Independent and Combined Effects of Physical Activity and Changes in Body Mass on Long-Term Changes in Blood Pressure among Adolescents: The HUNT Study, Norway

Background: The association between overweight or obesity and blood pressure is well established among adolescents. Also the beneficial effect of physical activity on reduction in body mass is well known. However, studies done on the possible effect of physical activity on blood pressure are limited. Thus, the purpose of this study is to examine the independent and combined effect of baseline physical activity and changes in body mass on change in blood pressure in a population of Norwegian adolescents. Methods: Weight, height, waist circumference (WC), hip circumference (HC), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, and body mass index (BMI) and waist-hip ratio (WHR) were calculated among 1814 adolescents (777 males and 1037 males) aged 13-19 years, who participated in a population based study in 1995-1997 (Young-HUNT 1), and a follow-up study in 2006-2008 (HUNT 3), in the county of Nord-Trøndelag, Norway. Internationally accepted cut-off points were used to classify the subjects as underweight, normal weight, overweight or obese, and changes between the body mass variables from baseline to follow-up was calculated. The adolescents completed a detailed questionnaire including physical activity and smoking habits. We calculated changes in mean SBP and DBP within categories of changes in body mass and level of physical activity score (PAS) at baseline, and examined the crude and adjusted differences in change in mean SBP and DBP between the categories. Results: An increase in either of the body mass variables resulted generally in a higher change in mean SBP and DBP among both males and females, compared to those who were stable, whereas there was no evidence of an independent effect of baseline PAS on changes in SBP or DBP. Analysis of the combined effect showed that those who had a stable BMI had approximately similar changes in SBP and DBP, irrespective of their baseline PAS level. Moreover, those who increased their BMI had a higher change in both SBP and DBP than those with a stable BMI, with no evidence of any modifying effect of PAS. Conclusion: In this population-based study of Norwegian adolescents, we found that an increase in body mass from Young-HUNT 1 to HUNT 3 was associated with a higher change in mean SBP and DBP, compared to those who were stable, but that baseline level of physical activity seemed to have no influence on these associations. Thus, avoiding weight gain seems to be the key factor to prevent unfavorable BP levels

A life course and intergenerational approach to the study of musculoskeletal pain: The HUNT Study

Sammendrag på norsk Livsløps- og generasjonsstudier av muskel- og skjelettsmerter i HUNT-studien Kroniske muskel- og skjelettsmerter er blant de fremste årsakene til redusert livskvalitet, sykefravær og uførhet i den vestlige verden. Forekomsten er høy også blant ungdom og unge voksne. I tillegg til den individuelle belastningen, har kroniske muskel- og skjelettsmerter en stor samfunnsøkonomisk betydning relatert til behandling, arbeidsevne og sykefravær. Kunnskap som kan gi mulighet for bedre forebygging og behandling er derfor viktig. Studier har vist at både miljømessige og arvelige faktorer spiller en rolle for utviklingen av kroniske muskel- og skjelettsmerter, og familiestudier har vist en sammenheng i smerte mellom foreldre og deres barn. Det er likevel uklart om denne sammenhengen vedvarer inn i barnas voksenliv. Ved bruk av data fra Helseundersøkelsen i Nord-Trøndelag (HUNT) koblet til Familieregisteret hos Statistisk Sentralbyrå har vi undersøkt hvorvidt det finnes en sammenheng mellom foreldre og deres voksne barn når det gjelder forekomst av kroniske muskel- og skjelettsmerter. Vi har også studert foreldre-barn sammenhenger i smerte lokaliserte til nakke/øvre rygg og/eller korsrygg for å vurdere om disse assosiasjonene er spesifikke når det gjelder smertelokalisasjon. I tillegg har vi prospektivt undersøkt om barnas risiko for smerte, assosiert med foreldresmerte, kan være modifisert av barnas kroppsmasseindeks og fysiske aktivitet. Resultatene fra disse familiestudiene viste at kroniske muskel- og skjelettsmerter blant både mødre og fedre er assosiert med høyere forekomst av kroniske muskel- og skjelettsmerter hos deres voksne barn. Assosiasjonene var sterkest når begge foreldrene rapporterer smerte. Vi observerte ingen klar spesifisitet i sammenhengene knyttet til lokalisasjon, men dersom foreldrene hadde smerte både i nakke/øvre rygg og korsrygg var det assosiert med høyere forekomst av smerte blant barna sammenlignet med smerte i bare en lokalisasjon. Resultatene fra den prospektive studien tyder på at normal kroppsvekt reduserte risikoen for å utvikle kroniske muskel- og skjelettsmerter blant barn av foreldre som rapporterte smerte, mens den modifiserende effekten av fysisk aktivitet var mindre klar. Studiene bidrar til kunnskap om familiære sammenhenger av kroniske muskel- og skjelettsmerter, og at slike sammenhenger er til stede også når barna er voksne. Dette kan være av betydning for valg av forebyggende strategier og terapeutiske tilnærminger for kroniske muskel- og skjelettsmerter. I tillegg tyder resultatene på faktorer som overvekt/fedme og fysisk aktivitet kan påvirke risikoen, særlig i familier som er rammet av kroniske muskel- og skjelettsmerter

Parental chronic pain in relation to chronic pain in their adult offspring: Family-linkage within the HUNT Study, Norway

Background: Little is known about the association between parental chronic musculoskeletal pain (CMP) and occurrence of CMP in the adult offspring. The main objective of this study was to assess the parent-offspring association of CMP, and also to examine possible modifying effects of age and sex. Methods: The study includes 11 248 parent-offspring trios from the Norwegian HUNT Study with information on parental CMP obtained in 1995–97 and offspring CMP obtained in 2006–08. Logistic regression was used to calculate adjusted odds ratios (ORs) for offspring CMP associated with parental CMP. Results: Maternal and paternal CMP was associated with 20-40% increased odds of CMP in sons and daughters. Both sons and daughters had an OR of 1.6 (95% CI 1.4 to 1.9) when both parents reported CMP, compared to when none of the parents had CMP. Restricting the analyses to parental CMP that was associated with limited work ability and leisure time activity did not change the strength of the association. Further, analyses stratified by parental age ±65 years showed no clear difference in the estimated associations, and there was no evidence of interaction for parental sex (P ≥ 0.39) or offspring age ±40 years (P ≥ 0.26). Conclusions: This large family-linkage study show that maternal and paternal CMP are positively associated with CMP in the adult offspring, irrespective of parental and offspring age, and that the associations are strongest when both parents have CMP. Although the high prevalence of CMP in both parents and offspring suggests that not all cases are clinically relevant, the results suggest that chronic pain has a heritable component

Familial Risk of Chronic Musculoskeletal Pain and the Importance of Physical Activity and Body Mass Index: Prospective Data from the HUNT Study, Norway

The main objectives of the current study was i) to prospectively examine if chronic musculoskeletal pain in parents is associated with risk of chronic musculoskeletal pain in their adult offspring, and ii) to assess if these parent-offspring associations are modified by offspring body mass index and leisure time physical activity. We used data on 4,742 adult offspring linked with their parents who participated in the population-based HUNT Study in Norway in 1995–97 and in 2006–08. Family relations were established through the national Family Registry. A Poisson regression model was used to estimate relative risk (RR) with 95% confidence interval (CI). In total, 1,674 offspring (35.3%) developed chronic musculoskeletal pain during the follow-up period of approximately 11 years. Both maternal (RR: 1.26, 95% CI: 1.03, 1.55) and paternal chronic musculoskeletal pain (RR: 1.29, 95% CI: 1.06, 1.57) was associated with increased risk of offspring chronic musculoskeletal pain. Compared to offspring of parents without chronic musculoskeletal pain, the adverse effect of parental pain was somewhat stronger among offspring who reported a low (RR: 1.82, 95% CI: 1.32, 2.52) versus high (RR: 1.32, 95% CI: 0.95, 1.84) level of leisure time physical activity. Offspring of parents with chronic musculoskeletal pain and who were classified as obese had more than twofold increased risk (RR: 2.33, 95% CI: 1.68, 3.24) of chronic musculoskeletal pain compared to normal weight offspring of parents without pain. In conclusion, parental chronic musculoskeletal pain is positively associated with risk of chronic musculoskeletal pain in their adult offspring. Maintenance of normal body weight may reduce the risk of chronic musculoskeletal pain in offspring of pain-afflicted parents

Risk for offspring chronic musculoskeletal pain associated with the combined effect of parental chronic musculoskeletal pain and offspring leisure time physical activity.

<p>Risk for offspring chronic musculoskeletal pain associated with the combined effect of parental chronic musculoskeletal pain and offspring leisure time physical activity.</p

Risk for offspring chronic musculoskeletal pain associated with the combined effect of parental chronic musculoskeletal pain and offspring body mass index.

<p>Risk for offspring chronic musculoskeletal pain associated with the combined effect of parental chronic musculoskeletal pain and offspring body mass index.</p

Flow chart showing selection procedures into the study.

<p>CMP: chronic musculoskeletal pain. ^aPercentage of N = 7,520 trios. ^bPercentage of 9,509 trios.</p

Baseline characteristics of the study population at HUNT2.

<p>Baseline characteristics of the study population at HUNT2.</p

Influence of family history on prognosis of spinal pain and the role of leisure time physical activity and body mass index: A prospective study using family-linkage data from the Norwegian HUNT study

Objectives To investigate the influence of parental chronic spinal pain on prognosis of chronic spinal pain in adult offspring, and whether offspring physical activity level and body mass index (BMI) modified this association. Design Prospective cohort study. Setting We used family-linked longitudinal data from the Norwegian HUNT study collected in HUNT2 (1995–1997) and HUNT3 (2006–2008). Participants A total of 1529 offspring who reported spinal pain in HUNT2 were linked with parental data and followed up in HUNT3. Outcomes We estimated relative risk (RR) with 95% CI for recovery from chronic spinal pain, and also from activity limiting spinal pain, in offspring related to chronic spinal pain in parents. We also investigated whether offspring leisure time physical activity and BMI modified these intergenerational associations in spinal pain. Results A total of 540 (35%) offspring were defined as recovered after approximately 11 years of follow-up. Offspring with both parents reporting chronic spinal pain were less likely to recover from chronic spinal pain (RR 0.83, 95% CI 0.69 to 0.99) and activity limiting spinal pain (RR 0.71, 95% CI 0.54 to 0.94), compared with offspring of parents without chronic spinal pain. Analyses stratified by BMI and physical activity showed no strong evidence of effect modification on these associations. However, offspring who were overweight/obese and with both parents reporting chronic spinal pain had particularly low probability of recovery from activity limiting spinal pain, compared with those who were normal weight and had parents without chronic spinal pain (RR 0.57, 95% CI 0.39 to 0.84). Conclusion Offspring with chronic spinal pain are less likely to recover if they have parents with chronic spinal pain, particularly if offspring are overweight/obese