Neuromuscular exercise and counseling for treating recurrent low back pain in female healthcare workers-Findings from a 24-month follow-up study of a randomized controlled trial.

BACKGROUND: Female healthcare workers have a high prevalence of low back pain (LBP)-related sickness absence. Here, we report findings of a 24-month follow-up of a previously published 6-month randomized controlled trial (RCT). METHODS: By adopting an RCT with 6 months of intervention and follow-up at 6, 12, and 24 months, we assessed the maintenance of changes in the effectiveness (LBP and fear of pain) of the interventions (neuromuscular exercise [NME], back-care counseling, both combined) using a generalized linear mixed model adjusted for baseline covariates. The incremental cost-effectiveness ratio was calculated in terms of quality-adjusted life years (QALY). A bootstrap technique was used to estimate the uncertainty around a cost-effectiveness acceptability curve. RESULTS: Of the 219 females, 71% had data at 24 months. Between 6 and 24 months, LBP intensity (primary outcome) remained low in all intervention arms (-20% to -48%) compared to the control (-10% to -16%). Pain interfering with work remained low in the combined and exercise arms for up to 24 months. At 24 months, the total costs were lowest in the combined arm (€484 vs. €613-948, p < 0.001), as were the number of back-related sickness absence days (0.16 vs. 1.14-3.26, p = 0.003). The analysis indicated a 95% probability of the combined arm to be cost-effective per QALY gained at €1120. CONCLUSIONS: Six months of weekly NME combined with four counseling sessions was cost-effective for treating LBP and the effect was maintained over 24 months. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01465698, 7/11/2011, prospective.

Fear-avoidance beliefs are associated with exercise adherence: secondary analysis of a randomised controlled trial (RCT) among female healthcare workers with recurrent low back pain.

BACKGROUND: Exercise is recommended for the treatment and management of low back pain (LBP) and the prevention of chronicity. Exercise adherence has been only modest in intervention studies among people with musculoskeletal pain. Fear-avoidance beliefs (FABs) are known to affect exercise adherence.The purpose was twofold: to examine which bio-psycho-social factors contributed to exercise adherence during a 6-month neuromuscular exercise intervention among female healthcare workers with recurrent LBP, and to investigate how exercising affects FABs at 6 and 12 months' follow-up. METHODS: Some 219 healthcare workers aged 30-55 years with mild-to-moderate re-current non-specific LBP were originally allocated into: 1) exercise, 2) counselling, 3) combined exercise and counselling, and 4) control groups. In the present secondary analysis, groups 1 and 3 (exercise only and exercise+counselling) were merged to be exercisers and groups 2 and 4 were merged to be non-exercisers. Baseline variables of the exercise compliers (≥24 times over 24 weeks; n = 58) were compared to those of the non-compliers (< 1 time/week, 0-23 times; n = 52). The effects of the exercise programme on FABs were analysed by a generalised linear mixed model according to the intention-to-treat principle (exercisers; n = 110 vs non-exercisers; n = 109) at three measurement points (baseline, 6, and 12 months). A per-protocol analysis compared the more exercised to the less exercised and non-exercisers. RESULTS: A low education level (p = 0.026), shift work (p = 0.023), low aerobic (p = 0.048) and musculoskeletal (p = 0.043) fitness, and high baseline physical activity-related FABs (p = 0.019) were related to low exercise adherence. The exercise programme reduced levels of both physical activity- and work-related FABs, and there was a dose response: FABs reduced more in persons who exercised ≥24 times compared to those who exercised 0-23 times. CONCLUSION: Healthcare workers who had lower education and fitness levels, worked shifts, and had high physical activity-related FABs had a lower adherence to the 6-month neuromuscular exercise programme. Exercising with good adherence reduced levels of FABs, which have been shown to be linked with prolonged LBP. Motivational strategies should be targeted at persons with low education and fitness levels and high FABs in order to achieve better exercise adherence.

Neuromuscular exercise reduces low back pain intensity and improves physical functioning in nursing duties among female healthcare workers; secondary analysis of a randomised controlled trial.

BACKGROUND: Low back pain (LBP) is common among healthcare workers, whose work is physically strenuous and thus demands certain levels of physical fitness and spinal control. Exercise is the most frequently recommended treatment for LBP. However, exercise interventions targeted at sub-acute or recurrent patients are scarce compared to those targeted at chronic LBP patients. Our objective was to examine the effects of 6 months of neuromuscular exercise on pain, lumbar movement control, fitness, and work-related factors at 6- and 12-months' follow-up among female healthcare personnel with sub-acute or recurrent low back pain (LBP) and physically demanding work. METHODS: A total of 219 healthcare workers aged 30-55 years with non-specific LBP were originally allocated to four groups (exercise, counselling, combined exercise and counselling, control). The present study is a secondary analysis comparing exercisers (n = 110) vs non-exercisers (n = 109). Exercise was performed twice a week (60 min) in three progressive stages focusing on controlling the neutral spine posture. The primary outcome was intensity of LBP. Secondary outcomes included pain interfering with work, lumbar movement control, fitness components, and work-related measurements. Between-group differences were analysed with a generalised linear mixed model according to the intention-to-treat principle. Per-protocol analysis compared the more exercised to the less exercised and non-exercisers. RESULTS: The mean exercise attendance was 26.3 (SD 12.2) of targeted 48 sessions over 24 weeks, 53% exercising 1-2 times a week, with 80% (n = 176) and 72% (n = 157) participating in 6- and in 12-month follow-up measurements, respectively. The exercise intervention reduced pain (p = 0.047), and pain interfering with work (p = 0.046); improved lumbar movement control (p = 0.042), abdominal strength (p = 0.033) and physical functioning in heavy nursing duties (p = 0.007); but had no effect on other fitness and work-related measurements when compared to not exercising. High exercise compliance resulted in less pain and better lumbar movement control and walking test results. CONCLUSION: Neuromuscular exercise was effective in reducing pain and improving lumbar movement control, abdominal strength, and physical functioning in nursing duties compared to not exercising.

Personalised eHealth intervention to increase physical activity and reduce sedentary behaviour in rehabilitation after cardiac operations: study protocol for the PACO randomised controlled trial (NCT03470246).

INTRODUCTION: Personalized intervention to increase physical Activity and reduce sedentary behaviour in rehabilitation after Cardiac Operations (PACO) is a smartphone-based and accelerometer-based eHealth intervention to increase physical activity (PA) and reduce sedentary behaviour (SB) among patients recovering from cardiac surgery. DESIGN: Prospective randomised controlled trial. METHODS AND ANALYSIS: The present protocol describes a randomised controlled clinical trial to be conducted in the Heart Centres of Kuopio and Turku university hospitals. The trial comprises 540 patients scheduled for elective coronary artery bypass grafting, aortic valve replacement or mitral valve repair. The patients will be randomised into two groups. The control group will receive standard postsurgical rehabilitation guidance. The eHealth intervention group will be given the same guidance together with personalised PA guidance during 90 days after discharge. These patients will receive personalised daily goals to increase PA and reduce SB via the ExSedapplication. Triaxial accelerometers will be exploited to record patients' daily accumulated PA and SB, and transmit them to the application. Using the accelerometer data, the application will provide online guidance to the patients and feedback of accomplishing their activity goals. The data will also be transmitted to the cloud, where a physiotherapist can monitor individual activity profiles and customise the subsequent PA and SB goals online. The postoperative improvement in patients' step count, PA, exercise capacity, quality of sleep, laboratory markers, transthoracic echocardiography (TTE) parameters and quality of life, and reduction in SB and incidence of major cardiac events are investigated as outcomes. CONCLUSIONS: The PACO intervention aims to build a personalised eHealth tool for the online tutoring of cardiac surgery patients. TRIAL REGISTRATION NUMBER: NCT03470246.

Socio-Ecological Natural Experiment with Randomized Controlled Trial to Promote Active Commuting to Work: Process Evaluation, Behavioral Impacts, and Changes in the Use and Quality of Walking and Cycling Paths.

Active commuting to work (ACW) has beneficial effects on health, traffic, and climate. However, more robust evidence is needed on how to promote ACW. This paper reports the findings of a multilevel natural experiment with a randomized controlled trial in 16 Finnish workplaces. In Phase 1, 11 workplaces (1823 employees) from Area 1 were exposed to environmental improvements in walking and cycling paths. In Phase 2, five more workplaces (826 employees) were recruited from Area 2 and all workplaces were randomized into experimental group (EXP) promoting ACW with social and behavioral strategies and comparison group (COM) participating only in data collection. Process and impact evaluation with questionnaires, travel diaries, accelerometers, traffic calculations, and auditing were conducted. Statistics included Wilcoxon Signed Ranks Test, Mann-Whitney U-test, and after-before differences with 95% confidence intervals (95% CI). After Phase 1, positive change was seen in the self-reported number of days, which the employees intended to cycle part of their journey to work in the following week (p = 0.001). After Phase 2, intervention effect was observed in the proportion of employees, who reported willingness to increase walking (8.7%; 95% CI 1.8 to 15.6) and cycling (5.5%; 2.2 to 8.8) and opportunity to cycle part of their journey to work (5.9%; 2.1 to 9.7). To conclude, the intervention facilitated employees' motivation for ACW, which is the first step towards behavior change.

Frequent sit-to-stand transitions and several short standing periods measured by hip-worn accelerometer are associated with smaller waist circumference among adults.

This cross-sectional study analysed the association of sedentary behaviour (SB) and standing with waist circumference. Finnish adults aged 30-75 years from a sub-sample of population-based Health 2011 Study used a hip-worn tri-axial accelerometer (Hookie AM20, Traxmeet, Ltd, Espoo, Finland) for seven days. Those 1405 participants (57% women) who used accelerometer at least four days, minimum of 10 hours/day, were included. SB and standing were analysed in 6s epochs using validated algorithm. Daily total time, daily number and accumulated time from bouts (30s-5min,30s-10min,30s-15min,30s 30min,>5min,>10min,>15min, >30min) as well as daily number of sit-to-stand transitions were determined. Waist circumference (cm) was measured in standardized way. Participants' mean age was 52 years (SD 12.2). Mean waist circumference was 97cm (SD 12.3) in men and 87cm (SD 12.7) in women. According to multivariable stepwise linear regression analysis, sit-to-stand transitions [standardised regression coefficient (ß)= -0.14, 95%CI -0.20 to -0.09], standing bouts of 30s-5min (ß= -0.21, 95%CI -0.26 to -0.15) and number of 30s-30min SB bouts (ß=0.12, 95%CI 0.06 to 0.17) were most strongly associated with waist circumference. Besides assessing total SB time, future studies should assess also different bout lengths of SB and sit-to-stand transitions and standing times should be assessed separately.

Effectiveness and cost-effectiveness of neuromuscular exercise and back care counseling in female healthcare workers with recurrent non-specific low back pain: a blinded four-arm randomized controlled trial.

BACKGROUND: Registered healthcare workers worldwide have a high prevalence of work-related musculoskeletal disorders, particularly of the back. Multidisciplinary interventions among these workers have improved fear avoidance beliefs, but not low back pain (LBP) and related sickness absences, cost-effectiveness studies are scarce. Our purpose was to investigate the effectiveness and cost-effectiveness of three intervention-arms (combined neuromuscular exercise and back care counselling or either alone) compared with non-treatment. METHODS: We randomly assigned female healthcare workers with recurrent non-specific LBP to one of four study-arms: Combined neuromuscular exercise and back care counseling; Exercise; Counseling; and no intervention Control. We assessed the effectiveness of the interventions on intensity of LBP, pain interfering with work and fear avoidance beliefs against the Control, and calculated the incremental cost-effectiveness ratios for sickness absence and QALY. RESULTS: We conducted three sub-studies in consecutive years of 2011, 2012, and 2013 to reach an adequate sample size. All together 219 women were randomized within each sub-study, of whom 74 and 68% had adequate questionnaire data at 6 and 12 months, respectively. No adverse events occurred. Compliance rates varied between intervention-arms. After 12 months, the Combined-arm showed reduced intensity of LBP (p = 0.006; effect size 0.70, confidence interval 0.23 to 1.17) and pain interfering with work (p = 0.011) compared with the Control-arm. Work-related fear of pain was reduced in both the Combined- (p = 0.003) and Exercise-arm (p = 0.002). Physical activity-related fear was reduced only in the Exercise-arm (p = 0.008). During the study period (0-12 months) mean total costs were lowest in the Combined-arm (€476 vs. €1062-€1992, p < 0.001) as were the mean number of sickness absence days (0.15 vs. 2.29-4.17, p = 0.025). None of the intervention-arms was cost-effective for sickness absence. There was 85% probability of exercise-arm being cost-effective if willing to pay €3550 for QALY gained. CONCLUSIONS: Exercise once a week for 6 months combined with five sessions of back care counseling after working hours in real-life settings effectively reduced the intensity of LBP, work interference due to LBP, and fear of pain, but was not cost-effective. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01465698 November 7, 2011 (prospective).

Six-minute walk test: a tool for predicting maximal aerobic power (VO2 max) in healthy adults.

BACKGROUND: The 6-min walk test (6MWT) is cost-effective and well-documented field test for assessing functional exercise capacity and response to medical interventions in diverse patient groups, and predicting cardiorespiratory fitness among healthy people. OBJECTIVE: Assessments of cardiorespiratory fitness in terms of maximal aerobic power (VO2 max) have great potential in public health monitoring to predict future health, early retirement and ability to independent living. This study aimed to develop a prediction model for VO2 max based on 6MWT results among healthy adults. DESIGN: The study comprised of pilot and validation studies. In validation study, seventy-five 19- to 75-year-old adults (39 men, 36 women) were equipped with portable gas analyser and heart rate monitor. Participants performed 6MWT on a 15-m indoor track and maximal graded exercise test (GXT) on a treadmill. We evaluated performance of the developed prediction model among 1583 Finnish adults. RESULTS: Participant's mean walking distance was 652 m (SD ± 74). Their mean VO2 max in GXT and O2 uptake at the end of the 6MWT were 34·4 ml kg-1 min-1 (SD ± 7·6) and 27·2  ml kg-1 min-1 (SD ± 6·5), respectively. For men, the best predictors for VO2 max were walking distance, age, BMI, heart rate at the end of 6MWT and height, and for women, walking distance, age and weight. The predictors explained 82% and 79% of men's and women's measured VO2 max with the standard error of estimate of 3·6 ml kg-1 min-1 and 3·5 ml kg-1 min-1 , respectively. CONCLUSION: The 6MWT performed along a 15-m track is a valid field test for predicting VO2 max of healthy adults with accuracy of about 1MET.

Aerobic physical activity assessed with accelerometer, diary, questionnaire, and interview in a Finnish population sample.

This study evaluates the agreement between different methods to assess moderate to vigorous physical activity (MVPA) in a large sample of Finnish adults. Methods were classified and examined pairwise (accelerometer vs diary; questionnaire vs interview). Proportion of participants meeting the aerobic health-enhancing physical activity (HEPA) recommendation was compared pairwise between all four methods. The present study of 1916 adults aged 18-75 years (mean age 50 years, 57% women) is a sub-sample of population-based Health 2011 Study conducted by the National Institute of Health and Welfare in Finland. Participants used accelerometer for 7 days and completed physical activity (PA) diary during the same period. PA questionnaire and interview were completed retrospectively to assess typical weekly PA over the past year. Agreement between the methods was analyzed with paired samples t-test and Bland-Altman plot. Kappa-test was used to compare the prevalence of meeting the HEPA recommendation. The accelerometer resulted in 13 minutes (P < 0.001) higher weekly total amount of MVPA compared to diary. According to Bland-Altman plot, the 95% limit of agreement was from +273 to -247 in weekly minutes. The comparison between questionnaire and interview showed non-significant mean difference of 3 minutes (P = 0.60) in weekly MVPA, but the Bland-Altman plot showing the 95% limit of agreement from +432 to -427 in weekly minutes. Agreement of meeting HEPA recommendation was moderate between questionnaire and interview (κ = 0.43) but poor (κ = 0.20-0.38) between other comparisons. The inter-method differences were large especially at the individual level. Thus the assessment of PA is strongly method-dependent and not interchangeable.

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

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

Effectiveness of a standardised exercise programme for recurrent neck and low back pain: a multicentre, randomised, two-arm, parallel group trial across 34 fitness clubs in Finland.

BACKGROUND: Neck and low back pain (LBP) are common in office workers. Exercise trials to reduce neck and LBP conducted in sport sector are lacking. We investigated the effectiveness of the standardised Fustra20Neck&Back exercise program for reducing pain and increasing fitness in office workers with recurrent non-specific neck and/or LBP. METHOD: Volunteers were recruited through newspaper and Facebook. The design is a multi-centre randomised, two-arm, parallel group trial across 34 fitness clubs in Finland. Eligibility was determined by structured telephone interview. Instructors were specially educated professionals. Neuromuscular exercise was individually guided twice weekly for 10 weeks. Webropol survey, and objective measurements of fitness, physical activity, and sedentary behavior were conducted at baseline, and at 3 and 12 months. Mean differences between study groups (Exercise vs Control) were analysed using a general linear mixed model according to the intention-to-treat principle. RESULTS: At least moderate intensity pain (≥40 mm) in both the neck and back was detected in 44% of participants at baseline. Exercise compliance was excellent: 92% participated 15-20 times out of 20 possible. Intensity and frequency of neck pain, and strain in neck/shoulders decreased significantly in the Exercise group compared with the Control group. No differences in LBP and strain were detected. Neck/shoulder and trunk flexibility improved, as did quality of life in terms of pain and physical functioning. CONCLUSIONS: The Fustra20Neck&Back exercise program was effective for reducing neck/shoulder pain and strain, but not LBP. Evidence-based exercise programs of sports clubs have potential to prevent persistent, disabling musculoskeletal problems.

Bio-psychosocial factors are associated with pain intensity, physical functioning, and ability to work in female healthcare personnel with recurrent low back pain.

OBJECTIVE: To investigate associations of various bio-psychosocial factors with bodily pain, physical func-tioning, and ability to work in low back pain. DESIGN: Cross-sectional study. SUBJECTS: A total of 219 female healthcare workers with recurrent non-specific low back pain. METHODS: Associations between several physical and psychosocial factors and: (i) bodily pain, (ii) physical functioning and (iii) ability to work were studied. Variables with statistically significant associations (p < 0.05) in bivariate analysis were set within a generalized linear model to analyse their relationship with each dependent variable. RESULTS: In generalized linear model analysis, perceived work-induced lumbar exertion (p < 0.001), multi-site pain (p <0.001) and work-related fear-avoidance beliefs (FAB-W) (p = 0.02) best explained bodily pain. Multi-site pain (p < 0.001), lumbar exertion (p = 0.005), FAB-W (p = 0.01) and physical performance in figure-of-eight running (p = 0.01) and modified push-ups (p = 0.05) best explained physical functioning; FAB-W (p <0.001), lumbar exertion (p = 0.003), depression (p = 0.01) and recovery after work (p = 0.03) best explained work ability. In bivariate analysis lumbar exertion was associated with poor physical performance. CONCLUSION: FAB-W and work-induced lumbar exertion were associated with levels of pain, physical functioning and ability to work. Poor physical performance capacity was associated with work-induced lumbar exertion. Interventions that aim to reduce fear-avoidance and increase fitness capacity might be beneficial.

Association of objectively measured sedentary behaviour and physical activity with cardiovascular disease risk.

Background We evaluated the association of accelerometer-based sedentary behaviour and physical activity with the risk of cardiovascular disease. Design The design of this study used a population-based, cross-sectional sample. Methods A subsample of participants in the Health 2011 Study in Finland used the tri-axial accelerometer (≥4 days, >10 h/day, n = 1398). Sedentary behaviour (sitting, lying) and standing still in six-second epochs were recognised from raw acceleration data based on intensity and device orientation. The intensity of physical activity was calculated as one-minute moving averages of mean amplitude deviation of resultant acceleration and converted to metabolic equivalents. Metabolic equivalents were categorised to light physical activity (1.5-2.9 metabolic equivalents) and moderate-to-vigorous physical activity (moderate-to-vigorous physical activity≥3.0 metabolic equivalents). Daily sedentary behaviour, standing still, light physical activity and moderate-to-vigorous physical activity were expressed as mean daily total time, accumulated time and number of different bouts (from 30 s to >30 min), mean daily metabolic equivalent and weekly peak metabolic equivalent levels of different bout lengths and number of breaks in sedentary behaviour. The ten-year cardiovascular disease risk was based on the Framingham risk model. Results The mean number of daily sedentary behaviour bouts was more strongly associated with cardiovascular disease risk than mean daily total time. In the best model, smaller waist circumference, greater value of mean daily metabolic equivalent levels of one-minute bouts, higher accumulated time of moderate-to-vigorous physical activity lasting ≤30 min, higher number of >5 min standing bouts and a higher number of long (>30 min) bouts of light physical activity were significantly associated with lower cardiovascular disease risk (R2 = 0.836). Conclusions The objectively measured number and accumulated time from different bout lengths of physical activity and sedentary behaviour were associated with cardiovascular disease risk, which is considered relevant for estimating cardiovascular diseases and for devising preventive actions.

Evaluation of the Effects of Physical Activity, Cardiorespiratory Condition, and Neuromuscular Fitness on Direct Healthcare Costs and Sickness-Related Absence Among Nursing Personnel With Recurrent Nonspecific Low Back Pain.

STUDY DESIGN: A cross-sectional study, part of a randomized controlled trial. OBJECTIVE: To evaluate the association of physical activity, cardiorespiratory fitness, and neuromuscular fitness with direct healthcare costs and sickness-related absence among nursing personnel with nonspecific low back pain. SUMMARY OF BACKGROUND DATA: Low back pain creates a huge economic burden due to increased sick leave and use of healthcare services. METHODS: Female nursing personnel with nonspecific low back pain were included (n = 219). Physical activity was assessed with accelerometry and a questionnaire. In addition, measurements of cardiorespiratory and muscular fitness were conducted. Direct costs and sickness-related absence for a 6-month period were collected retrospectively by questionnaire. Health care utilization and absence from work were analyzed with a general linear model. RESULTS: The mean total costs were 80.5% lower among women who met physical activity recommendations than inactive women. Those with a higher mean daily intensity level of 10-minute activity sessions showed lower total costs than women in the lowest tertile (middle: 64.0% of the lowest; highest: 54.3% of the lowest). Women with good cardiorespiratory fitness (the highest tertile) as measured with the 6-minute-walk test (based on walking distance) had 77.0% lower total costs when compared with the lowest tertile. Women in the highest third for the modified push-up test had 84.0% lower total costs than those with the poorest results (the bottom tertile). CONCLUSION: High cardiorespiratory and muscular fitness and meeting physical activity recommendations for aerobic and muscular fitness were strongly associated with lower total costs among nursing personnel with pain-related disorders of recurrent nonspecific low back pain. Actions to increase physical activity and muscle conditioning may significantly save on healthcare costs and decrease sick-leave costs due to low back pain.

Neuromuscular exercise and back counselling for female nursing personnel with recurrent non-specific low back pain: study protocol of a randomised controlled trial (NURSE-RCT).

INTRODUCTION: Nursing personnel have high risk for incidence of low back pain (LBP) followed by development of chronic pain and disability. Multiple risk factors such as patient handling, night shift work and lack of supporting work culture have been identified. In subacute LBP, high-fear avoidance is prognostic for more pain, disability and not returning to work. Lack of leisure-time physical activity predicts long-term sickness absence. The purpose of this study is to compare effectiveness of 6-month neuromuscular exercise and counselling in treating back pain in female nursing personnel with recurrent non-specific LBP pain compared with either (exercise or counselling) alone and a non-treatment control group. METHODS AND ANALYSIS: The design is of a double-blinded four-arm randomised controlled trial with cost-effectiveness evaluation at 12 and 24 months. The study is conducted in 3 consecutive substudies. The main eligibility criteria are experience of LBP during the past 4 weeks with intensity of at least 2 (Numeric Rating Scale 0-10) and engagement in patient handling. Sample size was estimated for the primary outcome of pain intensity (visual analogue scale). Study measurements are outlined according to the model of International Classification of Functioning, Disability and Health, which incorporates the biopsychosocial processes assessed. ETHICS AND DISSEMINATION: This study is carried out conforming to the guidelines of good scientific practice and provisions of the declaration of Helsinki. Increasing physical and mental capacity with interventions taking place immediately after working hours near the worksite may reduce development of chronic LBP and work disability in female nursing personnel with recurrent non-specific LBP. TRIAL REGISTRATION NUMBER: NCT04165698.

Objectively measured sedentary behavior and physical activity in a sample of Finnish adults: a cross-sectional study.

BACKGROUND: Regular physical activity (PA) confers many positive effects on health and well-being. Sedentary behavior (SB), in turn, is a risk factor for health, regardless of the level of moderate to vigorous PA. The present study describes the levels of objectively measured SB, breaks in SB, standing still and PA among Finnish adults. METHODS: This cross-sectional analysis is based on the sub-sample of the population-based Health 2011 Study of Finnish adults. The study population consisted of 18-to-85-year old men and women who wore a waist-worn triaxial accelerometer (Hookie AM 20) for at least 4 days, for at least 10 h per day (n = 1587) during a week. PA and SB were objectively assessed from the raw accelerometric data using novel processing and analysis algorithms with mean amplitude deviation as the processing method. The data was statistically analyzed using cross-tabulations, analysis of variance and analysis of covariance. RESULTS: The participants were on average 52 years old, 57 % being women. Participants were sedentary 59 % of their waking wear time, mainly sitting. They spent 17 % of the time standing still, 15 % in light intensity PA, 9 % in moderate PA and less than 1 % in vigorous PA. Participants aged 30-39 years had the highest number of breaks in SB per day. Younger participants (<30 years of age) had more moderate and vigorous PA than older ones (≥60 years of age), and 30-60-year-olds had the greatest amount of light PA. CONCLUSIONS: Participants spent nearly 60 % of their waking time sedentary, and the majority of their daily PA was light. From a public health perspective it is important to find effective ways to decrease SB as well as to increase the level of PA. Our analysis method of raw accelerometer data may allow more precise assessment of dose-response relationships between objectively measured PA and SB and various indicators of health and well-being.

Validation of Cut-Points for Evaluating the Intensity of Physical Activity with Accelerometry-Based Mean Amplitude Deviation (MAD).

PURPOSE: Our recent study of three accelerometer brands in various ambulatory activities showed that the mean amplitude deviation (MAD) of the resultant acceleration signal performed best in separating different intensity levels and provided excellent agreement between the three devices. The objective of this study was to derive a regression model that estimates oxygen consumption (VO2) from MAD values and validate the MAD-based cut-points for light, moderate and vigorous locomotion against VO2 within a wide range of speeds. METHODS: 29 participants performed a pace-conducted non-stop test on a 200 m long indoor track. The initial speed was 0.6 m/s and it was increased by 0.4 m/s every 2.5 minutes until volitional exhaustion. The participants could freely decide whether they preferred to walk or run. During the test they carried a hip-mounted tri-axial accelerometer and mobile metabolic analyzer. The MAD was calculated from the raw acceleration data and compared to directly measured incident VO2. Cut-point between light and moderate activity was set to 3.0 metabolic equivalent (MET, 1 MET = 3.5 ml · kg-1 · min-1) and between moderate and vigorous activity to 6.0 MET as per standard use. RESULTS: The MAD and VO2 showed a very strong association. Within individuals, the range of r values was from 0.927 to 0.991 providing the mean r = 0.969. The optimal MAD cut-point for 3.0 MET was 91 mg (milligravity) and 414 mg for 6.0 MET. CONCLUSION: The present study showed that the MAD is a valid method in terms of the VO2 within a wide range of ambulatory activities from slow walking to fast running. Being a device-independent trait, the MAD facilitates directly comparable, accurate results on the intensity of physical activity with all accelerometers providing tri-axial raw data.

Risk factors of acute and overuse musculoskeletal injuries among young conscripts: a population-based cohort study.

BACKGROUND: Military service in Finland is compulsory for all male citizens and annually about 80% of 19-year-old men enter into the service. The elevated risk for many chronic diseases and loss of function among those who are inactive and unfit can be often detected already in youth. On the other hand, activity-induced injuries among young are true public health issue. The purpose of the present prospective cohort follow-up study was to evaluate predictive associations between acute or overuse injuries and their various intrinsic risk factors. METHODS: Four successive cohorts of conscripts who formed a representative sample of Finnish young men were followed for 6 months. At the beginning of the service, the risk factors of injuries were measured and recorded and then the acute and overuse injuries treated at the garrison clinic were identified. Predictive associations between injuries and their risk factors were examined by multivariate Cox's proportional hazard models. RESULTS: Of the 1411 participants, 27% sustained an acute injury and 51% suffered from overuse injury. Concerning acute injuries, highest risk for severe injuries were detected among conscripts with low fitness level in both the standing long-jump and push-up tests (hazard rate, HR=5.9; 95% CI: 1.6‒21.3). A history of good degree in school sports was not a protective factor against acute injuries. High waist circumference and, on the other hand, being underweight according to BMI increased the HR for overuse injuries. Brisk leisure time physical activity before military entry was a protective factor against overuse injuries. Poor result in Cooper's test was a warning signal of elevated risk of overuse injuries. CONCLUSION: We confirmed previous findings that low level of physical fitness is predictor for musculoskeletal injuries during intensive physical training. The U-shaped relationship between body composition and overuse injuries was noticed indicating that both obesity and underweight are risk factors for overuse injuries. Persons with excellent sports skills according to their earlier degrees in school sports had similar HR for acute injuries than those with poorer degrees. This indicates that school-age sports skills and fitness do not carry far and therefore preventive programmes are needed to prevent activity-induced injuries.

A universal, accurate intensity-based classification of different physical activities using raw data of accelerometer.

OBJECTIVE: Accelerometers are increasingly used for objective assessment of physical activity. However, because of lack of the proprietary analysis algorithms, direct comparisons between accelerometer brands are difficult. In this study, we propose and evaluate open source methods for commensurate assessment of raw accelerometer data irrespective of the brand. DESIGN: Twenty-one participants carried simultaneously three different tri-axial accelerometers on their waist during five different sedentary activities and five different intensity levels of bipedal movement from slow walking to running. Several time and frequency domain traits were calculated from the measured raw data, and their performance in classifying the activities was compared. RESULTS: Of the several traits, the mean amplitude deviation (MAD) provided consistently the best performance in separating the sedentary activities and different speeds of bipedal movement from each other. Most importantly, the universal cut-off limits based on MAD classified sedentary activities and different intensity levels of walking and running equally well for all three accelerometer brands and reached at least 97% sensitivity and specificity in each case. CONCLUSION: Irrespective of the accelerometer brand, a simply calculable MAD with universal cut-off limits provides a universal method to evaluate physical activity and sedentary behaviour using raw accelerometer data. A broader application of the present approach is expected to render different accelerometer studies directly comparable with each other.

Neuromuscular exercise and counseling decrease absenteeism due to low back pain in young conscripts: a randomized, population-based primary prevention study.

STUDY DESIGN: Controlled intervention with group randomization. OBJECTIVE: To investigate the effectiveness of a 6-month neuromuscular exercise and counseling program for reducing the incidence of low back pain (LBP) and disability in young conscripts, with a healthy back at the beginning of their compulsory military service. SUMMARY OF BACKGROUND DATA: Basic military training is physically demanding on the back and requires adequate physical fitness. LBP causes significant morbidity and absence from military service. METHODS: Participants were conscripts of 4 successive age cohorts (n = 1409). In the prestudy year, before adoption of the intervention, 2 successive cohorts of conscripts of 4 companies (n = 719) were followed prospectively for 6 months to study the baseline incidence of different categories of LBP. In the intervention year, conscripts (n = 690) of 2 new cohorts of the same companies (intervention group: antitank, engineer; control group: signal, mortar) were followed for 6 months. The intervention program aimed to improve conscripts' control of their lumbar neutral zone and specifically to avoid full lumbar flexion in all daily tasks. RESULTS: Total number and incidence of off-duty days due to LBP were significantly decreased in the intervention companies compared with controls (adjusted hazard ratio = 0.42, 95% confidence interval = 0.18-0.94, P = 0.035). The number of LBP cases, number of health clinic visits due to LBP, and number of the most severe cases showed a similar decreasing trend but without statistical significance. CONCLUSION: These findings provide evidence that exercise and education to improve control of the lumbar neutral zone have a prophylactic effect on LPB-related off-duty service days in the military environment when implemented as part of military service among young healthy men.