Economic burden of low physical activity and high sedentary behaviour in Finland.

BACKGROUND: Low physical activity and high sedentary behaviour are unquestionably relevant for public health while also increasing direct and indirect costs. METHODS: The authors examined the direct and indirect costs attributable to low physical activity and high sedentary behaviour in Finland in 2017. Costs related to major non-communicable diseases drawn from Finnish registries covered direct costs (outpatient visits, days of inpatient care, medication and institutional eldercare) and indirect costs (sickness-related absences, disability pensions, unemployment benefits, all-cause mortality and losses of income tax revenue). Prevalences of low physical activity and high sedentary behaviour (≥8 hours per 16 waking hours) were based on self-reports among adolescents or accelerometer data among adults and the elderly from three Finnish population studies: FINFIT 2017, Health 2011 and the Cardiovascular Risk in Young Finns Study. Cost calculations used adjusted population attributable fractions (PAF) and regression models. Total annual costs were obtained by multiplying PAF by the total costs of the given disease. RESULTS: The total costs of low physical activity in Finland in 2017 came to approximately €3.2 billion, of which direct costs accounted for €683 million and indirect ones for €2.5 billion. Costs attributable to high sedentary behaviour totalled roughly €1.5 billion. CONCLUSION: The findings suggest that low physical activity and high sedentary behaviour levels create substantial societal costs. Therefore, actions intended to increase physical activity and reduce excessive sedentary behaviour throughout life may yield not only better health but also considerable savings to society.

Predicting the age at natural menopause in middle-aged women.

OBJECTIVE: To predict the age at natural menopause (ANM). METHODS: Cox models with time-dependent covariates were utilized for ANM prediction using longitudinal data from 47 to 55-year-old women (n = 279) participating in the Estrogenic Regulation of Muscle Apoptosis study. The ANM was assessed retrospectively for 105 women using bleeding diaries. The predictors were chosen from the set of 32 covariates by using the lasso regression (model 1). Another easy-to-access model (model 2) was created by using a subset of 16 self-reported covariates. The predictive performance was quantified with c-indices and by studying the means and standard deviations of absolute errors (MAE ±â€ŠSD) between the predicted and observed ANM. RESULTS: Both models included alcohol consumption, vasomotor symptoms, self-reported physical activity, and relationship status as predictors. Model 1 also included estradiol and follicle-stimulating hormone levels as well as SD of menstrual cycle length, while model 2 included smoking, education, and the use of hormonal contraception as additional predictors. The mean c-indices of 0.76 (95% CI 0.71-0.81) for model 1 and 0.70 (95% CI 0.65-0.75) for model 2 indicated good concordance between the predicted and observed values. MAEs of 0.56 ±â€Š0.49 and 0.62 ±â€Š0.54 years respectively for model 1 and 2 were clearly smaller than the MAE for predicted sample mean (1.58 ±â€Š1.02). CONCLUSIONS: In addition to sex hormone levels, irregularity of menstrual cycle, and menopausal symptoms, also life habits and socioeconomic factors may provide useful information for ANM prediction. The suggested approach could add value for clinicians' decision making related to the use of contraception and treatments for menopausal symptoms in perimenopausal women.

Video Summary:http://links.lww.com/MENO/A743 .

Validity and Reliability of a Single Question for Leisure-Time Physical Activity Assessment in Middle-Aged Women.

PURPOSE: To investigate the validity and test-retest reliability of a single seven-level scale physical activity assessment question (SR-PA L7) and its three-level categorization (SR-PA C3). METHODS: The associations of SR-PA L7 and C3 with accelerometer-measured leisure-time physical activity (ACC-LTPA) and with the results of four different physical performance tests (6-min walk [n = 733], knee extension [n = 695], vertical jump [n = 731], and grip force [n = 780]) were investigated among women aged 47-55 years participating in the Estrogenic Regulation of Muscle Apoptosis study (n = 795). The reliability was studied using Spearman correlations with 4-month test-retest period (n = 152). RESULTS: SR-PA L7 and C3 had low correlations with ACC-LTPA (rs = .105-.337). SR-PA L7, SR-PA C3, and ACC-LTPA explained comparable but small amount of variance of the physical performance test results. The reliability analysis provided moderate agreement (rs = .707 and .622 for SR-PA L7 and C3, respectively). CONCLUSIONS: SR-PA L7 and C3 demonstrated limited validity and reasonable repeatability.

Distinct trajectories of physical activity and related factors during the life course in the general population: a systematic review.

BACKGROUND: In recent years, researchers have begun applying a trajectory approach to identify homogeneous subgroups of physical activity (PA) in heterogeneous populations. This study systematically reviewed the articles identifying longitudinal PA trajectory classes and the related factors (e.g., determinants, predictors, and outcomes) in the general population during different life phases. METHODS: The included studies used finite mixture models for identifying trajectories of PA, exercise, or sport participation. Three electronic databases, PubMed (Medline), Web of Science, and CINAHL, were searched from the year 2000 to 13 February 2018. The study was conducted according to the PRISMA recommendations. RESULTS: Twenty-seven articles were included and organized into three age group: youngest (eleven articles), middle (eight articles), and oldest (eight articles). The youngest group consisted mainly of youth, the middle group of adults and the oldest group of late middle-aged and older adults. Most commonly, three or four trajectory classes were reported. Several trajectories describing a decline in PA were reported, especially in the youngest group, whereas trajectories of consistently increasing PA were observed in the middle and oldest group. While the proportion of persistently physically inactive individuals increased with age, the proportion was relatively high at all ages. Generally, male gender, being Caucasian, non-smoking, having low television viewing time, higher socioeconomic status, no chronic illnesses, and family support for PA were associated either with persistent or increasing PA. CONCLUSIONS: The reviewed articles identified various PA subgroups, indicating that finite mixture modeling can yield new information on the complexity of PA behavior compared to studying population mean PA level only. The studies also provided novel information how different factors relate to changes in PA during life course. The recognition of the PA subgroups and their determinants is important for the more precise targeting of PA promotion and PA interventions. TRIAL REGISTRATION: PROSPERO registration number: CRD42018088120 .

Associations of partnering transition and socioeconomic status with a four-year change in daily steps among Finnish adults.

Aim: The aim of this prospective four-year follow-up study was to examine how socioeconomic status (SES) and change in marital status are associated with the change in pedometer-measured physical activity (PA) in adulthood among participants in the 'Cardiovascular Risk in Young Finns Study'. Methods: Questionnaires were completed and pedometers worn at baseline in 2007 and again at follow-up in 2011 by 1051 Finnish adults (62.3% female, aged 30-45 years in 2007). A latent change score model was used to examine mean change in daily total steps, aerobic steps and non-aerobic steps during weekdays and weekend days between 2007 and 2011. Results: In women re-coupling or finding a new partner was associated with decrease in total steps (p=0.010) and being single was associated with increase in non-aerobic steps (p=0.047) during weekdays from 2007 to 2011 compared to women who were married. In men, divorcing was associated with decrease in non-aerobic steps (p=0.049). Conclusions: In order to promote PA in the general population of adults, it is recommended to pay attention to people with lower SES and those who have had changes in their marital status. These factors could be taken into account when developing strategies to promote PA among the adult population.

Results From Finland's 2016 Report Card on Physical Activity for Children and Youth.

BACKGROUND: Finland's 2016 Report Card on Physical Activity for Children and Youth gathers and translates research results and assesses the status and promotion of physical activity (PA) among Finnish children and youth less than 18 years of age. This article summarizes the results and provides grades for 9 indicators. METHODS: The working group evaluated the evidence and assigned grades of A (highest, 81% to 100%), B, C, D, or F (lowest, 0% to 20%) for 9 PA indicators using the Active Healthy Kids Canada Report Card development process. RESULTS: The grades varied in Finland as follows: 1) Overall PA/fulfillment of recommendations = D, 2) Organized Sport Participation = C, 3) Active Play = C, 4) Active Transportation = B, 5) Sedentary Behaviors = D, 6) Family and Peers = C, 7) School = B, 8) Community and the Built Environment = B, 9) Government = B. CONCLUSIONS: Despite good policies and programs to promote PA in Finland, children and youth overall PA levels are low, whereas their time spent sedentary is high. More effective interventions, operation models, concrete tools as well as environmental solutions are needed to support the work toward more physically active childhood and youth.

Income and Physical Activity among Adults: Evidence from Self-Reported and Pedometer-Based Physical Activity Measurements.

This study examined the relationship between income and physical activity by using three measures to illustrate daily physical activity: the self-reported physical activity index for leisure-time physical activity, pedometer-based total steps for overall daily physical activity, and pedometer-based aerobic steps that reflect continuous steps for more than 10 min at a time. The study population consisted of 753 adults from Finland (mean age 41.7 years; 64% women) who participated in 2011 in the follow-up of the ongoing Young Finns study. Ordinary least squares models were used to evaluate the associations between income and physical activity. The consistency of the results was explored by using register-based income information from Statistics Finland, employing the instrumental variable approach, and dividing the pedometer-based physical activity according to weekdays and weekend days. The results indicated that higher income was associated with higher self-reported physical activity for both genders. The results were robust to the inclusion of the control variables and the use of register-based income information. However, the pedometer-based results were gender-specific and depended on the measurement day (weekday vs. weekend day). In more detail, the association was positive for women and negative or non-existing for men. According to the measurement day, among women, income was positively associated with aerobic steps despite the measurement day and with totals steps measured on the weekend. Among men, income was negatively associated with aerobic steps measured on weekdays. The results indicate that there is an association between income and physical activity, but the association is gender-specific and depends on the measurement type of physical activity.

Recess physical activity and school-related social factors in Finnish primary and lower secondary schools: cross-sectional associations.

BACKGROUND: Participation in physical activities provides students with opportunities for social interaction and social skills development. The purpose of this study was to investigate the associations of students' recess physical activity with school-related social factors. METHODS: Data were collected in 19 schools countrywide in autumn 2010, and 1463 students from grades 4 and 5 (primary school) and from grades 7 and 8 (lower secondary school) completed an anonymous questionnaire. Multiple linear regression analysis was used to investigate whether self-reported physical activity at recess was associated with peer relationships at school, relatedness to school and school climate. Analyses were adjusted for self-reported overall physical activity and conducted for primary and lower secondary schools. Multi-group analysis was used to test sex differences among the associations. RESULTS: In primary school, physical activity at recess was positively associated with peer relationships at school (boys: b = 0.17, p = 0.007 and girls: b = 0.21, p <0.001), relatedness to school (boys: b = 0.18, p = 0.002 and girls: b = 0.24, p <0.001) and school climate (girls: b = 0.17, p = 0.001), after adjusting for overall physical activity. In lower secondary school, physical activity at recess was positively associated with peer relationships at school (boys: b = 0.09, p = 0.006 and girls: b = 0.12, p = 0.010) but not with other school-related social factors. No sex differences were observed in these associations. CONCLUSIONS: Our results suggest that students' participation in physical activities during school recess is positively associated with students' school-related social factors. In the future, it would be worthwhile to study how physical activity at recess should be organised in order to support the development of school-related social factors.

Leisure time physical activity in a 22-year follow-up among Finnish adults.

BACKGROUND: The aim of this study was to explore long-term predictors of leisure time physical activity in the general population. METHODS: This study comprised 718 men and women who participated in the national Mini-Finland Health Survey from 1978-1980 and were re-examined in 2001. Participants were aged 30-80 at baseline. Measurements included interviews, health examinations, and self-administered questionnaires, with information on socioeconomic position, occupational and leisure time physical activity, physical fitness, body mass index, smoking, alcohol consumption, and physical functional capacity. Analyses included persons who were working and had no limitations in functional capacity at baseline. RESULTS: The strongest predictor of being physically active at the follow-up was participation in physical activity at baseline, with an OR 13.82 (95%CI 5.50-34.70) for 3 or more types of regular activity, OR 2.33 (95%CI 1.22-4.47) for 1-2 types of regular activity, and OR 3.26 (95%CI 2.07-5.15) for irregular activity, as compared to no activity. Other determinants for being physically active were moving upwards in occupational status, a high level of baseline occupational physical activity and remaining healthy weight during the follow-up. CONCLUSIONS: To prevent physical inactivity among older adults, it is important to promote physical activity already in young adulthood and in middle age and to emphasize the importance of participating in many types of physical activity.

Daily steps among Finnish adults: variation by age, sex, and socioeconomic position.

AIMS: The aim of this study was to provide descriptive population-based pedometer data from adults aged 30-45 years in Finland, and to compare daily step counts with evidence-based indices. METHODS: The data was collected from 1853 participants in 7 consecutive days in winter 2007-08 in part of 27-year follow up of the Cardiovascular Risk in Young Finns study. RESULTS: The participants took (mean±standard deviation) 7499 ± 2908 steps/day. Step counts included 1925 ± 2052 aerobic steps/day gathered in bouts of at least 10 min continuous ambulatory activity. Women had more total steps than men ((7824 ± 2925 vs. 7089 ± 2774; p < 0.001). Although participants had higher mean total steps on weekdays than on weekend days, they took more aerobic steps on weekend days than weekdays (p < 0.001). High-level non-manual work, and unemployment were associated with having fewer total steps, but high-level non-manual workers had more aerobic steps than other occupation groups. According to pedometer thresholds proposed by Tudor-Locke and Basset, 26% of men and 16% of women could be classified as inactive (<5000 steps/day) and 20% of women and 15% of men would be classified as active (>10,000 steps/day). CONCLUSIONS: We conclude that about one-quarter of men and one-fifth of women are considered as inactive, based on the number of daily total steps. Our results suggest that total steps may provide a very different picture of activity from aerobic steps; important differences are evident by socioeconomic position and day of the week.

Factors related to seeking health care among adolescents with musculoskeletal pain.

Musculoskeletal pain is common among adolescents, but little is known about the factors that affect seeking health care for the problem. We examined the care-seeking pattern among adolescents reporting musculoskeletal pain. The study consisted of adolescents aged 16 years from the 1986 Northern Finland Birth Cohort who responded to a mailed questionnaire in 2001 and reported musculoskeletal pain over the preceding 6 months (n=5052). Logistic regression analyses were performed to assess whether enabling resources, need factors, personal health habits, and psychological problems were associated with seeking health care for musculoskeletal pain. Musculoskeletal pain during the preceding 6 months was reported by 68% of boys and 83% of girls in the study population. Only 16% of boys and 20% of girls reporting pain had sought medical care. Among both boys and girls, care-seeking was associated with being a member of a sports club (boys, odds ratio [OR] 2.1; girls, OR 1.5) and having one (boys, OR 2.1; girls, OR 1.8) or at least 2 (boys, OR 2.2; girls, OR 2.1) other health disorders. In addition, it was associated with a high physical activity level (OR 1.5) and low self-rated (OR 1.5) health among girls. Reporting pain in other anatomical areas decreased the likelihood of seeking care for pain among both genders. In conclusion, relatively few adolescents with musculoskeletal pain had consulted a health professional for the problem. Being physically active (trauma), participating in organized sport (accessibility of care), and having other health problems may explain why an adolescent seeks care for musculoskeletal pain.

Life-course analysis of a fat mass and obesity-associated (FTO) gene variant and body mass index in the Northern Finland Birth Cohort 1966 using structural equation modeling.

The association between variation in the fat mass and obesity-associated (FTO) gene and adulthood body mass index (BMI; weight (kg)/height (m)(2)) is well-replicated. More thorough analyses utilizing phenotypic data over the life course may deepen our understanding of the development of BMI and thus help in the prevention of obesity. The authors used a structural equation modeling approach to explore the network of variables associated with BMI from the prenatal period to age 31 years (1965-1997) in 4,435 subjects from the Northern Finland Birth Cohort 1966. The use of structural equation modeling permitted the easy inclusion of variables with missing values in the analyses without separate imputation steps, as well as differentiation between direct and indirect effects. There was an association between the FTO single nucleotide polymorphism rs9939609 and BMI at age 31 years that persisted after controlling for several relevant factors during the life course. The total effect of the FTO variant on adult BMI was mostly composed of the direct effect, but a notable part was also arising indirectly via its effects on earlier BMI development. In addition to well-established genetic determinants, many life-course factors such as physical activity, in spite of not showing mediation or interaction, had a strong independent effect on BMI.

Adolescents' physical activity in relation to family income and parents' education.

OBJECTIVE: Regular physical activity provides young people with important physical, mental, and social health benefits. This study aimed to evaluate the relationship of family income and parents' level of education with physical activity in Finnish adolescents. METHOD: The study population consisted of the Northern Finland Birth Cohort 1986, including 5457 boys and girls aged 15-16 years, and their parents who responded to a postal inquiry in 2001-2002. The associations between social background and adolescents' physical activity were analyzed in 2005 using cross-tabulation and multivariate logistic regression. RESULTS: High parental education was associated with adolescents being physically active. In boys father's high educational level (OR: 0.56; CI: 0.33, 0.95), and in girls both mother's (OR: 0.55; CI: 0.31, 0.98) and father's (OR: 0.35; CI: 0.20, 0.61) high educational levels were related to the least time spent watching TV. High family income was associated with being an active sports club member in boys (OR: 2.43; CI: 1.74, 3.40) and girls (OR: 2.67; CI: 1.81, 3.94). Adolescents' participation in different types of physical activity varied according to family income. CONCLUSIONS: Economic support for youth sports and informing parents on ways to encourage adolescents' physical activity are recommended to ensure equal opportunities for youths to participate in different physical activities.