RESEARCH ARTICLE
Open Access
Effectiveness of Start to Run, a 6-week training
program for novice runners, on increasing
health-enhancing physical activity: a controlled
study
Linda Ooms1,2*, Cindy Veenhof1 and Dinny H de Bakker1,2
Abstract
Background: The use of the organized sports sector as a setting for health-promotion is a relatively new strategy.
In the past few years, different countries have been investing resources in the organized sports sector for
promoting health-enhancing physical activity. In the Netherlands, National Sports Federations were funded to
develop and implement “easily accessible” sporting programs, aimed at the least active population groups. Start to
Run, a 6-week training program for novice runners, developed by the Dutch Athletics Organization, is one of these
programs. In this study, the effects of Start to Run on health-enhancing physical activity were investigated.
Methods: Physical activity levels of Start to Run participants were assessed by means of the Short QUestionnaire to
ASsess Health-enhancing physical activity (SQUASH) at baseline, immediately after completing the program and six
months after baseline. A control group, matched for age and sex, was assessed at baseline and after six months.
Compliance with the Dutch physical activity guidelines was the primary outcome measure. Secondary outcome
measures were the total time spent in physical activity and the time spent in each physical activity intensity
category and domain. Changes in physical activity within groups were tested with paired t-tests and McNemar
tests. Changes between groups were examined with multiple linear and logistic regression analyses.
Results: In the Start to Run group, the percentage of people who met the Dutch Norm for Health-enhancing
Physical Activity, Fit-norm and Combi-norm increased significantly, both in the short- and longer-term. In the
control group, no significant changes in physical activity were observed. When comparing results between groups,
significantly more Start to Run participants compared with control group participants were meeting the Fit-norm
and Combi-norm after six months. The differences in physical activity between groups in favor of the Start to Run
group could be explained by an increase in the time spent in vigorous-intensity activities and sports activities.
Conclusions: Start to Run positively influences levels of health-enhancing physical activity of participants, both in
the short- and longer-term. Based on these results, the use of the organized sports sector as a setting to promote
health-enhancing physical activity seems promising.
Keywords: Sports setting, Sporting organizations, Running, Health-enhancing physical activity, Controlled study,
Follow-up
* Correspondence: I.ooms@nivel.nl
1Netherlands Institute for Health Services Research (NIVEL), PO Box 1568,
3500 BN, Utrecht, The Netherlands
2Scientific Center for Transformation in Care and Welfare (Tranzo), Tilburg
University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
© 2013 Ooms et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
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Background
The positive effects of physical activity on health and
mortality have been well established. Participation in
regular physical activity decreases the risk of coronary
heart disease, stroke, type 2 diabetes mellitus, certain
cancers (e.g. breast cancer, colon cancer), osteoporosis,
obesity and falls [1-7]. Moreover, there is some evidence
that physical activity is positively associated with mental
health and quality of life [8,9].
Given the numerous health benefits of physical activity
participation, various guidelines have been published on
the recommended volume and intensity of physical activity
for healthy adults. Commonly used guidelines are those de-
veloped by the American College of Sports Medicine
(ACSM) and the American Heart Association (AHA). To
promote and maintain health, the ACSM and AHA recom-
mend that: “All healthy adults aged 18 to 65 years need
moderate-intensity aerobic (endurance) physical activity
for a minimum of 30 minutes on at least five days each
week or vigorous-intensity aerobic physical activity for a
minimum of 20 minutes on at least three days each week.
Also, combinations of moderate- and vigorous-intensity
activity can be performed to meet this recommenda-
tion.” [10] Similar guidelines have been adopted in the
Netherlands and are referred to as the Dutch Norm for
Health-enhancing Physical Activity (DNHPA) and the
Fit-norm. Someone who meets at least one of the two
guidelines adheres to the so-called “Combi-norm”, the
third norm used in the Netherlands (see Table 1) [11].
Despite the existence of these guidelines, more than
one third of the Dutch adult population does not engage
in sufficient physical activity: in 2009, 58% of the Dutch
adult population met the DNHPA, 33% met the Fit-
norm, and 62% met the Combi-norm [11].
One of the ways of being physically active is through
organized sports. There is large potential for the orga-
nized sports sector as a setting in which to promote
health-enhancing physical activity to the general popula-
tion, given the large numbers of participants, the extent
of community reach and the availability of many differ-
ent sports and professional trainers. Moreover, physical
activity opportunities are provided on a continuous basis
(i.e. people can play sport on a weekly basis at a sports
club). This is in contrast with physical activity interven-
tions, which are mostly of short or limited duration. In
this way, the organized sports sector can also play an
important role in maintaining physical activity levels.
Another positive aspect of the organized sports setting is
the possibility to socially interact with other people. As
social support has been identified as a determinant of
physical
activity
[12-14],
participation
in
organized
sports may lead to greater physical activity benefits than
other forms of physical activity. It is, for example, well
known that people who are involved in (organized)
sports are significantly more likely to meet physical ac-
tivity guidelines than those people who are not [11].
However, there are still people who are doing sports
activities below the recommend levels of physical activity
(i.e. with regard to frequency, duration and/or intensity)
and there are also people who never play sports at all.
According to recent data, 56% of the Dutch population
plays sports at least once a week. For the European
Union countries combined this percentage is only 40%
[15]. This shows the importance of further increasing
participation rates in (organized) sports.
Sports promotion has a long history in many coun-
tries, but the use of the organized sports sector as a set-
ting to gain control over health issues and unhealthy
behaviors, like physical inactivity, is a relatively new
strategy [16-19]. This settings-based health promotion
approach is based on the idea that changes in people’s
health and health behavior are easier to achieve if health
promoters focus on settings instead of individuals. It has
also been applied to other settings, like schools and
Table 1 Dutch physical activity guidelines for adults
Norm
Description
Dutch Norm for Health-enhancing
Physical Activity (DNHPA)
Adults (18-54 years):
Thirty minutes or more of at least moderate-intensity aerobic (endurance) physical activity
(≥ 4 MET; combined intensity score SQUASH ≥ 3) on at least five days each week.
Adults (55 years and older):
Thirty minutes or more of at least moderate-intensity aerobic (endurance) physical activity
(≥ 3 MET; combined intensity score SQUASH ≥ 3) on at least five days each week.
Fit-norm
Adults (18-54 years):
Twenty minutes or more of vigorous-intensity physical activity
(≥ 6.5 MET; combined intensity score SQUASH ≥ 6) on at least three days each week.
Adults (55 years and older):
Twenty minutes or more of vigorous-intensity physical activity
(≥ 5 MET; combined intensity score SQUASH ≥ 6) on at least three days each week.
Combi-norm
Meeting at least one of the previous mentioned norms (i.e. the DNHPA or Fit-norm).
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workplaces [20]. The approach builds on the Ottawa
Charter of 1986 that stated: “Health is created and lived
by people within the settings of their everyday life; where
they learn, work, play and love.” [21]
In the past few years, different countries have been
investing resources in the organized sports sector for pro-
moting health-enhancing physical activity: in Australia, for
example, State Sporting Associations were funded to de-
velop healthy (e.g. smoke-free settings) and welcoming en-
vironments in their associated clubs, to ultimately increase
participation in sport for health benefits [16,18]. In the
Netherlands, the Dutch Ministry of Health, Welfare and
Sport initiated the National Action Plan for Sport and Ex-
ercise (NAPSE). This program was aimed at increasing the
number of Dutch people meeting physical activity guide-
lines [17]. Within the NAPSE, National Sports Federations
were funded to develop and implement sporting programs
tailored to the needs and abilities of the least active popula-
tion groups, i.e. making sports activities easily accessible
and creating a welcoming sports environment for these tar-
get groups. A total of fourteen “easily accessible” sporting
programs were developed and implemented in different lo-
cations in the Netherlands. Start to Run, a 6-week training
program for novice runners, developed by the Dutch Ath-
letics Organization, is one of these programs. Participants
are given the opportunity to become acquainted with the
different aspects of running. Afterwards, they are stimu-
lated to continue running as member of a local athletics
club or the Dutch Athletics organization.
Running is a feasible form of a vigorous-intensity phys-
ical activity; it is not time consuming, it can be done any-
where and at any time, and only a pair of running shoes is
needed. As a result, running is a popular way to become
physically active, and there are many different training pro-
grams for novice runners available. There is strong litera-
ture on the health benefits of running in general and
different studies have been published about (the prevention
of) running related injuries [e.g. 22-26]. So far, no studies
have been conducted, however, about the effectiveness of
running programs on increasing health-enhancing physical
activity levels. In general, there is a lack of research and
evaluation of activities conducted in sports settings. Im-
provements in the research in this area are desirable. Par-
ticularly, there is a need for controlled study designs,
incorporating both the short- and longer-term effects of
sporting programs and activities, to move towards provid-
ing evidence-based programs [27,28].
Therefore, the aim of this study was to assess the effect-
iveness of Start to Run on increasing health-enhancing
physical activity, both in the short- and longer-term, and in
comparison with a control group. The results of the
current study will contribute to the knowledge base
concerning the effectiveness of programs initiated in sports
settings, and will, consequently, provide further insight into
the role of the organized sports sector in promoting health-
enhancing physical activity. The study findings may be of
interest to policy makers in the areas of sports and health.
Also, sporting organizations may use the results when de-
veloping and implementing similar sporting programs.
Methods
Study design
To assess the effectiveness of Start to Run on increasing
health-enhancing physical activity, a controlled study de-
sign was used. The study was performed according to
Dutch legislation on privacy. The privacy regulations of
the study were approved by the Dutch Data Protection
Authority. According to Dutch legislation, approval by a
medical ethics committee was not obligatory, as partici-
pants were not subjected to procedures, nor were they
required to follow rules of behavior (i.e. participants
were approached for the study after they had voluntarily
registered for the Start to Run training program).
Study population
Start to Run participants
Start to Run is aimed at adult novice runners who want to
learn to run continuously for at least three kilometers. The
program is offered two times a year (in March and Septem-
ber) by athletics clubs and running stores in more than
hundred different locations in the Netherlands. Partici-
pants are recruited locally using different recruitment strat-
egies (e.g. by advertisements in local media, posters, and
flyers). For this study, the Dutch Athletics Organization
provided data (i.e. name, email address, sex and age) of 513
individuals who had registered for the Start to Run pro-
gram in March 2009. These individuals were sent an email
with information about the study and a link to an online
baseline questionnaire. By completing the baseline ques-
tionnaire, the Start to Run participants gave consent for
participation in the study.
Control group participants
The control group consisted of members of the Dutch
Health Care Consumer Panel of the Netherlands Insti-
tute for Health Services Research (NIVEL). This panel
contains about three thousand individuals aged 18 years
and older and is representative for the Dutch population
with regard to age and sex. The panel members are
questioned four times a year about health care, health
insurance, and other related issues [29]. For the current
study, 1328 panel members were approached. Control
group participants did not receive any intervention.
Moreover, they were asked if they had participated in
the Start to Run program or any of the other NAPSE
sporting programs before or during the study period, as
this could influence results. Subsequently, control group
members who had done so were excluded from the
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study. Compared with the Start to Run group, the con-
trol group members were significantly older, and were
more likely to be male. As physical activity levels differ
by age and sex [15,30], the control group was matched
with the Start to Run group on age and sex.
Start to Run program
During the 6-week training period, except for the last
week, participants trained three times a week: one time in
a group under guidance of one or more professional
coaches (i.e. one coach per 15 participants), and two times
individually. As a rule, training days were followed by rest
days. In the last week, participants could test their running
abilities in a three kilometers test run. Participation in this
run, however, was not obligatory. A guided training ses-
sion lasted approximately 90 minutes and consisted of a
theoretical part (20-30 minutes), followed by a practical
part (60-70 minutes). During the theoretical part one of
the following theory items was discussed: health benefits
of running and (prevention of) running-related injuries,
running clothes and shoes, proper food and drinks (before,
during and after training), physiological changes during
running and training with a heart rate monitor. The prac-
tical part consisted of a warming-up, a run-walk part and
a cooling-down. Participants were instructed to walk and
perform light (stretching) exercises to warm up and to
cool down. During the warming-up also attention was
paid to running technique (e.g. proper posture, stride, foot
strike, breathing) and running technique exercises. The
run-walk part consisted of a combination of running and
walking, whereby running time and distance were grad-
ually increased during the training period. On average
there were 35 participants per group session, guided by
two professional coaches. An individual training session
lasted approximately 45 minutes and consisted, just as the
practical part of the group sessions, of a warming-up, a
run-walk part and a cooling-down. Participants received
instructions (e.g. training schedule, running tips) for the
individual training sessions during the group sessions from
their coach(es) and through weekly emails from the Dutch
Athletics Organization. After completing the program,
participants were stimulated to continue running. Partici-
pants were personally informed by their coach(es) about
membership from this or other local athletics clubs. Add-
itionally, participants received several emails from the
Dutch Athletics Organization with information about local
athletics clubs and an individual runner membership of
the Dutch Athletics Organization.
Outcome measures
Demographic data were collected for each participant,
including age and sex. The level of physical activity was
assessed by the Short QUestionnaire to ASsess Health-
enhancing physical activity (SQUASH). This instrument
has proven to be fairly reliable and reasonably valid in
ordering subjects according to their level of physical ac-
tivity in an adult population [31]. The SQUASH mea-
sures the amount of physical activity for five domains:
commuting activities, leisure-time activities, sports activ-
ities, household activities, and activities at work and
school. It consists of three main queries, namely days
per week, average time per day, and self-reported inten-
sity (light, moderate or vigorous). An average week in
the past month was taken as reference period. Using the
Ainsworth Compendium of Physical Activities, a meta-
bolic equivalent (MET) value was assigned to all physical
activities [32]. Based on age and assigned MET values,
physical activities were subdivided into three intensity
categories: light, moderate and vigorous. For adults aged
18-54 years, the following cut-off values were used: < 4.0
MET (light), 4.0 to 6.5 MET (moderate), ≥ 6.5 MET
(vigorous). For adults aged ≥ 55 years, the cut-off values
were: < 3.0 MET (light), 3.0 to 5.0 MET (moderate), ≥
5.0 MET (vigorous). This MET category was combined
with self-reported intensity for each activity, resulting in
a combined intensity score ranging from 1 to 9, with 1
being light MET and light self-reported intensity to 9 be-
ing vigorous MET and vigorous self-reported intensity.
The classification of physical activities according to the
combined intensity score was as follows: < 3 (light), 3 to
6 (moderate), ≥ 6 (vigorous). Subsequently, the following
outcome measures were calculated: compliance with the
Dutch physical activity guidelines (see Table 1); minutes
per week spent in light-, moderate- and vigorous-intensity
activities; minutes per week spent in commuting activities,
leisure-time activities, sports activities, household activities,
and activities at work and school; and total minutes per
week spent in physical activity. Compliance with the Dutch
physical activity guidelines was seen as the primary out-
come measure, as these guidelines specify the amount of
physical activity necessary to obtain health benefits. The
other physical activity outcome measures were used to ex-
plain possible changes in physical activity behavior in more
detail.
Start to Run participants were assessed by means of an
online questionnaire at baseline (t = 0), immediately after
completing the program (t = 6 weeks) and six months after
baseline (t = 6 months: i.e. 4.5 months after cessation of
the Start to Run training program). Control group partici-
pants were assessed at the start of the study (t = 0) by
means of a postal questionnaire and six months later (t = 6
months) by means of a postal or an online questionnaire.
The assessments of the control group were performed in
the same months as the assessments of the Start to Run
group. To increase response rates, reminders were sent
one week (for online questionnaires) or two weeks (for
postal questionnaires) later.
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Sample size
The sample size was based on detecting a difference in
habitual physical activity according to the Fit-norm. As
running is a vigorous-intensity activity, it was expected
that the Start to Run program would mostly affect the
percentage of people who met the Fit-norm. To detect a
20% difference between the Start to Run group and the
control group six months after baseline, with a two-
sided 5% significance level and a power of 80%, a sample
size of 89 participants per group was necessary. Given
the sample size of both the Start to Run group (n=513)
and the control group (n=1328), it was expected that
sufficient participants were included in the study.
Statistical analysis
All statistical analyses were performed using Stata stat-
istical software version 10.1 (Stata Corporation, College
Station, Texas). Descriptive statistics were used to de-
scribe the main characteristics of each group and to ex-
plore
baseline
comparability.
Means
and
standard
deviations were calculated for continuous measures,
while percentages were calculated for dichotomous
measures. Differences between groups with regard to
age and sex were tested with an independent t-test and
chi-squared test, respectively. Changes in physical activ-
ity within groups were examined with paired t-tests for
continuous physical activity measures and McNemar
tests for dichotomous physical activity measures. To
compare changes in physical activity between groups,
multiple regression analyses (linear regression was used
for continuous measures and logistic regression was
used for dichotomous measures) were performed with
physical activity level at six months as the dependent
variable and group (Start to Run group versus control
group, with the control group as the reference category)
as the independent variable. Adjustments were made
for baseline physical activity levels, by using this vari-
able as a covariate in the regression model. To check if
the results of the continuous physical activity outcome
measures were influenced by outliers, also more robust
regression techniques were applied: these techniques in-
cluded the use of robust standard errors (i.e. Huber-
White robust estimates of the standard errors and boot-
strap estimates of the standard errors). As these robust
regression techniques did not yield different results and
conclusions, these results will not be presented here. P-
values
less than 0.05 were
considered statistically
significant.
Results
Study participants
The flow of participants through the study is shown in
Figure 1.
Start to Run participants
Of 513 persons approached, 244 completed the baseline
assessment. Of these 244 persons, 125 completed the as-
sessment at six weeks. Two persons were excluded from
analysis, because compliance with the Dutch physical ac-
tivity guidelines could not be calculated. Therefore, data
of 123 persons were available to evaluate changes in
physical activity after six weeks. All persons who com-
pleted
the
baseline
assessment
(n=244)
were
also
approached for the assessment at six months, irrespect-
ive if they had completed the assessment at six weeks.
This was done to get an optimal response for compari-
sons with the control group. Of 244 persons approached,
104 completed the assessment at six months. Subse-
quently, four persons were excluded from analysis, be-
cause
compliance with
the
Dutch physical
activity
guidelines could not be calculated. Consequently, data of
100 persons were available to evaluate changes in phys-
ical activity after six months and to make comparisons
with the control group. There were 78 Start to Run par-
ticipants who completed all three assessments (not
shown in Figure 1). However, to optimally use data and
maintain study power (i.e. for comparisons with the
control group a sample size of 89 participants per group
was necessary), all available cases were included in the
analyses. This means that analyses were performed on
123 and 100 Start to Run participants for effects after
six weeks and six months, respectively. Non-response
analyses revealed that Start to Run participants who did
not complete the assessment after six months were sig-
nificantly younger (37 ± 9 years vs. 40 ± 10 years) and
were more likely to be female (92.4% female vs. 70.0%
female) compared with those who did complete this as-
sessment. There were no significant differences in base-
line physical activity levels between respondents and
non-respondents.
Control group participants
Of 1328 persons approached, 940 completed the base-
line assessment. Of these 940 persons, 745 completed
the assessment at six months. Subsequently, 46 persons
were excluded from analysis due to participation in the
Start to Run program (n=2) or any of the other NAPSE
sporting programs (n=44). In addition, six other persons
were excluded, because compliance with the Dutch
physical activity guidelines could not be calculated. Of
the remaining 693 persons, 100 were matched to the
Start to Run group on age and sex.
Baseline characteristics of study participants
The baseline characteristics of the Start to Run group (i.e.
the
participants
who
completed
the
six
months
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assessment) and the control group are shown in Table 2.
The Start to Run participants had a mean age of 40 years
(SD=10) and the control group participants had a mean
age of 42 years (SD=9). The percentage of women was
70.0% in both groups. There were no significant differ-
ences in age and sex between groups. Matching was there-
fore successful. With regard to baseline physical activity
levels, the Start to Run participants spent significantly less
time in moderate-intensity physical activities (213 ± 453
min/week vs. 406 ± 596 min/week, p=0.01) and household
activities (552 ± 780 min/week vs. 919 ± 968 min/week,
p=0.004) compared with controls. For the remaining phys-
ical activity outcome measures, no significant differences
were found between groups at baseline.
Changes in physical activity
Changes in physical activity after six weeks
In Table 3, physical activity outcome measures are
presented for the Start to Run group at baseline and after
six weeks. At baseline, 43.9% of the Start to Run partici-
pants met the DNHPA, 53.7% met the Fit-norm, and
57.7% met the Combi-norm. After six weeks, these per-
centages increased significantly (p<0.0001) to 74.8%,
87.0%, and 91.1% for the DNHPA, Fit-norm, and Combi-
norm, respectively. Although more Start to Run partici-
pants met physical activity guidelines after six weeks, the
total time spent in physical activity did not change signifi-
cantly (2237 ± 1183 min/week vs. 1996 ± 1451 min/week,
p=0.08). However, there were significant changes in
Approached for study (n=513)
Start to Run group
Start to Run training 
program
Completed assessment after Start to 
Run training program (n=125)
Completed assessment six months after 
baseline  (i.e. 4.5 months after cessation of 
the Start to Run training program) (n=104)
Completed baseline assessment (n=244)
Analyzed (n=100)
• Excluded from analysis because 
compliance with the Dutch physical activity 
guidelines could not be calculated (n=4).
Analyzed (n=123)
• Excluded from analysis because 
compliance with the Dutch physical 
activity guidelines could not be 
calculated (n=2).
Approached for study (n=1328)
Completed assessment six months after 
baseline (n=745)
Completed baseline assessment (n=940)
Unmatched control group (n=693) 
• Excluded from analysis because of 
participation in Start to Run (n=2) or another 
NAPSE sporting program (n=44).
• Excluded from analysis because 
compliance with the Dutch physical activity 
guidelines could not be calculated (n=6).
Control group
t = 0
t = 6 weeks
t = 6 months
Analyzed (n=100)
• Control group matched by age and sex.
4.5 months
Figure 1 Flow of participants through the study.
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physical activity behavior within physical activity intensity
categories and domains, i.e. after six weeks, the Start to
Run participants spent more time in vigorous-intensity ac-
tivities (200 ± 205 min/week vs. 410 ± 298 min/week,
p<0.0001), commuting activities (70 ± 110 min/week vs.
98 ± 155 min/week, p=0.01), leisure-time activities (240 ±
268 min/week vs. 301 ± 343 min/week, p=0.02) and sports
activities (101 ± 143 min/week vs. 243 ± 173 min/week,
p<0.0001), while less time was spent in light-intensity ac-
tivities (1827 ± 1192 min/week vs. 1423 ± 1296 min/week,
p=0.002) and activities at work and school (1293 ± 940
min/week vs. 792 ± 794 min/week, p<0.0001).
Changes in physical activity after six months: comparisons
within groups
In Table 4, physical activity outcome measures are
presented for both the Start to Run group and control
group at baseline and after six months. In the Start to
Run group, the percentage of people who met the
DNHPA (48.0% vs. 64.0%, p=0.004), Fit-norm (56.0% vs.
82.0%, p<0.0001), and Combi-norm (58.0% vs. 84.0%,
p<0.0001) increased significantly between baseline and
six months. These changes were accompanied by a sig-
nificant increase in the total time spent in physical activ-
ity (2265 ± 1251 min/week vs. 2536 ± 1210 min/week,
p=0.04). Also, significant changes in physical activity be-
havior were observed within physical activity intensity
categories and domains, i.e. after six months, the Start
to Run participants spent more time in vigorous-
intensity activities (238 ± 250 min/week vs. 382 ± 306
min/week, p<0.0001), commuting activities (88 ± 137
min/week vs. 132 ± 181 min/week, p=0.006) and sports
activities (126 ± 166 min/week vs. 225 ± 182 min/week,
p<0.0001). In contrast, the control group participants
did not significantly change their physical activity behav-
ior between baseline and six months.
Changes in physical activity after six months: comparisons
between groups
The results of the multiple linear and logistic regression
analyses are presented in Table 5. After six months, sig-
nificantly more Start to Run participants compared with
control group participants were meeting the Fit-norm
(OR=5.1; 95% CI: 2.3-11.1, p<0.001) and Combi-norm
(OR=3.3; 95% CI: 1.4-7.7, p=0.006). In addition, signifi-
cant effects were found in favor of the Start to Run
group concerning physical activity intensity categories
and domains: after six months, the Start to Run partici-
pants were spending more time in vigorous-intensity ac-
tivities (an average of 152 min/week more: b=152; 95%
CI: 80-223, p<0.001) and sports activities (an average of
107 min/week more: b=107; 95% CI: 69-145, p<0.001)
compared with controls. For the remaining physical ac-
tivity outcome measures, no significant differences were
found between groups.
Discussion
The aim of this study was to assess the effectiveness of
Start to Run, a 6-week training program for novice run-
ners, on increasing health-enhancing physical activity,
both in the short- and longer-term. In the Start to Run
group, short- and longer-term beneficial within group ef-
fects were observed. In the control group, however, there
were no significant changes in physical activity behavior
within a period of six months. When comparing results
between groups, the Start to Run program produced sig-
nificant positive changes in health-enhancing physical
activity levels: after six months, significantly more Start
to Run participants compared with control group partic-
ipants were meeting the Fit-norm and Combi-norm. The
differences in the amount of physical activity between
groups in favor of the Start to Run group could be
explained by an increase in the time spent in vigorous-
Table 2 Baseline characteristics of the Start to Run group
and control group
Start to
Run groupa
Control
group
P
Sample size (n)
100
100
Age (years)
Mean ± SD
40 ± 10
42 ± 9
0.12
Min-max
21-71
23-77
Sex (%)
Male
30.0
30.0
1.0
Female
70.0
70.0
Dutch physical activity guidelines (%)
Compliance with DNHPA
48.0
59.0
0.12
Compliance with Fit-norm
56.0
55.0
0.89
Compliance with Combi-norm
58.0
65.0
0.31
Physical activity by intensity,
mean ± SD (min/week)
Light-intensity activities
1814 ± 1224
1958 ± 1263
0.42
Moderate-intensity activities
213 ± 453
406 ± 596
0.01*
Vigorous-intensity activities
238 ± 250
253 ± 337
0.73
Physical activity by domain,
mean ± SD (min/week)
Commuting activities
88 ± 137
117 ± 251
0.30
Leisure-time activities
257 ± 296
328 ± 407
0.16
Sports activities
126 ± 166
107 ± 147
0.40
Household activities
552 ± 780
919 ± 968
0.004*
Activities at work and school
1309 ± 935
1182 ± 951
0.35
Total time spent in physical
activity, mean ± SD (min/week)
2265 ± 1251
2616 ± 1356
0.06
aStart to Run participants who completed the six months assessment.
*Significant (p<0.05) difference between groups.
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intensity activities (physical activity intensity category)
and sports activities (physical activity domain).
As running is a vigorous-intensity sports activity, these
results are not surprising. This is especially true for the
assessment after six weeks. More interesting is the fact
that these outcome measures were also positively af-
fected at the six months assessment. Considering the
higher levels of vigorous-intensity physical activity and
sports activity, the results suggest that most Start to Run
participants were still running even 4.5 months after ces-
sation of the Start to Run training program. Some add-
itional results, not presented in the results section,
confirm that this was indeed the case: at the six months
assessment, running behavior was also directly assessed
Table 4 Changes in physical activity after six months: comparisons within groups
Outcome measures
Start to Run group (n=100)
Control group (n=100)
Baseline
After six months
Pa
Baseline
After six months
Pb
Dutch physical activity guidelines (%)
Compliance with DNHPA
48.0
64.0
0.004*
59.0
62.0
0.68
Compliance with Fit-norm
56.0
82.0
<0.0001*
55.0
57.0
0.83
Compliance with Combi-norm
58.0
84.0
<0.0001*
65.0
73.0
0.10
Physical activity by intensity, mean ± SD (min/week)
Light-intensity activities
1814 ± 1224
1947 ± 1043
0.31
1958 ± 1263
1972 ± 1181
0.90
Moderate-intensity activities
213 ± 453
206 ± 369
0.88
406 ± 596
450 ± 740
0.47
Vigorous-intensity activities
238 ± 250
382 ± 306
<0.0001*
253 ± 337
238 ± 286
0.60
Physical activity by domain, mean ± SD (min/week)
Commuting activities
88 ± 137
132 ± 181
0.006*
117 ± 251
124 ± 215
0.80
Leisure-time activities
257 ± 296
276 ± 358
0.48
328 ± 407
325 ± 515
0.91
Sports activities
126 ± 166
225 ± 182
<0.0001*
107 ± 147
108 ± 142
0.96
Household activities
552 ± 780
585 ± 597
0.66
919 ± 968
807 ± 856
0.15
Activities at work and school
1309 ± 935
1381 ± 864
0.49
1182 ± 951
1322 ± 887
0.11
Total time spent in physical activity, mean ± SD (min/week)
2265 ± 1251
2536 ± 1210
0.04*
2616 ± 1356
2660 ± 1126
0.73
aP-value for difference in physical activity within the Start to Run group.
bP-value for difference in physical activity within the control group.
*Significant (p<0.05) change in physical activity after six months within the Start to Run group.
Table 3 Start to Run group: changes in physical activity after six weeks
Outcome measures
Start to Run group (n=123)
Baseline
After six weeks
Pa
Dutch physical activity guidelines (%)
Compliance with DNHPA
43.9
74.8
<0.0001*
Compliance with Fit-norm
53.7
87.0
<0.0001*
Compliance with Combi-norm
57.7
91.1
<0.0001*
Physical activity by intensity, mean ± SD (min/week)
Light-intensity activities
1827 ± 1192
1423 ± 1296
0.002*
Moderate-intensity activities
209 ± 462
163 ± 253
0.21
Vigorous-intensity activities
200 ± 205
410 ± 298
<0.0001*
Physical activity by domain, mean ± SD (min/week)
Commuting activities
70 ± 110
98 ± 155
0.01*
Leisure-time activities
240 ± 268
301 ± 343
0.02*
Sports activities
101 ± 143
243 ± 173
<0.0001*
Household activities
563 ± 759
614 ± 887
0.43
Activities at work and school
1293 ± 940
792 ± 794
<0.0001*
Total time spent in physical activity, mean ± SD (min/week)
2237 ± 1183
1996 ± 1451
0.08
aP-value for difference in physical activity within the Start to Run group.
*Significant (p<0.05) change in physical activity after six weeks within the Start to Run group.
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by a single question: “Are you (still) running at this mo-
ment?” The results of this question showed that 69.0%
of the Start to Run participants was still performing run-
ning activities [see Additional file 1 - Additional results
evaluation Start to Run program]. Based on these find-
ings, it seems that Start to Run can recruit people that
are insufficiently active; motivate them to take up run-
ning; and also frequently and long enough to meet levels
of health-enhancing physical activity (as measured by
the Fit-norm and Combi-norm). Consequently, Start
to Run can positively contribute to improving health of
participants.
To sustain health benefits, however, it is important
that this running behavior is maintained, i.e. that the
Start to Run participants continue to run on a regular
basis. Often maintenance is defined as implementing be-
havior change for at least six months after cessation of
intervention [33]. Since the last assessment of physical
activity was 4.5 months after cessation of the Start to
Run training program, it is difficult to ascertain whether
sustained changes in physical activity behavior have been
reached according to this definition of maintenance.
Others, however, do not define maintenance as sustain-
ing behavior change over a specified period of time.
Rothman (2000), for example, rather looks at the pro-
cesses that govern behavioral maintenance and he argues
that people will maintain a change in behavior only if
they are satisfied with the new behavior [34]. The Start
to Run participants gave the overall training program a
rating of 8.2 (scale 0-10; 0 being very poor and 10 being
excellent) [see Additional file 1 - Additional results
evaluation Start to Run program]. Moreover, the fact
that most Start to Run participants were still running 4.5
months after cessation of the Start to Run training pro-
gram, may on its own indicate that they were satisfied
with their new running behavior and thus will continue
running. Nonetheless, definite conclusions cannot be
drawn and follow-up assessments over longer periods of
time are necessary to establish if the Start to Run partici-
pants continue their newly acquired physical activity
behavior.
With regard to maintaining physical activity levels, the
organized sports sector itself may play an important role.
In this sector, physical activity opportunities are provided
on a continuous basis (i.e. people can play sports on a
weekly basis at a sports club). When first providing an eas-
ily accessible sporting program, like Start to Run, the next
step, i.e. participation in organized sports on a continuous
basis, may be facilitated. After completing the program, the
Start to Run participants were stimulated to continue run-
ning as a member of a local athletics club or the Dutch
Athletics Organization. At the six months assessment,
41.0% of the Start to Run participants reported that they
became (and still were) a member of a local athletics club
or the Dutch Athletics Organization, as a result of partici-
pation in the Start to Run training program [see Additional
Table 5 Changes in physical activity after six months: comparisons between groups
Dichotomous outcome measures
OR (group variable)a
95% CI
P (group variable)
Dutch physical activity guidelines
Compliance with DNHPA
1.5
0.8-3.0
0.22
Compliance with Fit-norm
5.1
2.3-11.1
<0.001*
Compliance with Combi-norm
3.3
1.4-7.7
0.006*
Continuous outcome measures
b-coefficient (group variable)a,b
95% CI
P (group variable)
Physical activity by intensity
Light-intensity activities
38
−234-311
0.78
Moderate-intensity activities
−126
−265-12
0.07
Vigorous-intensity activities
152
80-223
<0.001*
Physical activity by domain
Commuting activities
22
−27-71
0.37
Leisure-time activities
19
−63-101
0.65
Sports activities
107
69-145
<0.001*
Household activities
−45
−220-131
0.62
Activities at work and school
5
−216-226
0.96
Total time spent in physical activity
20
−274-313
0.90
aMultiple (linear or logistic) regression analyses were conducted with physical activity level at six months as the dependent variable, and group (Start to Run
group versus control group, with the control group as the reference category) as the independent variable. Adjustments were made for baseline physical
activity levels.
bUnstandardized regression coefficient.
*Significant (p<0.05) difference in physical activity between groups.
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file 1 - Additional results evaluation Start to Run program].
These data suggest that an easily accessible sporting pro-
gram, like Start to Run, may indeed facilitate participation
in organized sports. The role of the organized sports sector
in both increasing and maintaining health-enhancing phys-
ical activity levels should therefore be further explored.
Next to significant increases in vigorous-intensity
physical activity and sports activity, the study had some
other interesting findings: after six weeks, the Start to
Run participants were spending significantly more time
in commuting activities and leisure-time activities. These
results suggest that Start to Run may have led to in-
creases in physical activity in these domains. However,
in the same period, there was also a significant decrease
in the time spent in work and school activities and, con-
sequently, light-intensity activities. These results indicate
that, at six weeks, physical activity levels may have been
influenced by other factors, like weather conditions, sea-
son and/or holidays. The influence of these factors on
commuting activities, leisure-time activities and activities
at work and school seems plausible, since no effects
were found on these outcome measures at the six
months assessment when compared with the control
group. Yet, without an assessment of the control group
at six weeks, some uncertainty remains.
Another interesting finding is that Start to Run did
not directly affect the total time spent in physical activ-
ity. Despite no significant increases in the total time
spent in physical activity, additional health benefits are
obtained due to participation in Start to Run: as men-
tioned before, the increases in sports activity/vigorous-
intensity physical activity were substantial, and resulted
in more Start to Run participants meeting minimum
recommended amounts of vigorous-intensity physical
activity for health benefits. Also, there is evidence that
vigorous-intensity physical activities, like running, lead
to even greater improvements in aerobic fitness and
greater reductions in cardiovascular disease and mortal-
ity risk than moderate- or light-intensity physical activ-
ities, which is independent of their contribution to
energy expenditure [35-37].
To our knowledge, this is the first study evaluating the
effectiveness of a training program aimed at novice run-
ners on increasing health-enhancing physical activity. In
general, there is a lack of research and evaluation of ac-
tivities conducted in sports settings, especially of con-
trolled study designs incorporating both the short- and
longer-term effects [27,28]. Therefore, it is difficult to
compare these results with those of previous studies.
Most comparable studies would be physical activity
intervention studies, and a lot of research has been done
in this area [e.g. 38,39]: some physical activity interven-
tions that prescribed running positively affected physical
activity behavior of participants. However, comparability
is still limited, as these physical activity interventions did
not focus on running per se, were often multi-component,
took place in non-sports settings and used different out-
come measures.
There are some limitations to this study that should
be mentioned. First of all, the design of the study does
not allow drawing any conclusions on which specific as-
pect of the Start to Run program (e.g. group sessions, in-
dividual
sessions,
test
run)
is
most
important
for
increasing (and continuing) physical activity. Moreover,
participants’ compliance with the different program
components was not measured, making it even more dif-
ficult to disentangle the most effective program parts.
Second, in this study, a self-report measure of physical
activity was used. Despite their common use, there are
several limitations of self-report tools, including inaccur-
ate recall of the frequency, duration and intensity of
physical activity, problems with question comprehension
and interpretation, and social desirability bias which can
lead to over-reporting of physical activity [40]. However,
any inaccuracies are assumed to be random and among
both groups. It is therefore unlikely that these potential
sources of bias explain the differences in physical activity
between the Start to Run group and control group. Self-
report measures have the advantage that they are able to
collect data from a large number of people at low costs.
The SQUASH questionnaire itself has some distinct ad-
vantages compared with other physical activity question-
naires: it is short, quick to fill in (3-5 minutes), it
measures the amount of physical activity (separately) for
five different domains and provides the opportunity to
estimate compliance with physical activity guidelines.
An alternative to self-report measures is to use more ob-
jective instruments to measure physical activity, like ac-
celerometers and heart rate monitors. Compared with
self-report measures, objective instruments are more ex-
pensive and logistically more difficult to administer on a
large scale. For these reasons, it was decided to use a
self-report measure. Nonetheless, it would be interesting
to see if the results of this study could be replicated with
such an objective measure. Third, due to the voluntary
nature of participation in the Start to Run training pro-
gram, the possibility of selection bias cannot be entirely
excluded. It could be that people who registered for Start
to Run were already highly motivated to increase phys-
ical activity levels. Therefore, the findings of this study
may not pertain to inactive individuals, i.e. the ones who
are often less motivated to increase physical activity
levels. On the other hand, also a large group of people
who did not meet physical activity guidelines was
attracted by the Start to Run training program (i.e. al-
most half of the Start to Run participants), which may
indicate that the program is also suited for this popula-
tion group. Although this voluntary participation into
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Start to Run might have caused selection bias, it is a
strength of the study as well. First of all, behavior was
not forced. Next to that, the study population of Start to
Run was a sample of the actual Start to Run population.
The Start to Run participants in this study had a mean
age of 40 years and the percentage of women was 70.0%.
Demographic data collected by the Dutch Athletics
Organization of the entire Start to Run population in
March 2009 (n=4230) show that the study sample is rep-
resentative for the entire Start to Run population with
regard to age and sex: the average age of the entire Start
to Run population was also 40 years and 77.8% of partic-
ipants was female. Thus, the study was performed in a
generalizable
group.
Moreover,
since
the
study
was
performed in a real-world setting, namely the sports set-
ting, results are directly transferable into practice. Finally,
in this study, it was not possible to ascertain why more
than half of the Start to Run participants dropped out of
the study between the baseline and six months assessment.
It is very difficult to determine why participants did not fill
in this questionnaire, because no follow-up data were avail-
able of these persons. There could be cases that did not re-
spond to the invitation to fill in this questionnaire because
they stopped running (e.g. due to an injury or a bad run-
ning experience). Given the very low drop-out rate of the
Start to Run training program (according to the Dutch
Athletics Organization, only 2.2% of the participants
dropped out of the Start to Run training program) and the
(already) relatively high drop-out in this the study after six
weeks, this seems not a plausible explanation. With regard
to baseline characteristics, non-respondents were some-
what younger and more likely to be female. There were,
however, no significant differences in baseline physical
activity levels between respondents and non-respondents.
Therefore, the most likely explanation for the non-
response is that participants were not motivated to
participate in a scientific study and filling in a question-
naire. Furthermore, since no differences in baseline phys-
ical activity levels were found between respondents and
non-respondents, it is unlikely that these losses to follow-
up influenced study results substantially.
Conclusions
Considering the above-mentioned limitations, this study
does add to the knowledge base concerning the effective-
ness of programs initiated in sports settings. The results
indicate that an easily accessible program, like Start to
Run, organized by a sporting organization, can positively
influence levels of health-enhancing physical activity of
participants, both in the short- and longer-term. Conse-
quently, Start to Run can lead to tangible health benefits
among its participants. Based on these results, the use of
the organized sports sector as a setting to promote health-
enhancing physical activity seems promising. However,
further research is needed to establish maintenance of
physical activity behavior and generalizability of these re-
sults to other (easily accessible) sporting programs. More-
over, the role of the organized sports sector in maintaining
health-enhancing physical activity levels should be further
explored. In future studies, it is also recommended to in-
clude more in-depth analyses. It is, for example, important
to investigate which population groups benefit most from
a program like Start to Run (e.g. men vs. women, young
adults vs. older adults, obese vs. non-obese people) and to
establish the relative effectiveness of program parts. Re-
search in the area of effectiveness of sporting programs in
increasing health-enhancing physical activity is still
lacking. These data will hopefully encourage policy
makers and sporting organizations to both develop and
rigorously evaluate easily accessible sporting programs.
In this way, more knowledge about the role of the orga-
nized sports sector in both promoting and maintaining
health-enhancing physical activity can be acquired.
Additional file
Additional file 1: Additional results evaluation Start to Run
program. In the additional file, results can be found concerning the
evaluation of the Start to Run program that are not shown in the results
section of the article.
Abbreviations
ACSM: American College of Sports Medicine; AHA: American Heart
Association; DNHPA: Dutch Norm for Health-enhancing Physical Activity;
MET: METabolic equivalent; NAPSE: National Action Plan for Sport and
Exercise; NIVEL: Netherlands Institute for Health Services Research;
SQUASH: Short QUestionnaire to ASsess Health-enhancing physical activity.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
LO contributed to the design of the study, participated in the data collection
process, performed data analysis, and drafted the manuscript. CV and DHB
contributed to the design of the study, advised on the analytical approach,
and reviewed and commented on the manuscript. All authors read and
approved the final manuscript.
Acknowledgements
The authors gratefully acknowledge the contribution of the study
participants. This study was funded by the Netherlands Olympic Committee
and Netherlands Sports Federation (NOC*NSF). NOC*NSF had no role in
study design, data collection and analysis, interpretation of data, decision to
publish or preparation of the manuscript.
Received: 28 May 2013 Accepted: 26 July 2013
Published: 31 July 2013
References
1.
Gill JM, Cooper AR: Physical activity and prevention of type 2 diabetes
mellitus. Sports Med 2008, 38:807–824.
2.
Jakicic JM: The effect of physical activity on body weight. Obesity
(Silver Spring) 2009, 17(Suppl 3):S34–S38.
3.
Schmitt NM, Schmitt J, Doren M: The role of physical activity in the
prevention of osteoporosis in postmenopausal women-An update.
Maturitas 2009, 63:34–38.
Ooms et al. BMC Public Health 2013, 13:697
Page 11 of 12
http://www.biomedcentral.com/1471-2458/13/697
4.
Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC:
Effective exercise for the prevention of falls: a systematic review and
meta-analysis. J Am Geriatr Soc 2008, 56:2234–2243.
5.
Sofi F, Capalbo A, Cesari F, Abbate R, Gensini GF: Physical activity during
leisure time and primary prevention of coronary heart disease: an
updated meta-analysis of cohort studies. Eur J Cardiovasc Prev Rehabil
2008, 15:247–257.
6.
Thune I, Furberg AS: Physical activity and cancer risk: dose–response and
cancer, all sites and site-specific. Med Sci Sports Exerc 2001, 33:S530–S550.
7.
Wendel-Vos GC, Schuit AJ, Feskens EJ, Boshuizen HC, Verschuren WM, Saris
WH, Kromhout D: Physical activity and stroke. A meta-analysis of
observational data. Int J Epidemiol 2004, 33:787–798.
8.
Bize R, Johnson JA, Plotnikoff RC: Physical activity level and health-related
quality of life in the general adult population: a systematic review.
Prev Med 2007, 45:401–415.
9.
Strohle A: Physical activity, exercise, depression and anxiety disorders.
J Neural Transm 2009, 116:777–784.
10.
Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA,
Heath GW, Thompson PD, Bauman A: Physical activity and public health:
updated recommendation for adults from the American College of
Sports Medicine and the American Heart Association. Med Sci Sports Exerc
2007, 39:1423–1434.
11.
Hildebrandt VH, Chorus AMJ, Stubbe JH: Trend report of physical activity and
health 2008/2009. Leiden, The Netherlands: TNO Quality of Life; 2010.
12.
Eyler AA, Brownson RC, Donatelle RJ, King AC, Brown D, Sallis JF: Physical
activity social support and middle- and older-aged minority women:
results from a US survey. Soc Sci Med 1999, 49:781–789.
13.
Sallis JF, Hovell MF, Hofstetter CR: Predictors of adoption and
maintenance of vigorous physical activity in men and women. Prev Med
1992, 21:237–251.
14.
Wendel-Vos W, Droomers M, Kremers S, Brug J, van Lenthe F: Potential
environmental determinants of physical activity in adults: a systematic
review. Obes Rev 2007, 8:425–440.
15.
European Commission: Sport and Physical Activity. Special Eurobarometer
334/Wave 72.3. Brussels, Belgium: TNS Opinion & Social; 2010.
16.
Dobbinson SJ, Hayman JA, Livingston PM: Prevalence of health promotion
policies in sports clubs in Victoria, Australia. Health Promot Int 2006,
21:121–129.
17.
Dutch Ministry of Health, Welfare and Sport: Time for sport: exercise,
participate, perform. The Hague, The Netherlands: Dutch Ministry of Health,
Welfare and Sport; 2005.
18.
Eime RM, Payne WR, Harvey JT: Making sporting clubs healthy and
welcoming environments: a strategy to increase participation. J Sci Med
Sport 2008, 11:146–154.
19.
Kokko S, Kannas L, Villberg J: The health promoting sports club in
Finland–a challenge for the settings-based approach. Health Promot Int
2006, 21:219–229.
20.
Whitelaw S, Baxendale A, Bryce C, MacHardy L, Young I, Witney E: 'Settings'
based health promotion: a review. Health Promot Int 2001, 16:339–353.
21.
World Health Organization (WHO): Ottawa Charter for Health Promotion.
Geneva: WHO; 1986.
22.
Buist I, Bredeweg SW, van Mechelen W, Lemmink KA, Pepping GJ, Diercks
RL: No effect of a graded training program on the number of running-
related injuries in novice runners: a randomized controlled trial. Am J
Sports Med 2008, 36:33–39.
23.
Chakravarty EF, Hubert HB, Lingala VB, Fries JF: Reduced disability and
mortality among aging runners: a 21-year longitudinal study. Arch Intern
Med 2008, 168:1638–1646.
24.
Koplan JP, Powell KE, Sikes RK, Shirley RW, Campbell CC: An epidemiologic
study of the benefits and risks of running. JAMA 1982, 248:3118–3121.
25.
Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo
BD: A prospective study of running injuries: the Vancouver Sun Run
"In Training" clinics. Br J Sports Med 2003, 37:239–244.
26.
Williams PT: A cohort study of incident hypertension in relation to
changes in vigorous physical activity in men and women. J Hypertens
2008, 26:1085–1093.
27.
Priest N, Armstrong R, Doyle J, Waters E: Interventions implemented
through sporting organisations for increasing participation in sport.
Cochrane Database Syst Rev 2008(3). Art. No.: CD004812. DOI: 10.1002/
14651858.CD004812.pub3.
28.
Priest N, Armstrong R, Doyle J, Waters E: Policy interventions implemented
through sporting organisations for promoting healthy behaviour
change. Cochrane Database Syst Rev 2008.(3). Art. No.: CD004809.
DOI: 10.1002/14651858.CD004809.pub3.
29.
Reitsma-van Rooijen M, de Jong JD: Health Care Consumer Panel: basic report
with information about the panel, 2009. Utrecht, The Netherlands: Netherlands
Institute for Health Services Research (NIVEL); 2009.
30.
Bauman A, Bull F, Chey T, Craig CL, Ainsworth BE, Sallis JF, Bowles HR,
Hagstromer M, Sjostrom M, Pratt M: The International Prevalence Study on
Physical Activity: results from 20 countries. Int J Behav Nutr Phys Act 2009, 6:21.
31.
Wendel-Vos GC, Schuit AJ, Saris WH, Kromhout D: Reproducibility and
relative validity of the short questionnaire to assess health-enhancing
physical activity. J Clin Epidemiol 2003, 56:1163–1169.
32.
Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O'Brien
WL, Bassett DR Jr, Schmitz KH, Emplaincourt PO, Jacobs DR Jr, Leon AS:
Compendium of physical activities: an update of activity codes and MET
intensities. Med Sci Sports Exerc 2000, 32:S498–S504.
33.
Marcus BH, Dubbert PM, Forsyth LH, McKenzie TL, Stone EJ, Dunn AL, Blair
SN: Physical activity behavior change: issues in adoption and
maintenance. Health Psychol 2000, 19:32–41.
34.
Rothman AJ: Toward a theory-based analysis of behavioral maintenance.
Health Psychol 2000, 19:64–69.
35.
Lee IM, Paffenbarger RS Jr: Associations of light, moderate, and vigorous
intensity physical activity with longevity. The Harvard Alumni Health
Study. Am J Epidemiol 2000, 151:293–299.
36.
Swain DP: Moderate or vigorous intensity exercise: which is better for
improving aerobic fitness? Prev Cardiol 2005, 8:55–58.
37.
Swain DP, Franklin BA: Comparison of cardioprotective benefits of
vigorous versus moderate intensity aerobic exercise. Am J Cardiol 2006,
97:141–147.
38.
Foster C, Hillsdon M, Thorogood M: Interventions for promoting physical
activity. Cochrane Database Syst Rev 2005(1). Art. No.: CD003180. DOI:
10.1002/14651858.CD003180.pub2.
39.
Marcus BH, Williams DM, Dubbert PM, Sallis JF, King AC, Yancey AK, Franklin
BA, Buchner D, Daniels SR, Claytor RP: Physical activity intervention
studies: what we know and what we need to know: a scientific
statement from the American Heart Association Council on Nutrition,
Physical Activity, and Metabolism (Subcommittee on Physical Activity);
Council on Cardiovascular Disease in the Young; and the
Interdisciplinary Working Group on Quality of Care and Outcomes
Research. Circulation 2006, 114:2739–2752.
40.
Sallis JF, Saelens BE: Assessment of physical activity by self-report: status,
limitations, and future directions. Res Q Exerc Sport 2000, 71:S1–14.
doi:10.1186/1471-2458-13-697
Cite this article as: Ooms et al.: Effectiveness of Start to Run, a 6-week
training program for novice runners, on increasing health-enhancing
physical activity: a controlled study. BMC Public Health 2013 13:697.
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Ooms et al. BMC Public Health 2013, 13:697
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Effectiveness of Start to Run, a 6-week training program for novice runners, on increasing health-enhancing physical activity: a controlled study.
Ooms, Linda,Veenhof, Cindy,de Bakker, Dinny H