Liikunnan vaikutus päivittäiseen fyysiseen aktiivisuuteen ja tyypin 2 diabeteksen riskitekijöihin

The prevalence and incidence of non-communicable diseases, which have been associated with physical inactivity, are increasing worldwide. Thus, there is a great need for understanding possibilities to increase health enhancing physical activity. The main aims of this study were to investigate 1) the effects of a 13-day in-patient rehabilitation intervention and a 12-week exercise intervention on the intensity and volume of daily total physical activity and on its subcategories 2) the effect of exercise intervention on risk factors for type 2 diabetes, and 3) the effect of non-structured leisure-time physical activity (LTPA) on response to exercise training. The study consists of two separate study cohorts. The first data set included subjects (n = 19, 16 women and 3 men) with chronic neck or shoulder pain and who participated in active rehabilitation interventions. The second data set included 144 overweight or obese middle aged men with impaired glucose regulation who were randomly allocated into a non-exercise control (C) group, a Nordic walking (NW) group, and a power type resistance training (RT) group. During the 12-week intervention, the exercise groups performed structured supervised exercises three times a week for 60 minutes. In both datasets intensity and volume of physical activity was measured in metabolic equivalents of tasks (MET) and MET-hours before and during the interventions with combinations of objective measurement, diaries, and questionnaires. In the second dataset changes in glucose, lipid, and liver enzymes metabolism, adipocytokines, body composition, blood pressure, physical capacity, and dietary intake were measured with standard methods. The measurements were performed before and after the intervention. No increase in the volume of total physical activity was observed with either intervention. Both the rehabilitation and NW intervention increased the volume of leisure-time physical activity (LTPA). The weekly increase in the volume of total LTPA (structured exercises + non-structured LTPA) was associated with a decrease in the volume of non-LTPA (other than structured exercise or non-structured exercise). Compared to the control group, especially NW had beneficial effects on the body adiposity tissue and the adipocytokines (leptin and chemerin) associated with the regulation of lipid and glucose metabolism. The intensity of non-structured LTPA during the exercise intervention was found to independently explain 10%, 9%, and 7% of the variation of change in walking speed, body weight, and BMI, respectively. This effect was observed especially after the intensity threshold of 6.3 MET (77% of maximal physical capacity). Thus, interventions aimed to increase physical activity do not automatically increase the volume of total physical activity due to the compensation. They can, however, increase the volume of LTPA, which can subsequently have beneficial health effect on risk factors of type 2 diabetes. Better understanding of the physical activity regulation in response to training can also increase the specificity of the physical activity dosage.Fyysiseen inaktiivisuuteen yhdistettyjen elämäntapasairauksien esiintyvyys lisääntyy maailmanlaajuisesti. Tällä hetkellä onkin tarve löytää keinoja, joilla voidaan tehokkaasti lisätä terveyttä edistävää fyysistä aktiivisuutta. Tutkimuksen päätarkoituksena oli selvittää 1) 13 vuorokauden laitoskuntoutusintervention ja 12 viikon ohjatun harjoitteluintervention vaikutusta fyysiseen kokonaisaktiivisuuteen ja sen alakategorioihin, 2) harjoitteluintervention vaikutusta tyypin 2 diabeteksen riskitekijöihin ja 3) ei-ohjatun vapaa-ajan liikunnan vaikutusta harjoitteluintervention vasteeseen. Tutkimus koostuu kahdesta erillisestä aineistosta. Ensimmäinen aineisto koostuu kahden aktiivisen kuntoutusintervention osallistujista (n = 19, 16 naista ja 3 miestä), jotka kärsivät kroonisesta niska- tai hartiakivusta. Toisessa aineistossa 144 ylipainoista tai lihavaa keski-ikäistä miestä, joilla on häiriintynyt glukoosiaineenvaihdunnansäätely, satunnaistettiin kontrolliryhmään ja kahteen ohjattuun harjoitusryhmään (sauvakävely tai nopeusvoimatyyppinen kuntosaliharjoittelu). Harjoitusryhmät harjoittelivat 12 viikkoa 3 kertaa viikossa 60 minuuttia. Fyysisen aktiivisuuden intensiteetti ja volyymi mitattiin lepoaineenvaihdunnan kerrannaisina (MET) ja MET-tunteina ennen interventiota ja intervention aikana objektiivisten mittausten, päiväkirjojen ja kyselyiden yhdistelmällä. Tyypin 2 diabeteksen riskitekijät, glukoosi- ja rasva-aineenvaihdunnan ja maksan entsyymien aineenvaihdunnan indikaattorit, adiposytokiinit, kehon koostumus, verenpaine, fyysinen suorituskyky ja ravitsemus mitattiin standardimenetelmillä ennen ja jälkeen intervention. Fyysisen kokonaisaktiivisuuden (24 tuntia vuorokaudessa) volyymi ei lisääntynyt kuntoutus- tai harjoitteluintervention seurauksena. Sekä kuntoutus- että sauvakävelyinterventio lisäsivät vapaa-ajan liikunnan volyymia. Mitä enemmän sauva- ja kuntosaliryhmien viikoittainen vapaa-ajan kokonaisliikunnan (ohjattu harjoittelu + ei-ohjattu vapaa-ajan liikunta) volyymi lisääntyi, sitä enemmän ei-vapaa-ajan liikunnan volyymi väheni. Verrattuna kontrolliryhmään etenkin sauvakävelyllä oli terveydelle edullisia vaikutuksia kehon rasvakudokseen sekä rasva- ja glukoosiaineenvahdunnan säätelyyn vaikuttaviin adiposytokiineihin (chemeriini ja leptiini). Lisäksi ei-ohjatun vapaa-ajan liikunnan intensiteetti selitti itsenäisesti 10 % kävelynopeuden, 9 % kehon painon ja 7 % kehon painoindeksin muutoksen vaihtelusta. Tämä vaikutus oli nähtävissä erityisesti 6.3 MET (77% maksimaalisesta fyysisestä suorituskyvystä) raja-arvon jälkeen. Fyysisen aktiivisuuden lisäämiseen tähtäävät interventiot eivät automaattisesti lisää fyysisen kokonaisaktiivisuuden volyymia kompensaatiosta johtuen. Ne näyttäisivät kuitenkin lisäävän vapaa-ajan liikunnan volyymia, jolla saattaa olla tyypin 2 diabeteksen riskitekijöihin edullisia terveysvaikutuksia. Nykyistä parempi tietoisuus fyysisen aktiivisuuden säätelymekanismeista interventioiden aikana voi mahdollistaa nykyistä tarkemman terveyttä edistävän fyysisen aktiivisuuden annostelun

Erikoislääkärien ja erikoishammaslääkärien tarvearvio vuoteen 2035

Erikoislääkäri- ja erikoishammaslääkärikoulutuksen tavoitteena on potilaiden ja väestön laadukas hoito. Selvityksen tavoitteena oli arvioida alueellisesti ja erikoisalakohtaisesti erikoislääkärien ja erikoishammaslääkärien tarve vuonna 2035 siten, että ne vastaavat väestön ja palvelujärjestelmien tarpeita. Tämän pohjalta arvioitiin myös vuosittain valmistuvien tarve vuosina 2019–2035. Selvitystyö perustuu asiantuntijoiden antamiin arvioihin sekä rekisteripohjaisiin tietoihin. Analyyseissä on huomioitu eläköityminen, kuolleisuus ja maahanmuuton nettovaikutus. Kokonaistarve vuonna 2035 kuvastaa erikoislääkäreiden ja erikoishammaslääkäreiden tarvetta yhteiskunnassa, jossa lääkärien ja hammaslääkärien määrä ei rajoita potilaan hyvää hoitoa. Asiantuntija-arvioiden mukaan vuonna 2035 Suomessa tarvitaan huomattavasti enemmän sekä erikoislääkäreitä että erikoishammaslääkäreitä: 21 088 erikoislääkäriä ja 877 erikoishammaslääkäriä. Näiden tarpeiden tyydyttämiseksi olisi vuosien 2019–2035 aikana valmistuttava vuosittain yhteensä 934 erikoislääkäriä ja 40 erikoishammaslääkäriä. Lääketieteessä tarve on suurinta yleislääketieteen, työterveyshuollon ja geriatrian erikoisaloilla. Hammaslääketieteessä tarve on suurinta suu- ja leukakirurgiassa, oikomishoidossa sekä kliinisessä hammashoidossa protetiikan ja purentafysiologian painotusalalla

Effect of maternal weight during pregnancy on offspring muscle strength response to resistance training in late adulthood

Purpose: Maternal obesity can unfavorably influence offspring body composition, muscle strength, and possibly muscle's adaptability to training, but the human studies are scarce. Therefore, we aimed to investigate the effect of maternal obesity on offspring muscle strength responses to resistance training intervention in elderly frail women. Materials/methods: Recruited participants were elderly frail women offspring of lean/normal weight mothers (n = 19, mean body mass index (BMI): 22.8 kg/m2, range: 19.9-24.5) or overweight/obese mothers (n = 16, mean BMI: 29.7 kg/m2, range: 28.2-34.2). Information on maternal BMI immediately prior to delivery was collected from the birth registers. All women participated in a 4-month supervised progressive resistance training intervention three times a week for 60 min. Predicted 1-RM of abdominal crunch, hip abduction, leg curl, leg press, seated row, and total strength were measured at baseline and after each month of training. Results: According to rANOVA, strength increased significantly in both groups (p for time 0.072). On average, muscle strength of the women offspring of overweight/obese mothers tended to be lower than in women offspring of lean/normal weight mothers, but the only significant difference was found in leg curl (p = 0.006). No significant differences between the groups were found in relative strength changes from baseline to 4-months. Conclusions: Muscle strength response to supervised resistance training is not modulated by maternal adiposity in late pregnancy in elderly frail female offspring.Peer reviewe

Maternal body mass index, change in weight status from childhood to late adulthood and physical activity in older age

This study aimed to examine the longitudinal associations of maternal body mass index (BMI), weight status in childhood and late adulthood and device-measured total physical activity (TPA) in older age. The study involves 552 participants from Helsinki Birth Cohort Study who were born in Helsinki, Finland, in 1934-1944. TPA was measured with a multisensory body monitor at a mean age of 70 years and expressed in metabolic equivalent of task hours/day (METh/d). Childhood overweight (BMI > 85th percentile) was based on school health records at 6-7 years of age, and late adulthood overweight (BMI >= 25 kg/m(2)) was based on clinical measurements at the mean age of 61 years. Childhood overweight was associated with lower TPA, particularly in older women (mean difference -3.2 METh/d, 95% confidence interval (CI) -4.6 - -1.9), and late adulthood overweight was associated with lower TPA both in older women (mean difference -6.2, 95% CI (-7.2 - -5.1) and in older men (mean difference -2.6 METh/d, 95% CI -3.7 - -1.5). TPA in older age was highest in participants who were normal weight both in childhood and adulthood and lowest in participants who were overweight in childhood and adulthood. In participants with childhood overweight, TPA was lower in participants who were overweight both in childhood and adulthood compared to those who were overweight only in childhood. There was a U-shaped distribution of TPA according to maternal BMI in older women (P = .002), but not in older men. In conclusion, reaching normal weight after childhood predicted higher physical activity levels in older age.Peer reviewe

Impaired glucose regulation, depressive symptoms, and health-related quality of life

Introduction This study aims to investigate whether the associations between impaired glucose regulation and health-related quality of life are modified by severity or type of depressive symptoms. Research design and methods For this cross-sectional study, we included 1939 individuals (mean age 61.5 years) from the Helsinki Birth Cohort Study. Between 2001 and 2004, a standard 2-hour 75 g oral glucose tolerance test was applied to define normoglycemia, pre-diabetes, and newly diagnosed diabetes. Information on previously diagnosed diabetes was collected from national registers and questionnaires. Pre-diabetes was defined as having either impaired fasting glucose or impaired glucose tolerance. The Mental and Physical Component Scores of health-related quality of life were assessed with Short Form-36. Beck's Depression Inventory was employed to investigate the severity of depressive symptoms and to define minimal (depression score Results Glucose regulation subgroups, especially previously known diabetes, were associated with lower Physical Component Score (p=0.001) and higher depression score (p=0.015), but not with the Mental Component Score (p=0.189). Non-melancholic depression was associated with lower Physical and Mental Component Scores compared with those with depression score 0.54). Conclusions Non-melancholic type of depression and previously known diabetes are independently associated with lower health-related quality of life. This should be appraised in long-term treatment of diabetes and when treating non-melancholic depressive symptoms to maintain a higher health-related quality of life.Peer reviewe

Skin Autofluorescence in Young Adult Offspring of Women with Type 1 Diabetes : A Cross-Sectional Case-Control Study

Introduction: Offspring born to women with type 1 diabetes pregnancies have an elevated risk for early-onset obesity and type 2 diabetes compared with offspring born to women without diabetes. Skin autofluorescence (SAF) is a marker of accumulated advanced glycation end products (AGEs) and it has been shown to predict type 2 diabetes, cardiovascular disease, and mortality in the general population. The aim of this study was to evaluate whether maternal type 1 diabetes influences the SAF value in young adult offspring. Methods: This cross-sectional case-control study included 78 offspring of women with type 1 diabetes (cases) and 85 control participants (controls). All study participants, aged 18-23 years, were invited to participate in a clinical assessment including laboratory tests and questionnaires. SAF was assessed using the AGE reader from the dominant forearm of each participant. Results: The mean SAF value did not differ between the cases (1.61 [standard deviation (SD) 0.37]) arbitrary units [AU]) and the controls (1.64 [SD 0.41] AU) (p = 0.69). After adjusting for glycated hemoglobin A(1c), body fat percentage, smoking, and season the mean SAF value did not differ between the cases and the controls (p = 0.49) but differed between men and women (p = 0.008), without any interaction observed (p = 0.78). Conclusion: SAF values did not differ between the young adult offspring of women with type 1 diabetes and offspring born to mothers without diabetes. Surprisingly, young adult women showed higher SAF values than men in both case and control groups.Peer reviewe

Evaluation of Afterschool Activity Programs’ (ASAP) Effect on Children’s Physical Activity, Physical Health, and Fundamental Movement Skills

Publisher Copyright: © The Author(s) 2021.Background: Physical literacy-focused afterschool activity programs (ASAPs) can be an effective strategy to improve children’s health-related parameters. We sought to compare physical activity, body composition, aerobic capacity, and fundamental movement skills between physical literacy-focused ASAP and a standard recreational ASAP. Method: A pre–post (6 months) comparison study was conducted in 5- to 12-year-old children in a physical literacy-focused ASAP (physical literacy group, n = 14) and children attending a standard recreational ASAP (comparison group, n = 15). Physical activity guideline adherence was assessed using accelerometry, body composition was analyzed using bioelectrical impedance, aerobic capacity was estimated using the Progressive Aerobic Cardiovascular Endurance Run test, and fundamental movement skills were evaluated using the Test of Gross Motor Development–2. Results: There were no significant differences between groups at baseline. After 6 months, the physical literacy group exhibited a significant improvement in their total raw score for the Test of Gross Motor Development–2 (p =.016), which was likely due to improvements in object control skills (p =.024). The comparison group significantly increased body mass index (p =.001) and body fat (p =.009) over time. No significant between-group differences were found; however, there was a trend for improved aerobic capacity in the physical literacy group (d = 0.58). Conclusions: Engagement in the physical literacy-focused ASAP contributed to an attenuated increase in adiposity and an improvement in object control skills.Peer reviewe

Change in physical activity and health-related quality of life in old age-A 10-year follow-up study

The aim of the study was to examine the association between change in leisure-time physical activity (LTPA) and change in health-related quality of life (HRQoL) and symptoms of depression during a 10-year follow-up. This prospective study included 1036 men and women (mean age at baseline = 61.2 years) from the Helsinki Birth Cohort Study. Leisure-time physical activity was measured with a questionnaire, HRQoL with SF36 and depression symptoms with Beck's depression inventory (BDI). The association between the change in LTPA and change in HRQoL and BDI were investigated with sex-stratified general linear models adjusted for age, smoking, educational attainment, comorbidity score, and baseline value of outcomes. One standard deviation (SD) increase in LTPA was associated with increase in physical summary component of HRQoL in women (B = 0.7 unit, 95% CI = 0.1-1.3, P = 0.032) and in men (B = 0.8 unit, 95% CI = 0.2-1.5, P = 0.014). In women, the 1SD increase in LTPA was also associated with an increase in mental summary component score (B = 1.0, 95% CI = 0.3-1.7, P = 0.005) and a reduction in depressive symptoms (B = -0.7, 95% CI = -1.1 to -0.2, P = 0.003). In conclusion, increase in the volume of LTPA over a 10-year period in late adulthood was associated with improved HRQoL in both men and women, and also diminished depressive symptoms in women. The findings support the promotion of physical activity in later years to enhance HRQoL and mental well-being.Peer reviewe

Association between dog ownership and type 2 diabetes in later life : the Helsinki birth cohort study

Dog ownership has been reported to have beneficial effects on physical activity and emotional well-being, both known to reduce the risk for type 2 diabetes (T2D). The aim of this study was to evaluate the association between dog ownership during the whole life course and having T2D in later life. The study subjects consisted of 731 people (307 men and 424 women) from the Helsinki Birth Cohort Study. We assessed dog ownership with questionnaires, for every decade of life as well as current dog ownership. We investigated the associations between dog ownership and T2D with generalised estimating equation models and with generalised linear models. At a mean age of 71.0 (standard deviation [SD] 2.6) years, 13% of the participants had T2D. Dog ownership prior to the clinical examination was not associated with T2D (p >= 0.51). In men, but not in women, current dog owners had greater odds of having T2D compared with the non-owners when adjusted for age when clinically examined, socio-economic status, smoking, leisure-time physical activity, chronic diseases (OR = 3.32, 95% confidence interval 1.25-8.79, p = 0.016). In the age group of people around 70 years, dog ownership is not associated with reduced odds for developing T2D.Peer reviewe

Adiposity-Related Predictors of Vascular Aging From a Life Course Perspective-Findings From the Helsinki Birth Cohort Study

The main objective of this study was to study predictors of vascular health with focus on adiposity-related factors. Glucose metabolism, blood lipids, inflammatory markers and body composition were assessed 15 years before assessment of vascular health which was assessed with pulse wave velocity (PWV) in 660 subjects born 1934-44. In a univariate analysis in women the strongest association with PWV was seen for age, systolic blood pressure, dysglycemia, dyslipidemia, inflammatory markers and body fat percentage measured in late midlife and PWV measured 15 years later. In men age, body mass index (BMI), systolic blood pressure, dysglycemia, and body fat percentage in late midlife were associated with PWV. One novel finding was that adiposity-related factors were strong predictors of vascular health, something not fully encapsulated in BMI, lean body mass or body fat percentage alone. A higher fat mass index was associated with worse vascular health, which was not ameliorated by a higher lean mass index. Our findings stress the importance to study body composition and fat and lean body mass simultaneously because of their close interaction with each other also in relation to vascular health.Peer reviewe