Dorien Brouwer

24 PART 1 Chapter 1.1 · Self-efficacy, measured with the self-efficacy scale, a 9-item scale with scores that range from 1 to 5. Higher values indicate more confidence to carry out the behavior necessary to reach the desired goal. [30-32] Questions are formulated as: I think I am able to quit smoking / choose healthy food/ care for enough physical activity. Total scores range from 5-35. · Depression as measured with the CES-D (Centre for Epidemiologic Studies Depression Scale) for both depression and anxiety. [33, 34] Higher scores indicate more depressive symptoms. · Cognitive impairment, assessed with Montreal Cognitive Assessment (MoCA), a rapid screening instrument for cognitive impairment, in particular in stroke patients. [35] The MoCa screens visuospatial/ executive functions, naming, memory, attention, language, abstraction and delayed recall and orientation. Scores range from 0-30. Outcome measures Primary outcome measures were intention to change physical activity, dietary behavior, and smoking cessation at baseline and actual change in these behaviors at 3 months. The main outome, behavioral intention (intention to change) was assessed by means of a single item. [29] Patients were asked ‘on a scale of 1 to 5, how likely is it: - to get 30 minutes of moderate to heavy daily physical activity in the next 3 months - to decrease your intake of unhealthy fats/ reduce their total energy intake in the next three months? - to stop smoking within the next 3 months? At baseline and 3 months thereafter, health-related behavior was assessed: · Physical activity, measured with the International Physical Activity Questionnaire short (IPAQ-S) questionnaire. Patients were asked to report activities performed for at least 10 minutes during the last 7 days, and time spent in physical activity performed across leisure time, work, domestic activities, and transport at each of 3 intensities: walking, moderate, and vigorous. [29] We used reported minutes of moderate and vigorous physical activity to calculate a total physical activity score of minutes a day. · Dietary behavior, evaluated with the short Food Frequency Questionnaire (FFQ). This 14-item scale assesses the intake of saturated fatty acids, unsaturated fatty acids, and fruits and vegetables over the week before the visit. An overall cardiovascular dietary