Koistinen P

Miettinen TA

Pitkälä KH

Salomaa VV

Savela SL

Strandberg AY

Strandberg TE

Tilvis RS

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Author Contributions: Study concept and design: Desai,Brinker, and Iyasu. Acquisition of data: Brinker. Analysisand interpretation of data:Desai, Brinker, and Swann.Draft-ing of the manuscript:Desai and Brinker. Critical revisionof the manuscript for important intellectual content:Desai,Brinker, Swann, and Iyasu. Statistical analysis:Desai.Ad-ministrative, technical, and material support: Brinker andSwann. Study supervision: Brinker and Iyasu.Financial Disclosure: At the time this project was initi-ated, Dr Desai was on a practicum rotation with the FDAas a resident physician within the Johns Hopkins Gen-eral Preventive Residency Program. Drs Brinker, Swann,and Iyasu are employed at the FDA. These authors listno grants, directed financial support, or financial inter-ests in these data.1. Physicians’ Desk Reference. 62nd ed. Januvia (sitagliptin) tablets: Merck&CoInc. Montvale, NJ: Thompson Healthcare Inc; 2008:1492-1499.2. Uppsala Monitoring Centre. The use of theWHO-UMC system for standard-ized case causality assessment. http://www.who-umc.org/graphics/4409.pdf.Accessed January 20, 2009.3. Calabrese LH, Michel BA, Bloch DA, et al. The American College of Rheu-matology 1990 criteria for the classification of hypersensitivity vasculitis. Ar-thritis Rheum. 1990;33(8):1108-1113.4. Sachs RM, Bortnichak EA. An evaluation of spontaneous adverse drug reac-tion monitoring systems. Am J Med. 1986;81(suppl 5B):49-55.5. Lambeir A-M, DurinxC, Scharpe´ S, DeMeester I. Dipeptidyl-peptidase IV frombench to bedside: an update on structural properties, functions and clinical as-pects of the enzyme DPP IV. Crit Rev Clin Lab Sci. 2003;40(3):209-294.Physical Activity at Midlifeand Health-Related Qualityof Life in Older MenA recent study in the Archives1 investigated asso-ciations of midlife physical activity and healthstatus in older age, and the results showed astrong association between midlife leisure time physicalactivity and successful survival and exceptional healthstatus in later life. However, this cohort was limited towomen, and although health-related quality of life(HRQoL) was assessed with the 36-Item Short-FormHealth Survey (SF-36), these results were not reported.Because the SF-36, with its 8 domains, may give de-tailed information of the effects of physical activity onboth physical andmental dimensions in old age aspects,we investigated long-term associations between leisure-time physical activity in midlife and HRQoL in old agein the Helsinki Businessmen Study.2Methods. In1974, clinicallyhealthymiddle-agedmen(bornin 1919-1934; median age, 47 years) of similar socioeco-nomic status were assessed with questionnaires and clini-cal and laboratory examinations as described previously.2The men were asked how they rated their present healthon a 5-step scale (“very good,” “good,” “fair,” “poor,” and“very poor”), and a global description of leisure timephysi-cal activity was assessed with the following 4-step scale:1. Activitymainly reading, watching television, or other sed-entary activity.2. Walking, cycling, gardening, or other light exerciseweekly.3. Jogging, skiing, tennis, or similar exercise weekly on aregular basis.4. Regular vigorous/competitive exercise several times aweekon a regular basis.Details of physical activity were available for 782 clini-cally healthy men with various cardiovascular risk fac-tors. Men answering yes to question 1 were categorizedas low activity (n=148); yes to question 2, as moderateactivity (n=398); and yes to questions 3 and 4, as highactivity (n=236 [among whom only 11 men had a com-petitive activity level). After a 26-year follow-up in 2000(median age, 73 years; range, 66-81 years), 552men (91%of survivors at that time [deaths were verified from theCentral Population Register]) could be reassessed usingamailed questionnaire. The questionnaire included que-ries about anthropometric measures, housing, preva-lence of chronic diseases, medication, and lifestyle fac-tors. The Finnish version of the RAND-36 Item HealthSurvey 1.0, which is practically the same as SF-36 andvalidated in the Finnish population,3 was embedded intothe questionnaire. From the responses, a summary co-morbidity indexwas also assessed according to themethodofCharlson et al.4 The 8 domains of RAND-36were physi-cal function, role physical, bodily pain, general health,vitality, social function, role emotional, andmental health.Analyseswere performedusingNCSS 2004 statistical soft-ware (NCSS, Kaysville, Utah). Analysis of covariance wasused to compare baseline activity groups, and P .05wasconsidered statistically significant.Results. In 2000, men with a low physical activity inmidlife reported significantly higher prevalences of coro-nary artery disease (P=.02), cerebrovascular disorders(P=.046), and chronic obstructive pulmonary disease(P=.04). Of the adjusted HRQoL scales in old age (in theyear 2000), only physical function was significantly re-lated to physical activity inmidlife (Figure). Further ad-justment for individual diseases (history of coronary ar-1008090706050PFP = .004RPP = .28BPP = .80GHP = .15VTP = .17SFP = .66MHP = .28REP = .93RAND-36 ScaleRAND-36 ScoreLowModerateHighFigure. RAND-36 scores in old age in the year 2000 (n=552) according toleisure time physical activity (low, intermediate, or high) in healthymiddle-aged men (in 1974). The scores are adjusted for age, smoking,self-rated health at baseline, and Charlson comorbidity index in old age.Numbers above bars denote P values between physical activity groups.BP indicates body pain; GH, general health; MH, mental health; PF, physicalfunction; RE, role emotional; RP, role physical; SF, social function;VT, vitality.See Invited Commentaryat the end of this letter(REPRINTED) ARCH INTERN MED/VOL 170 (NO. 13), JULY 12, 2010 WWW.ARCHINTERNMED.COM1171©2010 American Medical Association. All rights reserved.Downloaded From: http://archinte.jamanetwork.com/ by a National Public Hlth Institute-Finland User  on 05/13/2014tery disease, cerebrovascular disease, heart failure, orchronic obstructive pulmonary disease, whichwere foundto be different between groups in 2000), or the Charl-son comorbidity index reduced but did not abolish thesignificance in physical function (P=.01 when diseaseswere included; P=.02 when the Charlson comorbidityindex was included).Comment. Leisure-time physical activity in midlife pre-dicted better physical function in old age but was not sig-nificantly associated withmental or social dimensions oftheHRQoL in this socioeconomically homogeneousmalecohort. Moreover, the relationship was not explained, al-beit attenuated, by diseases associated with less physi-cal activity. Because the physical function score of theSF-36 has been shown to be a valid measure of mobility-disability,5 more physical activity in healthy individualsinmidlifemay thus have an independent and specific im-pact for the prevention of disability in old age.Author Affiliations: Oulu City Hospital, Oulu, Finland(Drs Savela and Koistinen); Geriatric Clinic, Depart-ment of Medicine, University of Helsinki, Helsinki, Fin-land (Drs Tilvis, A. Y. Strandberg, and Miettinen); Unitof General Practice, Helsinki University Central Hospi-tal, Helsinki (Dr Pitkälä); National Institute for Healthand Welfare (THL), Helsinki (Dr Salomaa); and Insti-tute of Health Sciences/Geriatrics, University of Oulu andOulu City Hospital, Oulu (Dr T. E. Strandberg).Correspondence:Dr T. E. Strandberg, Institute of HealthSciences/Geriatrics, University of Oulu, and Oulu CityHospital, Aapistie 1, PO Box 5000, FIN-90014 OulunYliopisto, Finland (timo.strandberg@oulu.fi).Author Contributions: Study concept and design: Savela,Koistinen, Pitkälä, and T. E. Strandberg. Acquisition ofdata:Tilvis, Miettinen, and T. E. Strandberg.Analysis andinterpretation of data: Savela,Koistinen, Tilvis, A. Y. Strand-berg, Salomaa, and T. E. Strandberg.Drafting of themanu-script: Savela, Koistinen, and T. E. Strandberg. Criticalrevision of the manuscript for important intellectual con-tent: Tilvis, A. Y. Strandberg, Pitkälä, Salomaa, andMiettinen. Statistical analysis: Salomaa and T. E. Strand-berg. Obtained funding: T. E. Strandberg. Administrative,technical, andmaterial support:Tilvis andMiettinen. Studysupervision: Tilvis and Miettinen.Financial Disclosure: None reported.Funding/Support: This study was funded by the Jahns-son Foundation.1. Sun Q, Townsend MK, Okereke OI, Franco OH, Hu FB, Grodstein F. Physi-cal activity at midlife in relation to successful survival in women at age 70years or older. Arch Intern Med. 2010;170(2):194-201.2. Strandberg TE, Strandberg AY, Salomaa VV, et al. Explaining the obesity para-dox: cardiovascular risk, weight change, and mortality during long-term fol-low-up in men. Eur Heart J. 2009;30(14):1720-1727.3. Aalto A-M, Aro AR, Teperi J. RAND-36 as a Measure of Health-Related Qualityof Life: Reliability, Construct Validity and Reference Values in the Finnish Gen-eral Population. Helsinki, Finland: STAKES; 1999. Report 101.4. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classify-ing prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987;40(5):373-383.5. Syddall HE,Martin HJ, Harwood RH, Cooper C, Sayer A. The SF-36: a simple,effectivemeasure ofmobility-disability for epidemiological studies. J NutrHealthAging. 2009;13(1):57-62.INVITED COMMENTARYPhysical Activity Benefits VariousAspects of Healthy AgingP hysical activity is an effective approach to pre-venting chronic diseases.1We andothers have alsofound that physical activity in midlife is relatedto healthy aging.2-14 In this issue of the Archives, Savelaand colleagues report a significant positive associationbetweenhighermidlife physical activity and greater physi-cal function in oldermen; activity was not associatedwithother components of health-related quality of life. Ama-jor strength of this study is its long follow-up and de-tailed measures of quality of life in older age. However,2 limitations are notable. Assessment of physical activ-ity was limited, with 3 broad categories; thus, measure-ment errors might have attenuated associations. Sec-ond, the samplewas relatively small with 552 participants.In our previous study,14 as Savela et al note, we didnot consider individual quality of life components; ourinterest was in understanding overall successful sur-vival—a clear public health priority.Nonetheless, for com-parison, in our data, midlife physical activity was re-lated to the SF-36 mental health index and to physicalfunction (2 components in our definition of successfulsurvival, along with chronic diseases and cognition). Ad-justed odds ratios (95% confidence intervals) for the fifthvs first quintile of physical activity were 0.43 (0.38-0.49) (P value for trend,.001) for physical function and0.80 (0.72-0.90) (P value for trend, .001) for mentalhealth. Overall, however, despite relatively low power,the study by Savela et al adds to the growing evidencethat greater physical activity inmidlife contributes to as-pects of healthy aging.Author Affiliations:Departments of Nutrition (Drs SunandHu) and Epidemiology (Drs Hu andGrodstein), Har-vard School of Public Health, Boston,Massachusetts; andChanning Laboratory, Department ofMedicine, BrighamandWomen’s Hospital andHarvardMedical School, Bos-ton (Drs Hu and Grodstein).Correspondence:DrSun,DepartmentofNutrition,HarvardSchool of Public Health, 665 Huntington Ave, Room 349,Bldg 2, Boston, MA 02115 (qisun@hsph.harvard.edu).Financial Disclosure: None reported.Funding/Support: This study was supported by re-search grants AG13482, AG15424, and CA40356 fromSalla L. Savela, MDPentti Koistinen, MD, PhDReijo S. Tilvis, MD, PhDArto Y. Strandberg, MDKaisu H. Pitkälä, MD, PhDVeikko V. Salomaa, MD, PhDTatu A. Miettinen, MD, PhDTimo E. Strandberg, MD, PhDQi Sun, MD, ScDFrank B. Hu, MD, PhDFrancine Grodstein, ScD(REPRINTED) ARCH INTERN MED/VOL 170 (NO. 13), JULY 12, 2010 WWW.ARCHINTERNMED.COM1172©2010 American Medical Association. All rights reserved.Downloaded From: http://archinte.jamanetwork.com/ by a National Public Hlth Institute-Finland User  on 05/13/2014

Physical activity at midlife and health-related quality of life in older men

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Physical activity at midlife and health-related quality of life in older men

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