Norway

Every year the beautiful mountains of Norway turn into winter wonderland that you can criss cross with dog sledding, lightweight ski’s for cross country or alpine skiing. This is what we all did during our Christmas stay in Norway. We were first-timers in Norway and definitely this calls for more. The day before Christmas we arrived at Herangtunet boutique hotel after a scenic drive along stunning nature from Oslo Gardermoen. Herangtunet is in a unique location in the Valdres region between Fagernes and Beitostolen. Almost for a decade it is run by Marco and Marie-José who decided to swap city life in Amsterdam and to build a dream in Norway. Herangtunet has several timber buildings which were covered under a blanket of snow. All the rooms and suites have their own character and it is incredible to see how many attention is paid to all the details. Marco and Marie José have created a place where you are touched by magic. This is a place where you feel instantly at home. For a few days we have indulged ourselves in all the luxury they have to offer from the best foods and wine amidst a breath taking scenery and at night a starry sky. At Herangtunet you can do as much or as little you would like. We alternated between reading books in front of our stoked fire, enjoying the star quality meals or stretching our bones by going outside to explore the beautiful surroundings which was crisp, white and silent as in a fairytale. Our most remarkable experience was going for a dog sledding expedition by Beito Husky tours. The Husky’s fell over themselves to greet us when we arrived – they were all jumping for joy with fast swishing tails. It seems that sledding should be easier when you can ski, of course it concerns balancing and shifting of your weight carefully. However, the first hour of mushing was quite extensive. When you are about to start, the dogs jump and whine and want to run with an unexpected strength and loudness. At that moment you think the calmness won’t come back ever. After crossing the lake and climbing further where the trees got more dense and the snow thickened, the dogs became very quiet. It is almost a mindless activity – you have to rely on your body when you should lean and when you should use the break or to step off to help the dogs. Trust me they look back funnily enough when you are not working or helping them on steep hills. Most importantly never let go of the sled although you feel like to ride the sled with one hand. The views of the unspoiled nature are enhanced by stillness only interrupted by the sound of the sled moving across the snow and happy husky’s crunching the snow beneath them. At midday we stopped to have a lunch in the middle of nature – around a freshly stoked fire we ate our soup while the dogs could rest a little. Dogsledding is not just a sitting ride instead it is an energetic and sometimes a strenuous activity. Especially when you need to help the dogs uphill, finding your balance while going down again and using the brake at the right time.

Herangtunet is also a short drive to a ski area (Beitostolen), for a day we went skiing there. The slopes with their views on the frozen lake are beautiful but does not offer that much challenge as the Alps. Norway is the true home of cross-county skiing and we wanted to try it out. After having a lesson we went up to the track – it was a sunny day but with a very harsh wind. The movement is similar to ice skating and involves a pronounced motion of back and forward of the arms. Due to the strong wind, keeping your balance was quite a challenge. Our journey went to beautiful Arctic tundra landscapes (Jotunheimen) and when the last day hour of daylight arrived we were on our way to find a nice and cozy eatery. We ended up at the tapas bar (Beitostolen), which was crowded by Norwegians and offered nice local tapas.

The hauntingly beautiful Norwegian winter sun rise and sunset is something you want to keep seeing. For sure, we are coming back to Norway in summer to experience the country when the sun never seems to go down and the hills are lush green.

Recommendations

Stay at Herangtunet

Go dog sledding (Beito Husky tours)

Experience cross country skiing (Beito aktiv)

Sri Lanka – a few highlights

There is quite a buzz now around the pearl drop island Sri Lanka with its beautiful sunny beaches, colonial city’s, tea covered mountains, wildlife parks and small fisherman villages. Sri Lanka was the midpoint of the spice route from Europe to China – that’s why many different races from Indian, Arab, Dutch, British and Portuguese has left their influence. Ceylon was the former name of Sri Lanka (until 1972). The Tamil war ended in 2009 and since then the island is getting popular by travelers. People call it “India lite” and never have been to India but I can imagine what they mean. It is foremost very easy travelling with polite and noninvasive local people. Of course, everywhere you go, people will ask you things (mainly if you need transport), but the best thing I – say no thanks and they will walk along. Sri Lanka is the size of the Netherlands and Belgium together – quite a small area- but home to a huge variety of landscapes. It offers visitors so much experience within fairly short travel distances.

Nearly at the end of the rain season, I was able to visit Sri Lanka for a little more than a week. The travel went from Negombo – Kandy- Ella – Talalla- Udalawawe national park and Mirissa. We have stayed at precious spots from a cabin in the forest, a mud house, a beach house on a cliff overlooking the ocean – to a treetop house in the jungle.
Negombo is where we arrived late at night after our direct flight from Amsterdam. The next day we took a taxi to Kandy which was easily arranged since everyone wants to be your driver. We drove through beautiful hilly areas before arriving in Kandy. Our hotel for the night was Mountbatten bungalows. Mountbatten brings you back to British colonial times. The hotel surroundings are magnificent and we were spoilt by all the luxury. The next day a tuk-tuk driver brought us to the train station where our journey to Ella began. This was an incredible train journey along tea covered mountains. Since the British had built tea plantations in the central hills of Sri Lanka – the nation has acquired a reputation for top quality tea. Often this is called the most beautiful train ride in the world – I was jumping for joy pretty much the whole journey. Try to reserve a seat in advance – if there is no seat available at Kandy station – another option is Perideniya (close to Kandy). Price for a first class seat is around 12 euro and you get a meal for that. Put yourself at ease since the ride is quite long – 7 to 8 hours. I cannot mention enough how stunning the landscape is – the train takes you through tea plantations, waterfalls and rolling mountains covered in clouds and mist. Then finally we arrived at Ella, a village nested in a luscious hill country. Ella has a nice main street with bars, and good eateries. This town has a relaxing backpacker vibe to be compared with Ubud in Bali and Pai in Thailand. The next day we had an active day from hikinig to the nine arches bridge (definitely to be recommended) and to the little Adams Peak. The climb up is not hard at all, although at the top there are mountainous terrains- the views are hauntingly beautiful. After having our nature doses we were ready to go to the beach.
At Talalla we induldged ourselves in the tranquil atmosphere of paradisiacal surroundings for a few days. The Talalla bay beach house situated at a cliff overlooking the ocean was splendid. The palm trees, the sound of the waves and the tropical sun putted us at ease. At night, terrific dinners were served. Each night I fell asleep by the sound of the waves and during the day I relaxed on the terrace in a hammock in total privacy.

Quite impulsively we decided to have a break from the beach to go to the national park – Banyan camp. Banyan Camp is set on the banks of Lake Hambegamuwa. This eco treetop lodge is an incredible place where nature is not disturbed yet by (human) invaders. There is no electricity but instead the surrounding are lightened by lanterns which give a beautiful warm glow. The sleep area is an open plan with a maximum of 6 persons. In the afternoon we were picked up by a ranger to go canoeing in an old fishermen canoe. To experience the lake from the boat – to see all the birds- and 300-year old banyan tree was amazing. Our dinner was served at a raft next to the lake which was a perfect ending of the day.

Our final stop was Mirissa – this little beach town has the perfect combination of a natural beach plus evening entertainment without being overrun by too much tourism. After a perfect beach day, when the sun starts to set you can walk along the candlelit restaurants. We had delicious dinners at Zaphyr and also on one night they gave a great party. One of the most popular activities in Mirissa is going on a whale watching trip – this is the biggest tourist trap I have ever seen. Everyday overcrowded boats leave the harbour to hunt for whales. Literally they hunt for whales – all boats were chasing madly at the whales. Once a boat spotted a whale, all the boats go in the same direction and it turns into an ugly chase, scaring the animal. It is very tragic to see that they do not respect the whales ecological environment at all. Luckily, this was just a small part of our time in Mirissa where we stayed at an incredible guest house- the spice house. Each morning a terrific breakfast was served including egg hoppers – one of my greatest culinary pleasures- it is a cupped pancake fried with egg. We slept in the mud house, a precious spot with an outdoor shower. The boutique hotel is in a beautiful setting just 5 minutes set back from the beach. Once you walk through the gate, you are transported to another place with stepped-layered landscaped gardens surrounded by coconut trees with monkeys playing in there – which makes you feel at instant very zen. The owners Wathsala and Phil had created a hidden gem amidst the jungle where you wake up with the sounds of monkeys and singing of the birds. The food was the best we had during our stay in Sri Lanka.

This were just a few highlights from Sri Lanka and there’s even much more to experience (Adams peak, Sigirya rock, the colonial cities) – once you have seen the pearl drop island, you want to come back.

Recommended places to stay:

– Kandy – Mountbatten bungalows

– Tallalla – Talalla bay beach house

– Udalawawe national park – Banyan camp

– Mirissa – Spice house

Protocol paper – American Heart Journal

After two years of work, our protocol for the Spanish study has been accepted in the American Heart Journal.

A summary is given in the following:

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death worldwide. With atherosclerosis as the underlying cause for many CVD events, prevention or reduction of subclinical atherosclerotic plaque burden (SAPB) through a healthier lifestyle may have substantial public health benefits.

OBJECTIVE: To describe the protocol of a randomized controlled trial (RCT) investigating the effectiveness of a 30-month worksite-based lifestyle program aimed to promote cardiovascular health in participants having a high or a low degree of SAPB, compared to standard care.

METHODS:
We will conduct a RCT including middle–aged bank employees from the ´Progression of Early Subclinical Atherosclerosis´ (PESA) cohort, stratified by SAPB (high SABP n=260; low SABP n= 590). Within each stratum, participants will be randomized 1:1 to receive a lifestyle program or standard care. The program consists of three elements: (A) 12 personalized lifestyle counseling sessions using Motivational Interviewing over a 30-month period, (B) a wrist-worn physical activity tracker, and (C) a sit-stand workstation. Primary outcome measure is a composite score of blood pressure (BP), physical activity, sedentary time, body weight, diet and smoking (i.e. adapted FUSTER-BEWAT score) measured at baseline and at 1-, 2-, and 3-year follow-up.

CONCLUSIONS: The study will provide insights into the effectiveness of a 30-month worksite-based lifestyle program to promote cardiovascular health compared to standard care in participants with a high or low degree of SAPB.

If you would like to read how the study looks like, please click on the following link. coffeng_2016_protocol-tansnip

Madrid – Twin phenomenon

Researchers have identified that twelve areas of the DNA sequence are linked to age being a first time parent and family size which is recently published in Nature Genetics. This study is the first that shows that reproductive behavior is not only a mere personal choice, and/or a combination of social and environmental factors but there is also a biological basis for reproduction. The study led by University of Oxford, in cooperation with The Netherlands and Sweden, has analyzed information of more than 250.000 men and women for age at first birth and number of children. Their modelling shows that the variants in the 12 areas of the DNA predict less than 1% of the timing at which men and women have their first child and the amount of children they will have. Although this number is very small, it provides useful information about the genetic architecture of reproductive behavior which could be a basis for further improving infertility treatments.

These days I am working in Madrid and my mind wanders off to this article while I observe (like always) quite a lot twin buggies on my walks throughout the city. It is difficult not to see them as these double baby strollers are very difficult to steer in the smaller and crowded places around Malasaña.

The twinbuggies seem to be not a very strange phenomenon since Spain is a frontrunner when talking about multiple births. The increased incidence of multiple births in Spain is mostly related to the higher age of being a first time mom and assisted reproductive treatments. In 1983 fertility treatment was introduced in Spain and since then the number of twins has tripled. It is generally known that the age for being a first time mom/dad is high in Spain. At the moment, one of my colleagues is on a first time maternity leave, she is 38, which forms no exception at all. Spanish women start later with children and it is even among the highest among Europe aside Italy. Also, people are getting fewer children. This is in sharp contrast when Franco ruled. In the seventies and eighties, Franco promoted to have children. Nowadays, 59% of women aged from 36-39 will have their first child. Although Spain is pictured as a traditional family society, the trend in child bearing shows that there are fewer and fewer children born. Asking my Spanish colleagues why they chose to have children later is that it took a while to establish a career and to have sufficient financial resources for having a child which is likely to be achieved in mid 30s.

The findings published in Nature Genetics could help to gain future insights into how postponing parenthood may be more harmful for some than others – to give an answer to the pressing “how long can you wait” question.

Sedentary time in 3 work settings

Quite a while we have been working on an article investigating
sedentary behavior in 3 work settings and is this year published in PLOSone. The cross-sectional data was retrieved from the vitality in practice research program. All three studies were randomized controlled trials with baseline assessment and in each study a subgroup wore an accelerometer. The participants were from different work settings; white-collar office workers from a financial service provider (n=92); white collar workers from two research institutes in a governmental sector (n=102); blue-collar workers from a construction company (n=47). The study with white-collar workers from a financial service provider was the project where I did my PhD on. In great collaboration with TNO we have been analyzing the data and we found some interesting results, see the slides above.

Key findings were that sedentary behaviour is high among white-collar employees, especially the high educated females. Interventions should be aimed at reducing the amount of total and occupational sedentary time within this group.

Van Dommelen P, Coffeng JK, Van der Ploeg HP, van der Beek AJ, Boot CRL, and Hendriksen IJM. Accelerometer derived Sedentary time, Prolonged Sedentary Bouts and Physical Activity within 3 Dutch workplaces for complete and work days. PLoS One; 11 (3).

Madrid – Permanent jetlag

Last week I was in Madrid for the TANSNIP study. Although it was beginning of October and leaves were already falling slowly to the ground and sweaters came out to play, the temperatures suddenly increased to top summer levels again. The Spaniards are quite used to this metereological phenomenon which happens each year at the end of september and call it veranillo de San Miguel. It is connected to the celebration at the 29th of September: Saint’s day of San Miguel, San Rafael and San Gabriel (the three Archangels).

Malasaña.

Whatever it is, I was very happy with this San Miguel thing which implicated summer revival. This time my apartment (by Airbnb) was located in Malasaña – in my opinion one of the nicest neighborhoods in Madrid. At the end of Franco´s era, around the 80´s Malasaña became popular. It is known for its bohemian spirit, street art and special craftsman shops. In the heart of Malasaña is Calle del Espírity Santo which is a great mix of street art, colorful coffee chops and special foodshops (from popcorn, ice lollys to cakes ). After work I’d like to observe the local life and sitting on a terrace with a book is what I do often (recommended is restaurant Ojála ). It was not the first time that i was surprised by the fact that people eat extraordinary late and go to bed after noon. A logical thing to do would be to start working at 10am but they don’t. Most Spaniards start between 8am-9.30am which is to be compared to the Netherlands.

Spain – permanent jet lag.

While driving to the Spanish bank for some interviews – which is about 20km outside of Madrid – I decided to share this with my Spanish colleague. According to him, most Spaniards have a permanent jetlag and this is mainly because a large part of the peninsula is living in the wrong time zone (i.e., the Canary Islands forms an exception). In 1943 it was decided by dictator Franco that Spain needed to live in the same time zone as Nazi Germany. Portugal and Great Britain followed, but after the war years they returned to their original time. Looking up some history information reveals that time zones were identified during the International Meridian Conference in 1884 where they decided to split the earth in 24 time zones, with Greenwich (part of London) was the prime meridian. Spain is not an exception where times zones are not matched to country or state boundaries. For example, a part of France falls in the Greenwich area but they use the Central European time. Likewise, Chine is officially divided in 5 time zones but uses only one. My colleague mentioned that the people living in Madrid and other parts of the actual ‘Greenwich zone’ wake up an hour too early and to go bed an hour too late. This makes it harder to get 6 hours of sleep that is recommended by the World Health Organization. Research shows that the Spaniards sleep less than all Europeans. That I pick a hot topic is supported by the fact that there is a special committee investigating the hours – namely the ARHOE (National Commission for the Rationalization of Spanish Hours). According to ARHOE the incorrect time has far stretching implications for productivity, stress, accidents at work, and school performance for the youth.
Living ahead of the solar hour implicates that lunch is consumed at 2-3 pm and supper from 21-22 hours. Likewise, prime time television schedules (after 10pm) should be adapted – televisions stations are open for that but only wanting to do it if people will be home to tune in. Nowadays people do not arrive home before 10pm.
Resetting the time is ideally accompanied by better alignment of working hours. That Spaniards struggle to combine work / life is not irrational when you consider that they are working 200h per year more than the average of Europe. An explanation for these long workhours is the extensive amount of social gatherings during the workday combined with meals such as breakfast and lunch. Changing the time zone is for sure not a one-size-fits-all solution. Discussion should be focused on the use and distribution of daily work/private time in Spain which is totally different than Northern Europe.

Getting rid of the so-called permanent jetlag would come at no cost and is a lot easier than changing deep-rooted cultural habits. Much more is needed to end the marathon of working hours, general low work productivity, the late lunch and supper, and overall difficulties with balancing work/private life.



TANSNIP project

Just about 2 years, I am travelling back and forth to Madrid for the TANSNIP study. TANSNIP stands for Trans-Atlantic Network to Study Stepwise Noninvasive imaging as a Tool for Cardiovascular Prognosis & Prevention.

The TANSNIP study is a collaboration between Mount Sinai New York, CNIC Madrid, Banco Santander and VU medical center Amsterdam.
I am very lucky to be involved in developing and implementing the study. At the moment we have more than 700 participants that are included in the study at the Banco Santander Headquarter in Madrid and 325 participants started with the intervention program.
Why is this study so important?

Cardiovascular disease (CVD) remains the leading cause for premature death and morbidity worldwide. Given that the World Health Organization has identified the workplace as a key setting for promoting a healthy lifestyle for the prevention and control of non-communicable disease, there is a strong need to develop and evaluate long-term worksite health promotion programs. A number of reviews have indicated that worksite health promotion programs can be effective in promoting healthy lifestyle, including improving physical activity, sedentary and dietary behaviors, as well as smoking cessation. Our trial is linked to the The “Progression and Early detection of Subclinical Atherosclerosis” (PESA) cohort started in 2010 and consists of 4184 asymptomatic adult bank employees of the Banco de Santander Headquarters in Madrid, Spain (PESA: NCT01410318). PESA evaluates the presence and progression of subclinical atherosclerotic lesions in the carotid, aortic, coronary and ilio-femoral territories using noninvasive advanced imaging techniques. The value of subclinical atherosclerotic plaque burden identification and stratification driven by imaging data in a 30-month worksite-based lifestyle program will be assessed in the current TANSNIP-PESA study. Employees in the workplace-based lifestyle intervention program will receive 12 personalized lifestyle counseling sessions spread over the three-year period, a Fitbit personal fitness monitor to self-monitor physical activity, and an Ergotron sit-to-stand station. Data will be collected at baseline, at year one, at year two, and at year three. The primary outcome measure is the FUSTER-BEWAT score, a newly developed score, which consists of blood pressure, physical activity, sedentary behavior, body mass index, fruit and vegetable consumption and smoking. The researchers will also measure secondary outcomes such as changes in lifestyle, smoking, body weight, diet, vitality and quality of life, and risk factor profiles, as well as changes in blood biomarkers, and work-related outcomes such as work productivity and absenteeism.

More information about design of the study will be published soon. Of course, I will update on the study progress every now and then by means of this blog.

Travelling to the last 3 independent monarchies in Africa

There are hundreds of monarchies in Africa, however, there are only three independent monarchies in the whole of Africa. I was lucky to visit all three this year, i.e., Lesotho, Morocco and Swaziland. Lesotho and Morocco are constitutional monarchies and Swaziland is an absolute monarchy. Within an absolute monarchy, the king or queen rules with absolute power (also called undemocratic monarchy) whereas in a constitutional monarchy (also known as liberal monarchy), the head of state is elected and the king or queen has limited power since they rule along with a governing body.

Lesotho.

The Kingdom of Lesotho (a constitutional monarchy) is a small landlocked country entirely surrounded by South Africa. It is known as the ‘Kingdom in the skies’, the whole country being over 1,000 metres in altitude. Nearly 40% of the population live below the international poverty line of US$1.25 a day “. Just like Swaziland, the aids epidemic is disastrous and 26% of the population is infected. Life expectancy at birth is 50 years. In comparison to the neighboring kingdom Swaziland, things are quite different in Lesotho. The King Letsie the 3rd is popular and refrains from politics even when the his people ask him to intervene. In comparison to Swaziland, the British educated roman catholic has only one wife and not a large fry such as the Swazi neighbor.
We entered the country by the Sani Pass. The Sani Pass is the mother of all South African mountain passes, the most iconic gravel pass. Situated between KZN and Lesotho the pass was built circa 1950 and remains a challenging drive in 4×4 vehicles with all the drama, scenery, and treacherous conditions expected of a pass with a summit altitude of 2876 m”. .

Travel experiences Lesotho.

Africa and snow are not commonly found in the same sentence. So when we heard that the Sani Pass was open although it had snowed recently, we were very eager to go up. The drive up was spectacular along snow-dusted mountaintops and we did not encounter any problems. Arriving at the Swazi customs on top was another experience as it felt like arriving in medieval times. No strict boundaries are set and nice Rasta-haired men in a small golf-plated house gave you permission to enter the country after paying and filling in forms. Entering Lesotho, the kingdom in the sky, left us speechless. We rode over wind-blown hills, and into sheltered valleys carpeted with snow. Basotho people and their cattle were walking along the tar road, holding patterned blankets for protection from the cold. The road between Sani and Afriski and beyond has always been really bad. The trip used to take hours but took now just a few hours. We left Drakensbergen in the morning and still were on time to get an afternoon skiing in. We passed Letseng Diamond mine and crested the mountain over Tlaeeeng Pass. At 3255 meters above sea level it is one of the highest passes in Africa. The drive was absolutely beautiful. Afriski is situated in a natural bowl, cabins clustered on the hill above the ski slopes. It looks stereotypical, replete with winter cabins and frozen lakes. We decided to go for a ski afternoon, and we rented our outdated equipment from the local people in a funny ski shop. We satiated our lust for skiing after a few tracks; it was quite tiring with equipment that did not fit at all. We left exhausted but grinning after experiencing an après ski and ski show. Then we headed further along the A1 to New Oxbow lodge for the night. The next day, we moved back to South Africa through some of Africa’s most spectacular landscapes. Lesotho is still mainly a rural society and is not attracting many tourists. The country has spectacular sights and a very interesting culture – where can you experience that ponies are the most common form of public transport. Unfortunately, we did not had enough time to wander around to experience the local life.

Morocco.

The kingdom of Morocco, a country in the Maghreb region of North Africa, is just 13 km from the coast of Spain. Of the 3 independent kingdoms in Africa, Morocco has the best health statistics according to the World Health Organization. Life expectancy at birth is 71 years, the same as the world’s average. Stroke is leading cause of death, while HIV/AIDS are the leading causes of death in the other two kingdoms (in Morocco 0,1%). The so-called “cool” king Mohammed VI is the wealthiest monarch in Africa (2 billion dollar). Now he is 16 years on the throne and he has survived the Arab spring. The king had started reforming in early 2000 and therefore the king was successful in avoiding the commotion that the other countries in the region faced. Another explanation is that no king from any other country in the region has fallen from his throne during the Arab spring. It is believed that Arab monarchs are more legitimate than presidents because the monarch is a direct offspring from the prophet Mohammed. Most people, especially in rural areas belief that they are emotionally connected to the king. The king got a lot of credits for his reforms (one of his highlights was giving more rights to women) from the western world but on the other hand United Nations has reported higher incidence of torture.

Travel experiences Marrakech & Atlas.

Earlier this year I have travelled to Marrakech and the Atlas. In the red city we stayed in a riad (Palais Khum) which is a traditional Moroccan house built around a courtyard. For a few days we were sitting in cafés just to view the Moroccan live, ate a lot of tajines flavoured with saffron and argan, got lost in the medina, and sweat in the Medina. The famous Jemaa-el-Fnaa carnivalesque square is truly the chaos everyone mentions: every night lots of people are eating, shopping, watching magiicans and listening to music. It is very fascinating to watch.
We also visited the Atlas mountains, following the hairpinced Tizi-n-Tichka pass was adventurous. It was a journey across the Atlas Mountains with astounding beautiful countryside views. Though we did not spend much time in the Atlas, we were amazed by the beauty of the Kasbahs. I enjoyed the most strolling around the streets and climbing up to the summit of the Kasbah (Ait Benhaddou). The medieval red-earth village, UNESCO world heritage site brings you back to a century you never have experienced. This place is popular for many films such as the gladiator, babel and star wars.

Swaziland.

Significantly smaller than any other African country is Swaziland. It is sandwiched within South Africa and Mozambique. The country is listed among the few nations with an absolute monarchy next to Brunei, United Arab Emirates, Saudi Arabia, Vatican City, Oman and Qatar. The Swaziland constitution has come under a lot of criticism from Amnesty International for their lack of protection of human rights and the King for living a lavish lifestyle while most of his people live in poverty (63% below poverty line). The life expectancy at birth is only 54 years and the aids epidemic in Swaziland is disastrous (26% among the sexual active population). The annual reed dance ceremony (yearly market for the king to choose his new wife) was reintroduced in 1991 by the former king as a way to conserve virginity of young girls to lower HIV transmission. This august, the king had his annual ceremony where he chose his new wife and publicly tested her virginity. Partaking in this shocking long time tradition also results yearly in lost lives of the girls by car accidents or violence. Only one girl refused to marry him (2013) and is now living in England and is a vocal opponent of the Swazi regime.

Travel experiences Swaziland – Wide Horizons.

Ones you know all these facts, I was quite surprised that this little kingdom offers a refreshing escape from South Africa. A quite liberal and friendly atmosphere is felt as soon you get to the border, far more than in South Africa. We stayed 3 days in Swaziland at the Rosecraft farm in a safari tent (Wide Horizons). Hidden in the majestic Makungutsha mountains you will discover Wide Horizons. In the seventies it was founded by Rose. Rose played a big role in improving wealth of Swazi women. She opened a handweaving centre were nowadays still a lot of women are employed. We visited the weaving centre during our stay and were pleasantly surprised by the fact that women were charging all the batteries of mobile phones of their tribe members. They come up the hill each day with dozens of mobiles in their skirt to help their family and friends to charge. Rose a very charismatic lady had been leading for years the factory and now she is mainly involved in giving visitors from all over the world an unforgettable stay. Waking up in the sheer morning glow, seeing hauntingly beautiful views were precious moments. Swaziland is a dream for hikers and 4×4 adventurists since many of the roads are gravel.

Inspiring talks Health Promotion – Cape Town

Uplifted by the beats of African drum sounds and rhythmic dancing, the yearly conference on behavioral nutrition and physical activity (ISBNPA) was officially opened in the beautiful city Cape Town this time. During the conference days, several interesting talks were held and the majority of the keynotes were very inspiring; TEDx-like. Inspiring as such that it opened up new insights for myself personally and possibly for future work endeavors.

Boring exercise is not making you smarter.
The first keynote which garnered my undivided attention (professor Adele Diamonds; British Colombia, Canada) was on the benefits of physical activity and cognitive function in kids. It is shown that kids with better inhibitory control will have, later in life, better health, higher income, better jobs, a better quality of life. Executive functions (EF) include ‘thinking outside the box’ (e.g., reasoning, creative problem solving, working memory, and self-control). When you are sad, stressed, not physically fit, prefrontal cortex and executive functioning are the first of the brain and mental functions to suffer. People are able to think more clearly and creatively, have better self-control and discipline (better EF functioning) when they are feeling happy, not high in stress and physically fit. Various activities are helpful in improving EFs in children, i.e., yoga and martial arts.

What can be learned from Adele Diamonds’ research so far is that Executive Function needs to progressively challenged and repetition is key. Focusing on for example aerobic activity alone is not very effective. Children devote time to activities they love and adults need to adopt this child-like enthusiasm. What was most striking to hear is that boring exercise is not likely to improve one’s executive function. So, it has been shown that aerobic exercise does not seem to have or has very little benefit in improving one’s executive functions. The so-called “Mindless aerobics”, is not that the aerobic fitness itself causes executive benefits. Instead, it seems that cognitive challenges exercises such as my climb described in my other blog to Lion’s Head and Table Mountain helps in improving executive functions. It is that the difficult motor skills give a boost to our executive function. Taken that, it gives me understanding into why I feel always so mentally refreshed after engaging in for me challenging exercises such as mountain biking, boot camping and ski-trekking.

Besides that, sports need a challenging component, for good functioning executive functions, happiness and passion is vital. Take-home message for myself is that for good EF function in adults and children, it is key to combine challenging physical activities with fun. What is also interesting for my research on worksite health promotion is that confidence, camaraderie and happiness might be key factors for intervention success. Interventions are mostly not targeted on those aspects.

Both Dads and Kids are great role models.
A very charming talk was given by Phil Morgan from Newcastle Australia. He stressed the importance of Dads & that kids can not only nag their parents but can make great role models.
Most weight-loss programs do not take into account gender differences in design and delivery. There is a severe underrepresentation as men find these weight loss programs unappealing. This is of concern since almost 70% of Australian men are overweight or obese. The burden of disease is higher for men due to greater abdominal fat tissue that increases the risk of cardiovascular disease. To address this, appealing evidence-based programs are high in need. Phil Morgan leaded in designing and evaluating gender-tailored weight management programs.
Healthy dads, Healthy kids and DADEE (are just two of his many leading initiatives in obesity prevention for men.
The multi-award winning evidence-based program Healthy Dads, Healthy kids was designed to help father to control their weight, to have children to eat more healthy, to increase physical activity and improve quality of life for families. What is the magic behind this award-winning program? Why dads sign up to the study is that they would like to reduce some weight but also like to have quality time with their kids. Both Dads and children are motivated to work together. To illustrate, a kid is told that he or she needs to help his Dad to lose weight by eating his/her own veggies as Dad might copy him/her. Likewise, Dads can serve as a role model by giving the right example(s). Another great example is that kids can play the personal trainer for their Dad. Besides paying attention to a healthy diet, also physical activity sessions are interactive and fun. On top of this, Dads become more involved in their children’s lives, increasing the social and emotional well-being of their kids. The total success package for sustainable lifestyle change involves: Dad’s desire to the best for his child(s), father’s unique mean of play, being physically interactive and engaging with their children. With the DADEE program for Dads and their daughters, girls self-esteem increased so much – take off gender glasses. Girls are marginalized in physical activity contexts; Dad’s can play such a vital role in correcting this. Moreover, the DADEE intervention strengthens the father daughter relationship. Other programs directed at men are the SHED-IT program and Workplace POWER.

Social media has to power to change society.
The conference ended with a keynote by Gerard Hastings (Scotland) on social marketing. For years, it used to be the big tobacco industries that were frightened for the ever-growing regulation, but nowadays the big food, big soda and the big alcohol organizations are facing the same fears. These giants are protecting themselves by using several tactics. Our efforts to prevent non-communicable diseases (e.g., diabetes, cancer etc.) are against the business of these powerful companies. These companies are using marcomms (marketing and communication techniques) which are subtle and difficult to detect such as emotional appeals that makes us feel happy about the consumption process, celebrity endorsement and sponsorships. Social media has helped in enhancing the reach and thus playground for those subtle appeals even more. Gerard Hastings insisted on increasing awareness of the wider audience of those unhealthy marketing endeavors of the giants. Possible tools for this is by building their critical capacity, offering counter marketing involving media efforts like truth campaigns and regulation to reduce exposure to unhealthy marketing. Social media is ubiquitous and has the power to change just not behaviors but also societies.

Charity run.
To compensate for the prolonged sitting while listening to the talks, we were instructed that we needed to stand up and clap in our hands after each presentation. Although, many of us did not do so or found it extremely annoying. I do think it was a good initiative to disrupt prolonged sitting. Other activities to give a boost to activity were the 6AM morning run, bootcamp classes and yoga treats ( I never managed it to get up that early ;)).
What I did join with full enthusiasm was the charity run along the seaside sponsored by Multiply. On Friday after the conference talks, we were picked up by buses to bring us to the seaside. There the charity run (5K) started with members of the conference. Multiply created a nice area with uplifting music. The run was spectacular along the coast, and due to the harsh wind more exhausting than expected. Many of my colleagues were fanatic and soon I mimicked their run style and I ran faster than I am used to. Putting the lessons from Adele Diamond in practice, again I experienced that after a quite challenging but fun run, I felt mentally refreshed.

Main lessons learned:
Boring exercise does not help you to get a clearer mind but you need to engage in challenging physical activities where you feel passionate about.

Dads and Kids play a crucial role in promoting their health.

Social media is not only an add-on tool for supporting behavior change but well-implemented can change society, also in a threatening way.

Outdoor activities – Cape Town

“Sport has the power to change the world. It has the power to inspire. It has the power to unite people in a way that little else does. It speaks to youth in a language they understand. Sport can create hope where once there was only despair. It is more powerful than government in breaking down racial barriers”.

– Nelson Mandela

Sports was one of the key themes of my visit to Cape Town for the conference on behavioral nutrition and physical activity (ISBNPA). During my free days exploring Cape Town, I had plenty of opportunities to engage in exercise. Cape Town is a great city which offers a lot of outdoor.

Paddling through Cape Town.

Upon the day of our arrival, we started with biking through the city (Awol tours; highly recommended). Our companion was a Dutch man who has been living for over 15 years in Cape Town. Together we explored the city by learning about Cape Town’s rich heritage. There are no bike lanes, which asks for being creative by taking pedestrian routes. While paddling through the city from the historic city centre, colourful Bo-Kaap to Green point, he shared several anecdotes about South Africa.

South-Africa has quite a young population. And with the turbulent history the country has, a growing part of the population has never experienced what it is like to live under apartheid, the unjust system that separated people on the basis of race. About forty per cent of the total population is born after 1994, the date on which the first fully democratic election was held. In other words, they are freeborns and they have no memory of apartheid involving recollection of going to separate schools or living in designated neighborhoods. It is expected that in the coming years a lot is going to change when freeborns step by step are gaining power at ministry positions.
While it is true that these freeborns have no recollection of apartheid, they are still living in chains due to high rates of unemployment. Also, racial preference (black freeborns are automatically assigned as previously disadvantaged) is under attack as it imposes costs on the economy and reinforces victimhood and entitlement. Our guide also shared with us how the government has offered to build stony houses just outside the townships. This deed is borne from a historic pledge signed by the ANC party in 1994. Sadly, the realization of these homes is too costly and takes up too much time. It usually takes about 10 to 15 years of waiting, in which case it makes much more sense
to sell off these properties and build a shack instead.

Cape Town’s schizophrenia.
Although the apartheid is years away, Cape Town is only a paradise for a minority. This minority, usually white and advantaged, dwell in the most luxurious real estate that can be found on the entire continent. It seems that Cape Town is designed by an inner city and coastline for the rich, and the side settlements are for the poor. Cape Town feels schizophrenic since you can head from cliff located villas with infinity pools in the west to the townships in the east in a mere 20 minutes.

Robben Island.
A must-see in Cape Town is Robben Island, where Nelson Mandela was incarcerated 18 of the 27 years before the fall of the apartheid. Two former presidents of South-Africa (Mandela and Motlanthe) and the current president Jacob Zuma were imprisoned at Robben Island where they fought against apartheid. This UNESCO world heritage site (declared in 1999) is just 9 kilometers offshore from Cape Town in the middle of shark-infested waters. It was named Robben Island by early settlers (the Dutch) referring to the seal population situated there.

The 1-hour ferry trip to the island is spectacular with views of Cape Town and Table Mountain. Over the centuries, the island housed the deprived, i.e., prisoners, lepers, mentally-ill people. Entering the island is paradoxical at the same time as the island is also a well-conserved sanctuary for bird and animal life – being a place for unwanted people in a mystic animal environment. We were guided through the prison by an ex-prisoner who had to stay there for 5,5 years. He was walking around with a wooden stock (arthrosis, due to sleeping on an ice cold floor for years, only a thin mat separated him from the cold floor). He was having eyesight and respiratory problems due to endured crushing and lifting of heavy rocks in the blinding sun and dust. It is incredible to see that the tour guides are former prisoners and you might think that it is very difficult to re-enter the island where immense brutality was set against them. However, the main reason for coming back is not a bold gesture but for the sake of money.

Climbing adventures.
It was time to get rid of the inactivity and to explore the adventurous options the city has to offer. Early in the morning, we headed with a group of colleagues of the conference to Cape Town’s Icon Lion’s Head. Lion’s Head is majestically peeking out the skyline forms part of the Table Mountain range and has a height of 669 m above sea level. The Dutch Settlers called it Leeuwen Kop (Lions Head), its counterpart Signal Hill was called Leeuwen Staart (Lion’s Tail). This winding path, which travels around the mountain, provides constant scenic views over the mother city, Table Mountain and Camps Bay. Although the hike of around 2 hours requires a level of fitness (not suited for unfit or very young children) and no freight of height; it is not too difficult as you find chains and ladders to help you steep sections. Once you reach the summit, you are rewarded by astonishing views.

While walking down, we were triggered by the beautiful views of Table Mountain and wanted to climb that mountain as well right after. We asked the mountaineers and they mentioned that the ascent is less steep and can be taken lightly. A bit overconfident, the three of us started with climbing Table Mountain (1085m) directly after the Lion’s Head. We took the Platteklip Gorge, a beautiful hike with a straight, but in my opinion steep ascent. We already had some climbing kilometers in our legs and therefore the hike was for me quite exhaustive. After 1,5 hour climbing on a fast pace, we reached the summit, which treated me again with astounding views.

After a day of climbing both Lion’s Head and Table Mountain involving more than 20.000 steps, 4 hours of climbing, 900 height meters, I felt extremely satisfied, relaxed and any workload was disappeared. This made me realize that for me working out in the nature is something that helps me to relax and to gain a clearer mental picture of everything. How this is supported by scientific evidence, that is what I will find out during the ISBNPA conference, which will be described in my next blog.

Worksite Health Promotion