Fyysisen aktiivisuuden ja paikallaanolon yhteydet iäkkäiden henkilöiden sokeriaineenvaihduntaan sekä sydän- ja verisuonisairauksien ja kuoleman riskeihin:väestöpohjainen Oulu45-kohorttitutkimus

Abstract The amount of physical activity decreases and sedentary time increases with aging, predisposing older adults to increased risk of type 2 diabetes and cardiovascular diseases. The aims of this study were to evaluate the associations between accelerometer-measured physical activity and sedentary time with glucose metabolism, cardiovascular risk and mortality in older adults. In 2013–2015, population-based sample of older adults (n = 714) participated in the Oulu45 cohort study at age of 67–70 years. Physical activity and sedentary time were measured with wrist-worn Polar Active accelerometer based activity monitor for two weeks. Participants’ underwent an oral glucose tolerance test and risk of cardiovascular diseases was estimated with Framingham risk score. The data for all-cause mortality were identified from the Digital and Population Data Services Agency, Finland after an average of 6.2 years follow-up. Four physical activity profiles were identified. In more active profiles, prevalence of glucose metabolism disorders, 120 min glucose and insulin values in oral glucose tolerance test were lower compared with the less active profiles. In older adults with central obesity, even light physical activity and avoiding sedentary time were associated with improved glucose metabolism and decreased insulin resistance. Both light and moderate to vigorous physical activity were associated with lower risk of cardiovascular diseases. High sedentary time was associated with increased cardiovascular risk. Low sedentary time and high time spent in light physical activity were associated with lower mortality. Based on these results, a higher amount of physical activity, at any intensity level, and avoidance of sedentary time were associated with reduced risk of type 2 diabetes, cardiovascular diseases and mortality in older adults. Especially overweight older adults should be encouraged to increase their physical activity and to avoid being sedentary.Tiivistelmä Vähäinen fyysisen aktiivisuuden määrä ja runsas paikallaanoloaika lisäävät riskiä sairastua tyypin 2 diabetekseen sekä sydän- ja verisuonisairauksiin. Tämän tutkimuksen tavoitteina oli selvittää kiihtyvyysanturilla mitatun kevyen, kohtuukuormitteisen ja raskaan fyysisen aktiivisuuden sekä paikallaanolon yhteyttä iäkkäiden henkilöiden sokeriaineenvaihduntaan sekä sydän- ja verisuonisairauksien ja kuoleman riskiin. Väestöpohjaisen Oulu45-kohorttitutkimuksen aineisto (n = 714) kerättiin vuosina 2013–2015, ja tutkittavat olivat iältään 67–70-vuotiaita. Tutkittavien fyysinen aktiivisuus ja paikallaanolo mitattiin kahden viikon ajan ranteessa pidettävällä kiihtyvyysanturiin perustuvalla Polar Active -aktiivisuusmittarilla. Tutkittaville tehtiin sokerirasituskoe ja heidän sydän- ja verisuonisairauksien riskiään arvioitiin Framinghamin riskipisteillä. Kuolleisuustiedot kerättiin Digi- ja väestötietovirastosta keskimäärin 6,2 vuoden seuranta-ajan jälkeen. Tutkimuksessa tunnistettiin iäkkäistä neljä liikkujaprofiilia. Profiililtaan fyysisesti aktiivisilla oli harvemmin sokeriaineenvaihdunnan häiriöitä ja matalammat 120 minuutin glukoosi- ja insuliiniarvot sokerirasituskokeessa. Kevyt fyysinen aktiivisuus ja vähäisempi paikallaanoloaika tehostivat etenkin keskivartalolihavien iäkkäiden sokeriaineenvaihduntaa ja vähensivät insuliiniresistenssiä. Sekä kevyt, että kohtuukuormitteinen ja raskas fyysinen aktiivisuus vähensivät sydän- ja verisuonisairauksien riskiä, kun taas runsas paikallaanoloaika lisäsi riskiä. Runsaampi kevyt fyysinen aktiivisuus ja vähäinen paikallaanoloaika pienensivät kuoleman riskiä. Tämän väitöskirjan tulosten perusteella vähäinenkin fyysinen aktiivisuus on paikallaanoloa parempi vaihtoehto iäkkäiden henkilöiden sokeriaineenvaihdunnan ja sydänterveyden edistämiseksi. Erityisesti keskivartalolihavia iäkkäitä tulisi rohkaista lisäämään liikkumista ja vähentämään paikallaanoloa

Physical activity profiles and glucose metabolism:a population‐based cross‐sectional study in older adults

Abstract The aim was to analyze the relationship of accelerometry measured physical activity (PA) and sedentary time (SED) profiles to glucose metabolism in 660 people aged 67‐69 years. In this cross‐sectional study, four different PA profiles were identified (couch potatoes, light movers, sedentary actives, actives) based on moderate to vigorous physical activity (MVPA) and SED. Glucose metabolism was determined by an oral glucose tolerance test. The prevalence of any glucose metabolism disorder was lower in more active PA profiles than in less active profiles (couch potatoes 50%, actives 33%). According to multivariable linear regression, insulin resistance, 120‐min glucose, and insulin values were lower among the actives compared with the couch potatoes (HOMA‐IR: β = −0.239, 95% CI − 0.456 to −0.022, P = .031; 120‐min glucose: β = −0.459, 95% CI − 0.900 to −0.019, P = .041; 120‐min insulin: β = −0.210, 95% CI − 0.372 to −0.049, P = .011). Prevalence of glucose metabolism disorders were lower and insulin sensitivity was better among the actives compared with the couch potatoes. Active lifestyle with daily MVPA and low SED seems to improve glucose metabolism even in older age and should be recommended for older adults

Cardiovascular disease risk and all-cause mortality associated with accelerometer-measured physical activity and sedentary time:a prospective population-based study in older adults

Abstract Background: Low levels of physical activity (PA) and high sedentary time (ST) are common in older adults and lack of PA is a risk factor for cardiovascular disease (CVD). Knowledge about associations with accelerometer-measured PA, ST and CVD risk in older adults is insufficient. This study examines the associations of accelerometer-measured PA and ST with cardiovascular risk measured using the Framingham risk score (FRS) and all-cause mortality in older adults. Methods: A population-based sample of 660 (277 men, 383 women) older people (mean age 68.9) participated in the Oulu45 cohort study from 2013‒2015. PA and ST were measured with wrist-worn accelerometers at baseline for two weeks. Ten-year CVD risk (%) was estimated with FRS. The data for all-cause mortality were identified from the Digital and Population Data Services Agency, Finland after an average of 6.2 years follow-up. The associations between moderate to vigorous physical activity (MVPA), light physical activity (LPA), ST and FRS were analyzed using the multivariable linear regression analysis. Associations between LPA, ST and mortality were analyzed using the Cox proportional-hazard regression models. Results: Each 10 min increase in MVPA (β = -0.779, 95% CI -1.186 to -0.371, p < 0.001) and LPA (β = -0.293, 95% CI -0.448 to -0.138, p < 0.001) was negatively associated with FRS while a 10 min increase in ST (β = 0.290, 95% CI 0.158 to 0.421, p < 0.001) was positively associated with FRS. After adjustment for waist circumference, only ST was significantly associated with FRS. Each 10 min increase in LPA was associated with 6.5% lower all-cause mortality risk (HR = 0.935, 95% CI 0.884 to 0.990, p = 0.020) and each 10 min increase in ST with 5.6% increased mortality risk (HR = 1.056, 95% CI 1.007 to 1.108, p = 0.025). Conclusions: A higher amount of daily physical activity, at any intensity level, and avoidance of sedentary time are associated with reduced cardiovascular disease risk in older people. Higher time spent in light physical activity and lower sedentary time are associated with lower all-cause mortality

Good safety practice in a randomized controlled trial (CadColdEx) involving increased cardiac workload in patients with coronary artery disease

Abstract Background Methodological information acknowledging safety of cardiac patients in controlled medical experiments are lacking. The descriptive report presents one good practice for considering safety in a randomized controlled study involving augmented cardiovascular strain among persons with coronary artery disease (CAD). Methods The patients were pre-selected by a cardiologist according to strictly defined selection criteria. Further confirmation of eligibility included screening of health. In addition, assessments of physical capacity by a graded bicycle ergometer test were implemented and safety monitored by an exercise physiologist and medical doctor. In this context, an emergency simulation was also carried out. A total of 18 CAD patients each underwent four different experimental interventions where either temperature (+ 22 °C and − 15 °C) and the level of exercise (rest and brisk walking) were employed for 30 min in random order (72 experiments). Baseline (20 min) and follow-up (60 min) measurements were conducted resting at + 22 °C. ECG, and brachial blood pressure were measured and perceived exertion and symptoms of chest pain inquired throughout the experiments. An emergency nurse was responsible for the health monitoring and at least two persons followed the patient throughout the experiment. A medical doctor was available on call for consultation. The termination criteria followed the generally accepted international guidelines for exercise testing and were planned prior to the experiments. Results The exercise test simulation revealed risks requiring changes in the study design and emergency response. The cardiovascular responses of the controlled trials were related to irregular HR, ST-depression or post-exercise hypotension. These were expected and the majority could be dealt on site by the research personnel and on call consultation. Only one patient was encouraged to seek for external health care consultation. Conclusions Appropriate prospective design is a key to safe implementation of controlled studies involving cardiac patients and stimulation of cardiovascular function. This includes careful selection of participants, sufficient and knowledgeable staff, as well as identifying possible emergency situations and the required responses. Trial registration ClinicalTrials ID: NCT02855905

Association between accelerometer-measured physical activity, glucose metabolism, and waist circumference in older adults

Abstract Aims: To examine the association of physical activity (PA) and sedentary time (ST) with glucose metabolism according to waist circumference (WC) in older people. Methods: A population-based sample of 702 individuals (aged 67–70 years) wore wrist-worn accelerometers for two weeks and underwent an oral glucose tolerance test. The associations between moderate-to-vigorous (MVPA) and light (LPA) PA, ST, and glucose metabolism across the tertiles of WC were analysed using general linear regression. Results: Among highest WC tertile, LPA negatively associated with fasting insulin (β = − 0.047, 95% CI − 0.082 to − 0.012), HOMA-IR (β = − 0.098, 95% CI − 0.184 to − 0.012), and HOMA-β (β = − 3.367, CI − 6.570 to − 0.783). ST associated with 120 min glucose (β = 0.140, CI 0.021 to 0.260). Among lowest WC tertile, MVPA negatively associated with 30 min insulin (β = − 0.086, 95% CI − 0.168 to − 0.004) and 120 min insulin (β = − 0.160, 95% CI − 0.257 to − 0.063) and positively associated with Matsuda index (β = 0.076, 95% CI 0.014 to 0.139). Light PA negatively associated with 120 min insulin (β = − 0.054, 95% CI − 0.104 to − 0.005). Conclusion: With the limitation of the cross-sectional study, reducing ST and increasing LPA may be beneficial for glucose metabolism among abdominally obese older adults. Lean older adults could benefit more from increasing MVPA

Good safety practice in a randomized controlled trial (CadColdEx) involving increased cardiac workload in patients with coronary artery disease

Abstract Background: Methodological information acknowledging safety of cardiac patients in controlled medical experiments are lacking. The descriptive report presents one good practice for considering safety in a randomized controlled study involving augmented cardiovascular strain among persons with coronary artery disease (CAD). Methods: The patients were pre-selected by a cardiologist according to strictly defined selection criteria. Further confirmation of eligibility included screening of health. In addition, assessments of physical capacity by a graded bicycle ergometer test were implemented and safety monitored by an exercise physiologist and medical doctor. In this context, an emergency simulation was also carried out. A total of 18 CAD patients each underwent four different experimental interventions where either temperature (+ 22 °C and − 15 °C) and the level of exercise (rest and brisk walking) were employed for 30 min in random order (72 experiments). Baseline (20 min) and follow-up (60 min) measurements were conducted resting at + 22 °C. ECG, and brachial blood pressure were measured and perceived exertion and symptoms of chest pain inquired throughout the experiments. An emergency nurse was responsible for the health monitoring and at least two persons followed the patient throughout the experiment. A medical doctor was available on call for consultation. The termination criteria followed the generally accepted international guidelines for exercise testing and were planned prior to the experiments. Results: The exercise test simulation revealed risks requiring changes in the study design and emergency response. The cardiovascular responses of the controlled trials were related to irregular HR, ST-depression or post-exercise hypotension. These were expected and the majority could be dealt on site by the research personnel and on call consultation. Only one patient was encouraged to seek for external health care consultation. Conclusions: Appropriate prospective design is a key to safe implementation of controlled studies involving cardiac patients and stimulation of cardiovascular function. This includes careful selection of participants, sufficient and knowledgeable staff, as well as identifying possible emergency situations and the required responses. Trial registration: ClinicalTrials ID: NCT02855905