Prevention of Gestational Diabetes: Design of a Cluster-Randomized Controlled Trial and One-Year Follow-Up

<p>Abstract</p> <p>Background</p> <p>Annual prevalence of gestational diabetes mellitus (GDM) is 12.5% among Finnish pregnant women. The prevalence is expected to rise with the increasing overweight among women before pregnancy. Physical activity and diet are both known to have favourable effects on insulin resistance and possibly on the risk of GDM. We aimed to investigate, whether GDM can be prevented by counseling on diet, physical activity and gestational weight gain during pregnancy.</p> <p>Methods/Design</p> <p>A cluster-randomized controlled trial was conducted in 14 municipalities in the southern part of Finland. Pairwise randomization was performed in order to take into account socioeconomic differences. Recruited women were at 8-12 weeks' gestation and fulfilled at least one of the following criteria: body mass index ≥ 25 kg/m², history of earlier gestational glucose intolerance or macrosomic newborn (> 4500 g), age ≥ 40 years, first or second degree relative with history of type 1 or 2 diabetes. Main exclusion criterion was pathological oral glucose tolerance test (OGTT) at 8-12 weeks' gestation. The trial included one counseling session on physical activity at 8-12 weeks' gestation and one for diet at 16-18 weeks' gestation, and three to four booster sessions during other routine visits. In the control clinics women received usual care. Information on height, weight gain and other gestational factors was obtained from maternity cards. Physical activity, dietary intake and quality of life were followed by questionnaires during pregnancy and at 1-year postpartum. Blood samples for lipid status, hormones, insulin and OGTT were taken at 8-12 and 26-28 weeks' gestation and 1 year postpartum. Workability and return to work were elicited by a questionnaire at 1- year postpartum. Linkage to the national birth register of years 2007-2009 will provide information on perinatal complications and GDM incidence among the non-participants of the study. Cost-effectiveness evaluation will be based on quality-adjusted life years. This study has received ethical approval from the Ethical board of Pirkanmaa Hospital District.</p> <p>Discussion</p> <p>The study will provide information on the effectiveness and cost-effectiveness of gestational physical activity and dietary counseling on prevention of GDM in a risk group of women. Also information on the prevalence of GDM and postpartum metabolic syndrome will be gained. Results on maintaining the possible health behaviour changes are important in order to prevent chronic diseases such as cardiovascular disease and diabetes.</p> <p>Trial registration</p> <p>The trial is registered ISRCTN 33885819</p

Lifestyle counseling in overweight truck and bus drivers : Effects on dietary patterns and physical activity

We studied dietary patterns, physical activity (PA), and monthly goal setting in a weight reduction intervention in long-distance professional drivers. The study was conducted in Finland in 2009–2012. Male drivers with waist circumference >100cm were randomized to a lifestyle counseling (LIFE, N=55) and a reference (REF, N=58) group. During 12months, LIFE participated in 6 face-to-face and 7 telephone counseling sessions on diet and PA. Dietary patterns were assessed using an index combining food diary and counselor interview, and PA with the number of daily steps using a pedometer. Monthly lifestyle goals, perceived facilitators and barriers, and adverse effects of PA in the LIFE participants were monitored using counselors' log books. Forty-seven (85%) LIFE participants completed the 12-month program. After 12months, the mean dietary index score improved by 12% (p=0.002, N=24), and the number of daily steps increased by 1811 steps (median; p=0.01, N=22). The most frequent dietary goals dealt with meal frequency, plate model, and intake of vegetables, fruits, and berries. The most common PA mode was walking. Typical facilitators to reach monthly lifestyle goals were support from family and friends and ailment prevention; typical barriers were working schedules and ailments. Adverse effects, most commonly musculoskeletal pain, occurred among 83% of the LIFE participants. Positive changes in lifestyle habits were observed during counseling. Monthly lifestyle counseling combining face-to-face and phone contacts seemed appropriate to long-distance drivers. Barriers for reaching lifestyle changes, and adverse effects of PA were common and need to be addressed when planning counseling. Trial registration: Clinical Trials NCT00893646Peer reviewe

Feasibility of a controlled trial aiming to prevent excessive pregnancy-related weight gain in primary health care

<p>Abstract</p> <p>Background</p> <p>Excessive gestational weight gain and postpartum weight retention may predispose women to long-term overweight and other health problems. Intervention studies aiming at preventing excessive pregnancy-related weight gain are needed. The feasibility of implementing such a study protocol in primary health care setting was evaluated in this pilot study.</p> <p>Methods</p> <p>A non-randomized controlled trial was conducted in three intervention and three control maternity and child health clinics in primary health care in Finland. Altogether, 132 pregnant and 92 postpartum women and 23 public health nurses (PHN) participated in the study. The intervention consisted of individual counselling on physical activity and diet at five routine visits to a PHN and of an option for supervised group exercise until 37 weeks' gestation or ten months postpartum. The control clinics continued their usual care. The components of the feasibility evaluation were 1) recruitment and participation, 2) completion of data collection, 3) realization of the intervention and 4) the public health nurses' experiences.</p> <p>Results</p> <p>1) The recruitment rate was slower than expected and the recruitment period had to be prolonged from the initially planned three months to six months. The average participation rate of eligible women at study enrolment was 77% and the drop-out rate 15%. 2) In total, 99% of the data on weight, physical activity and diet and 96% of the blood samples were obtained. 3) In the intervention clinics, 98% of the counselling sessions were realized, their contents and average durations were as intended, 87% of participants regularly completed the weekly records for physical activity and diet, and the average participation percentage in the group exercise sessions was 45%. 4) The PHNs regarded the extra training as a major advantage and the high additional workload as a disadvantage of the study.</p> <p>Conclusion</p> <p>The study protocol was mostly feasible to implement, which encourages conducting large trials in comparable settings.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN21512277</p

Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial

In a cluster-randomized trial, Riitta Luoto and colleagues find that counseling on diet and activity can reduce the birthweight of babies born to women at risk of developing gestational diabetes mellitus (GDM), but fail to find an effect on GDM

Liikunnan vaikutus vaihdevuosi-ikäisten naisten elämänlaatuun

22.6.2016 tarkastettavan väitöstutkimuksen mukaan aerobinen liikunta tarjoaa hyvän vaihtoehdon vaihdevuosioireiden lievittämiseen ja elämänlaadun parantamiseen. Terveystieteiden maisteri Kirsi Mansikkamäen tutkimuksen tulokset osoittavat, että terveysliikuntasuositusten mukainen liikunta vähentää muun muassa vaihdevuosi-ikäisten naisten masentuneisuutta sekä unta häiritseviä kuumia aaltoja. Yleisimpiä vaihdevuosien oireita ovat kuumat aallot, mielialan vaihtelut, ärtyneisyys, unihäiriöt sekä selkä- ja lihaskivut. Vaihdevuosien hormonihoito lievittää yksittäisiä oireita, mutta lääkityksen vaikutukset oireisiin ja elämänlaatuun saattavat olla ristiriitaisia eivätkä lääkkeet sovi kaikille. Liikunnan merkitystä vaihdevuosioireiden hoitoon ja lievitykseen on tutkittu, mutta tulokset ovat olleet ristiriitaisia. Kirsi Mansikkamäen väitöstutkimus kuitenkin osoittaa, että liikunnalla on keskeinen merkitys vaihdevuosi-ikäisten naisten elämässä. Vaihdevuosioireiden lievitystä liikunnan avulla tarkasteltiin Mansikkamäen väitöskirjassa ja sen osajulkaisuissa kyselytutkimuksen ja satunnaistetun harjoittelututkimuksen menetelmin. Kyselytutkimuksen tulokset osoittivat, että väestön terveysliikuntasuosituksen mukaisesti liikkuvilla vaihdevuosi-ikäisillä naisilla oli vähemmän ahdistuneisuutta ja masentuneisuutta, somaattisia oireita sekä muisti- ja keskittymisongelmia. Lisäksi he kokivat elämänlaatunsa paremmaksi, kun heitä verrattiin naisiin, jotka eivät harrastaneet liikuntaa suosituksen mukaisesti. Kuuden kuukauden mittaisen harjoittelututkimuksen tulosten perusteella säännöllisesti liikuntaa harrastavien vaihdevuosi-ikäisten naisten unen laatu oli parempi ja unta häiritsevien yöllisten kuumien aaltojen määrä oli vähäisempi kuin verrokkiryhmän naisilla. Neljän vuoden seurannassa tutkimustulokset olivat samankaltaiset, sillä harjoitteluryhmän naisilla todettiin liikunnan pitkäaikaisvaikutuksena parempi sosiaalinen ja fyysinen toimintakyky sekä vähemmän kuumia aaltoja. Kyselytutkimus suoritettiin vuonna 2012 osana Suomen Syöpärekisterin rintasyöpähanketta. Liikuntaa ja elämänlaatua koskeva kysely oli kohdistettu 49-vuotiaille naisille. Kyselyyn vastasi yhteensä 2606 naista. Liikuntaharjoittelututkimus ja sen jälkeinen neljän vuoden seurantatutkimus toteutettiin UKK-instituutissa Tampereella vuosina 2009–2013. Harjoittelututkimukseen valittiin 176 vaihdevuosioireista naista, jotka liikkuivat vähäisesti eivätkä käyttäneet hormonikorvaushoitoja. Tutkimuksessa tarkasteltiin, kuinka kuuden kuukauden mittainen aerobinen harjoittelujakso vaikutti uneen, elämänlaatuun ja vaihdevuosioireisiin. Liikuntaryhmään kuuluneet naiset ohjeistettiin liikkumaan neljä kertaa viikossa. Harjoittelu sisälsi vähintään kaksi kävely- tai sauvakävelylenkkiä sekä muuta kestävyysliikuntaa. Verrokkiryhmän naiset puolestaan ohjeistettiin pitämään liikuntatottumukset ennallaan.The dissertation and its original publications are based on a survey from a national population-based breast cancer screening programme and a randomized controlled trial (RCT) with 4-year follow-up. The purpose of the study was to examine the association between the leisuretime physical activity (LTPA) and quality of life (QoL), and to assess the effects of aerobic training on sleep quality, and on dimensions of quality of life and hot flushes. The survey participants (n=2606) were a part of a cohort study that focuses on evaluating associations between breast cancer prevention, lifestyle and quality of life in relation to the population-based Finnish mammography screening programme. The survey was conducted from April to November in 2012. The study population was randomly drawn from the Finnish National Population Registry using the birth year as the only restricting factor. The participants were at the age of 49. Nearly one fourth of the participants (23%) had had no menstruation for 12 months and were thus postmenopausal. A third of the women (31%) had irregular menstruation,and were perimenopausal and 28% of the women were premenopausal with regular menstruation. The amount of leisure-time physical activity was elicited with a question to which the women responded with how much exercise they did in a typical week, during the previous 12 months and including any regular weekly physical activity for at least 10 min at a time, including commuting. Participants for the training intervention were recruited via a newspaper advertisement in Pirkanmaa area, Finland, 176 women who fulfilled the inclusion criteria were randomly assigned to an exercise (EX) and a control (CON) group. The RCT and follow-up was conducted between March 2009 and June 2013 at the UKK Institute for Health Promotion Research, Tampere, Finland. All participants were symptomatic (had daily hot flushes), they were not current hormone therapy (HT) users, nor had they taken hormones in the past three months. The participants were not physically active (physical exercise less than twice a week), and 6-36 months since last menstruation. The unsupervised exercise programme consisted of aerobic training four times per week, with 50 min of exercise each time. The intensity of exercise was checked by ratings of perceived exertion (RPE) and the women were instructed to exercise at a level corresponding to 13-16 on a scale from 6-20, which corresponds to about 64-80% of maximal heart rate. EX was advised to include at least two sessions of walking or Nordic walking while the other two sessions could include other aerobic exercise. CON was advised to keep their physical activity habits unchanged. Adherence to the trial was supported by an option to participate weekly in supervised aerobics session at the UKK Institute for Health Promotion Research twice a week. All participants responded to questionnaires concerning menopause-specific quality of life (QoL) by Women’s Health Questionnaire (WHQ) and health-related quality of life by using the SF-36 questionnaire (SF-36). In the RCT anthropometry, and cardiorespiratory fitness measurements were performed at baseline, after the 6-month intervention, and at 4-year follow-up. During the intervention women reported their training workouts, day-time and night-time hot flushes, other menopausal symptoms and sleep by making entries in a mobile-phone diary twice a day. At 4-year follow-up women were instructed to complete a one-week diary recording the number of hot flushes and their severity, type of physical exercise, duration and intensity, and sleep quality. In addition, women wore Hookie® accelerometers to record PA during one week. In the survey participants advised that the recommended levels of LTPA were associated with better quality of life along four WHQ dimensions – anxiety/depressed mood, well-being, somatic symptoms and memory/concentration problems. In the RCT aerobic training for six months improved sleep quality and diminished hot flushes disturbing sleep hot flushes in women with menopausal symptoms. Longterm positive effects of aerobic training were found on the physical and mental dimensions of quality of life and hot flushes four years after beginning of the intervention. This study demonstrated the importance of LTPA in menopausal women’s lives. It moreover showed the positive short and long-term effects of aerobic training on menopausal symptoms, sleep and quality of life. Moderate intensity aerobic training, such as brisk walking, has many health benefits and it is safe and well-tolerated with minor adverse effects. For menopausal women physical exercise is a potential alternative to alleviate symptoms

Liikunnan vaikutus vaihdevuosi-ikäisten naisten elämänlaatuun

22.6.2016 tarkastettavan väitöstutkimuksen mukaan aerobinen liikunta tarjoaa hyvän vaihtoehdon vaihdevuosioireiden lievittämiseen ja elämänlaadun parantamiseen. Terveystieteiden maisteri Kirsi Mansikkamäen tutkimuksen tulokset osoittavat, että terveysliikuntasuositusten mukainen liikunta vähentää muun muassa vaihdevuosi-ikäisten naisten masentuneisuutta sekä unta häiritseviä kuumia aaltoja. Yleisimpiä vaihdevuosien oireita ovat kuumat aallot, mielialan vaihtelut, ärtyneisyys, unihäiriöt sekä selkä- ja lihaskivut. Vaihdevuosien hormonihoito lievittää yksittäisiä oireita, mutta lääkityksen vaikutukset oireisiin ja elämänlaatuun saattavat olla ristiriitaisia eivätkä lääkkeet sovi kaikille. Liikunnan merkitystä vaihdevuosioireiden hoitoon ja lievitykseen on tutkittu, mutta tulokset ovat olleet ristiriitaisia. Kirsi Mansikkamäen väitöstutkimus kuitenkin osoittaa, että liikunnalla on keskeinen merkitys vaihdevuosi-ikäisten naisten elämässä. Vaihdevuosioireiden lievitystä liikunnan avulla tarkasteltiin Mansikkamäen väitöskirjassa ja sen osajulkaisuissa kyselytutkimuksen ja satunnaistetun harjoittelututkimuksen menetelmin. Kyselytutkimuksen tulokset osoittivat, että väestön terveysliikuntasuosituksen mukaisesti liikkuvilla vaihdevuosi-ikäisillä naisilla oli vähemmän ahdistuneisuutta ja masentuneisuutta, somaattisia oireita sekä muisti- ja keskittymisongelmia. Lisäksi he kokivat elämänlaatunsa paremmaksi, kun heitä verrattiin naisiin, jotka eivät harrastaneet liikuntaa suosituksen mukaisesti. Kuuden kuukauden mittaisen harjoittelututkimuksen tulosten perusteella säännöllisesti liikuntaa harrastavien vaihdevuosi-ikäisten naisten unen laatu oli parempi ja unta häiritsevien yöllisten kuumien aaltojen määrä oli vähäisempi kuin verrokkiryhmän naisilla. Neljän vuoden seurannassa tutkimustulokset olivat samankaltaiset, sillä harjoitteluryhmän naisilla todettiin liikunnan pitkäaikaisvaikutuksena parempi sosiaalinen ja fyysinen toimintakyky sekä vähemmän kuumia aaltoja. Kyselytutkimus suoritettiin vuonna 2012 osana Suomen Syöpärekisterin rintasyöpähanketta. Liikuntaa ja elämänlaatua koskeva kysely oli kohdistettu 49-vuotiaille naisille. Kyselyyn vastasi yhteensä 2606 naista. Liikuntaharjoittelututkimus ja sen jälkeinen neljän vuoden seurantatutkimus toteutettiin UKK-instituutissa Tampereella vuosina 2009–2013. Harjoittelututkimukseen valittiin 176 vaihdevuosioireista naista, jotka liikkuivat vähäisesti eivätkä käyttäneet hormonikorvaushoitoja. Tutkimuksessa tarkasteltiin, kuinka kuuden kuukauden mittainen aerobinen harjoittelujakso vaikutti uneen, elämänlaatuun ja vaihdevuosioireisiin. Liikuntaryhmään kuuluneet naiset ohjeistettiin liikkumaan neljä kertaa viikossa. Harjoittelu sisälsi vähintään kaksi kävely- tai sauvakävelylenkkiä sekä muuta kestävyysliikuntaa. Verrokkiryhmän naiset puolestaan ohjeistettiin pitämään liikuntatottumukset ennallaan.The dissertation and its original publications are based on a survey from a national population-based breast cancer screening programme and a randomized controlled trial (RCT) with 4-year follow-up. The purpose of the study was to examine the association between the leisuretime physical activity (LTPA) and quality of life (QoL), and to assess the effects of aerobic training on sleep quality, and on dimensions of quality of life and hot flushes. The survey participants (n=2606) were a part of a cohort study that focuses on evaluating associations between breast cancer prevention, lifestyle and quality of life in relation to the population-based Finnish mammography screening programme. The survey was conducted from April to November in 2012. The study population was randomly drawn from the Finnish National Population Registry using the birth year as the only restricting factor. The participants were at the age of 49. Nearly one fourth of the participants (23%) had had no menstruation for 12 months and were thus postmenopausal. A third of the women (31%) had irregular menstruation,and were perimenopausal and 28% of the women were premenopausal with regular menstruation. The amount of leisure-time physical activity was elicited with a question to which the women responded with how much exercise they did in a typical week, during the previous 12 months and including any regular weekly physical activity for at least 10 min at a time, including commuting. Participants for the training intervention were recruited via a newspaper advertisement in Pirkanmaa area, Finland, 176 women who fulfilled the inclusion criteria were randomly assigned to an exercise (EX) and a control (CON) group. The RCT and follow-up was conducted between March 2009 and June 2013 at the UKK Institute for Health Promotion Research, Tampere, Finland. All participants were symptomatic (had daily hot flushes), they were not current hormone therapy (HT) users, nor had they taken hormones in the past three months. The participants were not physically active (physical exercise less than twice a week), and 6-36 months since last menstruation. The unsupervised exercise programme consisted of aerobic training four times per week, with 50 min of exercise each time. The intensity of exercise was checked by ratings of perceived exertion (RPE) and the women were instructed to exercise at a level corresponding to 13-16 on a scale from 6-20, which corresponds to about 64-80% of maximal heart rate. EX was advised to include at least two sessions of walking or Nordic walking while the other two sessions could include other aerobic exercise. CON was advised to keep their physical activity habits unchanged. Adherence to the trial was supported by an option to participate weekly in supervised aerobics session at the UKK Institute for Health Promotion Research twice a week. All participants responded to questionnaires concerning menopause-specific quality of life (QoL) by Women’s Health Questionnaire (WHQ) and health-related quality of life by using the SF-36 questionnaire (SF-36). In the RCT anthropometry, and cardiorespiratory fitness measurements were performed at baseline, after the 6-month intervention, and at 4-year follow-up. During the intervention women reported their training workouts, day-time and night-time hot flushes, other menopausal symptoms and sleep by making entries in a mobile-phone diary twice a day. At 4-year follow-up women were instructed to complete a one-week diary recording the number of hot flushes and their severity, type of physical exercise, duration and intensity, and sleep quality. In addition, women wore Hookie® accelerometers to record PA during one week. In the survey participants advised that the recommended levels of LTPA were associated with better quality of life along four WHQ dimensions – anxiety/depressed mood, well-being, somatic symptoms and memory/concentration problems. In the RCT aerobic training for six months improved sleep quality and diminished hot flushes disturbing sleep hot flushes in women with menopausal symptoms. Longterm positive effects of aerobic training were found on the physical and mental dimensions of quality of life and hot flushes four years after beginning of the intervention. This study demonstrated the importance of LTPA in menopausal women’s lives. It moreover showed the positive short and long-term effects of aerobic training on menopausal symptoms, sleep and quality of life. Moderate intensity aerobic training, such as brisk walking, has many health benefits and it is safe and well-tolerated with minor adverse effects. For menopausal women physical exercise is a potential alternative to alleviate symptoms

Liikunnan vaikutus vaihdevuosi-ikäisten naisten elämänlaatuun

22.6.2016 tarkastettavan väitöstutkimuksen mukaan aerobinen liikunta tarjoaa hyvän vaihtoehdon vaihdevuosioireiden lievittämiseen ja elämänlaadun parantamiseen. Terveystieteiden maisteri Kirsi Mansikkamäen tutkimuksen tulokset osoittavat, että terveysliikuntasuositusten mukainen liikunta vähentää muun muassa vaihdevuosi-ikäisten naisten masentuneisuutta sekä unta häiritseviä kuumia aaltoja. Yleisimpiä vaihdevuosien oireita ovat kuumat aallot, mielialan vaihtelut, ärtyneisyys, unihäiriöt sekä selkä- ja lihaskivut. Vaihdevuosien hormonihoito lievittää yksittäisiä oireita, mutta lääkityksen vaikutukset oireisiin ja elämänlaatuun saattavat olla ristiriitaisia eivätkä lääkkeet sovi kaikille. Liikunnan merkitystä vaihdevuosioireiden hoitoon ja lievitykseen on tutkittu, mutta tulokset ovat olleet ristiriitaisia. Kirsi Mansikkamäen väitöstutkimus kuitenkin osoittaa, että liikunnalla on keskeinen merkitys vaihdevuosi-ikäisten naisten elämässä. Vaihdevuosioireiden lievitystä liikunnan avulla tarkasteltiin Mansikkamäen väitöskirjassa ja sen osajulkaisuissa kyselytutkimuksen ja satunnaistetun harjoittelututkimuksen menetelmin. Kyselytutkimuksen tulokset osoittivat, että väestön terveysliikuntasuosituksen mukaisesti liikkuvilla vaihdevuosi-ikäisillä naisilla oli vähemmän ahdistuneisuutta ja masentuneisuutta, somaattisia oireita sekä muisti- ja keskittymisongelmia. Lisäksi he kokivat elämänlaatunsa paremmaksi, kun heitä verrattiin naisiin, jotka eivät harrastaneet liikuntaa suosituksen mukaisesti. Kuuden kuukauden mittaisen harjoittelututkimuksen tulosten perusteella säännöllisesti liikuntaa harrastavien vaihdevuosi-ikäisten naisten unen laatu oli parempi ja unta häiritsevien yöllisten kuumien aaltojen määrä oli vähäisempi kuin verrokkiryhmän naisilla. Neljän vuoden seurannassa tutkimustulokset olivat samankaltaiset, sillä harjoitteluryhmän naisilla todettiin liikunnan pitkäaikaisvaikutuksena parempi sosiaalinen ja fyysinen toimintakyky sekä vähemmän kuumia aaltoja. Kyselytutkimus suoritettiin vuonna 2012 osana Suomen Syöpärekisterin rintasyöpähanketta. Liikuntaa ja elämänlaatua koskeva kysely oli kohdistettu 49-vuotiaille naisille. Kyselyyn vastasi yhteensä 2606 naista. Liikuntaharjoittelututkimus ja sen jälkeinen neljän vuoden seurantatutkimus toteutettiin UKK-instituutissa Tampereella vuosina 2009–2013. Harjoittelututkimukseen valittiin 176 vaihdevuosioireista naista, jotka liikkuivat vähäisesti eivätkä käyttäneet hormonikorvaushoitoja. Tutkimuksessa tarkasteltiin, kuinka kuuden kuukauden mittainen aerobinen harjoittelujakso vaikutti uneen, elämänlaatuun ja vaihdevuosioireisiin. Liikuntaryhmään kuuluneet naiset ohjeistettiin liikkumaan neljä kertaa viikossa. Harjoittelu sisälsi vähintään kaksi kävely- tai sauvakävelylenkkiä sekä muuta kestävyysliikuntaa. Verrokkiryhmän naiset puolestaan ohjeistettiin pitämään liikuntatottumukset ennallaan.The dissertation and its original publications are based on a survey from a national population-based breast cancer screening programme and a randomized controlled trial (RCT) with 4-year follow-up. The purpose of the study was to examine the association between the leisuretime physical activity (LTPA) and quality of life (QoL), and to assess the effects of aerobic training on sleep quality, and on dimensions of quality of life and hot flushes. The survey participants (n=2606) were a part of a cohort study that focuses on evaluating associations between breast cancer prevention, lifestyle and quality of life in relation to the population-based Finnish mammography screening programme. The survey was conducted from April to November in 2012. The study population was randomly drawn from the Finnish National Population Registry using the birth year as the only restricting factor. The participants were at the age of 49. Nearly one fourth of the participants (23%) had had no menstruation for 12 months and were thus postmenopausal. A third of the women (31%) had irregular menstruation,and were perimenopausal and 28% of the women were premenopausal with regular menstruation. The amount of leisure-time physical activity was elicited with a question to which the women responded with how much exercise they did in a typical week, during the previous 12 months and including any regular weekly physical activity for at least 10 min at a time, including commuting. Participants for the training intervention were recruited via a newspaper advertisement in Pirkanmaa area, Finland, 176 women who fulfilled the inclusion criteria were randomly assigned to an exercise (EX) and a control (CON) group. The RCT and follow-up was conducted between March 2009 and June 2013 at the UKK Institute for Health Promotion Research, Tampere, Finland. All participants were symptomatic (had daily hot flushes), they were not current hormone therapy (HT) users, nor had they taken hormones in the past three months. The participants were not physically active (physical exercise less than twice a week), and 6-36 months since last menstruation. The unsupervised exercise programme consisted of aerobic training four times per week, with 50 min of exercise each time. The intensity of exercise was checked by ratings of perceived exertion (RPE) and the women were instructed to exercise at a level corresponding to 13-16 on a scale from 6-20, which corresponds to about 64-80% of maximal heart rate. EX was advised to include at least two sessions of walking or Nordic walking while the other two sessions could include other aerobic exercise. CON was advised to keep their physical activity habits unchanged. Adherence to the trial was supported by an option to participate weekly in supervised aerobics session at the UKK Institute for Health Promotion Research twice a week. All participants responded to questionnaires concerning menopause-specific quality of life (QoL) by Women’s Health Questionnaire (WHQ) and health-related quality of life by using the SF-36 questionnaire (SF-36). In the RCT anthropometry, and cardiorespiratory fitness measurements were performed at baseline, after the 6-month intervention, and at 4-year follow-up. During the intervention women reported their training workouts, day-time and night-time hot flushes, other menopausal symptoms and sleep by making entries in a mobile-phone diary twice a day. At 4-year follow-up women were instructed to complete a one-week diary recording the number of hot flushes and their severity, type of physical exercise, duration and intensity, and sleep quality. In addition, women wore Hookie® accelerometers to record PA during one week. In the survey participants advised that the recommended levels of LTPA were associated with better quality of life along four WHQ dimensions – anxiety/depressed mood, well-being, somatic symptoms and memory/concentration problems. In the RCT aerobic training for six months improved sleep quality and diminished hot flushes disturbing sleep hot flushes in women with menopausal symptoms. Longterm positive effects of aerobic training were found on the physical and mental dimensions of quality of life and hot flushes four years after beginning of the intervention. This study demonstrated the importance of LTPA in menopausal women’s lives. It moreover showed the positive short and long-term effects of aerobic training on menopausal symptoms, sleep and quality of life. Moderate intensity aerobic training, such as brisk walking, has many health benefits and it is safe and well-tolerated with minor adverse effects. For menopausal women physical exercise is a potential alternative to alleviate symptoms

Opiskeluun vaikuttavia voimavaroja

Mielekkääseen oppimiseen ja opettamiseen vaikuttavat monet seikat. Tässä työssä on käsitelty erityisesti ergonomiaa, ravintoa, terveyttä, psyykkisiä tekijöitä sekä verkossa tapahtuvaa opiskelua. Nämä tekijät ovat tärkeitä opiskeluun vaikuttavia voimavaroja. Psyykkinen hyvinvointi tarkoittaa kykyä selviytyä vaatimuksista, joita ihminen kohtaa. Vaatimukset voivat tulla ympäristön, opiskelun tai ihmisen itsensä taholta. Hyvinvoiva ihminen kykenee hoitamaan opiskelunsa, nauttimaan ihmissuhteista, tulemaan toimeen itsenäisesti, pitämään huolen itsestään sekä tekemään päätöksiä. Hyvinvointi ei tarkoita ongelmatonta elämää vaan kykyä kohdata vastoinkäymiset ja silti säilyttää toimintakykynsä ja positiivinen kuva itsestä. Opiskeluun ja oppimiseen vaikuttavat opiskelijoiden hyvinvoinnin eri osatekijät, kuten fyysisen, psyykkisen ja sosiaalisen toimintakyvyn lisäksi ammatillinen osaaminen, arvot, asenteet ja motivaatio. Opiskelutaidot ja opiskeluolosuhteet vaikuttavat monine piirteineen motivaatioon ja opiskelun etenemiseen suotuisasti tai haitallisesti. Eri oppialojen opintoihin sisältyy useita työssä oppimisen jaksoja, joissa opiskelija altistuu moninaisille fyysisille kuormitustilanteille. Ergonomisen työskentelytavan hallitseminen auttaa opiskelijaa ylläpitämään opiskelun aikana vaadittavia voimavarojaan sekä luo edellytykset toimia ergonomisesti oikealla tavalla tulevissa työtehtävissään. Joustava oppimisympäristö -osuudessa käsitellään asioita, joita pitää ottaa huomioon verkkoympäristössä opetettaessa, jotta oppiminen ja opettaminen ovat mielekästä. Oppimisympäristöllä tarkoitetaan muutakin kuin pelkkää paikkaa tai luokkahuonetta, se on siellä, missä opetus tapahtuu. Verkkoympäristössä opetettaessa tulee ottaa huomioon oppijan erilaiset orientaatiotaipumukset ja omat voimavarat

Short- and Long-term Effects of a Physical Exercise Intervention on Work Ability and Work Strain in Symptomatic Menopausal Women

Background: Physical exercise during leisure time is known to increase physical capacity; however, the long-term effects on work ability and work strain are inconclusive. The aim of this study was to investigate the effects of a 6-month physical exercise program on work ability and work strain after 6 months and 30 months, among women with menopausal symptoms at baseline. Methods: A questionnaire including questions on work ability and work strain was mailed in the beginning, at 6 months and after 30 months after the intervention to occupationally active women participating in a randomized controlled study on physical exercise and quality of life. The intervention included aerobic exercise training 4 times per week, 50 minutes per session. Work ability was measured with the Work Ability Index (WAI) and with questions about physical and mental work strain. Results: Women aged 47–62 years (N = 89) who were occupationally active at baseline were included in the analyses. The increase in WAI from baseline to the end of the exercise intervention (6 months) was statistically significantly greater among the intervention group than among the control group (regression coefficient 2.08; 95% confidence interval 0.71–3.46). The difference between the groups persisted for 30 months. No significant short- or long-term effects on physical and mental work strain were found. Conclusion: A 6-month physical exercise intervention among symptomatic menopausal women had positive short-term as well as long-term effects on work ability