Impacts of temperature and solar radiation changes in northern Europe on key population health behaviors: a scoping review of reviews.

AIM: Climate change threatens health directly as well as indirectly through impacts on health-related behaviors. Physical activity, nutrition and sleep are key health-related behaviors for population health. We aimed at elucidating the impacts of climate change which emerge gradually on these three key health-related behaviors, particularly focusing on scenarios and projections relevant to people living in the northern Europe. METHODS: We conducted a systematic literature search in three different databases in January 2023 to identify English language review articles summarizing the effects of climate change on either physical activity, nutrition, sleep, or their combination. RESULTS: We identified 15 review articles on the topic. Data on climate change impacts on nutrition and sleep were sparse, and those on physical activity were heterogeneous. The climate in northern Europe will become warmer and sunnier in summer as well as warmer and darker in winter, which will probably increase the level of physical activity, but decrease the consumption of fruits and vegetables, as well as increase the occurrence of sleep disturbances in a population. CONCLUSIONS: The anticipated changes in physical activity, nutrition and sleep driven by climate change influence population health and call for grass-roots action plans for adaptation.

Targeted health promotion with guided nature walks or group exercise: a controlled trial in primary care.

Background: Contact with nature promotes wellbeing through diverse pathways, providing a potential way of supporting health especially in primary care, where patients commonly suffer from multimorbidity and poor general health. Social prescribing is a non-pharmaceutical approach for improving health as well as social inclusion. This field study explores and compares the effects of a nature-based and an exercise-based social prescribing scheme on mental wellbeing and sleep, in a primary care population. Methods: Primary care patients identified to benefit from a general improvement to their health were recruited by nurses, doctors, or social workers to this non-randomized, intention-to-treat, pilot field-study. Participants (n = 79) chose between the group interventions, either taking part in guided walks in nature, including immersion in a forest with high biodiversity, or participating in a versatile sports program. Mental wellbeing was assessed with the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS), with additional questions evaluating self-rated health and sleep. Impact on mental wellbeing was explored in relation to perceived health. The amount and quality of sleep was measured with wrist-worn accelerometers. With a focus on everyday life impacts, the assessments took place before and after the 8-week intervention. All participants lived in Sipoo, Finland, an area with abundant accessible green space. Results: Participants (mean age 57 years, 79% female) rated their general and mental health lower than the general population. Participation in the Nature-group resulted in improved mental wellbeing (change in WEMWBS by 3.15, p = 0.008), with a positive change for feeling relaxed, being cheerful, having energy to spare, feeling able to deal well with problems, feeling good about oneself and feeling close to other people. The Sports-group was beneficial for those initially rating their health as good. Sleep duration improved in the Sports-group, while participants in the Nature-group reported better sleep quality. Following the interventions there was improvement in perceived health and ability to function in both groups, while perceived mental health improved only in the Nature-group. Conclusion: We attest that even in areas surrounded by greenery, active interventions can further improve health in a primary care population, and that nature-based interventions are beneficial for those in poor health. Clinical trial registration: ClinicalTrials.gov, Identifier NCT05893212.

The effects of long-term physical activity interventions in communities: Scoping review in the Nordic countries.

Aims: Physical activity (PA) is an important part of maintaining good overall health. Currently, the number of insufficiently physically active adults and children is alarmingly high worldwide. To tackle the challenge, several interventions have been conducted, however, current knowledge on intervention effectiveness is still inconclusive. This scoping review aimed to summarize the effects of long-term PA interventions across all age groups in the Nordic countries. Methods: A scoping review was conducted by including all age groups and interventions lasting more than 12 months. The aims of the interventions had to focus on increasing PA and/or fitness. The Behaviour Change Wheel framework was used to describe components of the intervention functions. Results: Initially, 1937 studies were identified. Twelve intervention studies fulfilled the inclusion criteria and were included in the analysis. From the included studies, seven focused on children and/or their parents and five on working-age adult populations. Most of the studies built on theoretical backgrounds and included several behaviour change functions. A hindering factor for synthesis was variation in measurement methods: both subjective and objective outcome measures were reported. Among all age groups, intervention effects on PA were modest. Conclusions: There was no clear evidence of increased PA or fitness from long-term interventions in communities. However, even small improvements in PA are important for increasing PA at a population level and enhancing public health. More research is required for evidence-based community and public health planning.

Adiposity Markers as Predictors of 11-Year Decline in Maximal Walking Speed in Late Midlife.

Background: Obesity is linked to poorer physical functioning in older adults, but impact of excess adiposity on loss of functional capacity in late midlife is unclear. This study examined associations between adiposity markers and 11-year change in maximal walking speed, a sensitive indicator of physical functioning, among adults aged 55 to 69 years. Method: Maximal walking speed over 6.1 m was assessed in 2000 and 2011 among Finnish men (n = 409) and women (n = 498) from the prospective Health 2000 Survey. Body mass index (BMI) and waist circumference were assessed in 2000. Generalized estimating equation models estimated changes in maximal walking speed by BMI and waist circumference, stratified by sex. Results: BMI greater than 30 kg/m2 was associated with accelerated decline in maximal walking speed particularly in women. Associations with waist circumference were nonsignificant. Conclusion: Late midlife obesity may speed up the decline in functional capacity as measured by maximal walking speed, especially in women.

Associations between physical activity types and reaching the physical activity guidelines: The FinHealth 2017 Study.

Physical activity (PA) guidelines for adults recommend to both aerobic and muscle-strengthening exercise. We aimed to report prevalence of adults reaching these guidelines and further study associations of types of physical activities with the PA guidelines. In a national FinHealth 2017 Study, adults (18+ years, n = 5335) reported participation in different types of physical activities in summer and winter, in duration of moderate- and vigorous-intensity aerobic PA, and frequency of muscle-strengthening PA. Logistic regression analysis was used, adjusting for age, education, and self-rated health, stratified into age-groups of 18-64 years and 65+ years by gender. PA guidelines were reached in the age-group of 18-64 years by 42% of men and 39% of women and in the age-group of 65+ years by 26% of men and 20% of women. Walking, cleaning and maintenance work, and stair climbing were the most popular PA types throughout the year. Workout and muscle-strengthening exercises were consistently associated with 3-8 times higher odds for reaching the PA guidelines across age, gender, and season. Other PA types (eg, jogging, swimming, skiing, gardening, or stair climbing) had more varied associations with the PA guidelines across gender, age, and season. Our data suggest that only certain conditioning activity types associate with reaching PA guidelines. Findings indicate that future interventions could more specifically use information on gender and age variation in the PA types, to find solutions for low physical activity in the population.

Change and determinants of total and context specific sitting in adults: A 7-year longitudinal study.

OBJECTIVES: To assess the stability and determinants of total and context specific sitting in a follow-up of adults. DESIGN: Longitudinal study. METHODS: Participants in the DILGOM cohort (n=3735, men 45%), reported daily sitting in five contexts (work-related, in vehicle, at home by the TV, at home at the computer, and elsewhere) in 2007 and 2014. Sociodemographic background, lifestyle and health were assessed in 2007. Total sitting comprised the sum of context specific sitting. Changes in, and determinants of context specific sitting, stratified by baseline age into young middle-aged (<53 years); late middle-aged (53-68 years) and older-aged (>68 years) were estimated by generalized linear mixed models. RESULTS: In 2007, total daily sitting was 7h 26min, 6h 16min, and 6h 3min in young middle-aged, late middle-aged and older-aged groups, respectively. Over 7 years, total sitting decreased on average by 26min. Sitting at the computer increased by 7-17min. The late middle-aged group also increased sitting by the TV, and decreased total, work-related, vehicle and elsewhere sitting. Occupational status determined context specific sitting, but somewhat differently in young and late middle-aged groups. Poor self-rated health determined less work-related and more sitting by the TV in the young, whereas good health determined less work-related sitting in the late middle-aged group. CONCLUSIONS: Self-reported sitting is a fairly stable behavior, with the exception for the late middle-aged group, where all context specific and total sitting changed significantly. Occupational status and health determined changes in sitting; however, somewhat differently by age group.

Compliance with the 24-h movement guidelines and the relationship with anthropometry in Finnish preschoolers: the DAGIS study.

BACKGROUND: Recent 24-h movement guidelines for the early years established recommendations for physical activity (PA), screen time (ST), and sleep. To date, few studies have focused on compliance with meeting the guidelines and their associations with health outcomes. Thus, we aimed to investigate: 1) compliance with the 24-h movement guidelines, and 2) associations between compliance and anthropometry in Finnish preschoolers. METHODS: We utilized DAGIS survey data that were collected in 2015-2016 (N = 864). PA was assessed 24 h/day over 7 days using a waist-worn ActiGraph wGT3X-BT accelerometer. ST and sleep were reported by the parents during the same 7 days. Anthropometry was assessed using body mass index (BMI, kg/m2) and waist circumference (WC, cm). Children were classified as meeting the guidelines if they averaged ≥180 min/day of PA, which consisted of ≥60 min of moderate-to-vigorous intensity; ≤60 min/day of ST; and 10-13 h/day of sleep. In total, 778 children (51% boys, mean age: 4.7 ± 0.9 years) were included in the study. The compliance with meeting the 24-h movement guidelines was calculated for each behavior separately and in combinations. Adjusted linear regression analyses were applied to examine associations of compliance with BMI and WC. RESULTS: Children were physically active on average 390 (±46.2) min/day and spent 86 (±25.5) min/day in moderate-to-vigorous PA. They spent 76 (±37.4) min/day on ST and had on average 10:21 (±0:33) h:min/day of sleep. The compliance rate in meeting all three movement guidelines overall was 24%. The highest compliance rate was found for PA (85%), followed by sleep (76%) and ST (35%). Meeting guidelines separately for PA or sleep, or for both, were associated with lower WC (PA: B = -1.37, p < 0.001; Sleep: B = -0.72, p = 0.009; PA + Sleep: B = -1.03, p < 0.001). In addition, meeting guidelines for sleep or for both PA and sleep were associated with lower BMI (Sleep: B = -0.26, p = 0.027; PA + Sleep: B = -0.30, p = 0.007). There were no significant associations found regarding ST. CONCLUSIONS: Meeting recommendations for PA and sleep may have an important role in supporting a healthy weight status in young children. However, there is still a need to improve compliance with the 24-h movement guidelines, especially for ST.

Gender, age and socioeconomic variation in 24-hour physical activity by wrist-worn accelerometers: the FinHealth 2017 Survey.

Assessing movement over 24 hours increases our understanding of the total physical activity level and its patterns. In the FinHealth 2017 Survey, a population-based health examination study, 940 participants between 25 and 93 years were instructed to wear an accelerometer (Actigraph GT9X Link) on their non-dominant wrist for 24 hours on 7 consecutive days. Physical activity information was extracted from 100-Hz triaxial 60-second epoch data as average vector magnitude counts per minute (VM cpm). Results were analyzed by gender, 10-year age-groups, employment status, and education. Hourly means were plotted and compared. Analyses included 915 participants (44% men) who wore the device at least 10 hours on 4 or more days, with mean wear time being 149.5 hours (standard deviation of 615.2 minutes).Women had higher average VM cpm than men (p < 0.001), with significant gender differences in all age-groups until 65 years and older. Total physical activity was lower with age, unemployment, and retirement, where the hourly patterns mirrored the findings. Our findings agree with previous large-scale wrist-accelerometry data, but extend current knowledge by providing data on gender and socioeconomic variation in physical activity across 24 hours in a population-based adult sample representing a broad age range.

Insomnia and cardiorespiratory fitness in a middle-aged population: the SCAPIS pilot study.

BACKGROUND: The relationship between insomnia and cardiorespiratory fitness (CRF), a well-established risk factor for cardiovascular disease, has not been extensively studied. We aimed to assess the independent association between insomnia and CRF in a population-based cohort of subjects aged 50 to 64 years. METHODS: Subjects participating in the Swedish CArdioPulmonary bioImaging Study (SCAPIS) pilot cohort (n = 603, men 47.9%) underwent a submaximal cycle ergometer test for estimation of maximal oxygen consumption (VO2max). Data on physical activity and sedentary time were collected via waist-worn accelerometers. An insomnia severity index score ≥ 10 was used to define insomnia. RESULTS: Insomnia was identified in 31.8% of the population. The VO2max was significantly lower in insomnia subjects compared with the non-insomnia group (31.2 ± 6.3 vs. 32.4 ± 6.5 ml* kg-1 *min-1, p = 0.028). There was no difference in objectively assessed physical activity or time spent sedentary between the groups. In a multivariate generalized linear model adjusting for confounders, an independent association between insomnia status and lower VO2max was found in men, but not in women (ß = - 1.15 [95% CI - 2.23-- 0.06] and - 0.09 [- 1.09-0.92], p = 0.038 and 0.866, respectively). CONCLUSIONS: We found a modest, but significant, association between insomnia and lower CRF in middle-aged men, but not in women. Our results suggest that insomnia may link to cardiovascular disease via reduced CRF. Insomnia may require a specific focus in the context of health campaigns addressing CRF.

Subjects with cardiovascular disease or high disease risk are more sedentary and less active than their healthy peers.

OBJECTIVES: We investigated differences in objectively measured sedentary behaviour (SB) and physical activity (PA) levels in subjects with cardiovascular disease (CVD) diagnosis or high CVD risk compared with healthy controls. METHODS: The present study includes a subsample (n=1398, Health 2011 Study) of participants, who attended health examinations and wore a triaxial accelerometer (≥4 days). Patients with CVD were identified and CVD risk was calculated for others using Framingham Risk Score (FRS). Participants were categorised into groups: FRS<10%; FRS=10%-30%; FRS>30%/CVD. Raw acceleration data were analysed with mean amplitude deviation (MAD) and angle for posture estimation (APE). MAD corresponding to intensity of PA was converted to metabolic equivalents (MET) and categorised to light (1.5-2.9 METs) and moderate to vigorous PA (MVPA≥3.0 METs). APE recognises SB and standing. RESULTS: Daily accumulated time of >30 s MVPA bouts was higher in FRS<10% group (46 min) than in FRS>30%/CVD group (29 min) (p<0.001). FRS>30%/CVD group were more sedentary, their mean daily number of >10 min SB bouts (13.2) was higher than in FRS <10% group (11.5) (p=0.002). CONCLUSION: Number and accumulated times of SB and PA bouts differed between the CVD risk groups. Causative research is required to assess the importance of SB and PA in prevention and rehabilitation of CVDs.

The associations between chronotype, a healthy diet and obesity.

Unhealthy diet has been associated with obesity. Evening type has been associated with unhealthier food and nutrient intake that could predict a higher risk of obesity among them as compared to morning type. However, thus far no study has examined the interrelationships between chronotype, a healthy diet and obesity. We examined whether a healthy diet mediates the association between chronotype and obesity and whether chronotype modifies the association between a healthy and obesity. The National FINRISK 2007 Study included 4421 subjects aged 25-74 years. Diet was assessed using a validated food frequency questionnaire. Baltic Sea diet score (BSDS), including nine dietary components, was used as a measure of adherence to a healthy Nordic diet. Weight, height, body fat percentage and waist circumference were measured, and body mass index values were calculated. Chronotype was assessed using a shortened version of Horne and Östberg's morningness-eveningness questionnaire (MEQ). The sum score calculated from MEQ was either used as a continuous variable or divided into tertiles of which the lowest tertile demonstrated evening preference and the highest tertile demonstrated morning preference. A series of regression analyses were conducted to determine whether the BSDS mediates the association between chronotype and obesity. Likelihood ratio test was used to determine whether chronotype modifies the association between the BSDS and the obesity measures. After testing the interaction, chronotype-stratified analysis for the association between the BSDS and obesity measures was determined by linear regression. Generally, the evening types had lower adherence to the BSDS and were more often smokers (men), physically inactive and had lower perceived health than the other chronotypes (p < 0.05). The poorer health behavior of this group, however, was not manifested in their obesity measures, and no evidence that the BSDS would mediate the association between chronotype and obesity was found (p > 0.05). No evidence that chronotype would modify the association between the BSDS and obesity was found either (p > 0.05).

Where to Sit? Type of Sitting Matters for the Framingham Cardiovascular Risk Score.

BACKGROUND: Current evidence on associations of type-specific sedentary behavior with cardiovascular disease (CVD) is limited to mainly screen-time sedentary behavior (SB). We aimed to study the associations of type-specific and total time spent sitting with the Framingham 10-year cardiovascular disease risk score (Framingham score) in Finnish adults. METHODS: Data comprise the National FINRISK 2007 and 2012 health examination surveys with 10,185 participants aged 25-74 years, apparently free of CVD. Participants reported average daily time spent sitting in different locations: work-related sitting, at home in front of television (TV), at home in front of computer, in a vehicle, and elsewhere. Total SB time was calculated from these context-specific self-reports. Accelerometer-based sedentary time was assessed in 988 FINRISK 2012 participants. Framingham score was calculated using information on blood pressure and its medication, cholesterol levels, age, diabetes status, and smoking. Analyses were adjusted for age, study year, education, employment status, leisure time physical activity, and body mass index. RESULTS: Out of several type-specific sitting behaviors, only TV sitting showed systematic associations with the Framingham score in both genders. The lowest Framingham risk was found for TV sitting from 6 minutes to less than 1 hour daily. Of other types of sitting, computer sitting was inversely associated with the Framingham risk in men only. Total self-reported sitting time did not show significant associations with the Framingham score, but instead higher objectively assessed sedentary time showed higher Framingham risk in men. CONCLUSIONS: TV sitting showed most systematic associations with CVD risk score. This suggests that of all types of SB, reducing TV sitting should be targeted for reducing CVD risk.

Evening typology and morning tiredness associates with low leisure time physical activity and high sitting.

Circadian typology is a latent trait that is usually assessed with scoring on a series of questions thought to represent the construct. But, in the classification, most people fall into the intermediate type, i.e. neither a definite morning nor an evening type, but still showing stronger preference towards either end of the continuum. Our aim was to operationalize chronotype using latent class analysis (LCA) for a 6-item scale derived from the original Horne-Östberg Morningness-Eveningness Questionnaire to compare and understand characteristics of chronotype in a population-based sample of adults in Finland. A total of 4904 men and women aged 25-74 years were included. We also analyzed the associations of chronotypes with physical activity (PA) and sitting. We found five latent chronotype groups including "rested more-evening type" (28%), "rested more-morning type" (24%), "morning type" (23%), "tired more-evening type" (17%) and "evening type" (8%) groups. Operationalization of chronotype by LCA suggests that morning alertness is an important feature differentiating chronotypes. Further, the "evening type" and the "tired, more-evening type" had higher odds for none to very low as well as low PA, as compared to "morning type". In addition, "evening type" was associated with higher odds for more time spent sitting, as compared to "morning type". Our findings indicate that it is important to assess sleep schedules and morning tiredness, which then could be targeted as a potential mediating factor for health behaviors, in particular, PA and health status.

Interrelationships of Physical Activity and Sleep with Cardiovascular Risk Factors: a Person-Oriented Approach.

PURPOSE: Associations of behaviorally modifiable factors like physical activity (PA), sedentary behaviors, and sleep with cardiovascular diseases (CVDs) are complicated. We examined whether membership in latent classes (LCs) differentiated by PA and sleep profiles (real-life clustering of behaviors in population subgroups) associate with metabolic risk factors and CVD risk. METHODS: The National FINRISK 2012 Study comprise a cross-sectional sample of 10,000 Finns aged 25 to 74 years. Analyses included participants with complete data on a health questionnaire, a health examination, who had no prevalent CVD (n = 4031). LCs with PA and sleep profiles were previously defined using latent class analysis. Ten metabolic risk factors and the Framingham 10-year CVD risk score were compared between the LCs. RESULTS: PA and sleep class profiles were substantially similar for genders. Compared to LC-1, with a profile including high PA and sufficient sleep, membership in LC-4, with a profile including sedentariness and insufficient sleep was associated with high metabolic risk factors in women but not in men. In women, also membership in LC-2, with a profile including light PA, sufficient sleep, and high sedentariness was associated with high metabolic risk factors. The Framingham 10-year CVD risk score was highest in LCs 2 and 4 in both genders. CONCLUSIONS: Membership in LCs differentiated by PA and sleep profiles was associated with metabolic risk factors merely in women, suggesting gender differences in the interrelationships of health behaviors and metabolic risk factors. Total CVD risk differed between the LCs despite of gender; however, the effect was small.

Physical activity and sleep profiles in Finnish men and women.

BACKGROUND: Physical activity (PA) and sleep are related to cardiovascular diseases (CVD) and their risk factors. The interrelationship between these behaviors has been studied, but there remain questions regarding the association of different types of PA, such as occupational, commuting, and leisure time to sleep, including quality, duration and sufficiency. It is also unclear to what extent sleep affects peoples' PA levels and patterns. Our aim is to investigate the interrelationship between PA and sleep behaviors in the Finnish population, including employment status and gender. METHODS: The study comprised population based data from the FINRISK 2012 Study. A stratified, random sample of 10,000 Finns, 25 to 74 years-old, were sent a questionnaire and an invitation to a health examination. The participation rate was 64% (n = 6,414). Latent class analysis was used to search for different underlying profiles of PA and sleep behavior in men and women, respectively. Models with one through five latent profiles were fitted to the data. Based on fit indicators, a four-class model for men and women, respectively, was decided to be the best fitted model. RESULTS: Four different profiles of PA and sleep were found in both men and women. The most common profile of men comprised 45% of the total participants, and in women, 47%. These profiles were distinguished by probabilities for high leisure time PA and sleep, subjectively rated as sufficient, as well as sleep duration of 7-7.9 hours. The least common profiles represented 5% (men) and 11% (women) of the population, and were characterized by probabilities for physical inactivity, short sleep, and evening type for women and morning type for men. There was also one profile in both genders characterized by likelihood for both high occupational PA and subjectively experienced insufficient sleep. CONCLUSIONS: The use of latent class analysis in investigating the interrelationship between PA and sleep is a novel perspective. The method provides information on the clustering of behaviors in people and the profiles found suggest an accumulative nature of leisure time PA, and better sleep. Our data also suggest that high levels of occupational PA are associated with shorter and poorer sleep.