Nurses' experiences of competence in lifestyle counselling with adult patients in healthcare settings: A qualitative systematic literature review.

AIMS AND OBJECTIVES: To identify and synthesise nurses' experiences of competence in lifestyle counselling with adult patients in healthcare settings. BACKGROUND: Modifiable lifestyle risk behaviours contribute to an increased prevalence of chronic diseases worldwide. Lifestyle counselling is part of nurses' role which enables them to make a significant contribution to patients' long-term health in various healthcare contexts, but requires particular competence. DESIGN: Qualitative systematic literature review and meta-aggregation. METHOD: The review was guided by Joanna Briggs Institute's methodology for conducting synthesis of qualitative studies. PRISMA-checklist guided the review process. Relevant original studies were search from databases (CINAHL, PubMed, Scopus, Medic and Psych Articles, Ebscho Open Dissertations and Web of Science). After researcher consensus was reached and quality of the studies evaluated, 20 studies were subjected to meta-aggregation. RESULTS: From 20 studies meeting the inclusion criteria, 75 findings were extracted and categorised into 13 groups based on their meaning, resulting in the identification of 5 synthesised findings for competence description: Supporting healthy lifestyle adherence, creating interactive and patient-centred counselling situations, acquiring competence through clinical experience and continuous self-improvement, collaborating with other professionals and patients, planning lifestyle counselling and managing work across various stages of the patient's disease care path. CONCLUSION: The review provides an evidence base that can be used to support nurses' competence in lifestyle counselling when working with adult patients in healthcare settings. Lifestyle counselling competence is a complex and rather abstract phenomenon. The review identified, analysed and synthesised the evidence derived from nurses' experience which shows that lifestyle counselling competence is a multidimensional entity which relates to many other competencies within nurses' work. IMPLICATIONS FOR THE PROFESSION: Recognising the competencies of nurses in lifestyle counselling for adult patients can stimulate nurses' motivation. The acquisition of these competencies can have a positive impact on patients' lives and their health. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. IMPACT: The research may enhance nurses' competence in lifestyle counselling, leading to improved health outcomes, better adherence to recommendations and overall well-being. It may also drive the development of interventions, improving healthcare delivery in lifestyle counselling. REPORTING METHOD: The review was undertaken and reported using the PRISMA guidelines. PROTOCOL REGISTRATION: Blinded for the review.

Problematic Internet Use among Adults: A Cross-Cultural Study in 15 Countries.

BACKGROUND: The present study compared adult usage patterns of online activities, the frequency rate of problematic internet use (PIU), and risk factors (including the psychopathology associated with PIU, i.e., distress and impulsivity) among adults in 15 countries from Europe, America, and Asia. METHODS: A total of 5130 adults from Belgium, Finland, Germany, Italy, Spain, France, Switzerland, Hungary, Poland, UK, Norway, Peru, Canada, US, and Indonesia completed an online survey assessing PIU and a number of psychological variables (i.e., depression, anxiety, stress, and impulsivity). The sample included more females, with a mean age of 24.71 years (SD = 8.70). RESULTS: PIU was slightly lower in European countries (rates ranged from 1.1% in Finland to 10.1% in the UK, compared to 2.9% in Canada and 10.4% in the US). There were differences in specific PIU rates (e.g., problematic gaming ranged from 0.4% in Poland to 4.7% in Indonesia). Regression analyses showed that PIU was predicted by problematic social networking and gaming, lack of perseverance, positive urgency, and depression. CONCLUSIONS: The differences in PIU between countries were significant for those between continental regions (Europe versus non-European countries). One of the most interesting findings is that the specific PIU risks were generally low compared to contemporary literature. However, higher levels of PIU were present in countries outside of Europe, although intra-European differences existed.

The association of problematic gaming characteristics with dietary habits among Finnish vocational school students.

Digital gaming is a popular pastime among young people, but its links to dietary habits have been little studied. The purpose of the study was to describe dietary habits and to examine their associations to problematic gaming behavior with regard to the degree of daily digital gaming time and the overall levels of disordered-like gaming behavior among students in vocational education in the Oulu region of Finland. This cross-sectional study consisted of a total of 773 first-year vocational school students who had played digital games regularly. Data was collected by using an online survey measuring sociodemographic information, dietary habits, amount of digital gaming time, and symptoms of problematic gaming behavior. Most prevalent weekly consumed food types were chicken (90.1%), chips (87.7%), and sausages/cold cuts (85.4%). Around one-fourth of students skipped breakfast on weekdays and at weekends. A higher amount of digital gaming time was associated with skipping breakfast on weekdays. More elevated levels of disordered gaming behavior were particularly associated with the use of a group of food types encompassing carbohydrate-dense and fast food. Current research provides indications that digital gaming may have an impact on youths' dietary habits, while at the same time, however, emphasizing that the issue can be affected by several interrelated and complex factors.

The association between the social environment of childhood and adolescence and depression in young adulthood - A prospective cohort study.

BACKGROUND: Good social relationships with parents and peers protect children and adolescents from developing mental disorders in adulthood while several negative experiences increase the risk of depression in later life. METHODS: We used population-based cohort data from the Northern Finland Birth Cohort (NFBC) 1986. Participants (n = 6147), their teachers and parents reported factors associated with the social environment of children and adolescents. Diagnoses of depression of cohort members were derived from Finnish nationwide registers. We conducted regression analyses to assess which factors of the social environment of childhood and adolescence were associated with depression in young adulthood. RESULTS: Bullying victimization in adolescence was the strongest predictor of depression in young adulthood among girls (OR 2.23: 95% CI 1.47-3.39) and boys (OR 2.44: 95% CI 1.49-4.00). Loneliness and bullying behavior in childhood were associated with depression in boys only. Loneliness in adolescence (OR 1.63: 95% CI 1.30-2.04) was associated with depression among both genders. Spending with the family seemed to protect against the negative impact of bullying and loneliness. LIMITATIONS: We used single-item study questions to measure social relationships. These questions do not necessarily describe the phenomena as accurately as the measures validated for them. CONCLUSION: Problems in social relationships with peers in childhood and adolescence are associated with depression in young adulthood. Time spent with the family is emphasized in situations in which adolescents have problems in peer-relationships.

The effects of an early intervention on adults' gaming-related problems - a pilot study.

Gaming Disorder (GD) has been recognized as an official psychiatric condition characterized by individuals' impaired control over gaming, continuous gaming despite the occurrence of negative side-effects, and gaming taking increasing priority over other important areas of life, thus leading to significant impairments in their everyday lives. To date few prevention and treatment programs have been developed. The present pilot study aimed to investigate the effects of an early psycho-educational intervention for young adults with excessive gaming behaviors. A one-group pre- and post-test design without a control group was used. A total of 22 young adults (20 males and 2 females) aged between 18 and 28 (M = 23.05, SD = 3.02) years old, engaged with the intervention. The severity of gaming-related problems, average gaming time per day, quality of life, and mental well-being were assessed at pretest and post-test stages. Participants demonstrated a slight reduction in gaming time (d = 0.13, p = .545 for weekdays, and d = 0.08, p = .714 for weekend days) and in the severity of problematic gaming (d = 0.17, p = .411) over the three-month intervention period. Changes in neither gaming-related measures nor self-assessed quality of life (p > .01) and mental well-being (d = 0.23, p = .288) reached statistical significance, however. Regardless of limitations on sample size, this study shows encouraging signs that this brief 10-session and three-month educational intervention can achieve positive effects on gaming behavior. A larger scale investigation is needed to develop the intervention further.

Risk Factors for Excessive Social Media Use Differ from Those of Gambling and Gaming in Finnish Youth.

PURPOSE: Adolescents' excessive social media use has characteristics similar to other addictive behaviours. This study aims to explore whether the same risk factors are associated with excessive social media use as with excessive gaming and gambling among Finnish adolescents. METHODS: Multinomial logistic regression analyses were carried out using the European School Survey Project on Alcohol and Other Drugs data, collected from Finnish adolescents aged 15-16 in 2019 (n = 4595). RESULTS: Excessive use of social media was more common among girls (reported by 46% of respondents) than boys of the same age (28%), whereas boys reported both excessive gaming (23%) and gambling (6%) more often than girls (4% and 1%, respectively). All differences between genders were statistically significant (p < 0.0001). Daily smoking was associated with a high risk of excessive gambling (AOR = 3.23) and low risk of excessive gaming (AOR = 0.27) but had no significant effect on excessive social media use. Cannabis use in the past 12 months was positively associated only with excessive gambling (AOR = 2.39), while past 12 months alcohol consumption increased the risk for excessive social media use (AOR = 1.25). CONCLUSIONS: Adolescent girls are at greater risk of excessive social media use than boys, while boys are at greater risk of excessive gaming and gambling. The associations with known risk factors are somewhat different for excessive use of social media as compared to excessive gambling and gaming and should be acknowledged when developing preventive measures for adolescents.

Lower parental socioeconomic status in childhood and adolescence predicts unhealthy health behaviour patterns in adolescence in Northern Finland.

OBJECTIVES: To determine the association between parental socioeconomic status in childhood and adolescence and unhealthy health behaviour patterns among adolescents in Northern Finland. METHODS: The sample, drawn from the Northern Finland Birth Cohort 1986 Study, consisted of 15- to 16-year-old adolescents (n = 4305). Data on socioeconomic status and health behaviours were based on questionnaires collected from cohort members and their parents during the former's childhood and adolescence. Logistic regression served to assess the association. RESULTS: Controlling for all other factors in the model, several socioeconomic factors were found to be significant predictors of unhealthy health behaviour patterns. In childhood, father's low and medium education for boys, and mother's low or medium education as well as fathers' unemployment for girls predicted greater likelihood of engaging in unhealthy behaviour patterns. For both genders, having a stay-at-home mother in childhood (and for boys also in adolescence) protected from unhealthy health behaviour patterns. For boys, mother's and for girls, fathers' low occupational education in adolescence increased the risk of developing unhealthy patterns. CONCLUSIONS: In the development of effective health prevention strategies, it is important to identify children and adolescents who are at risk of developing lifestyle diseases.

Associations between Childhood and Adolescent Emotional and Behavioral Characteristics and Screen Time of Adolescents.

The correlations between emotional and behavioral problems and increased screen time among young people has been highlighted in the literature. This study examined both longitudinal and cross-directional associations between the degree of childhood and adolescent emotional and behavioral problem characteristics and a higher level of daily screen time in adolescence using an extensive population study. Questionnaires providing data on a representative cohort sample (the Northern Finland Birth Cohort 1986 Study, NFBC 1986; n = 6479; 3101 males) were completed at birth, in childhood, and in adolescence. Male gender, and self-reported behavioral issues (such as a higher degree of hyperactivity/distractibility problems at the beginning of formal schooling and adolescent rule-breaking problems), predicted higher daily screen time in adolescence, after controlling for confounding factors. Higher levels of anxious-depression symptoms among adolescents were inversely related to them having elevated daily digital screen time. Individual behavioral tendencies at the start of formal schooling and later in adolescence may predict higher screen time among young people.

Parental socioeconomic status, adolescents' screen time and sports participation through externalizing and internalizing characteristics.

The socioeconomic status of parents is reportedly closely related to the digital screen usage and physical inactivity levels of children and adolescents. Internalizing and externalizing behavior characteristics may be linked to these associations and explain them. The purpose of the present study was to investigate the effects of parents' socioeconomic status (SES) on youths' total screen time along with physical inactivity through internalizing and externalizing behavior characteristics. Thus, we examined associations between parents' socioeconomic status (using scores based on several indicators) and adolescents' total digital screen exposure and physical inactivity level, together with the potentially predicting role of the adolescents' internalizing and externalizing behavior. For this, we assessed the internalizing and externalizing problem characteristics, total screen time exposure, physical inactivity level and parental socioeconomic status of a large cohort sample of Finnish adolescents (the Northern Birth Cohort, 1986 comprised 2899 males and 3059 females). The present study includes data collected in two phases, in 1985-1986 and 2000-2001. Path modeling suggests that a low SES of parents was directly associated with adolescents' physical inactivity level, while externalizing characteristics were a significant and additional contributing factor in adolescents' level of screen exposure in both genders. Gender moderated the relationship between adolescents' internalizing and externalizing characteristics and physical inactivity levels. The results also suggest that parents' socioeconomic status constitutes a risk factor in relation to media screen exposure only in female adolescents. Implications of the findings are discussed.

Association Between Psychosocial Problems and Unhealthy Health Behavior Patterns Among Finnish Adolescents.

The aim of the study was to investigate how psychosocial problems in childhood and adolescence associate with an unhealthy health behavior pattern among adolescents in Northern Finland. The study population consisted of 4350 participants, drawn from the Northern Finland Birth Cohort 1986 Study. Health behavior patterns were assessed in adolescence and psychosocial problems in childhood and adolescence. Logistic regression analyses were performed to determine the associations. Several psychosocial problems predicted greater likelihood of engaging in unhealthy health behavior pattern. Externalizing problems in childhood predicted greater likelihood of engaging in unhealthy behavior patterns for girls. For both genders, externalizing problems and inattention in adolescence were associated with unhealthy health behavior patterns. Boys and girls with externalizing problems both in childhood and adolescence had an increased risk of unhealthy patterns. Psychosocial problems contribute to unhealthy lifestyles and should therefore be acknowledged when designing and targeting health promotion strategies aimed at adolescents.

Problematic gaming behaviour and health-related outcomes: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to investigate the interplay between problematic gaming behaviour and health-related outcomes at different developmental stages. A total of 50 empirical studies met the specified inclusion criteria, and a meta-analysis using correlation coefficients was used for the studies that reported adverse health implications regarding the impact of problematic gaming behaviour on depression, anxiety, obsessive-compulsive disorder and somatisation. Overall, the results suggested that problematic gaming behaviour is significantly associated with a wide range of detrimental health-related outcomes. Finally, the limitations of this review alongside its implications were discussed and considered for future research.

Clusters of health behaviours and their relation to body mass index among adolescents in Northern Finland.

AIMS: To identify clusters of health behaviours among Finnish adolescents and examine whether these clusters are associated with body mass index (BMI). METHODS: The data, drawn from the prospective population-based Northern Finland Birth Cohort 1986, comprised a total of 7182 adolescents who replied to a follow-up postal questionnaire at the age 15 to 16. The adolescents were asked about multiple health behaviours, such as physical activity, screen time, cigarette smoking, alcohol use and diet. Adolescents who answered the questions concerning all of these variables were included in the study, yielding a final sample of 4305 subjects. K-means cluster analysis was performed to identify group of adolescents with similar health behaviours. Chi-squared tests were performed to analyse the association between the clusters and BMI. RESULTS: Two clusters - Healthy Lifestyle and Unhealthy Lifestyle - were identified for both genders. The values of all the studied variables differed significantly between the clusters identified for both boys and girls. No significant relationship between the identified clusters and BMI was found for either boys or girls. CONCLUSIONS: It is important to consider multiple lifestyle-related behaviours and trying to identify groups that present probability for developing lifestyle diseases.

Cross-Cultural Validation of the Compulsive Internet Use Scale in Four Forms and Eight Languages.

The 14-item Compulsive Internet Use Scale (CIUS) is one of the most frequently internationally adapted psychometric instruments developed to assess generalized problematic Internet use. Multiple adaptations of this instrument have led to versions in different languages (e.g., Arabic and French), and different numbers of items (e.g., from 5 to 16 items instead of the original 14). However, to date, the CIUS has never been simultaneously compared and validated in several languages and different versions. Consequently, the present study tested the psychometric properties of four CIUS versions (i.e., CIUS-14, CIUS-9, CIUS-7, and CIUS-5) across eight languages (i.e., German, French, English, Finnish, Spanish, Italian, Polish, and Hungarian) to (a) examine their psychometric properties, and (b) test their measurement invariance. These analyses also identified the optimal versions of the CIUS. The data were collected via online surveys administered to 4,226 voluntary participants from 15 countries, aged at least 18 years, and recruited from academic environments. All brief versions of the CIUS in all eight languages were validated. Dimensional, configural, and metric invariance were established across all languages for the CIUS-5, CIUS-7, and CIUS-9, but the CIUS-5 and CIUS-7 were slightly more suitable because their model fitted the ordinal estimate better, while for cross-comparisons, the CIUS-9 was slightly better. The brief versions of the CIUS are therefore reliable and structurally stable instruments that can be used for cross-cultural research across adult populations.

Psychometric properties of the Internet Gaming Disorder Test (IGDT-10) and problematic gaming behavior among Finnish vocational school students.

This study was conducted to investigate the psychometric properties of the Finnish version of the Internet Gaming Disorder Test (IGDT-10), identify the proportion displaying problematic gaming behavior (PGB) among Finnish vocational school students, and characterize the relationships between sociodemographic factors and gaming characteristics predicting PGB in this population. This cross-sectional study involving 773 students (mean age 17.5 years). Socio-demographic and gaming behavior characteristics were established using a web-based survey. A confirmatory factor analysis (CFA) showed that the IGDT-10 test has appropriate psychometric properties. The proportion of students exhibiting PGB based on the DSM-5 cut-off threshold was 1.3%. Regression analysis showed that male gender, preference for gaming on a personal computer, gaming time, poor self-perceived health status, and a preference for the solo and multiplayer online battle arenas (MOBA) game genres related positively to PGB scores. These findings demonstrate the appropriateness of the IGDT-10 test for the assessment of problematic gaming among adults, and support further research on PGB in Finland.

Measurement Invariance of the Short Version of the Problematic Mobile Phone Use Questionnaire (PMPUQ-SV) across Eight Languages.

The prevalence of mobile phone use across the world has increased greatly over the past two decades. Problematic Mobile Phone Use (PMPU) has been studied in relation to public health and comprises various behaviours, including dangerous, prohibited, and dependent use. These types of problematic mobile phone behaviours are typically assessed with the short version of the Problematic Mobile Phone Use Questionnaire (PMPUQ⁻SV). However, to date, no study has ever examined the degree to which the PMPU scale assesses the same construct across different languages. The aims of the present study were to (i) determine an optimal factor structure for the PMPUQ⁻SV among university populations using eight versions of the scale (i.e., French, German, Hungarian, English, Finnish, Italian, Polish, and Spanish); and (ii) simultaneously examine the measurement invariance (MI) of the PMPUQ⁻SV across all languages. The whole study sample comprised 3038 participants. Descriptive statistics, correlations, and Cronbach's alpha coefficients were extracted from the demographic and PMPUQ-SV items. Individual and multigroup confirmatory factor analyses alongside MI analyses were conducted. Results showed a similar pattern of PMPU across the translated scales. A three-factor model of the PMPUQ-SV fitted the data well and presented with good psychometric properties. Six languages were validated independently, and five were compared via measurement invariance for future cross-cultural comparisons. The present paper contributes to the assessment of problematic mobile phone use because it is the first study to provide a cross-cultural psychometric analysis of the PMPUQ-SV.

Mobile gaming and problematic smartphone use: A comparative study between Belgium and Finland.

Background and aims Gaming applications have become one of the main entertainment features on smartphones, and this could be potentially problematic in terms of dangerous, prohibited, and dependent use among a minority of individuals. A cross-national study was conducted in Belgium and Finland. The aim was to examine the relationship between gaming on smartphones and self-perceived problematic smartphone use via an online survey to ascertain potential predictors. Methods The Short Version of the Problematic Mobile Phone Use Questionnaire (PMPUQ-SV) was administered to a sample comprising 899 participants (30% male; age range: 18-67 years). Results Good validity and adequate reliability were confirmed regarding the PMPUQ-SV, especially the dependence subscale, but low prevalence rates were reported in both countries using the scale. Regression analysis showed that downloading, using Facebook, and being stressed contributed to problematic smartphone use. Anxiety emerged as predictor for dependence. Mobile games were used by one-third of the respective populations, but their use did not predict problematic smartphone use. Very few cross-cultural differences were found in relation to gaming through smartphones. Conclusion Findings suggest mobile gaming does not appear to be problematic in Belgium and Finland.

Problematic Gaming Behavior Among Finnish Junior High School Students: Relation to Socio-Demographics and Gaming Behavior Characteristics.

Multiplatform digital media use and gaming have been increased in recent years. The aim of this study was to examine associations between sociodemographics and digital gaming behavior characteristics (i.e., gaming time, medium, and genres) with problematic gaming behavior in adolescents. A convenience sample of Finnish junior high school students (n = 560; mean age 14 years, ranging from 12 to 16 years) participated in the cross-sectional survey, of which, 83% (n = 465) reported having played digital games regularly. Sociodemographic data, different forms of digital media use, gaming behavior characteristics and problematic gaming behavior was assessed. Study participants spent on average one hour per day playing digital games; casual games (23.9%), shooting games (19.8%), and sport games (12.9%), were the most popular games among participants. By using regression analysis, a blended family structure and gaming time related positively to problematic gaming behavior. Preferences for game genres such as solo, Massively Multiplayer Online Role-Playing and strategy-management games were also positively associated with problematic use of digital games. These findings provide knowledge that can be utilized in the prevention of the possible negative consequences of digital gaming.

Self-reported dependence on mobile phones in young adults: A European cross-cultural empirical survey.

Background and aims Despite many positive benefits, mobile phone use can be associated with harmful and detrimental behaviors. The aim of this study was twofold: to examine (a) cross-cultural patterns of perceived dependence on mobile phones in ten European countries, first, grouped in four different regions (North: Finland and UK; South: Spain and Italy; East: Hungary and Poland; West: France, Belgium, Germany, and Switzerland), and second by country, and (b) how socio-demographics, geographic differences, mobile phone usage patterns, and associated activities predicted this perceived dependence. Methods A sample of 2,775 young adults (aged 18-29 years) were recruited in different European Universities who participated in an online survey. Measures included socio-demographic variables, patterns of mobile phone use, and the dependence subscale of a short version of the Problematic Mobile Phone Use Questionnaire (PMPUQ; Billieux, Van der Linden, & Rochat, 2008). Results The young adults from the Northern and Southern regions reported the heaviest use of mobile phones, whereas perceived dependence was less prevalent in the Eastern region. However, the proportion of highly dependent mobile phone users was more elevated in Belgium, UK, and France. Regression analysis identified several risk factors for increased scores on the PMPUQ dependence subscale, namely using mobile phones daily, being female, engaging in social networking, playing video games, shopping and viewing TV shows through the Internet, chatting and messaging, and using mobile phones for downloading-related activities. Discussion and conclusions Self-reported dependence on mobile phone use is influenced by frequency and specific application usage.

Problematic digital gaming behavior and its relation to the psychological, social and physical health of Finnish adolescents and young adults.

BACKGROUND AND AIMS: The aim of this study was to identify problematic gaming behavior among Finnish adolescents and young adults, and evaluate its connection to a variety of psychological, social, and physical health symptoms. METHODS: This cross-sectional study was conducted with a random sample of 293 respondents aged from 13 to 24 years. Participants completed an online survey. Problematic gaming behavior was measured with the Game Addiction Scale (GAS). Self-reports covered health measures such as psychological health (psychopathological symptoms, satisfaction with life), social health (preferences for social interaction), and physical health (general health, Body Mass Index [BMI], body discomfort, physical activity). RESULTS: Problematic gaming behavior was found to relate to psychological and health problems, namely fatigue, sleep interference, depression and anxiety symptoms. Multiple linear regression indicated that the amount of weekly gaming, depression and a preference for online social interaction predicted increased problematic gaming symptoms. CONCLUSIONS: This research emphasized that problematic gaming behavior had a strong negative correlation to a variety of subjective health outcomes.

Sedentary lifestyle, poor cardiorespiratory fitness, and the metabolic syndrome.

PURPOSE: The cross-sectional associations of leisure-time physical activity (LTPA) and cardiorespiratory fitness with the metabolic syndrome (MS) were investigated in a population-based sample of 1069 middle-aged men without diabetes, cardiovascular disease, or cancer. METHODS: LTPA was assessed using a detailed quantitative questionnaire. Maximal oxygen uptake VO(2max) and core and related features of the MS were determined. A modified World Health Organization definition of the MS and factor analysis were used. RESULTS: Men who engaged in at least moderate-intensity (>or=4.5 metabolic equivalents) LTPA <1.0 h.wk-1 were 60% more likely to have the MS than those engaging in >or= 3.0 h.wk-1 even after adjustment for confounders. Low-intensity (<4.5 metabolic equivalents) LTPA was not associated with the metabolic syndrome. Men with a VO(2max) <29.1 mL x kg-1 x min-1 were almost seven times more likely to have the MS than those with a VO(2max) >or=35.5 mL.kg-1.min-1 even after adjusting for confounders. In first-order factor analysis using a promax rotation, the principal factor explained 20% of total variance and had heavy loadings for VO(2max) (-0.57) and at least moderate-intensity LTPA (-0.44), and moderate or heavy loadings for the main components of the MS. The second-order factor analysis generated a principal factor that was strongly loaded on by the main components of the MS and VO(2max) (-0.50) but not LTPA. CONCLUSION: A sedentary lifestyle and especially poor cardiorespiratory fitness are not only associated with the MS but could also be considered features of the MS. Measurement of VO(2max) in sedentary men with risk factors may provide an efficient means for targeting individuals who would benefit from interventions to prevent the MS and its consequences.