Association between education and future leisure-time physical inactivity: a study of Finnish twins over a 35-year follow-up

Genetic Liability to Higher Muscle Strength Associates With a Lower Risk of Cardiovascular Disease Mortality in Men Irrespective of Leisure-Time Physical Activity in Adulthood: A Longitudinal Cohort Study

BACKGROUND

Low muscle strength predicts premature mortality. We determined whether genetic liability to muscle strength is associated with mortality and whether this association is influenced by long-term leisure-time physical activity (LTPA).

METHODS AND RESULTS

We estimated the effects of a polygenic score for handgrip strength (PGS HGS) on all-cause and cardiovascular disease (CVD) mortality risk in the older Finnish Twin Cohort (N=8815, 53% women). LTPA was assessed longitudinally using validated questionnaires. During the 16.9-year median follow-up (143 723 person-years), 2896 deaths occurred, of which 1089 were attributable to CVD. We found a significant interaction between sex and PGS HGS (P=0.016) in relation to all-cause mortality. In men, 1-SD increase in the PGS HGS was associated with a decreased risk of all-cause (hazard ratio [HR], 0.93 [95% CI, 0.89-0.98]) and CVD mortality (HR, 0.88 [95% CI, 0.81-0.96]), but was not statistically significantly associated with mortality in women (HR, 1.01 [95% CI, 0.96-1.07]; and HR, 0.96 [95% CI, 0.87-1.05], respectively). In men, associations remained after adjusting for LTPA and persisted for CVD mortality (HR, 0.85 [95% CI, 0.76-0.96]), even after accounting for other lifestyle covariates. This remained statistically significant even when non-CVD death was accounted for as a competing risk event. No PGS HGS×LTPA interactions were found. The predictive area under the curve estimates for PGS HGS alone were limited (0.53-0.64) but comparable to that of several lifestyle factors.

CONCLUSIONS

Higher PGS HGS was associated with a decreased risk of CVD mortality in men. Long-term LTPA in adulthood did not potentiate this association.

How are socioeconomic status, social support, and health history associated with unhealthy lifestyle behaviours in middle-aged adults? Results of the Swedish CArdioPulmonary bioImage Study (SCAPIS) COHORT

BACKGROUND

Unhealthy lifestyle behaviours, including unhealthy alcohol consumption, physical inactivity, smoking, and nonadherence to dietary recommendations, are major contributors to non-communicable diseases and mortality. While adopting healthy behaviours can reduce these risks in middle-aged adults, research is limited. Therefore, the aim of this study was to assess the distribution of unhealthy lifestyle behaviours in middle-aged adults and their associations with socioeconomic factors, social support, and history of disease.

METHOD

This was a cross-sectional study of the Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort (2013-2018) at six Swedish university hospitals. Multilevel regression models were estimated using Bayesian inference with priors shrinking covariate estimates towards the null.

RESULTS

In total, 59 909 participants, aged 50-64 years old were invited to SCAPIS, of which 30 154 (50.3%) decided to participate. The mean age of participants was 58 (SD = 4) years old, and 51% were women (n = 15 508). Men had higher unhealthy alcohol consumption and were less adherent to dietary recommendations compared to women. Older participants were more physically inactive compared to younger participants. Low education and financial difficulties were associated with smoking, physical inactivity, and poor diet adherence. Financial difficulties were also associated with unhealthy alcohol consumption. Having more people to turn to in difficulties was associated with lower alcohol consumption. Lack of appreciation and comfort support was associated with smoking and poor diet adherence. Diabetes was associated with lower alcohol consumption. Diabetes and lung diseases were associated with smoking and inactivity.

CONCLUSIONS

Middle-aged adults with lower socioeconomic status, less quality social support, and a history of disease were more likely to engage in unhealthy behaviours. This study helps to identify groups of middle-aged adults who may require additional attention when it comes to prioritizing the development of preventive measures.

Physical activity, fear avoidance beliefs and level of disability in a multi-ethnic female population with chronic low back pain in Suriname: A population-based study

BACKGROUND

Chronic low back pain (CLBP) is an important cause for reduced daily physical activity (PA) and loss of quality of life, especially in women. In Suriname, a middle-income country in South America, the relationship between PA and CLBP is still unknown.

AIMS

To assess the level of PA in women with CLBP of different ethnicity, and to identify whether fear avoidance beliefs (FAB), disability, co-occurring musculoskeletal pain sites and various sociodemographic and lifestyle factors were associated with self-reported PA.

METHODS

A cross-sectional community-based house-to-house survey was conducted between April 2016 and July 2017. The survey followed the Community Oriented Program for Control of Rheumatic Diseases methodology. Selection criteria were being female of Asian-Surinamese, African-Surinamese or of Mixed ethnicity and aged 18 or older, living in an urban area, and reporting CLBP. Data was collected on PA, FAB, disability, co-occurring musculoskeletal pain sites, CLBP intensity and sociodemographic and lifestyle factors.

RESULTS

Urban adult women with current CLBP (N = 210) were selected. Nearly 57% of the population met the WHO recommendation on PA, with work-related PA as the largest contributor to total self-reported PA. Most women showed low FAB scores (FABQ-Work ≤34 (96.2%) and FABQ-PA ≤14 (57.6%)) and low disability levels (Oswestry Disability Index ≤20 (62.4%)). An inverse association between total PA and FABQ-Work (OR = 0.132, CI: 0.023; 0.750) was found. In contrast, total PA had a significant, positive association with disability (OR = 2.154, CI: 1.044; 4.447) and workload (OR = 2.224, CI: 1.561; 3.167). All other variables showed no association with total PA.

CONCLUSION

This was the first study in Suriname reporting that 43.3% of urban adult women with CLBP were physically inactive. Total self-reported PA is influenced by FABQ-Work, average to heavy workload and moderate to severe disability. In this study, PA-Work was the major contributor to total PA. Therefore, future longitudinal studies should evaluate different types and aspects of PA in relation to CLBP management.

Physical inactivity in nine European and Central Asian countries: an analysis of national population-based survey results

Background

Physical inactivity is a major risk factor for non-communicable diseases. However, recent and systematically obtained national-level data to guide policy responses are often lacking, especially in countries in Eastern Europe and Central Asia. This article describes physical inactivity patterns among adults in Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan.

Methods

Data were collected using the Global Physical Activity Questionnaire drawing nationally representative samples of adults in each country. The national prevalence of physical inactivity was calculated as well as the proportional contribution to total physical activity (PA) during work, transport and leisure-time. An adjusted logistic regression model was applied to analyze the association of age, gender, education, household status and income with physical inactivity.

Results

National prevalence of physical inactivity ranged from 10.1% to 43.6%. The highest proportion of PA was registered during work or in the household in most countries, whereas the lowest was during leisure-time in all countries. Physical inactivity was more likely with older age in eight countries, with female gender in three countries, and with living alone in three countries. There was no clear pattern of association with education and income.

Conclusion

Prevalence of physical inactivity is heterogeneous across the region. PA during leisure-time contributes minimally to total PA in all countries. Policies and programs that increase opportunities for active travel and leisure-time PA, especially for older adults, women and people living alone will be an essential part of strategies to increase overall population PA.

Physical Activity in Women With Hypothyroidism on Thyroid Hormone Therapy: Associated Factors and Perceived Barriers and Benefits

BACKGROUND

The purpose of this study was to analyze factors associated with physical activity (PA) and to identify perceived barriers and benefits of PA among patients with hypothyroidism on thyroid hormone therapy.

METHODS

This survey-based cross-sectional study was conducted among members of the Dutch thyroid patient organization. Self-reported data on respondents' PA levels and demographic, clinical, and physical health variables were collected. Moreover, perceived barriers and benefits to PA were identified. Respondents were categorized as physically active when meeting the recommended Dutch PA guidelines and physically inactive otherwise. To compare physically active and inactive respondents, potential confounders were entered into univariate analyses. Factors showing significant correlations (P < .20) were added to a multivariate model to determine the associated factors of PA.

RESULTS

About 1724 female respondents (mean age 53.0 [11.6] y) were included; 16.1% reported meeting the PA recommendations. Multivariate analysis showed that factors associated with PA included levothyroxine/liothyronine therapy, comorbidities, self-perceived physical fitness, and diminished physical endurance. Overall, physically related barriers to PA were rated highest.

CONCLUSIONS

The vast majority of treated hypothyroid respondents are physically inactive and experience long-term exercise intolerance. Considering the health implications of physical inactivity, promotion of regular PA is of key importance in this population.

Perioperative Exercise Intention and Influencing Factors: A Multi-Centered Cross-Sectional Study

Objectives: This study aimed to evaluate the level and factors affecting the perioperative exercise intention in China. Design: This study was a cross-sectional survey in Southwest China. Methods: Four hundred and ninety nine participants were randomly sampled in eight medical centers from November 23, 2020 to November 27, 2020. The survey included sociodemographic information and a 24-item modified questionnaire, which aimed to evaluate the attitude toward daily exercise, perception of perioperative exercise, social support and the perioperative exercise intention. A multivariable linear regression model was used to evaluate the effect of different items on the patients' intention for perioperative exercise. Results: A total of 523 responses (95.09%) were collected and 499 (95.41%) were analyzed. The level of exercise intention of the patients during the perioperative period was: 14.83% planned to exercise every day in the hospital, 21.04% planned to exercise every other day, and 35.87% planned to exercise every week. Intensity of daily exercise (P = 0.016), positive attitude of daily exercise (P < 0.001), positive attitude of perioperative exercise (P < 0.001) and social support (P < 0.001) were positively associated with the intention for perioperative exercise. Female (P = 0.012), non-tertiary center (P = 0.011), and preoperative anxiety (P = 0.023) was negatively associated with it. Conclusions: The intention for perioperative exercise was low in Southwest China. The authors aimed to relieve preoperative anxiety, promote the education of perioperative exercise, design perioperative exercise programs, and provide more social support from medical staff and family for inpatients undergoing elective surgery.

Understanding Vocational Students' Motivation for Dietary and Physical Activity Behaviors

Unhealthy eating behaviors and low levels of physical activity are major problems in adolescents and young adults in vocational education. To develop effective intervention programs, more research is needed to understand how different types of motivation contribute to health behaviors. In the present study, Self-Determination Theory is used to examine how motivation contributes to dietary and physical activity behaviors in vocational students. This cross-sectional study included 809 students (mean age 17.8 ± 1.9 years) attending vocational education in the Netherlands. Linear multilevel regression analyses were used to investigate the association between types of motivation and dietary and physical activity behaviors. Amotivation was negatively associated with breakfast frequency and positively associated with diet soda consumption and high-calorie between-meal snacks. A positive association was found between autonomous motivation and water intake, breakfast frequency, fruit intake, and moderate-to-vigorous physical activity. Autonomous motivation was negatively associated with the consumption of unhealthy products. Controlled motivation was not associated with physical activity or dietary behaviors. Different types of motivation seem to explain either healthy or unhealthy dietary behaviors in vocational students. Autonomous motivation, in particular, was shown to be associated with healthy behaviors and could therefore be a valuable intervention target.

Level of physical activity among middle-aged and older Chinese people: evidence from the China health and retirement longitudinal study

Background

With data from different regions accumulated, physical inactivity (PI) was found to be pandemic worldwide. Using China Health and Retirement Longitudinal Study (CHARLS), a nationwide longitudinal survey data, we aimed to delineate the prevalence, incidence and risk factors of physical inactivity (PI) among Chinese people aged 45 years and older.

Methods

The CHARLS covered nearly all provinces, autonomous regions, municipalities of mainland China. With data from CHARLS, three cross-sectional analyses and a cohort analysis were conducted. In cross-sectional studies, we used surveys at 2011, 2013 and 2015 to examine the prevalence and its trend of PI. Multivariate generalized linear model was conducted in survey at 2011 to examine the risk factors for prevalent PI. Multiple imputation of missing values was used and results before and after imputation were compared. In cohort analysis, we identified people free of PI at 2011 and followed them up until 2015 to estimate the incidence of PI. Generalized estimating equation was used to examine the risk factors associated with incidence PI. In all analyses, PI was defined as insufficient physical activity according to the International Physical Activity Questionnaire (IPAQ) criterion.

Results

6650, 5946 and 9389 participants were eligible for cross-sectional analyses, and 4525 participants were included for cohort analysis. The weighted prevalence of PI was 22.25% (95% CI: 20.63–23.95%) in 2011, 20.64% (95% CI: 19.22–22.14%) in 2013 and 19.31% (95% CI: 18.28–20.38%) in 2015. In multivariate analysis, PI was associated with older age, higher education, overweight, obesity and difficulties in daily living, and was negatively associated with working and higher level of expenditure. No material change was detected in results after multiple imputation. In cohort analysis, older age, abundant public facilities, difficulties in daily living were identified as risk factors of incidence PI, while urban areas, college and above education, and working were protective factors.

Conclusions

PI is pandemic in 45 years and older people in China. People with older age, difficulties in daily living and people who are not working are at higher risk. More efforts should be paid in estimating and promoting leisure-time physical activities.

Socioeconomic status and change in sports activity among middle-aged and older men and women: evidence from the German Ageing Survey

BACKGROUND

Sports activity (SA) behavior is unequally distributed across socioeconomic status (SES) groups. However, little is known about the impact of SES on change in SA over time.

METHODS

Based on data from the German Ageing Survey, we examined the role of objective (education, occupational prestige, household equivalent income, composite SES-index) and subjective (self-rated standard of living) SES indicators on negative and positive changes in SA during a follow-up of 6 years among adults aged 40+ years using logistic regression analysis.

RESULTS

Among active individuals at baseline, 32.1% of males and 24.8% of females experienced a negative change in SA. Among inactive individuals, 25.8 and 29.9% experienced a positive change. In the multivariate analysis, males and females with low SES were about twice as likely to experience a negative change and half as likely to experience a positive change. These patterns were observed regardless which SES indicator was examined.

CONCLUSIONS

This study provides comprehensive evidence for socioeconomic inequalities in negative and positive changes in SA behavior among middle-aged and older adults in Germany. To reduce socioeconomic inequalities, future SA interventions should address the mechanisms leading to differential probabilities of change in SA behavior by SES.

Associations of sitting time with leisure-time physical inactivity, education, and body mass index change

We aimed to investigate the associations of long-term leisure-time physical inactivity, body mass index (BMI) change, and education with sitting time in a 35-year follow-up based on self-reports in surveys. Influences of working status in 2011 and familial confounding on the associations were tested. Data were based on the population-based Finnish Twin Cohort of 5232 twins (53-67-year-old, 41% men) with four surveys in 1975-2011. Statistical analyses were performed using linear regression with several covariates. The effect of familial confounding (genetics and shared environment) was analyzed using a co-twin control design which should be interpreted as if familial confounding plays a role, an association should be seen among all individuals but not in discordant twin pairs. Compared to those not at work, those at work had a longer total sitting time/d. For those at work, higher education was associated with more total sitting but with less non-work sitting. Long-term leisure-time physical inactivity was associated with more non-work sitting among those at work, whereas long-term weight gain with more total and non-work sitting regardless of working status. Familial confounding attenuated the associations, except for the association of increasing BMI with total and non-work sitting among women at work. To conclude, total sitting time was longer among those still at work, but it was also influenced by long-term leisure-time physical inactivity, higher education, and an increase of BMI over the years. Public health efforts should be targeted to reduce sedentary behavior by promoting life-long leisure-time physical activity and weight control.

The Older Finnish Twin Cohort - 45 Years of Follow-up

The older Finnish Twin Cohort (FTC) was established in 1974. The baseline survey was in 1975, with two follow-up health surveys in 1981 and 1990. The fourth wave of assessments was done in three parts, with a questionnaire study of twins born during 1945-1957 in 2011-2012, while older twins were interviewed and screened for dementia in two time periods, between 1999 and 2007 for twins born before 1938 and between 2013 and 2017 for twins born in 1938-1944. The content of these wave 4 assessments is described and some initial results are described. In addition, we have invited twin-pairs, based on response to the cohortwide surveys, to participate in detailed in-person studies; these are described briefly together with key results. We also review other projects based on the older FTC and provide information on the biobanking of biosamples and related phenotypes.

Participation in group-based physical activity programmes for adults in Germany and associated factors: data from a nationwide cohort study

BACKGROUND

Characteristics of different participation groups can provide important information to increase participation in group-based physical activity programmes (GPAPs). This study examined four types of participation in GPAPs and the factors that characterised these participant groups.

METHODS

The present sample comprised 3219 participants. The analyses were based on data from the 'German Health Interview and Examination Survey for Adults' (t1) conducted in 2009-2011, which included 3959 people who had participated in the 'German National Health Interview and Examination Survey 1998' (t0). The outcome variable was participation in GPAPs, classified in four groups: 'once at t1' (participation only at t1), 'twice' (participation at t0 and t1), 'once at t0' (participation only at t0) and 'no' (no participation). Predictor variables were sex, age, educational level, income, sports activity, self-rated health and counselling for physical activity, measured at t0 and t1. Frequencies with 95% confidence intervals (CI) for each group were calculated. Four stepwise logistic regression models with estimated odds ratios (OR) were used to determine group differences.

RESULTS

The largest participant group was 'no' (80.8%). Among those who participated in GPAPs, the 'once at t1' group was the largest (13.1%), followed by the 'once at t0' (4.0%) and 'twice' (2.1%) groups. 'Once at t1' participation was associated with female sex (OR 2.58), being active in sports (OR 6.59), a high level of education (OR 1.88). If additionally health status and the physician's counselling are included into the models, then having fair/poor/very poor health (OR 1.71) and having had physician counselling on physical activity (OR 2.50) are relevant factors. For 'twice' participation, being female (OR 5.19) and practising sports (OR 4.51) were predictors.

CONCLUSIONS

GPAPs should be tailored to build on previous experience of sports activities and to reach men as well as people with low education, groups that have been the least reached. To reach more people and encourage participation in GPAPs, providing opportunity for physician counselling for physical activity may be promising, especially with groups of poorer health.

Awareness of ParticipACTION among Canadian adults: a seven-year cross-sectional follow-up

INTRODUCTION

In this cross-sectional follow-up study, we explored Canadian's awareness of ParticipACTION and their levels of physical activity (PA) after seven years of campaigns.

METHODS

A population-based survey was conducted with 7282 adults over a period of 14 months from February 2014 to May 2015. The survey consisted of questions on the 2014-2015 Physical Activity Monitor relating to awareness and knowledge of ParticipACTION. Weighted logistic models were constructed to examine whether awareness was associated with PA-related beliefs, intentions, and leisure time physical activity (LTPA).

RESULTS

Approximately 20% of Canadians reported unprompted awareness of ParticipACTION and 82% reported prompted awareness. Education, income, and having children were significant correlates of awareness among Canadians. The adjusted odds of people being aware of ParticipACTION (prompted and unprompted) were greater if they were more educated (OR = 1.57, 95% CI: 1.04-2.39; OR = 2.00, 95% CI: 1.24-3.24), reported higher income (OR = 3.92, 95% CI: 2.35-6.53; OR = 2.29, 95% CI: 1.44-3.62), and had children (OR = 1.93, 95% CI: 1.40-2.66; OR = 1.70, 95% CI: 1.26-2.30). Furthermore, awareness of ParticipACTION was positively associated with outcome expectations and self-efficacy, and negatively associated with LTPA status.

CONCLUSION

Levels of unprompted awareness of ParticipACTION are higher than previously reported and, in comparison to active Canadians, inactive Canadians are more likely to be aware of the organization. Given that it had primarily targeted parents of inactive children over the past seven years, it appears the organization has been partially effective in achieving its communication goals.

Of weekend warriors and couch potatoes: Socio-economic determinants of physical activity in Swiss middle-aged adults

Determinants of the interplay between physical activity (PA) and sedentary (SE) status are poorly known. We assessed the socio-economic determinants of PA and SE behaviours and patterns in a population-based study (The CoLaus study, Lausanne, Switzerland, 2014-2017). 2229 adults (51.8% women, age range 45-86 years) had PA and SE levels measured for 14 days using a wrist-worn accelerometer. Four activity behaviours: (1) 'Couch potato': low PA & high SE; (2) 'Light mover': low PA & low SE; (3) 'Sedentary exerciser': high PA & high SE, and (4) 'Busy bee': high PA & low SE; and three activity patterns: (1) 'Inactive', (2) 'Weekend warrior', and (3) 'Regularly active' were defined. Employment, household income and educational level were collected by questionnaire. For activity behaviours, relative to 'Couch potatoes', multivariate analysis showed that being employed and having a low educational level were positively associated with 'Light movers': relative risk ratios and (95% confidence interval): 1.54 (1.00-2.37) and 1.73 (1.11-2.69), respectively, and also with 'Busy bees': 1.49 (1.09-2.04) and 1.71 (1.26-2.32), respectively. High household income was negatively associated with 'Light movers': 0.58 (0.34-0.97) and positively with 'Sedentary exercisers': 1.85 (1.10-3.10). For activity patterns, relative to 'Inactives', being employed and having a high household income were positively associated with 'Weekend warriors': 1.78 (1.26-2.50) and 1.59 (1.07-2.36), respectively, while having a low educational level was positively associated with 'Regularly actives': 1.76 (1.32-2.34). Employment, educational level and household income are significantly but differently associated with activity behaviours and patterns.