multidisciplinary) expert discussions and indicates their value for real world clinical practice.

In the study by Verstraeten et al. higher rates of mortality were observed in Caribbean islands that have a higher degree of autonomy to their original colonizer. This study highlights how population determinants can affect population health. Geoffrey Rose was one of the first to propose to study population determinants and use a population strategy of prevention to create healthy populations. The study by Verstraeten et al. indicates the importance of population determinants and challenges us to think about our own population determinants. We experience an epidemic of obesity, diabetes type 2 and cardiovascular disease in the Netherlands. The current approach of identifying high risk individuals and individually targeting has not brought this epidemic to an end. A population approach could be a promising alternative to greatly improve public health.

This chapter discusses ageism and experiences of older adults in the Netherlands. It seeks to empower, elevate, and amplify the voices and experiences of older adults through the production of the website wijencorona.nl, which collected their stories during the first few months of the COVID-19 pandemic. It also reviews the 'intelligent' lockdown by the Dutch government, which is an approach to managing the pandemic that appealed to solidarity and self-discipline in order to comply with social distancing and staying at home. The chapter delves into the views of individuals aged 50 years and older that experienced COVID-19 in an urban or rural context. It uses the stories to discover opportunities for rural and urban futures.

Many age-related diseases can be prevented or delayed by daily physical activity. Unfortunately, many older adults do not perform physical activity at the recommended level. Professional interventions do not reach large numbers of older adults for a long period of time. We studied a peer-coach intervention, in which older adults coach each other, that increased daily physical activity of community dwelling older adults for over 6 years. We studied the format and effects of this peer coach intervention for possible future implementation elsewhere. Through interviews and participatory observation we studied the format of the intervention. We also used a questionnaire (n = 55) and collected 6-min walk test data (n = 261) from 2014 to 2016 to determine the motivations of participants and effects of the intervention on health, well-being and physical capacity. Vitality Club is a self-sustainable group of older adults that gather every weekday to exercise coached by an older adult. Members attend on average 2.5 days per week and retention rate is 77.5% after 6 years. The members perceived improvements in several health measures. In line with this, the 6-min walk test results of members of this Vitality Club improved with 21.7 meters per year, compared with the decline of 2-7 meters per year in the general population. This Vitality Club is successful in durably engaging its members in physical activity. The members perceive improvements in health that are in line with improvements in a physical function test. Because of the self-sustainable character of the intervention, peer coaching has the potential to be scaled up at low cost and increase physical activity in the increasing number of older adults.

Physical activity (PA) is important for maintaining good physical health. WHO recommends 150 min of PA per week to the older population but many older people do not meet this recommendation. The increasing use of mobile technology among elderly provides an opportunity to increase PA. This systematic review was aimed at the usability, acceptability and effectiveness of mHealth (including smartphone, mobile phone, tablet apps, mobile text messages) to increase PA in older people above the age of 55. A literature search related to mHealth, PA and older people was conducted in PubMed, Embase, Web of science and COCHRANE library. The search generated 829 articles, after the screening of articles and reference lists, ten studies were included in the review. Included studies were diverse in the aspects of study design, intervention mode, duration, frequency of reminders and assessment measures. The results of this review indicated that mHealth interventions with motivational back up may be usable, acceptable and beneficial for the maintenance and improvement of PA in the short term. However, the findings are inconclusive about the difference in effectiveness between simple (mobile text message) and complex mHealth interventions (app monitoring with sensors), the optimal frequency for activity reminders and on the long term effectiveness of mHealth.

Judith S. Hochman, MD; Harmony R. Reynolds, MD; Sripal Bangalore, MD, MHA; Sean M. O’Brien, PhD; Karen P. Alexander, MD; Roxy Senior, MD, DM; William E. Boden, MD; Gregg W. Stone, MD; Shaun G. Goodman, MD, MSc; Renato D. Lopes, MD, PhD; Jose Lopez-Sendon, MD, PhD; Harvey D. White, MB ChB, DSc; Aldo P. Maggioni, MD; Leslee J. Shaw, PhD; James K. Min, MD; Michael H. Picard, MD; Daniel S. Berman, MD; Bernard R. Chaitman, MD; Daniel B. Mark, MD, MPH; John A. Spertus, MD, MPH; Derek D. Cyr, PhD; Balram Bhargava, MD, DM; Witold Ruzyllo, MD, PhD; Gurpreet S. Wander, DM; Alexander M. Chernyavskiy, MD; Yves D. Rosenberg, MD, MPH; David J. Maron, MD; for the ISCHEMIA Research Group