Effect of 5 years of exercise training on the cardiovascular risk profile of older adults: the Generation 100 randomized trial.

AIMS: The aim of this study was to compare the effects of 5 years of supervised exercise training (ExComb), and the differential effects of subgroups of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), with control on the cardiovascular risk profile in older adults. METHODS AND RESULTS: Older adults aged 70-77 years from Trondheim, Norway (n = 1567, 50% women), able to safely perform exercise training were randomized to 5 years of two weekly sessions of HIIT [∼90% of peak heart rate (HR), n = 400] or MICT (∼70% of peak HR, n = 387), together forming ExComb (n = 787), or control (instructed to follow physical activity recommendations, n = 780). The main outcome was a continuous cardiovascular risk score (CCR), individual cardiovascular risk factors, and peak oxygen uptake (VO2peak). CCR was not significantly lower [-0.19, 99% confidence interval (CI) -0.46 to 0.07] and VO2peak was not significantly higher (0.39 mL/kg/min, 99% CI -0.22 to 1.00) for ExComb vs. control. HIIT showed higher VO2peak (0.76 mL/kg/min, 99% CI 0.02-1.51), but not lower CCR (-0.32, 99% CI -0.64 to 0.01) vs. control. MICT did not show significant differences compared to control or HIIT. Individual risk factors mostly did not show significant between-group differences, with some exceptions for HIIT being better than control. There was no significant effect modification by sex. The number of cardiovascular events was similar across groups. The healthy and fit study sample, and contamination and cross-over between intervention groups, challenged the possibility of detecting between-group differences. CONCLUSIONS: Five years of supervised exercise training in older adults had little effect on cardiovascular risk profile and did not reduce cardiovascular events. REGISTRATION: ClinicalTrials.gov: NCT01666340.

Absolute and relative accelerometer thresholds for determining the association between physical activity and metabolic syndrome in the older adults: The Generation-100 study.

BACKGROUND: When assessing population adherence to physical activity (PA) recommendation using accelerometers, absolute intensity threshold definition is applied despite having limited validity in those with low cardiorespiratory fitness (CRF), who are unable to reach them (e.g older adults). Thus, PA thresholds relative to CRF may be an alternative approach. We compared the proportion of the older adults meeting the PA recommendation when PA is assessed using absolute versus sex-and-CRF-adjusted (relative) accelerometer thresholds and determined the association between relative versus absolute moderate PA (MPA), vigorous PA (VPA) and moderate-to-vigorous PA (MVPA) and metabolic syndrome (MetS). METHODS: Cross-sectional study of 509 men and 567 women aged 70-77. Accelerometer assessed MPA, VPA and MVPA were analyzed using absolute and relative thresholds. Meeting the PA-recommendation was defined as amounting ≥150 min/week in MPA/MVPA or 75 min/week in VPA, respectively. CRF was directly measured as peak oxygen uptake (VO2peak). MetS was defined as 3 or more of the following: elevated waist circumference, fasting glucose, hypertension, triglycerides, decreased HDL-cholesterol or diabetes, dyslipidemia or hypertension medication. RESULTS: Higher proportion of the population met the recommendation when PA was assessed with relative compared to absolute thresholds: VPA (72.4% vs. 1.7%) and MVPA (75.2% vs. 33.8%). Logistic regression analysis revealed that men and women not meeting the relative-MVPA or VPA recommendation had higher likelihood of MetS (Men: MVPA OR: 1.59, 95% CI: 1.08-2.33. VPA OR: 1.81, 95%CI: 1.23-2.67 and Women: MVPA OR: 2.12, 95% CI: 1.36-3.31; VPA OR: 1.95, 95% CI: 1.29-2.95), compared to men and women meeting the relative MVPA or VPA recommendation. There was no significant association between MetS and absolute MVPA, MPA or VPA recommendations in the fully adjusted model. CONCLUSIONS: The association between meeting/not meeting the PA recommendation and MetS differed with method. Not meeting relative MVPA and VPA recommendation was associated with significantly higher likelihood for presence of MetS. Since relative intensity is part of the current PA recommendation, it should be considered when assessing population PA and associated health risks in the older adults. TRIAL REGISTRATION: Clinical Trial Registration: NCT01931111 (Date of trial registration: July 19, 2013).

Correlates of Objectively Measured Physical Activity Among Norwegian Older Adults: The Generation 100 Study.

The aim of this study was to identify how demographics, physical activity (PA) history, and environmental and biological correlates are associated with objectively measured PA among older adults. PA was assessed objectively in 850 older adults (70-77 years, 48% females) using the ActiGraph GT3X+ activity monitor. Hierarchical multiple regression analysis was used to identify important PA correlates. The included correlates explained 27.0% of the variance in older adult's PA. Cardiorespiratory fitness (CRF), gender, and season were the most important correlates, explaining 10.1%, 3.9%, and 2.7% of the variance, respectively. PA was positively associated with CRF, females were more physically active than males, and PA increased in warmer months compared with colder months. This is, to our knowledge, the largest study of PA correlates in older adults that has combined objectively measured PA and CRF. Our findings provide new knowledge about how different correlates are associated with PA.

New relative intensity ambulatory accelerometer thresholds for elderly men and women: the Generation 100 study.

BACKGROUND: Public health initiatives world-wide recommend increasing physical activity (PA) to improve health. However, the dose and the intensity of PA producing the most benefit are still debated. Accurate assessment of PA is necessary in order to 1) investigate the dose-response relationship between PA and health, 2) shape the most beneficial public health initiatives and 3) test the effectiveness of such initiatives. Actigraph accelerometer is widely used to objectively assess PA, and the raw data is given in counts per unit time. Count-thresholds for low, moderate and vigorous PA are mostly based on absolute intensity. This leads to largely inadequate PA intensity assessment in a large proportion of the elderly, who due to their declining maximal oxygen uptake (VO2max) cannot reach the moderate/vigorous intensity as defined in absolute terms. To resolve this issue, here we report relative Actigraph intensity-thresholds for the elderly. METHODS: Submaximal-oxygen-uptake, VO2max and maximal heart rate (HRmax) were measured in 111 70-77 year olds, while wearing an Actigraph-GT3X+. Relationship between VO2max percentage (%), counts-per-minute (CPM) and gender (for both the vertical-axis (VA) and vector-magnitude (VM)) and VO2max% and HRmax% was established using a mixed-regression-model. VM-and VA-models were tested against each other to see which model predicts intensity of PA better. RESULTS: VO2max and gender significantly affected number of CPM at different PA intensities (p < 0.05). Therefore, intensity-thresholds were created for both men and women of ranging VO2max values (low, medium, high). VM-model was found to be a better predictor of PA-intensity than VA-model (p < 0.05). Established thresholds for moderate intensity (46-63 % of VO2max) ranged from 669-3367 and 834-4048 CPM and vigorous intensity (64-90 % of VO2max) from 1625-4868 and 2012-5423CPM, for women and men, respectively. Lastly, we used this evidence to derive a formula that predicts customized relative intensity of PA (either VO2max% or HRmax%) using counts-per-minute values as input. CONCLUSION: Intensity-thresholds depend on VO2max, gender and Actigraph-axis. PA intensity-thresholds that take all these factors into account allow for more accurate relative intensity PA assessment in the elderly and will be useful in future PA research. TRIAL REGISTRATION: (ClinicalTrials.gov Identifier: NCT02017847, registered 17. December 2013).

Temporal changes in personal activity intelligence and mortality: Data from the aerobics center longitudinal study.

BACKGROUND: Personal activity intelligence (PAI) is a metric developed to simplify a physically active lifestyle for the participants. Regardless of following today's advice for physical activity, a PAI score ≥100 per week at baseline, an increase in PAI score, and a sustained high PAI score over time were found to delay premature cardiovascular disease (CVD) and all-cause mortality in a large population of Norwegians. However, the association between long-term temporal change in PAI and mortality in other populations have not been investigated. OBJECTIVE: To test whether temporal change in PAI is associated with CVD and all-cause mortality in a large population from the United States. METHODS: We studied 17,613 relatively healthy participants who received at least two medical examinations in the Aerobics Center Longitudinal Study between 1974 and 2002. The participant's weekly PAI scores were estimated twice, and adjusted hazard ratios (AHR) and 95% confidence intervals (CI) for CVD and all-cause mortality related to changes in PAI between baseline and last examination were assessed using Cox proportional hazard regression analyses. RESULTS: During a median follow-up time of 9.3 years [interquartile range, 2.6-16.6; 181,765 person-years], there were 1144 deaths, including 400 CVD deaths. We observed an inverse linear association between change in PAI and risk of CVD mortality (P=0.007 for linear trend, and P=0.35 for quadratic trend). Compared to participants with zero PAI at both examinations, multivariable-adjusted analyses demonstrated that participants who maintained high PAI scores (≥100 PAI at both examinations) had a 51% reduced risk of CVD mortality [AHR, 0.49: 95% CI, 0.26-0.95)], and 42% reduced risk of all-cause mortality [AHR, 0.58: 95% CI, 0.41-0.83)]. For participants who increased their PAI scores over time (PAI score of zero at first examination and ≥100 at last examination), the AHRs were 0.75 (95% CI, 0.55-1.02) for CVD mortality, and 0.82 (95% CI, 0.69-0.99) for all-cause mortality. Participants who maintained high PAI score had 4.8 (95% CI, 3.3-6.4) years of life gained. For those who increased their PAI score over time, the corresponding years gained were 1.8 years (95% CI, 0.1-3.5). CONCLUSION: Among relatively healthy participants, an increase in PAI and maintaining a high PAI score over time was associated with reduced risk of CVD and all-cause mortality. CONDENSED ABSTRACT: Our objective was to investigate the association between temporal changes in PAI and mortality in a large population from the United States. In this prospective cohort study of 17,613 relatively healthy participants at baseline, maintaining a high PAI score and an increase in PAI score over an average period of 6.3 years was associated with a significant reduction in CVD and all-cause mortality. Based on our results, clinicians can easily recommend that patients obtain at least 100 PAI for most favourable protection against CVD- and all-cause mortality, but can also mention that significant benefits also occur at maintaining low-to-moderate PAI levels.

Effect of exercise training for five years on all cause mortality in older adults-the Generation 100 study: randomised controlled trial.

OBJECTIVE: To evaluate the effect of five years of supervised exercise training compared with recommendations for physical activity on mortality in older adults (70-77 years). DESIGN: Randomised controlled trial. SETTING: General population of older adults in Trondheim, Norway. PARTICIPANTS: 1567 of 6966 individuals born between 1936 and 1942. INTERVENTION: Participants were randomised to two sessions weekly of high intensity interval training at about 90% of peak heart rate (HIIT, n=400), moderate intensity continuous training at about 70% of peak heart rate (MICT, n=387), or to follow the national guidelines for physical activity (n=780; control group); all for five years. MAIN OUTCOME MEASURE: All cause mortality. An exploratory hypothesis was that HIIT lowers mortality more than MICT. RESULTS: Mean age of the 1567 participants (790 women) was 72.8 (SD 2.1) years. Overall, 87.5% of participants reported to have overall good health, with 80% reporting medium or high physical activity levels at baseline. All cause mortality did not differ between the control group and combined MICT and HIIT group. When MICT and HIIT were analysed separately, with the control group as reference (observed mortality of 4.7%), an absolute risk reduction of 1.7 percentage points was observed after HIIT (hazard ratio 0.63, 95% confidence interval 0.33 to 1.20) and an absolute increased risk of 1.2 percentage points after MICT (1.24, 0.73 to 2.10). When HIIT was compared with MICT as reference group an absolute risk reduction of 2.9 percentage points was observed (0.51, 0.25 to 1.02) for all cause mortality. Control participants chose to perform more of their physical activity as HIIT than the physical activity undertaken by participants in the MICT group. This meant that the controls achieved an exercise dose at an intensity between the MICT and HIIT groups. CONCLUSION: This study suggests that combined MICT and HIIT has no effect on all cause mortality compared with recommended physical activity levels. However, we observed a lower all cause mortality trend after HIIT compared with controls and MICT. TRIAL REGISTRATION: ClinicalTrials.gov NCT01666340.

Personal Activity Intelligence (PAI): A new standard in activity tracking for obtaining a healthy cardiorespiratory fitness level and low cardiovascular risk.

Despite all the evidence of health benefits related to physical activity (PA) and cardiorespiratory fitness (CRF), low levels of PA have reached pandemic proportions, and inactivity is the fourth leading cause of death worldwide. Lack of time, and inability to self-manage are often cited as main barriers to getting adequate PA. Recently, a new personalized metric for PA tracking named Personal Activity Intelligence (PAI) was developed with the aim to make it easier to quantify how much PA per week is needed to reduce the risk of premature mortality from non-communicable diseases. PAI can be integrated in self-assessment heart rate devices and defines a weekly beneficial heart rate pattern during PA by considering the individual's sex, age, and resting and maximal heart rates. Among individuals ranging from the general population to subgroups of patients with cardiovascular disease (CVD), a PAI score ≥100 per week at baseline, an increase in PAI score, and a sustained high PAI score over time were found to delay premature death from CVD and all causes, regardless of whether or not the current PA recommendations were met. Importantly, a PAI score ≥100 at baseline, maintaining ≥100 PAIs and an increasing PAI score over time was associated with multiple years of life gained. Moreover, obtaining a weekly PAI ≥100 attenuated the deleterious association between CVD risk factor clustering and prolonged sitting time. PAI and objectively measured CRF (as indicated by VO2peak) were positively associated in a graded fashion, and individuals with a PAI score between 100 and 150 had expected age and sex specific average VO2peak values. A PAI score ≥100 was associated with higher VO2peak in both men (4.1 mL·kg-1·min-1; 95% CI, 3.5 to 4.6) and women (2.9 mL·kg-1·min-1; 95% CI, 2.4 to 3.3), compared to the reference group of <100 PAI. The combined analysis of PAI, PA and VO2peak demonstrated that a PAI score ≥100 was associated with high VO2peak values regardless of meeting or not meeting the current PA recommendations. Collectively, these findings suggest that PAI has the potential to be a useful tool to motivate people to become and stay physically active by quantifying the amount of PA needed to produce significant health benefits.

Predictors of Dropout in Exercise Trials in Older Adults: The Generation 100 Study.

PURPOSE: Dropout from exercise programs, both in the real world and in research, is a challenge, and more information on dropout predictors is needed for establishing strategies to increase the likelihood of maintaining participants in a prescribed exercise program. The aim of the present study was to determine the dropout rate and its predictors during a 3-yr exercise program in older adults. METHODS: In total, 1514 men and women (mean ± SD age = 72.4 ± 1.9 yr) were included in the present study. Participants were randomized to either a supervised exercise intervention or to follow national guidelines for physical activity (PA). Self-reported demographics (e.g., education), general health, morbidity (e.g., heart disease, memory loss, and psychological distress), smoking, and PA were examined at baseline. Cardiorespiratory fitness (CRF) and grip strength were directly measured at baseline. Dropout rate was evaluated after 1 and 3 yr. Multivariate logistic regression analysis was used to identify dropout predictors. RESULTS: The total dropout rate was 11.0% (n = 166) after 1 yr and 14.9% (n = 225) after 3 yr. Significant predictors of dropout after 1 yr were low education, low grip strength, lower cardiorespiratory fitness, low PA level, and randomization to supervised exercise. The same predictors of dropout were significant after 3 yr, with reduced memory status as an additional predictor. CONCLUSION: This is the largest study to identify dropout predictors in a long-term exercise program in older adults. Our findings provide new and important knowledge about potential risk factors of dropout in long-term exercise programs in older adults.

Temporal changes in cardiorespiratory fitness and risk of dementia incidence and mortality: a population-based prospective cohort study.

BACKGROUND: Cardiorespiratory fitness is associated with risk of dementia, but whether temporal changes in cardiorespiratory fitness influence the risk of dementia incidence and mortality is still unknown. We aimed to study whether change in estimated cardiorespiratory fitness over time is associated with change in risk of incident dementia, dementia-related mortality, time of onset dementia, and longevity after diagnosis in healthy men and women at baseline. METHODS: We linked data from the prospective Nord-Trøndelag Health Study (HUNT) done in Nord-Trøndelag, Norway with dementia data from the Health and Memory Study and cause of death registries (n=30 375). Included participants were apparently healthy individuals for whom data were available on estimated cardiorespiratory fitness and important confounding factors. Datasets were matched to each participant through their 11-digit personal identification number. Cardiorespiratory fitness was estimated on two occasions 10 years apart, during HUNT1 (1984-86) and HUNT2 (1995-97). HUNT2 was used as the baseline for follow-up. Participants were classified into two sex-specific estimated cardiorespiratory fitness groups according to their age (10-year categories): unfit (least fit 20% of participants) and fit (most fit 80% of participants). To assess the association between change in estimated cardiorespiratory fitness and dementia, we used four categories of change: unfit at both HUNT1 and HUNT2, unfit at HUNT1 and fit at HUNT2, fit at HUNT1 and unfit at HUNT2, fit at both HUNT1 and HUNT2. Using Cox proportional hazard analyses, we estimated adjusted hazard ratios (AHR) for dementia incidence and mortality related to temporal changes in estimated cardiorespiratory fitness. FINDINGS: During a median follow-up of 19·6 years for mortality, and 7·6 years for incidence, there were 814 dementia-related deaths, and 320 incident dementia cases. Compared with participants who were unfit at both assessments, participants who sustained high estimated cardiorespiratory fitness had a reduced risk of incident dementia (AHR 0·60, 95% CI 0·36-0·99) and a reduced risk of dementia mortality (0·56, 0·43-0·75). Participants who had an increased estimated cardiorespiratory fitness over time had a reduced risk of incident dementia (AHR 0·52, 95% CI 0·30-0·90) and dementia mortality (0·72, 0·52-0·99) when compared with those who remained unfit at both assessments. Each metabolic equivalent of task increase in estimated cardiorespiratory fitness was associated with a risk reduction of incident dementia (adjusted HR 0·84, 95% CI 0·75-0·93) and dementia mortality (0·90, 0·84-0·97). Participants who increased their estimated cardiorespiratory fitness over time gained 2·2 (95% CI 1·0-3·5) dementia-free years, and 2·7 (0·4-5·8) years of life when compared with those who remained unfit at both assessments. INTERPRETATION: Change in estimated cardiorespiratory fitness is an independent risk factor for incidence dementia and dementia mortality. Maintaining or improving cardiorespiratory fitness over time may be a target to reduce risk of dementia incidence and mortality, delay onset, and increase longevity after diagnosis. Our data highlight the importance of assessing cardiorespiratory fitness in health risk assessment for people at risk of dementia. FUNDING: The KG Jebsen Foundation, the Norwegian Research Council, the Liaison Committee between the Central Norway Regional Health Authority, and the Norwegian University of Science and Technology.

Personal Activity Intelligence and Mortality in Patients with Cardiovascular Disease: The HUNT Study.

OBJECTIVE: To test whether Personal Activity Intelligence (PAI), a personalized metric of physical activity (PA) tracking, is associated with all-cause and cardiovascular disease (CVD) mortality in patients with self-reported CVD and to determine whether these associations change depending on whether contemporary PA recommendations are met. PATIENTS AND METHODS: A total of 3133 patients with CVD (mean [SD] age, 67.6 [10.3] years; 64% men) were followed from the date of participation in the Nord-Trøndelag Health Study (between January 1, 1984, and February 28, 1986) until the date of death or the end of follow-up (December 31, 2015). The participants' weekly PAI score was calculated and divided into 4 groups (PAI scores of 0, ≤50, 51-99, and ≥100). We used Cox proportional hazards regression models to estimate hazard ratios for CVD and all-cause mortality rates. RESULTS: After mean follow-up of 12.5 years (39,157 person-years), there were 2936 deaths (94%), including 1936 CVD deaths. Participants with weekly PAI scores of 100 or greater had 36% (95% CI, 21%-48%) and 24% (95% CI, 10%-35%) lower risk of mortality from CVD and all causes, respectively, compared with the inactive group. Participants had similar risk reductions associated with their weekly PAI scores regardless of following contemporary PA recommendations or not. CONCLUSION: Obtaining a weekly PAI score of at least 100 was associated with lower mortality risk from CVD and all causes in individuals with CVD regardless of whether the current PA recommendations were met.

Do weather changes influence physical activity level among older adults? - The Generation 100 study.

INTRODUCTION: Understanding how individual and environmental factors impact physical activity (PA) level is important when building strategies to improve PA of older adults. No studies have examined how hour-to-hour weather changes influence PA in older adults or how the association between weather and PA eventually is related to cardiorespiratory fitness (CRF) measured as peak oxygen uptake. The aim of this study was therefore to examine how hour-to-hour changes in weather effects hour-to-hour PA in a cohort of Norwegian older adults across CRF levels, gender and seasons. METHODS: PA was assessed objectively in 1219 older adults (70-77 years, 51% females) using the Actigraph GT3X+ accelerometer, and quantified as counts·min-1 (CPM). Weather (Norwegian meteorological Institute) and CRF (MetaMax II) were measured objectively. Panel data analysis added a longitudinal dimension when 110.888 hours of weather- and PA data were analyzed. RESULTS: Older adults had a higher PA level in warmer (597 CPM) than colder months (556 CPM) (p<0.01). Fixed effects regression-models revealed that increasing temperatures (per hour) influenced PA positively in both colder and warmer months (all, p<0.01), with greater influence in fitter vs. less fit participants (p<0.01). In warmer months, increasing precipitation negatively influenced PA in both unfit females and unfit males (p<0.01). In colder months, increasing precipitation positively influenced PA for moderately fit to fit males (p<0.01), but not for females and unfit males. CONCLUSION: To the best of our knowledge, this is the first study to examine the association between weather conditions and objectively-measured-PA among Norwegian older adults. Our findings demonstrates that unfit older adults will be less likely to participate in PA when the weather is unpleasant, compared to those highly fit. The data suggests that the impact of weather should not be ignored when planning public health strategies for increasing PA among older adults.

Personal Activity Intelligence (PAI), Sedentary Behavior and Cardiovascular Risk Factor Clustering - the HUNT Study.

Prolonged sedentary behavior (SB) positively associates with clustering of risk factors for cardiovascular disease (CVD). The recently developed metric for physical activity (PA) tracking called Personal Activity Intelligence (PAI) takes into account age, sex, resting and maximum heart rate, and a score of ≥100 weekly PAI has been shown to reduce the risk of premature CVD death in healthy as well as individuals with known CVD risk factors, regardless of whether or not the current PA recommendations were met. The aim of the present study was to examine if PAI modifies the associations between SB and CVD risk factor (CV-RF) clustering in a large apparently healthy general population cohort (n=29,950, aged ≥20 years). Logistic regression revealed that in those with ≥100 weekly PAI, the likelihood of CV-RF clustering prevalence associated with prolonged SB was attenuated across age groups. Monitoring weekly PAI-level could be useful to ensure that people perform enough PA to combat SB's deleterious association with CV-RF.

Cardiorespiratory Reference Data in Older Adults: The Generation 100 Study.

PURPOSE: Cardiorespiratory fitness (CRF) is regarded a clinical vital sign, and accurate reference values for all age groups are essential. Little data exist on CRF and cardiorespiratory function in older adults. The aim of this study was to provide normative values for CRF and cardiorespiratory function in older adults, including people with history of cardiovascular diseases (CVD). METHODS: In total, 1537 (769 women) participants age 70 to 77 yr underwent clinical examinations and cardiopulmonary exercise tests. Peak oxygen uptake (V˙O2peak), ventilation (V˙Epeak), expiration of carbon dioxide (VV˙CO2peak), breathing frequency (BFpeak), tidal volume (VTpeak), oxygen pulse (O2 pulsepeak), ventilatory efficiency (EqV˙O2peak and EqV˙CO2peak), and 1-min HR recovery were assessed. RESULTS: Men compared with women had higher V˙O2peak (31.3 ± 6.7 vs 26.2 ± 5.0 mL·min·kg), BFpeak (41.8 ± 8.0 vs 39.7 ± 7.1 breaths per minute), VTpeak (2.3 ± 0.5 vs 1.6 ± 0.3), O2 pulsepeak (16.4 ± 3.2 vs 11.3 ± 2.0), V˙CO2peak (2.9 ± 0.2 and 1.9 ± 0.1 L·min), V˙Epeak (96.2 ± 21.7 vs 61.1 ± 21.6 L·min), EqV˙O2peak (38.0 ± 6.9 vs 35.1 ± 5.6), and EqV˙CO2peak (33.5 ± 5.7 vs 31.9 ± 4.5). Women and men with CVD had lower V˙O2peak (14% and 19%), peak HR (5% and 6%), V˙Epeak (8% and 10%), VTpeak (7% and 4%), and lower EqV˙CO2peak (4% and 6%) compared with their healthy counterparts, respectively. Compared with healthy women and men, 1-min HR recovery was 12% and 16% lower for women and men with CVD. CONCLUSIONS: This study represents the largest reference material on directly measured CRF and cardiorespiratory function in older men and women, with and without CVD. This novel information will help researchers and clinicians to interpret data form cardiopulmonary testing in older adults.

Sedentary Time, Cardiorespiratory Fitness, and Cardiovascular Risk Factor Clustering in Older Adults--the Generation 100 Study.

OBJECTIVE: To determine whether meeting physical activity (PA) recommendations and/or having high age-specific cardiorespiratory fitness (CRF) attenuate the adverse effect of prolonged sedentary time on cardiovascular risk factor (CV-RF) clustering in older adults. PATIENTS AND METHODS: We conducted a cross-sectional study of Norwegian women (495) and men (379) aged 70 to 77 years from August 22, 2012, through June 30, 2013. Sedentary time and PA were assessed by accelerometers and CRF by directly measured peak oxygen uptake (VO2peak). Logistic regression was used to estimate adjusted odds ratios (ORs) and CIs for the association between sedentary time and prevalence of CV-RF clustering (≥3 of the following: hypertension, high blood glucose level, high waist circumference, low high-density lipoprotein cholesterol level, or high triglyceride level) and for the modifying effect of PA and CRF. RESULTS: Overall, 163 of the 495 women (32.9%) and 140 of the 379 men (36.9%) had CV-RF clustering. Each additional hour of sedentary time was associated with 22% (OR, 1.22; 95% CI, 1.02-1.45) and 27% (OR, 1.27; 95% CI, 1.04-1.55) higher likelihood of having CV-RF clustering in women and men, respectively, whereas a 1-metabolic equivalent decrement in VO2peak corresponded to 57% (OR, 1.57; 95% CI, 1.34-1.84) and 67% (OR, 1.67; 95% CI, 1.44-1.95) higher likelihood of CV-RF clustering in women and men, respectively. High CRF (VO2peak >27.5 mL/kg per minute in women and >34.4 mL/kg per minute in men) attenuated the adverse effects of high sedentary time on CV-RF clustering, even among individuals not meeting recommendations for PA. CONCLUSION: High age-specific CRF fully attenuates the adverse effect of prolonged sedentary time on CV-RF clustering, independent of meeting the PA consensus recommendation in older adults.

Are Older Adults Physically Active Enough - A Matter of Assessment Method? The Generation 100 Study.

INTRODUCTION: Physical activity (PA) is beneficial for general health. As a result, adults around the world are recommended to undertake regular PA of either absolute or relative intensity. Traditionally, adherence to PA recommendation is assessed by accelerometers that record absolute intensity thresholds. Since ageing often results in a decrease in cardiorespiratory fitness (CRF), older adults (aged > 65 years) might be more susceptible to not meeting the PA recommendation when measured in absolute terms. The aim of the present study was to compare the adherence to the PA recommendation using both absolute and relative thresholds. Additionally, we aimed to report the reference values for overall PA in a large sample of Norwegian older adults. METHODS: PA was assessed for 7 days using the Actigraph GT3X+ accelerometer in 1219 older adults (624 females) aged 70-77 years. Overall PA was measured as counts per minute (CPM) and steps. Absolute and relative moderate-to-vigorous PA (MVPA) thresholds were applied to quantify adherence to PA recommendation. The relative MVPA thresholds were developed specifically for the Generation 100 population sample. CRF was directly measured as peak oxygen uptake (VO2peak). RESULTS: Proportions meeting PA recommendation were 29% and 71% when utilizing absolute and relative MVPA, respectively. More females met the relative PA recommendation compared to males. Overall PA was higher among the youngest age group. Older adults with medium- and high levels of CRF were more physically active, compared to those with the lowest levels of CRF. CONCLUSION: This is the first study to compare adherence to PA recommendation, using absolute and relative intensity thresholds among older adults. The present study clearly illustrates the consequences of using different methodological approaches to surveillance of PA across age, gender and CRF in a population of older adults.

Effect of Change in VO2max on Daily Total Energy Expenditure in a Cohort of Norwegian Men: A Randomized Pilot Study.

OBJECTIVE: To investigate how a change in VO2max induced through 6 weeks of high intensity aerobic interval training affects daily total energy expenditure (TEE), active energy expenditure (AEE) and mitochondrial function in people not previously exposed to structured high intensity aerobic interval training (AIT). METHODS: Thirty healthy males (39±6 yrs) not exposed to structured exercise training were randomized to either 1x4 min AIT (1-AIT), 4x4 min AIT (4-AIT), both at 90-95% maximum heart rate (HRmax) or 47 min of MCT at 70% HRmax. TEE, AEE, number of steps, active time, sedentary time, VO2max and mitochondrial function in m. vastus lateralis were measured before and after intervention. RESULTS: TEE increased 14% (p=0.014) and AEE increased 43% (p= 0.004) after MCT. There was no change in TEE or AEE after 1-AIT or 4-AIT, but 1-AIT had significantly lower TEE (p=0.033) and step-count (p=0.011) compared to MCT post intervention. VO2max increased 7% after 1-AIT (p= 0.004) and 9% after 4-AIT (p=0.004), with no change after MCT. No change was observed in maximal mitochondrial respiration (VMAX) or Citrate Synthase (CS) activity within or between interventions. Basal respiration (V0) increased after 1-AIT (p=0.029) and 4-AIT (p=0.022), with no significant change after MCT. CONCLUSION: AIT interventions that increase VO2max, do not stimulate subjects to increase TEE or AEE. The intensity of exercise seems to play apart, as MCT increased TEE and AEE and AIT did not. Emphasis should be placed on the importance of maintaining everyday activities when introducing structured exercise training to untrained individuals.