Change in physical activity and accumulation of cardiometabolic risk factors

Impact of Obesity on Cardiac Autonomic System Functioning in Military Police Officers

INTRODUCTION

Cardiac autonomic system functioning may be altered by obesity leading to cardiovascular diseases and associated complications. Military police officers are exposed to traditional and occupational risk factors for the development of CVD, however data on the cardiovascular health in this population is still scarce.

AIM

In this cross-sectional study, we investigated the impact of obesity on cardiac autonomic modulation and the hemodynamic profile in male active-duty military police officers.

METHODS

The body composition of the volunteers was assessed by octapolar electrical bioimpedance. Participants were classified as non-obese or obese in accordance with their body fat, with further subgroups as physically active obese or insufficiently active obese using International Physical Activity Questionnaire (IPAQ). Cardiac autonomic modulation was assessed by heart rate variability and the automatic oscillometric method allowed us to assess hemodynamic features.

RESULTS

102 military police officers from the state of São Paulo participated in the study. Cardiac autonomic modulation revealed significant impairment in time and frequency domains and non-linear methods in the obese group compared to the non-obese (p < 0.05). A higher physical activity level did not alter these results in the obese group. However, no significant differences in the hemodynamic profile were observed between groups (p > 0.05).

CONCLUSION

These findings suggest a negative association between obesity and cardiac autonomic modulation in military police officers, unaffected by increased physical activity.

Are changes in sleep problems associated with changes in life satisfaction during the retirement transition?

Retirement reduces sleep problems, but changes in life satisfaction during the retirement transition are multifactorial and partly unknown. The aim of this prospective cohort study was to examine whether changes in sleep problems are associated with changes in total and domain-specific life satisfaction during the retirement transition (on average 0.5 years before and 0.5 years after retirement). The study population consisted of Finnish public sector employees (n = 3518) from the Finnish Retirement and Aging (FIREA) study who responded to annual surveys before and after transition to statutory retirement. Sleep problems were measured with Jenkins Sleep Problem Scale questionnaire and participants were grouped into four sleep problem groups depending on the state of their sleep problems during the retirement transition: 'Never,' 'Decreasing,' 'Increasing,' and 'Constant' sleep problems. Life satisfaction was measured with the Life Satisfaction Scale questionnaire including four domains (interestingness, happiness, easiness, togetherness). We found that the improvement in total life satisfaction was greatest for participants in the 'Decreasing' (0.17, 95% CI 0.11-0.23, SMD 0.27) and 'Constant' (0.12, 95% CI 0.07-0.18, SMD 0.19) sleep problem groups. Of the specific life satisfaction domains, similar findings were observed only for the easiness domain. It seems that decreasing or constant sleep problems are associated with improved life satisfaction during the retirement transition, especially in the feeling of easiness of life. This may be due to the fact that as the demands of working life are removed, sleep problems are alleviated or it becomes easier to live with them, which improves life satisfaction.

Do Sleep Problems Explain the Association Between Work Stress and the Trajectories of Work Ability From Midlife to Pensionable Age?

OBJECTIVE

This study examined whether mid-life work stress, defined as job strain and effort-reward imbalance (ERI), predicts work ability trajectories observed 12 years preceding the individual pensionable age. In addition, the role of sleep problems as a mediator in these associations was examined.

METHODS

Survey data were collected from 2707 Finnish municipal employees.

RESULTS

Identified work ability trajectories were "stable excellent," "stable good," "moderate," and "low decreasing." Baseline job strain and ERI were associated with a greater likelihood of belonging to impaired work ability trajectories when compared with "stable good" trajectory. Baseline sleep problems explained the association of job strain by 38% and of ERI by 54%.

CONCLUSIONS

Mid-life work stress is associated with work ability in the last years preceding pensionable age. Sleep problems might be a potential mediator in these associations.

Concurrent changes in physical activity and physical functioning during retirement transition-a multi-trajectory analysis

BACKGROUND

Physical activity and physical functioning have been reported to change over retirement transition, but the results have been inconsistent, and the two constructs have not been studied concurrently. The objective of this study was to examine concurrent changes in physical activity and physical functioning during transition to retirement among public sector employees, and to examine if occupation, sex, marital status, body mass index (BMI), alcohol consumption and smoking status are associated with observed different multi-trajectory paths.

METHODS

3,550 participants of the Finnish Retirement and Aging study responded to an annual survey on physical activity and physical functioning (SF-36) before and after retirement. Group-based multi-trajectory analysis was used to identify clusters with dissimilar concurrent changes in physical activity and physical functioning. Multinomial regression analysis was used to describe the associations between covariates and the probability of being classified to a certain cluster.

RESULTS

Participants were 63.4 (SD 1.4) years old, 83% women, 65% professional workers. Four trajectories of concurrent changes in physical activity and physical functioning were identified, one with decreasing physical functioning and low activity, one with increasing high activity and stable high functioning and two with fluctuating moderate physical activity and stable high functioning. Single, women, obese participants and risk-users of alcohol were more likely to be classified into group with low physical activity and declining physical functioning.

CONCLUSIONS

Low physical activity below the level usually recommended was associated with lower physical functioning during retirement transition. These findings could be useful when planning interventions for retirees to maintain their physical functioning level.

Physical activity and self-rated health during retirement transition: a multitrajectory analysis of concurrent changes among public sector employees

OBJECTIVES

The aim of the study was to evaluate concurrent changes in physical activity and self-rated health during retirement transition over 4 years by multivariate trajectory analysis and to examine whether sociodemographic and lifestyle factors predict the probability of being classified to a certain subgroup of observed changes.

DESIGN

Prospective cohort study.

SETTING

Public sector employees.

PARTICIPANTS

3550 participants of the Finnish Retirement and Aging study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants estimated on a yearly questionnaire their weekly hours of different types of activities converted to metabolic equivalent of task-hour/week. Self-rated health was assessed on a 5-point Likert-like scale from poor to excellent and dichotomised as suboptimal and optimal. Multivariate trajectory analysis was used to distinguish different subgroups of trajectories. Multinomial regression analysis was used to describe the associations between covariates and the probability of being classified to a certain trajectory group.

RESULTS

Three trajectory groups were identified, all displaying increasing activity during retirement with a simultaneous decrease in perceived suboptimal health. Physical activity peaked at 18 months after retirement and then slightly decreased, except for initially highly physically active participants (9%) with good self-rated health, who demonstrated a constant high level of physical activity. Male gender, professional occupation, being married or cohabiting, body mass index <30 kg/m2, not smoking and using alcohol below risk levels were associated with higher physical activity and better self-rated health.

CONCLUSION

Changes in physical activity and perceived health during retirement transition were interconnected. Both were improved during retirement transition, but the change was temporary. Longer follow-up studies are required to assess the changes over a longer period after retirement.

The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women's Lifespan: An Updated Review

Physical inactivity (PI) represents a significant, modifiable risk factor that is more frequent and severe in the female population worldwide for all age groups. The physical activity (PA) gender gap begins early in life and leads to considerable short-term and long-term adverse effects on health outcomes, especially cardiovascular (CV) health. Our review aims to highlight the prevalence and mechanisms of PI across women's lifespan, describing the beneficial effects of PA in many physiological and pathological clinical scenarios and underlining the need for more awareness and global commitment to promote strategies to bridge the PA gender gap and limit PI in current and future female generations.

Longitudinal associations between physical activity and five risk factors of metabolic syndrome in middle-aged adults in Germany

BACKGROUND

We examined the longitudinal association between (change in) physical activity (PA) with new onset of five risk factors of metabolic syndrome among 657 middle-aged adults (mean age 44.1 (standard deviation (SD) 8.6) years) who were free of the respective outcome at baseline, in a longitudinal cohort study spanning over 29 years.

METHODS

Levels of habitual PA and sports-related PA were assessed by a self-reported questionnaire. Incident elevated waist circumference (WC), elevated triglycerides (TG), reduced high-density lipoprotein cholesterols (HDL), elevated blood pressure (BP), and elevated blood-glucose (BG) were assessed by physicians and by self-reported questionnaires. We calculated Cox proportional hazard ratio regressions and 95% confidence intervals.

RESULTS

Over time, participants developed (cases of incident risk factor; mean (SD) follow-up time) elevated WC (234 cases; 12.3 (8.2) years), elevated TG (292 cases; 11.1 (7.8) years), reduced HDL (139 cases; 12.4 (8.1) years), elevated BP (185 cases; 11.4 (7.5) years), or elevated BG (47 cases; 14.2 (8.5) years). For PA variables at baseline, risk reductions ranging between 37 and 42% for reduced HDL levels were detected. Furthermore, higher levels of PA (≥ 16.6 METh per week) were associated with a 49% elevated risk for incident elevated BP. Participants who increased PA levels over time, had risk reductions ranging between 38 and 57% for elevated WC, elevated TG and reduced HDL. Participants with stable high amounts of PA from baseline to follow-up had risk reductions ranging between 45 and 87% for incident reduced HDL and elevated BG.

CONCLUSIONS

PA at baseline, starting PA engagement, maintaining and increasing PA level over time are associated with favorable metabolic health outcomes.

Sex and Age Differences in Association between Physical Activity and Metabolic Syndrome: Results from NHANES 2003-2006

OBJECTIVE

To examine whether and how sex and age modify the association between accelerometer-based physical activity (PA) and metabolic syndrome (MetS) among American (US) adults.

METHOD

Adults aged ≥20 years old who participated in the mobile center examination during 2003-2006 in the National Health and Nutrition Examination Survey were included for analysis. The total minutes per day of moderate-to-vigorous PA (MVPA) was estimated using ActiGraph. Multivariable logistic regression was used to estimate the odds ratio (OR) of having MetS at an increasing MVPA time. The modification effects of gender and age on the association between MetS and MVPA time were examined by testing for two-way and three-way interaction terms of MVPA time, sex, and age in the model after adjusting for relevant covariates.

RESULTS

The prevalence of MetS generally decreased with the MVPA time and was lower in females than in males, although the sex difference varied across age groups. After adjusting for demographic and lifestyle covariates, there was a significant sex difference in how an increased MVPA time lowered the odds of MetS. This interactive effect also varied with age. MVPA benefitted young and middle-age populations up until about 65 years old for both sexes, and the protective effect weakened with age. Although the effect of MVPA was stronger for males than females at young ages, the rate at which it attenuated was quicker in males. The OR of MetS between males and females per unit change of MVPA time was 0.73 (95% CI: [0.57, 0.93]) at age = 25 years, compared to OR = 1.00 (95% CI: [0.88, 1.16]) at age = 60 years. Before the age of 50, the gender difference in the protective effect on MetS was larger at low MVPA levels and became smaller at higher MVPA levels. The male advantage was quite stable with an increasing MVPA time for ages 50-60, and no longer significant at older ages.

CONCLUSIONS

Young and middle-age populations benefitted from MVPA, lowering the risk of MetS for both sexes. A longer MVPA time was associated with a greater decrease in the risk of MetS in young men than in women, but the sex difference reduced with age and was no longer apparent in older populations.

Longitudinal Association between Physical Activity, Blood Lipids, and Risk of Dyslipidemia among Chinese Adults: Findings from the China Health and Nutrition Surveys in 2009 and 2015

Physical activity is needed in today’s highly sedentary society. Research into Chinese trends with respect to the longitudinal association between changes in physical activity (PA) and dyslipidemia (DL) is limited. The present study assessed PA and PA-related changes associated with the level of serum lipids, and the risk of dyslipidemia stratified by gender, via a population-based longitudinal observational study among adults (>18 years old) residing in nine provinces in China. Data of 3380 adult participants, gleaned from two surveys in 2009 and 2015 used by the China Health and Nutrition Survey (CHNS), were analyzed. Three-level random intercept growth models were used to calculate the associations between total physical activity (TPA), the four activity subtypes, and changes in the level of blood lipids. Three-level logistic regression models were utilized to assess the association between TPA and the risk of DL. The highest level of TPA was observed to correlate with the lowest prevalence of DL. Compared with the lowest level of TPA, the highest level of TPA increases the concentration of HDL-C (β = 0.050, 95% CI = 0.005, 0.096) in males, and also reduces the risk in males of having low HDL-C by 31% (OR = 0.69, 95% CI = 0.52, 0.91). Occupational PA was positively associated with higher HDL-C levels in both genders (males: β = 0.004, 95% CI = 0.002, 0.007; females: β = 0.002, 95% CI = 0.000, 0.004), and leisure-time physical activity (LTPA) was negatively associated with TG levels in males. Increasing TPA benefited HDL-C levels in males, irrespective of the level of basic TPA of individuals. Physical activity (especially occupational PA) was superior in positively influencing HDL-C in males, but not in females. Leisure-time physical activity needs to be increased substantially in order to increase TPA to levels that would be beneficial to blood lipid levels and DL, irrespective of baseline TPA levels.

Multi-trajectory analysis of changes in physical activity and body mass index in relation to retirement: Finnish Retirement and Aging study

BACKGROUND

Physical activity and body mass index (BMI) have been reported to change around retirement. The objective was to examine the concurrent changes in physical activity and BMI around retirement, which have not been studied before. In addition, the associations of different demographic characteristics with these changes were examined.

METHODS

The prospective cohort study consisted of 3,351 participants in the ongoing Finnish Retirement and Ageing Study (FIREA). Repeated postal survey, including questions on physical activity and body weight and height, was conducted once a year up to five times before and after the retirement transition, the mean follow-up time being 3.6 years (SD 0.7). Group-based multi-trajectory modeling was used to identify several clusters with dissimilar concurrent changes in physical activity and BMI within the studied cohort.

RESULTS

Of the participants, 83% were women. The mean age at the last wave before retirement was 63.3 (SD 1.4) years. Four clusters with different trajectories of physical activity and BMI were identified. BMI remained stable around retirement transition in all four clusters, varying from normal weight to class II obesity. The association of BMI trajectories with physical activity levels were inverse, however, each activity trajectory showed a temporary increase during the retirement transition.

CONCLUSIONS

Retirement seems to have more effect on physical activity than BMI, showing a temporary increase in physical activity at the time of retirement.

Association between exercise habit changes and mortality following a cardiovascular event

OBJECTIVE

To investigate the associations between exercise habit changes following an incident cardiovascular event and mortality in older adults.

METHODS

We analysed the relationship between exercise habit change and all-cause, cardiovascular and non-cardiovascular deaths in adults aged ≥60 years between 2003 and 2012 who underwent two consecutive health examinations within 2 years before and after diagnosis of cardiovascular disease (CVD). They were categorised into four groups according to exercise habit changes: persistent non-exercisers, exercise dropouts, new exercisers and exercise maintainers. Differences in baseline characteristics were adjusted using inverse probability of treatment weighting.

RESULTS

Of 6076 participants, the median age was 72 (IQR 69-76) years and men accounted for 50.6%. Compared with persistent non-exercisers (incidence rate (IR) 4.8 per 100 person-years), new exercisers (IR 3.5, HR 0.73, 95% CI 0.58 to 0.91) and exercise maintainers (IR 2.9, HR 0.53, 95% CI 0.38 to 0.73) were associated with reduced risk of all-cause death. The rate of non-cardiovascular death was significantly lower in new exercisers (IR 2.3, HR 0.73, 95% CI 0.56 to 0.95) and exercise maintainers (IR 2.3, HR 0.61, 95% CI 0.42 to 0.90) than in persistent non-exercisers (IR 3.2). Also, trends towards reduced cardiovascular death in new exercisers and exercise maintainers were observed (p value for trend <0.001).

CONCLUSIONS

More virtuous exercise trajectories in older adults with CVD are associated with lower mortality rates. Our results support public health recommendations for older adults with CVD to perform physical activity.

Relationship of leisure-time and household physical activity level and type with cardiovascular disease: secondary analysis of the Takashima Study data

Background

High levels of participation in leisure-time and household physical activity lower the risk of cardiovascular disease (CVD), although it is unclear whether the number of activity types is related to new-onset CVD. We aimed to evaluate the effect of the amount of leisure-time physical activity and the number of types of leisure-time physical activities on the risk of CVD incidence.

Methods

From 2002 to 2003, 3,741 participants without any history of CVD participated in the Takashima Study. Data on the amount of leisure-time and household physical activity and the types of leisure-time and household physical activity were obtained from a self-administered questionnaire. Hazard ratios for CVD (acute myocardial infarction and stroke) incidence (follow-up data from 2002 to 2013), according to the participation level and number of activity types, were calculated using Cox proportional hazards models.

Results

The mean age of the subjects was 58.7 ± 13.1 years. During the mean follow-up period of 8.0 ± 1.1 years, 92 participants developed CVD. An inverse dose–response relationship was noted between the amount of leisure-time and household physical activity and CVD events. After adjusting for baseline characteristics, lifestyle-related diseases, and the amount of physical activity other than leisure-time and household, the risk of CVD onset was compared by dividing the participants into two groups by the level of participation; the highest activity group had an adjusted hazard ratio (95% confidence interval) of 0.40 (0.20–0.82) compared to the lowest activity group. Compared to participants who engaged in 0–1 type of activity, participants who engaged in two or more types of activities had a multivariable-adjusted hazard ratio (95% confidence interval) of 0.31 (0.12–0.79).

Conclusion

Increasing the amount of leisure-time and household physical activity and promoting engagement in two or more types of such activities may reduce the rate of CVD incidence in the Japanese general population.

Associations of changes in physical activity and discretionary screen time with incident obesity and adiposity changes: longitudinal findings from the UK Biobank

BACKGROUND

Physical activity (PA) and discretionary screen time (DST; television and computer use during leisure) are both associated with obesity risk, but little longitudinal evidence exists on their combined influence. This study examined the independent and joint associations of changes in PA and DST with incident obesity, body mass index (BMI) and waist circumference (WC).

METHODS

We analysed the data of individuals aged 40-69 years from the UK Biobank, a large-scale, population-based prospective cohort study. PA was measured using the International Physical Activity Questionnaire and DST was defined as the total of daily TV viewing and non-occupational computer use. Changes in PA and DST over time were defined using departure from sex-specific baseline tertiles and categorised as worsened (PA decreased/DST increased), maintained, and improved (PA increased/DST decreased). We then used each exposure change to define a joint PA-DST change variable with nine mutually exclusive groups. We used multivariable adjusted mixed-effects linear and Poisson models to examine the independent and joint associations between PA and DST changes with BMI and WC and incident obesity, respectively. Development of a BMI ≥ 30 kg/m² was defined as incident obesity.

RESULTS

Among 30,735 participants, 1,628 (5.3%) developed incident obesity over a mean follow-up of 6.9 (2.2) years. In the independent association analyses, improving PA (Incident Rate Ratio (IRR) 0.46 (0.38-0.56)) was associated with a lower risk of incident obesity than maintaining PA, maintaining DST, or improving DST. Compared to the referent group (both PA and DST worsened), all other combinations of PA and DST changes were associated with lower incident obesity risk in the joint association analyses. We observed substantial beneficial associations in the improved PA groups, regardless of DST change [e.g., DST worsened (IRR 0.31 (0.21-0.44)), maintained (IRR 0.34 (0.25-0.46)), or improved (IRR 0.35 (0.22-0.56)]. The most pronounced decline in BMI and WC was observed when PA was maintained or improved and DST was maintained.

CONCLUSION

We found that improved PA had the most pronounced beneficial associations with incident obesity, irrespective of DST changes. Improvements in PA or DST mutually attenuated the deleterious effects of the other behaviour's deterioration.

Sleep duration and sleep difficulties as predictors of occupational injuries: a cohort study

STUDY OBJECTIVES

To examine the association between sleep duration and sleep difficulties with different types and causes of workplace and commuting injuries.

METHODS

The data were derived from the Finnish Public Sector study including 89.543 participants (178.309 person-observations). Participants reported their sleep duration and sleep difficulties between 2000 and 2012. These were linked to occupational injury records from the national register maintained by the Federation of Accident Insurance Institutions. Risk of injuries was followed up 1 year after each study wave. Logistic regression analysis with generalised estimating equations (GEEs) was used to examine the association between sleep duration/difficulties and risk of injuries, and multinomial logistic regression with GEE was used to examine the association with injury types and causes.

RESULTS

Both sleep duration and difficulties were associated with injuries. Employees with short sleep (≤6.5 hours) had 1.07-fold odds of workplace injuries (95% CI 1.00 to 1.14) and 1.14 times higher odds of commuting injuries (95% CI 1.04 to 1.26) compared with employees with normal sleep duration. For employees with disturbed sleep, the corresponding ORs were 1.09-fold (95% CI 1.02 to 1.17) and 1.14-fold (95% CI 1.04 to 1.26) compared with those without sleep difficulties, respectively. The risk of commuting injuries was higher among those who had difficulty in falling asleep (OR 1.29, 95% CI 1.07 to 1.55), woke up too early (OR 1.11, 95% CI 1.00 to 1.23) or had non-restorative sleep (OR 1.18, 95% CI 1.05 to 1.33).

CONCLUSIONS

Short sleep duration and sleep difficulties are associated with slightly increased risk of workplace and commuting injuries.

Physical activity and stroke among women - A non-linear relationship

Studies have identified non-linear inverse relationships between physical activity and the risk of stroke. A U-shaped response has been observed between haemorrhagic stroke and physical activity. The objective of this study was to investigate the associations between physical activities on stroke. We used data from the E3N cohort study, a French prospective study of women initiated in 1990. From the women in the study, we included those without cardiovascular disease or cancer at baseline, resulting in 94,169 women. We assessed total physical activity in 1993, grouped as quartiles. Cox models adjusted for potential confounders were used to assess the relationship with stroke, considering cases until 2008. Splines were used to assess the shape of the response. Similarly, we then considered high and low-intensity physical activity grouped as tertiles. Among the included women, with a mean age of 51.2 ± 6.7 years, 592 cases of stroke were identified over an average follow-up time of 16.2 years. Total physical activity was associated with a lower stroke risk (HR_Q1-Q4 = 0.38 [0.31, 0.49]). An inverse relationship was observed between physical activity and all stroke sub-types. A non-linear (L-shaped) relationship was observed for all-stroke, and ischemic stroke, and a U-shaped response for sub-arachnoid and intracerebral haemorrhage. High-intensity activities were associated with a U-shaped response for haemorrhagic stroke types. Low-intensity activities were associated with a linear response for all stroke types. Our results support other observations that physical activity may reduce stroke risk.

Sports activity patterns and cardio-metabolic health over time among adults in Germany: Results of a nationwide 12-year follow-up study

BACKGROUND

Physical activity is favorable for health, and vigorous sports activity is particularly beneficial. This study investigates the association between changes in sports participation patterns over time and cardio-metabolic and self-perceived health outcomes.

METHODS

Data from 3752 adults (18-79 years of age) who participated in 2 national health interview and examination surveys in 1997-1999 and 2008-2011 were included, with a mean follow-up time of about 12 years. A change in self-reported sports activity was analyzed with respect to the incidence of type 2 diabetes, coronary heart disease (CHD), hypertension, obesity, dyslipidemia, metabolic syndrome, and poor self-perceived health. Participants with pre-existing disease or risk factor of interest at baseline were excluded from the analysis. Being sufficiently active in sports was specified as doing sports for at least 1-2 h per week, and 4 activity categories were defined: 1) inactive at both time points (inactive-inactive), 2) inactive at baseline and active at follow-up (inactive-active), 3) active at baseline and inactive at follow-up (active-inactive), and 4) active at both time points (active-active). Associations between sports activity engagement and health outcomes were estimated by logistic regression models with different stages of adjustments.

RESULTS

Not engaging in any regular sports activity at both time points (inactive-inactive) was associated with higher rates of type 2 diabetes (odds ratio (OR) = 1.82, 95% confidence interval (95%CI): 1.08-3.08), CHD (OR = 1.82, 95%CI: 1.16-2.84), hypertension (OR = 1.36, 95%CI: 1.03-1.81), metabolic syndrome (OR = 1.58, 95%CI: 1.08-2.32), and poor self-perceived health (OR = 2.54, 95%CI: 1.83-3.53) compared to doing regular sports for a minimum of 1-2 h per week over time (active-active). In case of change from inactivity to any regular sports activity (inactive-active), the rate of risk factor occurrence was not statistically different from the active-active reference group except for poor self-perceived health, but it was higher for type 2 diabetes (OR = 2.15, 95%CI: 1.12-4.14) and CHD (OR = 1.77, 95%CI: 1.03-3.03). Being active at baseline but inactive at follow-up (active-inactive) was not associated with higher disease incidence of type 2 diabetes (OR = 0.70, 95%CI: 0.25-1.97) or CHD (OR = 1.20, 95%CI: 0.49-2.99), but was associated with higher rates of hypertension (OR = 1.61, 95%CI: 1.11-2.34), obesity (OR = 2.34, 95%CI: 1.53-3.57), metabolic syndrome (OR = 1.70, 95%CI: 1.11-2.63), and poor self-perceived health (OR = 2.16, 95%CI: 1.53-3.07) at follow-up.

CONCLUSION

Even a low weekly quantity (1-2 h) of regular sports activity is partly associated with health benefits. Being formerly but not currently active was not associated with an increased disease incidence, but was associated with a higher risk-factor development compared to the reference group (active-active). Becoming active was preventive for risk-factor development but was not preventive for disease incidence, which probably means that the health benefits from sports activity are not sustainable and disease incidence is only shifted to a later period in life. For this reason, the promotion of and commitment to regular sports activity should be addressed as early as possible over the lifespan to achieve the best health benefits.

Daily Physical Activity Patterns and Their Association With Health-Related Physical Fitness Among Aging Workers-The Finnish Retirement and Aging Study

BACKGROUND

This study aimed to identify accelerometer-measured daily physical activity patterns, and to examine how they associate with health-related physical fitness among aging workers.

METHODS

The study population consisted of 263 participants (mean age 62.4 years, SD 1.0) from the Finnish Retirement and Aging study, who used wrist-worn ActiGraph accelerometer for at least 1 week including both workdays and days off. Health-related physical fitness measures included body composition (waist circumference, bioimpedance), cardiorespiratory fitness (bicycle ergometer test), and muscular fitness (push-up and chair rise tests).

RESULTS

Based on the latent class trajectory analysis, 6 trajectories were identified for workdays showing variation in activity level on working hours and on evening hours. Moderate activity during working hours and increase of activity level in the evening was associated with the most favorable health-related fitness in comparison to low activity throughout the workday: waist circumference 90.0 cm (95% confidence interval [CI] 85.5-94.5) versus 99.5 cm (95% CI 96.8-102.3), fat mass 13.9 kg (9.3-18.5) versus 23.8 kg (20.2-27.4), cardiorespiratory fitness 33.4 mL/kg/min (95% CI 31.4-35.3) versus 29.1 mL/kg/min (95% CI 27.8-30.3) (adjusted for age, sex, days off activity, smoking, and alcohol). For the days off, 2 different trajectories were identified, but they differed only in terms of level and not by timing of physical activity.

CONCLUSIONS

A large variation in the workday physical activity patterns was observed among aging workers. Independent of worktime activity, people who were more active in the evenings had more favorable health-related physical fitness than those who were less active throughout the day.

Assessment of Cardiometabolic Health, Diet and Physical Activity in Helicopter Rescue Paramedics

Objective: Shift work is an established risk factor for weight gain, cardiovascular disease, Type II diabetes mellitus, and impaired health-related quality of life (HRQoL). Prolonged exposure to shift work is common in paramedics and other emergency medical service (EMS) providers. Sub-populations of EMS workers may have varying health outcomes when exposed to shift work, but the reasons for this have not been investigated. We sought to describe cardiometabolic health, dietary patterns, physical activity, and health-related quality of life (HRQoL) in a sample of experienced intensive care flight paramedics (ICFPs) working for a Helicopter Emergency Medical Service (HEMS).Methods: Fifteen paramedics (median age 45, IQR 42-48 years) were recruited to undertake a range of health assessments. These included a food frequency questionnaire to assess dietary patterns, sampling of biomarkers to determine cardiometabolic health risk, maximal aerobic capacity assessment via treadmill running and assessment of HRQoL via the SF-36 survey. In an extension of the study protocol, ten of the fifteen participants wore a physical activity monitor for one year.Results: Median (IQR) weight was 79.9 (72.3-89.3) kg, body fat percentage 23.3 (21.9-26.5) %, body mass index (BMI) 25.1 (21.9-27.4) kg.m², and waist to height ratio 0.48 (0.45-0.54). Dietary analyses showed high discretionary food intake. Biomarkers of cardiometabolic health risk were all within normal range. HRQoL was 86.2/100 for physical health and 85.1/100 for mental health. V̇O_2max was 47.0 (43.0-54.6) mL.kg^-1.min^-1. The ten participants that wore activity monitors completed 11,235 (8334-15,380) steps per day and undertook 50 (12-98) minutes per day/350 (84-686) minutes per week of moderate to vigorous physical activity. The least amount of physical activity was conducted on day shifts.Conclusions: For ICFPs included in this study, HRQoL, cardiometabolic and physical activity outcomes are representative of good health. Although shift work influences the amount of physical activity, ICFPs exceeded minimum recommendations even when rostered to duty. Despite lengthy careers in EMS, ICFPs demonstrate an excellent health profile that is likely due to high physical activity levels and healthy BMI. This information may be useful in guiding health interventions in the wider EMS workforce.

Effects of the total physical activity and its changes on incidence, progression, and remission of hypertension

OBJECTIVES

Moderate to vigorous physical activity is recommended to prevent hypertension according to the current guidelines. However, the degree to which the total physical activity (TPA) and its changes benefit normotensives and hypertensives is uncertain. We aimed to examine the effects of TPA and its changes on the incidence, progression, and remission of hypertension in the large-scale prospective cohorts.

METHODS

A total of 73,077 participants (55,101 normotensives and 17,976 hypertensives) were eligible for TPA analyses. During a mean follow-up of 7.16 years (394,038 person-years), 12,211 hypertension cases were identified. TPA was estimated as metabolic equivalents and categorized into quartiles. Cox proportional hazards regression and multivariable logistic regression were used to estimate associations of TPA and changes in TPA with incident hypertension and progression/remission of hypertension.

RESULTS

Compared with the lowest quartile of TPA, normotensives at the third and the highest quartile had a decreased risk of incident hypertension, with hazard ratios (HRs) of 0.86 [95% confidence interval (CI): 0.81-0.91] and 0.81 (95% CI: 0.77-0.86), respectively. Hypertensives at the highest quartile of TPA demonstrated a decreased risk of progression of hypertension [odds ratio (OR) = 0.87, 95% CI: 0.79-0.95], and an increased probability of hypertension remission (OR = 1.17, 95% CI: 1.05-1.29). Moreover, getting active from a sedentary lifestyle during the follow-up period could reduce 25% (HR = 0.75, 95% CI: 0.58-0.96) risk of incident hypertension, whereas those becoming sedentary did not achieve benefit from initially being active.

CONCLUSIONS

Our findings indicated that increasing and maintaining TPA levels could benefit normotensives, whereas higher TPA levels were needed to effectively control progression and improve remission of hypertension. Physical activity played undoubtedly an essential role in both primary and secondary prevention of hypertension.

Insulin resistance and the adiponectin/leptin ratio as a surrogate measure of insulin resistance in Japanese collegiate baseball players

BACKGROUND

No study has previously investigated insulin resistance in collegiate baseball players. The purposes of this study were to examine: 1) the insulin resistance; and 2) the usefulness of the adiponectin/leptin (A/L) ratio compared with the homeostasis model assessment of insulin resistance (HOMA-IR) for assessing insulin resistance in collegiate baseball players.

METHODS

Twenty collegiate baseball players with abdominal obesity (AO group) defined by a waist circumference (WC) ≥85 cm, 65 lean baseball players with a WC<85 cm (L group), and 20 controls who were sedentary for at least 1 year (C group) were compared. The Body Mass Index, WC, systolic and diastolic blood pressures, fasting plasma glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, apolipoprotein B, insulin, leptin, adiponectin, and high-sensitivity C-reactive protein (hs-CRP) were measured.

RESULTS

The AO group had a significantly higher insulin level, HOMA-IR, and leptin level, and lower A/L ratio than the L and C groups. The AO group had a significantly higher prevalence of insulin resistance (50%) than the L (14%) group. The A/L ratio was significantly negatively correlated with body weight, Body Mass Index, WC, triglycerides, triglycerides/HDL-C ratio, apolipoprotein B, hs-CRP, insulin, HOMA-IR, and leptin, and positively correlated with HDL-C, whereas HOMA-IR was significantly positively correlated with body weight, Body Mass Index, WC, systolic and diastolic blood pressures, fasting plasma glucose, and insulin, and negatively correlated with adiponectin and the A/L ratio. In the forward stepwise multiple regression analysis, WC, triglycerides, and hs-CRP were the significant determinants for the A/L ratio, whereas diastolic blood pressure and WC were the significant determinants for HOMA-IR. This model explained 53.7% of the variance in the A/L ratio and 13.6% of the variance in HOMA-IR.

CONCLUSIONS

The present study suggested that the baseball players with abdominal obesity had a significantly higher prevalence of insulin resistance than the lean baseball group. The A/L ratio may be more useful than HOMA-IR to accurately assess insulin resistance in male collegiate baseball players.

Association between Health Indicators and Health-Related Quality of Life according to Physical Activity of Older Women

The purpose of this study was to compare sociodemographic factors, health factors and nutritional status according to the physical activity of older women, and to analyze the factors affecting their quality of life. The subjects of this study were 5661 older women aged 60 or older who participated in the Korean National Health and Nutrition Survey (KNHANES) from 2008 to 2013. The socioeconomic factors, subjective health status and disease status, lifestyle and dietary quality, and life quality were compared among two groups (active group and inactive group). The inactive group had significantly higher rates of obesity and unemployment, comorbidities, numbers without spouses, experiencing stress, poor subjective health status, depression or suicidal thoughts, and also higher rates of skipping meals. The life quality index and dietary quality was also significantly lower in the inactive group, and subjects experienced significantly higher pain or discomfort and problems in mobility and the usual activities. The results of multivariate analysis after adjusting for age in groups engaging in physical activities showed the life quality index to increase in accordance with the diet quality, economic income, and education level. It was confirmed that life quality was significantly low if the participant showed a poor subjective health evaluation, obese with many diseases, spouseless, and experienced high levels of stress. Considering the rapid aging and high life expectancy of women, regular physical activity is very important for maintaining health and improving the life quality of older women, and it is believed that comprehensive attention and management of lifestyle and diet quality are necessary.

Comparison between recent and long-term physical activity levels as predictors of cardiometabolic risk: a cohort study

OBJECTIVE

To compare recent and long-term physical activity levels as predictors of cardiometabolic risk in a risk factor-free adult population.

DESIGN

A 12-year prospective cohort study.

SETTING

The Finnish Public Sector study with surveys conducted in four waves at 4-year intervals.

PARTICIPANTS

19 230 participants (mean age 50.2 (SD 9.1) years, 84% women) with no prevalent cardiometabolic risk factors at wave 3 were included. Physical activity was assessed at waves 1, 2 and 3. The long-term physical activity level was determined as the mean of activity from wave 1 to 3 (over 8 years).

OUTCOME MEASURE

4-year incidence of cardiometabolic risk factors (obesity, hypertension, dyslipidaemia and diabetes) after wave 3, measured individually and as a sum (accumulation of two or more risk factors vs none). Logistic and multinomial logistic regression analyses were used for the analysis.

RESULTS

Graded associations between higher physical activity levels and lower odds of all risk factors were observed (p for trend <0.01). In comparison with the persistently vigorously active participants (≥60 metabolic equivalent (MET)-hours/week), those who were persistently inactive (<7 MET-hours/week) were about four times more likely to develop obesity (OR=4.24, 95% CI=2.83 to 6.36), two times more likely to develop hypertension (OR=2.02, 95% CI=1.45 to 2.82) and dyslipidaemia (OR=1.82, 95% CI=1.03 to 3.22) and eight times more likely to develop diabetes (OR=7.84, 95% CI=1.78 to 34.6). The corresponding OR for accumulating two or more risk factors was 5.24-fold (95% CI=2.39 to 11.47). For recently inactive versus recently vigorously active, the estimates were weaker (OR=2.36, 95% CI=1.71 to 3.25 for obesity; 1.78, 95% CI=1.35 to 2.35 for hypertension; 1.71, 95% CI=1.04 to 2.82 for dyslipidaemia; 3.56, 95% CI=1.06 to 11.96 for diabetes and 2.66, 95% CI=1.48 to 4.78 for ≥2 risk factors).

CONCLUSION

Cardiometabolic risk associated with physical inactivity is better captured by repeated measurements of physical activity than by a single measurement of the most recent activity level.

The relation of work-related factors with ambulatory blood pressure and nocturnal blood pressure dipping among aging workers

Objectives

Individuals with reduced nocturnal blood pressure (BP) dipping are at increased risk of cardiovascular disease compared to persons with normal BP dipping. Although the relation of work-related factors and BP has been studied extensively, very little is known of the association between work-related factors and 24-h BP patterns in aging workers. We examined the cross-sectional relation of work-related risk factors, including occupational status, work-time mode, job demands and job control, with ambulatory BP in aging workers, focusing on nocturnal BP dipping.

Methods

208 workers (mean age 62 ± 3 years; 75% women) from two Finnish population-based cohort studies underwent 24-h ambulatory BP monitoring. Work-related factors were inquired using a questionnaire. Nocturnal BP dipping was calculated as [1 − (asleep BP/awake BP)] × 100.

Results

Shift workers demonstrated a higher nocturnal diastolic BP dipping than regular day workers (19% vs. 17%, p = 0.03) and had a significantly higher systolic awake BP than regular day workers (136.5 mmHg vs. 132.5 mmHg, p = 0.03). Participants with high job demands demonstrated a smaller nocturnal systolic BP dipping than participants with low job demands (14% vs. 16%, p = 0.04). We did not observe significant differences in nocturnal systolic or diastolic BP dipping between groups categorized by occupational status or job control.

Conclusions

Although shift workers have a higher daytime BP than regular daytime workers, they exhibit greater nighttime BP dipping. Participants with high job demand had smaller nighttime BP dipping than participants with low job demand. Job control or occupation did not affect the 24-h ambulatory BP profile of aging workers.

Trajectories of self-rated health before and after retirement: evidence from two cohort studies

Objectives

Previous studies have produced conflicting findings on the health consequences of retirement. We aimed at identifying trajectories of self-rated health over retirement transition using repeated measurements and examined which preretirement factors predicted membership to each trajectory.

Methods

The study population consisted of Finnish public sector employees from two independent cohorts (Finnish Public Sector Study (FPS), n=5776 with a 4-year follow-up interval; and Finnish Retirement and Aging Study (FIREA), n=2796 with a 1-year follow-up interval). Both cohorts included assessment of self-rated health one to three times before and one to three times after retirement (average number of measurement points: 3.7 in FPS and 3.5 in FIREA). We used latent trajectory analysis to identify trajectories of self-rated health.

Results

In both cohorts four similar trajectories were identified: ‘Sustained good health’ (47% in FPS and 74% in FIREA), ‘From good to suboptimal health’ (19% and 6%), ‘From suboptimal to good health’ (14% and 8%) and ‘Sustained suboptimal health’ (20% and 12%). There were more women and persons in high occupational status in the ‘From suboptimal to good health’ trajectory group when compared with ‘Sustained suboptimal health’ trajectory group in FPS. Those in the trajectory ‘From good to suboptimal health’ had lower occupational status and higher job strain in comparison with those in the ‘Sustained good health’ trajectory in both cohorts.

Conclusions

A large majority of public sector employees maintain their perceived health status during retirement transition. Adverse trajectory in self-rated health relate to low occupational status and work-related stressors.

The Extended Postoperative Care-Score (EXPO-Score)-An Objective Tool for Early Identification of Indication for Extended Postoperative Care

Extended postoperative care and intensive care unit capacity is limited and efficient patient allocation is mandatory. This study aims to develop an effective yet simple score to predict indication for extended postoperative care, as there is a lack of objective criteria for early prediction of admission to extended care in surgical patients. This prospective observational study was divided into two periods (Period 1: Extended Postoperative Care-Score (EXPO)-Score generation; Period 2: EXPO-Score validation) and it was performed at a tertiary university center in Germany. A total of 4042 (Period 1) and 2198 (Period 2) adult patients ≥ 18 years old receiving elective or emergency surgery were included in this study. After identifying patient- and surgery-related risk factors by an expert panel, the EXPO-Score was developed through logistic regression from data of Period 1 and validated in Period 2. Three risk factors are sufficient for generating a reliable predictive EXPO-Score: (1) the American Society of Anesthesiologists’ (ASA) physical status, (2) cardiopulmonary physical exercise status expressed in metabolic equivalents (MET), and (3) the type of surgery. The score threshold (0.23) has a sensitivity of 0.87, a specificity of 0.91, and an accuracy of 0.90 for predicting indication for extended postoperative care. The EXPO-Score provides a validated, early collectable, and easy-to-use tool for predicting indication of extended postoperative care in adult surgical patients.