Motivators and barriers to exercise among adults with a high risk of type 2 diabetes--a qualitative study.

PURPOSE: Type 2 diabetes (T2D) can be prevented through lifestyle changes. Regular exercise for more than 4 hours per week, combined with weight loss and changes in dietary habits reduces the incidence of T2D. The aim of this study was to describe motivators and barriers to exercise among adults with a high risk of T2D. METHODS: Altogether, 74 subjects participated in a study on the Effectiveness and Feasibility of Activating Counseling Methods and Videoconferences in Dietary Group Counseling of Subjects with high risk of T2D. The qualitative data were gathered from video-recorded group counselling sessions and were analysed using content analysis. RESULTS: Enjoyment from exercise, social relationships related to exercise, encouragement from others, benefits to health, and the aim of weight control motivated subjects to exercise. The wish to join people with an active lifestyle, admiration of active friends and willingness to serve as an example for children reflected why exercise was an important value in life. The barriers to exercise were weather/season, health problems, lack of time, work-related factors and lack of interest. CONCLUSIONS: Adults with high risk of T2D experienced many individually meaningful motivators. They experienced few barriers to exercise and highlighted the motivators. Thus, we present that they had a positive attitude towards increasing exercise during participation to counselling. The results can be used when developing counselling methods because they provide concrete content for counselling discussion such as importance of work-related factors, family exercise, time management skills and social support for regular exercise.

Is insufficient quantity and quality of sleep a risk factor for neck, shoulder and low back pain? A longitudinal study among adolescents.

The quantity and quality of adolescents' sleep may have changed due to new technologies. At the same time, the prevalence of neck, shoulder and low back pain has increased. However, only a few studies have investigated insufficient quantity and quality of sleep as possible risk factors for musculoskeletal pain among adolescents. The aim of the study was to assess whether insufficient quantity and quality of sleep are risk factors for neck (NP), shoulder (SP) and low back pain (LBP). A 2-year follow-up survey among adolescents aged 15-19 years was (2001-2003) carried out in a subcohort of the Northern Finland Birth Cohort 1986 (n = 1,773). The outcome measures were 6-month period prevalences of NP, SP and LBP. The quantity and quality of sleep were categorized into sufficient, intermediate or insufficient, based on average hours spent sleeping, and whether or not the subject suffered from nightmares, tiredness and sleeping problems. The odds ratios (OR) and 95% confidence intervals (CI) for having musculoskeletal pain were obtained through logistic regression analysis, adjusted for previously suggested risk factors and finally adjusted for specific pain status at 16 years. The 6-month period prevalences of neck, shoulder and low back pain were higher at the age of 18 than at 16 years. Insufficient quantity or quality of sleep at 16 years predicted NP in both girls (OR 4.4; CI 2.2-9.0) and boys (2.2; 1.2-4.1). Similarly, insufficient sleep at 16 years predicted LBP in both girls (2.9; 1.7-5.2) and boys (2.4; 1.3-4.5), but SP only in girls (2.3; 1.2-4.4). After adjustment for pain status, insufficient sleep at 16 years predicted significantly only NP (3.2; 1.5-6.7) and LBP (2.4; 1.3-4.3) in girls. Insufficient sleep quantity or quality was an independent risk factor for NP and LBP among girls. Future studies should test whether interventions aimed at improving sleep characteristics are effective in the prevention and treatment of musculoskeletal pain.

Pedometer use among adults at high risk of type 2 diabetes, Finland, 2007-2008.

INTRODUCTION: A pedometer helps adults exercise more, but sedentary adults need instruction and advice to be motivated to use one. We conducted this qualitative study to describe the experiences of participants at high risk of type 2 diabetes who began using a pedometer. METHODS: A total of 74 people at high risk of type 2 diabetes participated in 6 months of group counseling. From April 2007 to April 2008, we collected data through questionnaires, theme interviews (n = 22) and video recordings of counseling sessions. From October 2007 through June 2008, we analyzed the data. RESULTS: Pedometers were useful tools for observing levels of exercise, setting personal goals for walking, and helping evaluate whether daily goals were met. Negative experiences were associated with functional failures, pedometers' unsuitability for exercise other than walking, and the goal of 10,000 steps, which some participants considered too high. CONCLUSION: Sedentary adults can be motivated to use a pedometer if we inform them that regular users find it a useful instrument for increasing their level of exercise. These adults should set realistic goals for walking and receive adequate instructions for using pedometers.

Association between ADHD symptoms and adolescents' psychosocial well-being: a study of the Northern Finland Birth Cohort 1986.

OBJECTIVES: To investigate the psychosocial well-being of adolescents with and without symptoms of attention deficit hyperactive disorder (ADHD). STUDY DESIGN: A cross-sectional study. METHODS: Adolescents who were 15 and 16 years old with (n = 487) and without (n = 5988) ADHD symptoms were drawn from the Northern Finland Birth Cohort 1986 (n = 9432). ADHD symptoms were assessed by the parents on the SWAN scale while the adolescents completed a questionnaire on their current life situation. RESULTS: The adolescents with ADHD symptoms more often attended a special school and had repeated a grade than those without. Over one-third of those with symptoms were uncertain about their educational plans while 44% of them preferred vocational education. They also reported their health as being poorer and they visited a physician or a nurse more often than the others. Most adolescents reported that they were satisfied with their life, but there were a larger proportion of adolescents with ADHD symptoms among the fairly dissatisfied ones. As well, boys with ADHD symptoms reported the lack of close friends. Adverse psychosocial factors accumulated in those adolescents with greater ADHD symptoms. CONCLUSIONS: The adolescents with ADHD symptoms considered their psychosocial well-being to be poorer than those without ADHD symptoms. In clinical work, it is essential to recognize the most impaired adolescents who need special attention and support at school as well as in their social interactions with their peers and families. From a public health perspective, this information is necessary in order to focus society's limited resources on those with a higher risk of experiencing complicated outcomes.

Motivation to physical activity among adults with high risk of type 2 diabetes who participated in the Oulu substudy of the Finnish Diabetes Prevention Study.

Type 2 diabetes can be prevented by lifestyle changes such as sufficient level of physical activity. The number of persons at high risk of or diagnosed with type 2 diabetes is increasing all over the world. In order to prevent type 2 diabetes and develop exercise counselling, more studies on motivators and barriers to physical activity are needed. Thus, the aim of this qualitative study was to describe the motivators and barriers to physical activity among individuals with high risk of type 2 diabetes who participated in a substudy of the Finnish Diabetes Prevention Study in Oulu and to consider whether the motivators or barriers changed during the follow-up from 2003 to 2008. Questionnaires with open-ended questions were conducted twice: in the first follow-up in 2003 altogether 63 participants answered the questionnaire (n = 93), and in the second follow-up in 2008 altogether 71 participants answered the questionnaire (n = 82). Thus, response rate was 68% in 2003 and 87% in 2008. The study was conducted in the city of Oulu in Finland. Qualitative data were analysed by inductive content analysis using the QSR NVivo 8 software. The results of this study showed that motivators to physical activity included weight management, feelings of physical and mental well being. In addition, social relationships associated with exercise were also motivators. In conclusion, we present that regular counselling is important in order to promote exercise among older people, and that motivators to exercise are strengthened by positive experiences of exercise as one grows older.

Suspected motor problems and low preference for active play in childhood are associated with physical inactivity and low fitness in adolescence.

BACKGROUND: This prospective longitudinal study investigates whether suspected motor problems and low preference for active play in childhood are associated with physical inactivity and low cardiorespiratory fitness in adolescence. METHODOLOGY/PRINCIPAL FINDINGS: The study sample consisted of the Northern Finland Birth Cohort 1986 (NFBC 1986) composed of 5,767 children whose parents responded to a postal inquiry concerning their children's motor skills at age 8 years and who themselves reported their physical activity at age 16 years. Cardiorespiratory fitness was measured with a cycle ergometer test at age 16 years. Odds ratios (OR) and their 95% confidence intervals (95% CI) for the level of physical activity and fitness were obtained from multinomial logistic regression and adjusted for socio-economic position and body mass index. Low preference for active play in childhood was associated with physical inactivity (boys: OR 3.31, 95% CI 2.42-4.53; girls: OR 1.79, 95% CI 1.36-2.36) and low cardiorespiratory fitness (boys: OR 1.87, 95% CI 1.27-2.74; girls: OR 1.52, 95% CI 1.09-2.11) in adolescence. Suspected gross (OR 2.16, 95% CI 1.33-3.49) and fine (OR 1.88, 95% CI 1.35-2.60) motor problems were associated with physical inactivity among boys. Children with suspected motor problems and low preference for active play tended to have an even higher risk of physical inactivity in adolescence. CONCLUSIONS/SIGNIFICANCE: Low preference for active play in childhood was associated with physical inactivity and low cardiorespiratory fitness in adolescence. Furthermore, children with suspected motor problems and low preference for active play tended to have an even higher risk of physical inactivity in adolescence. Identification of children who do not prefer active play and who have motor problems may allow targeted interventions to support their motor learning and participation in active play and thereby promote their physical activity and fitness in later life.

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.

Is prematurity associated with adult cognitive outcome and brain structure?

Previous studies have indicated that preterm birth and low birth weight are associated with structural brain abnormalities and neurocognitive deficits in childhood and adolescence, although very few studies have included follow-up in adulthood. Here we assessed the effect of preterm delivery (524 subjects; mean 34.6 weeks, S.D. = 1.7) or low birth weight (366 subjects; mean 2159 g, S.D. = 303) on educational and occupational outcomes at age 31 years in the Northern Finland 1966 Birth Cohort, along with 10,132 term, normal birth weight control subjects. Cognitive tests and brain morphology using magnetic resonance imaging were assessed at age 33-35 years in a subset of the cohort (9 subjects; 95 controls). The preterm or low birth weight subjects had slightly lower school ratings and lower educational levels in adulthood, and they performed worse in verbal learning. The low birth weight subjects were less likely to be employed. There were no mean differences in the magnetic resonance imaging tissue segmentation analysis of the brain. In conclusion, although there were no overall changes in brain morphology in the preterm or low birth weight group, there was evidence for slightly poorer educational and occupational careers and cognitive capacity, which may reflect functional disruption not evident in structure.

Risk factors for persistence of multiple musculoskeletal pains in adolescence: a 2-year follow-up study.

Musculoskeletal pain in multiple sites is common already in adolescence, and may lead to subsequent musculoskeletal complaints in adulthood. We examined predictive factors for the persistence of multiple musculoskeletal pains in adolescence over a 2-year time span. A postal questionnaire was administered to a subsample of the Northern Finland Birth Cohort 1986 (n=1773) when subjects were aged 16 and 18. The adjusted odds ratios (OR) and 95% confidence intervals (CI) for the possible risk factors of new-onset of multiple pains at 18 years and 2-year persistence of multiple pains were obtained using multinomial logistic regression. Multiple musculoskeletal pains were common; 43% of boys and 63% of girls at 16, and 61% of boys and 81% of girls at 18 reported pain in more than one site during the last 6 months. Moreover, multiple pains had a high persistence rate, as 75% of boys and 88% of girls with multiple pains at 16 reported multiple pains also at 18. In the multivariate analysis, emotional and behavioral problems (internalizing problems, OR 2.3; externalizing problems, OR 2.2), and high sitting time (OR 1.6) among boys, and internalizing problems (OR 3.7), high physical activity level (OR 1.6), short sleeping time (OR 1.7), and smoking (OR 1.9) among girls were predictive factors for the persistence of multiple pains. No statistically significant associations between the baseline variables and new-onset multiple pains were found. Multiple musculoskeletal pains appear to have a high tendency to persist in adolescence; both psychosocial factors and lifestyle factors contribute to this vulnerability.

Psychosocial, mechanical, and metabolic factors in adolescents' musculoskeletal pain in multiple locations: a cross-sectional study.

Recent studies indicate that adolescents often experience musculoskeletal pains in two or more body locations. However, previous studies have mainly focused on localized pains, and the determinants of multiple musculoskeletal pains in adolescents are not well known. The present study was set to evaluate the role of psychosocial, mechanical, and metabolic factors in adolescents' musculoskeletal pains in multiple locations. The study population consisted of the 1986 Northern Finland Birth Cohort; 15- to 16-year-old adolescents (n=6986), who responded to a mailed questionnaire in 2001. We assessed the associations of emotional and behavioral problems, physical activity, sitting time, sleeping time, overweight and smoking with musculoskeletal pains using multinomial logistic regression. Multiple pains were common, 23% of boys and 40% of girls reported feeling pain in at least three locations over the past 6 months. These pains were not only associated with anxious/depressed symptoms, withdrawn/depressed symptoms, somatic complaints, rule-breaking and aggressive behavior, social problems, thought and attention problems, but also with high physical activity level, long sitting time, short sleeping time and smoking, among both boys and girls. In addition, pain in three to four locations associated with overweight in girls. A high number of psychosocial, mechanical and metabolic factors associated strongly with multiple pains. In conclusion, multiple musculoskeletal pains were strongly associated with psychosocial complaints, but also with mechanical and metabolic factors. Reported musculoskeletal pains in multiple locations in adolescence may have both peripheral (trauma, decreased regenerative ability) and central (sensitivity) causes.

Emotional and behavioral problems in relation to physical activity in youth.

PURPOSE: Physical inactivity is known to be associated with mental health problems in adulthood, but the association in youth is unclear. This study evaluated the association between the level of physical activity and the prevalence of emotional and behavioral problems in Finnish adolescents. METHODS: The study population consisted of the Northern Finland Birth Cohort 1986 including 7002 adolescents who responded to a postal inquiry in 2001-2002 at the age of 15-16 yr. They completed the Youth Self-Report questionnaire assessing their emotional and behavioral problems and a questionnaire concerning their moderate- to vigorous-intensity physical activity (MVPA). The odds ratios (OR) and their 95% confidence intervals (95% CI) for having different emotional and behavioral problems were obtained in 2007 from logistic regression and adjusted for family type, income, parents' education, and body mass index. RESULTS: In boys, physical inactivity (1 h or less of MVPA per week) was associated with anxious/depressed symptoms (OR = 2.9, 95% CI = 1.5-5.7), withdrawn/depressed symptoms (OR = 2.8, 95% CI = 1.8-4.2), social problems (OR = 3.6, 95% CI = 1.8-5.1), thought problems (OR = 2.3, 95% CI = 1.1-5.2), and attention problems (OR = 1.9, 95% CI = 1.0-3.4) when compared to being physically active (4 h or more of MVPA per week). In girls, physical inactivity was associated with withdrawn/depressed symptoms (OR = 2.3, 95% CI = 1.5-3.6), somatic complaints (OR = 1.4, 95% CI = 1.0-1.9), social problems (OR = 3.2, 95% CI = 1.7-6.1), attention problems (OR = 2.1, 95% CI = 1.3-3.2), and rule-breaking behavior (OR = 1.8, 95% CI = 1.3-2.5) compared to being physically active. CONCLUSIONS: Physical inactivity was associated with several emotional and behavioral problems in adolescents. Future research should investigate the mechanisms behind these associations and the effectiveness of physical activity in the treatment of emotional and behavioral problems among young people.

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.