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Myllyaho MM, Ihalainen JK, Hackney AC, Valtonen M, Nummela A, Vaara E, Häkkinen K, Kyröläinen H, Taipale RS. Hormonal Contraceptive Use Does Not Affect Strength, Endurance, or Body Composition Adaptations to Combined Strength and Endurance Training in Women. J Strength Cond Res 2021; 35:449-457. [PMID: 29927884 DOI: 10.1519/jsc.0000000000002713] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Myllyaho, MM, Ihalainen, JK, Hackney, AC, Valtonen, M, Nummela, A, Vaara, E, Häkkinen, K, Kyröläinen, H, and Taipale, RS. Hormonal contraceptive use does not affect strength, endurance, or body composition adaptations to combined strength and endurance training in women. J Strength Cond Res 35(2): 449-457, 2021-This study examined the effects of a 10-week period of high-intensity combined strength and endurance training on strength, endurance, body composition, and serum hormone concentrations in physically active women using hormonal contraceptives (HCs, n = 9) compared with those who had never used hormonal contraceptives (NHCs, n = 9). Training consisted of 2 strength training sessions and 2 high-intensity running interval sessions per week. Maximal bilateral isometric leg press (Isom), maximal bilateral dynamic leg press (one repetition maximum [1RM]), countermovement jump (CMJ), a 3,000-m running test (3,000 m), body composition, and serum hormone levels were measured before and after training between days 1-5 of each subject's menstrual cycle. Both groups increased 1RM and CMJ: HC = 13.2% (p < 0.001) and 9.6% (p < 0.05), and NHC = 8.3% (p < 0.01) and 8.5% (p < 0.001). Hormonal contraceptive improved 3,000 m by 3.5% (p < 0.05) and NHC by 1% (n.s.). Never used hormonal contraceptive increased lean mass by 2.1% (p < 0.001), whereas body fat percentage decreased from 23.9 ± 6.7 to 22.4 ± 6.0 (-6.0%, p < 0.05). No significant changes were observed in body composition in HC. No significant between-group differences were observed in any of the performance variables. Luteinizing hormone concentrations decreased significantly (p < 0.05) over 10 weeks in NHC, whereas other hormone levels remained statistically unaltered in both groups. It seems that the present training is equally appropriate for improving strength, endurance, and body composition in women using HC as those not using HC without disrupting hypothalamic-pituitary-gonadal axis function.
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Affiliation(s)
- Moona M Myllyaho
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Johanna K Ihalainen
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Anthony C Hackney
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, North Carolina
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | | | - Ari Nummela
- Research Institute for Olympic Sport, Jyväskylä, Finland
| | - Elina Vaara
- JAMK University of Applied Sciences, Jyväskylä, Finland ; and
| | - Keijo Häkkinen
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Heikki Kyröläinen
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Vaara JP, Santtila M, Vasankari T, Fogelholm M, Mäntysaari M, Pihlainen K, Vaara E, Kyröläinen H. Cardiorespiratory and muscular fitness in young adult Finnish men between 2003 and 2015. Scand J Med Sci Sports 2020; 30:716-724. [PMID: 31872487 DOI: 10.1111/sms.13619] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/11/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Physical fitness is strongly related to health and may offer valuable information about public health. We investigated trends in physical fitness, leisure-time physical activity (LTPA), and anthropometry of young healthy adult Finnish men in representative population-based samples between 2003 and 2015. METHODS Three independent cross-sectional samples of 18- to 35-year-old Finnish men were assessed in 2003 (n = 889), 2008 (n = 803), and 2015 (n = 690). Cardiorespiratory (VO2 max) and muscular fitness (1-minute sit-ups and push-ups), body mass, and height were measured. Self-reported LTPA was assessed. RESULTS After adjusting for age, education, and smoking, cardiorespiratory fitness was higher in 2003 (mean: 43.5, 95%CI: 42.9-44.1 mL/kg/min) compared to 2008 (41.3, 95%CI: 40.7-41.9 mL/kg/min) and 2015 (40.6, 95%CI: 40.0-41.2 mL/kg/min) (P < .001), whereas no difference was observed between 2008 and 2015. The lowest values in muscular fitness were observed in 2003, while no clear trends were further noticed. The adjusted BMI was higher in 2008 (25.1, 95%CI: 24.9-25.4) and 2015 (25.3, 95%CI: 25.3, 95%CI: 25.0-25.6) compared to 2003 (24.5, 95%CI: 24.3-24.8) (P < .005). In 2015, a higher proportion of individuals exercised at least four times per week compared to 2003 and 2008 (P < .05). CONCLUSION The decrease in cardiorespiratory fitness that took place between 2003 and 2008 plateaued after 2008. The plateau is in accordance with the previously observed trend of 5-10 years younger Finnish men. Moreover, muscular fitness was for the most part higher in 2008 and 2015 compared to 2003. Efforts directed to promote regular physical activity and improve physical fitness are needed.
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Affiliation(s)
- Jani P Vaara
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
| | - Matti Santtila
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
| | - Tommi Vasankari
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Mikael Fogelholm
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Matti Mäntysaari
- Aeromedical Centre, Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
| | - Kai Pihlainen
- Training Division of Defence Command, Finnish Defence Forces, Helsinki, Finland
| | - Elina Vaara
- JAMK, University of Applied Sciences, Jyväskylä, Finland.,Faculty of Sport Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Heikki Kyröläinen
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland.,Faculty of Sport Sciences, University of Jyväskylä, Jyväskylä, Finland
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Abstract
IMPORTANCE High physical fitness is associated with a reduction in risk of cardiovascular diseases and death, but the underlying mechanisms are insufficiently understood. OBJECTIVE To determine how aerobic fitness and muscular strength are associated with serum metabolome measures. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included Finnish men receiving military refresher training from May 5, 2015, to November 28, 2015, representing partly overlapping groups of individuals with the lowest vs highest aerobic fitness and the lowest vs highest muscular strength. Data analyses were conducted from January 1, 2018, to May 31, 2019. MAIN OUTCOMES AND MEASURES The associations of aerobic fitness (determined with maximum oxygen consumption in milliliters per minute per kilogram, measured with maximal cycle ergometer test) and muscular strength (determined with a maximal strength test for lower extremities in kilograms) with 66 metabolome measures from fasting serum samples (nuclear magnetic resonance-based metabolomics) were analyzed. RESULTS Participants included 580 Finnish men (mean [SD] age, 26.1 [6.5] years). Including overlap between groups, there were 196 men in the lowest aerobic fitness group and 197 men in the highest aerobic fitness group as well as 196 men in the lowest muscular strength group and 197 men in the highest muscular strength group. Of 66 studied metabolome measures, 48 differed between high vs low aerobic fitness groups, including small very low-density lipoprotein (standardized median difference, -0.67; 95% CI, -0.83 to -0.49), large high-density lipoprotein (standardized median difference, 0.89; 95% CI, 0.69-1.15), total triglyceride levels (standardized median difference, -0.52; 95% CI, -0.65 to -0.34), isoleucine (standardized median difference, -0.37; 95% CI, -0.55 to -0.16), leucine (standardized median difference, -0.55; 95% CI, -0.72 to -0.34), phenylalanine (standardized median difference, -0.54; 95% CI, -0.71 to -0.32), glycerol (standardized median difference, -0.64; 95% CI, -0.81 to -0.48), and glycoprotein (standardized median difference, -0.78; 95% CI, -0.95 to -0.62) concentration, a high unsaturation degree of fatty acids (standardized median difference, 0.59; 95% CI, 0.42-0.81), and apolipoprotein B to apolipoprotein A1 ratio (standardized median difference, -0.88; 95% CI, -1.08 to -0.67). Adding aerobic fitness into the regression model after age, education, smoking, use of alcohol, and dietary factors accounted for more than an additional 5% of variation for 25 metabolome measures (R2 range, 5.01%-15.90% by measure). With these 2 criteria, maximal muscular strength was not associated with any metabolome measures. Aerobic fitness was associated with high large high-density lipoprotein particle concentration (R2, 14.97%; 95% CI, 10.65%-20.85%), low apolipoprotein B to apolipoprotein A1 ratio (R2, 14.49%; 95% CI, 10.58%-19.51%), and low glycoprotein concentration (R2, 15.90%; 95% CI, 11.22%-21.51%). Aerobic fitness was also associated with low very low-density lipoprotein, triglyceride, isoleucine, leucine, phenylalanine, glycerol, and glycoprotein concentrations and with a high unsaturation degree of fatty acids. Adjusting for recent physical activity influenced the results minimally. Adjusting for body fat percentage showed that some of the associations were mechanistically associated with body fat percentage. CONCLUSIONS AND RELEVANCE This study provides data on the association of high aerobic fitness with underlying oxidative lipid metabolism associated with a reduction in cardiometabolic risk. High maximal muscular strength is not similarly associated with these benefits.
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Affiliation(s)
- Urho M. Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jani P. Vaara
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
| | - Heikki Kainulainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tommi Vasankari
- The UKK Institute, Centre for Health Promotion Research, Tampere, Finland
| | - Elina Vaara
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Heikki Kyröläinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Sillanpää E, Laakkonen EK, Vaara E, Rantanen T, Kovanen V, Sipilä S, Kaprio J, Ollikainen M. Biological clocks and physical functioning in monozygotic female twins. BMC Geriatr 2018; 18:83. [PMID: 29614968 PMCID: PMC5883300 DOI: 10.1186/s12877-018-0775-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 03/26/2018] [Indexed: 02/06/2023] Open
Abstract
Background Biomarkers of biological aging – DNA methylation age (DNAm age) and leukocyte telomere length (LTL)– correlate strongly with chronological age across the life course. It is, however, unclear how these measures of cellular wear and tear are associated with muscle strength and functional capacity, which are known to decline with older age and are associated with mortality. We investigated if DNAm age and LTL were associated with body composition and physical functioning by examining 48 monozygotic twin sisters. Methods White blood cell DNAm age (predicted years) was calculated from Illumina 450 k BeadChip methylation data using an online calculator. DNAm age acceleration was defined from the residuals derived from a linear regression model of DNAm age on chronological age. LTL was measured by qPCR. Total body percentage of fat and lean mass were estimated using bioimpedance. Physical functioning was measured by grip strength, knee extension strength and by 10 m maximal walking speed test. Results In all participants, DNAm age (58.4 ± 6.6) was lower than chronological age (61.3 ± 5.9 years). Pairwise correlations of monozygotic co-twins were high for DNAm age (0.88, 95% CI 0.79, 0.97), age acceleration (0.68, 95% CI 0.30, 0.85) and LTL (0.77, 95% CI 0.60, 0.94). Increased age acceleration i.e. faster epigenetic aging compared to chronological age was associated with lower grip strength (β = − 5.3 SE 1.9 p = 0.011), but not with other measures of physical functioning or body composition. LTL was not associated with body composition or physical functioning. Conclusions To conclude, accelerated DNAm age is associated with lower grip strength, a biomarker known to be associated with physiological aging, and which predicts decline in physical functioning and mortality. Further studies may clarify whether epigenetic aging explains the decline in muscle strength with aging or whether DNAm age just illustrates the progress of aging. Electronic supplementary material The online version of this article (10.1186/s12877-018-0775-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elina Sillanpää
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (VIV), FIN-40014, Jyväskylä, Finland. .,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.
| | - Eija K Laakkonen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (VIV), FIN-40014, Jyväskylä, Finland
| | - Elina Vaara
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Taina Rantanen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (VIV), FIN-40014, Jyväskylä, Finland
| | - Vuokko Kovanen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (VIV), FIN-40014, Jyväskylä, Finland
| | - Sarianna Sipilä
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (VIV), FIN-40014, Jyväskylä, Finland
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Miina Ollikainen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
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Erkkola M, Saloheimo T, Hauta-alus H, Kukkonen AK, Virta S, Kronberg-Kippilä C, Vaara E, Pelkonen AS, Fogelholm M, Mäkelä MJ. Burden of allergy diets in Finnish day care reduced by change in practices. Allergy 2016; 71:1453-60. [PMID: 27117067 DOI: 10.1111/all.12902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Nonessential allergy diets in children with mild symptoms may harm the development of immunological tolerance and impose a burden on families and day care. We aimed to reduce the high prevalence of allergy diets in day care by reforming the practices for inquiring about need of special diets from parents. METHODS We developed a new special diet form and an information leaflet based on the new allergy guidelines. The new form was implemented into 40 Finnish day care centres in the capital region in 2013-2015. The questionnaires on practices concerning special diets in day care centres and allergy knowledge were collected from the personnel. RESULTS After 2 years, the new special diet form was used by 64% of families with food-allergic children, and the prevalence of allergy diets in day care centres decreased by 43% to 4.3% (IQ range 3.05-5.96). A significant decrease was found in the prevalence of all basic (milk, grains, egg) and most other allergy diets (P for trend < 0.01). The new practice was well accepted by day care and kitchen personnel. Lack of updated allergy knowledge was noted among day care personnel. CONCLUSIONS The burden of allergy diets in day care settings could be decreased by simple pragmatic changes based on current allergy guidelines. Old allergy attitudes persisted among day care personnel, indicating the need for continuous education.
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Affiliation(s)
- M. Erkkola
- Division of Nutrition; Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - T. Saloheimo
- Division of Nutrition; Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - H. Hauta-alus
- Division of Nutrition; Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - A. K. Kukkonen
- Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - S. Virta
- Division of Nutrition; Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - C. Kronberg-Kippilä
- Division of Nutrition; Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - E. Vaara
- Division of Nutrition; Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - A. S. Pelkonen
- Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - M. Fogelholm
- Division of Nutrition; Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - M. J. Mäkelä
- Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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Pajari AM, Päivärinta E, Paavolainen L, Vaara E, Koivumäki T, Garg R, Heiman-Lindh A, Mutanen M, Marjomäki V, Ridley AJ. Ellagitannin-rich cloudberry inhibits hepatocyte growth factor induced cell migration and phosphatidylinositol 3-kinase/AKT activation in colon carcinoma cells and tumors in Min mice. Oncotarget 2016; 7:43907-43923. [PMID: 27270323 PMCID: PMC5190067 DOI: 10.18632/oncotarget.9724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 05/16/2016] [Indexed: 11/25/2022] Open
Abstract
Berries have been found to inhibit colon carcinogenesis in animal models, and thus represent a potential source of compounds for prevention and treatment of colorectal cancer. The mechanistic basis for their effects is not well understood. We used human colon carcinoma cells and Min mice to investigate the effects of ellagitannin-rich cloudberry (Rubus chamaemorus) extract on cancer cell migration and underlying cell signaling. Intrinsic and hepatocyte growth factor (HGF) -induced cell motility in human HT29 and HCA7 colon carcinoma cells was assessed carrying out cell scattering and scratch wound healing assays using time-lapse microscopy. Activation of Met, AKT, and ERK in cell lines and tumors of cloudberry-fed Min mice were determined using immunoprecipitation, Western blot and immunohistochemical analyses. Cloudberry extract significantly inhibited particularly HGF-induced cancer cell migration in both cell lines. Cloudberry extract inhibited the Met receptor tyrosine phosphorylation by HGF and strongly suppressed HGF-induced AKT and ERK activation in both HT29 and HCA7 cells. Consistently, cloudberry feeding (10% w/w freeze-dried berries in diet for 10 weeks) reduced the level of active AKT and prevented phosphoMet localization at the edges in tumors of Min mice. These results indicate that cloudberry reduces tumor growth and cancer cell motility by inhibiting Met signaling and consequent activation of phosphatidylinositol 3-kinase/AKT in vitro and in tumors in vivo. As the Met receptor is recognized to be a major target in cancer treatment, our results suggest that dietary phytochemicals may have therapeutic value in reducing cancer progression and metastasis.
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Affiliation(s)
- Anne-Maria Pajari
- Department of Food and Environmental Sciences, Division of Nutrition, University of Helsinki, Helsinki, Finland
- University College London, Ludwig Institute for Cancer Research, London, UK
| | - Essi Päivärinta
- Department of Food and Environmental Sciences, Division of Nutrition, University of Helsinki, Helsinki, Finland
| | - Lassi Paavolainen
- Department of Biological and Environmental Science / Nanoscience Center, University of Jyväskylä, Jyväskylä, Finland
| | - Elina Vaara
- Department of Food and Environmental Sciences, Division of Nutrition, University of Helsinki, Helsinki, Finland
| | - Tuuli Koivumäki
- Department of Food and Environmental Sciences, Division of Food Chemistry, University of Helsinki, Helsinki, Finland
| | - Ritu Garg
- Randall Division of Cell & Molecular Biophysics, King's College London, New Hunt's House, Guy's Campus, London, UK
| | - Anu Heiman-Lindh
- Department of Food and Environmental Sciences, Division of Nutrition, University of Helsinki, Helsinki, Finland
| | - Marja Mutanen
- Department of Food and Environmental Sciences, Division of Nutrition, University of Helsinki, Helsinki, Finland
| | - Varpu Marjomäki
- Department of Biological and Environmental Science / Nanoscience Center, University of Jyväskylä, Jyväskylä, Finland
| | - Anne J. Ridley
- University College London, Ludwig Institute for Cancer Research, London, UK
- Randall Division of Cell & Molecular Biophysics, King's College London, New Hunt's House, Guy's Campus, London, UK
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Tiainen K, Raitanen J, Vaara E, Hervonen A, Jylhä M. Longitudinal changes in mobility among nonagenarians: the Vitality 90+ Study. BMC Geriatr 2015; 15:124. [PMID: 26472649 PMCID: PMC4608212 DOI: 10.1186/s12877-015-0116-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 10/05/2015] [Indexed: 11/26/2022] Open
Abstract
Background Several studies have focused on predictors of mobility limitations and disabilities. Yet little is known about the pace and patterns of mobility changes among very old people. This study examined changes in functional mobility among individuals aged 90 years and older during a 2-9-year follow-up. In addition, we were interested in the patterns of mobility changes. Methods Data were collected through a mailed questionnaire in the years 2001, 2003, 2007 and 2010. The study population (n = 948) consisted of individuals from three cohorts (2001, 2003, 2007) who participated in at least two survey rounds and answered the mobility questions. The length of the follow-up varied from 2–9 years between individuals as well as according to how many times an individual took part in the survey. Multilevel ordinal logistic regression analysis was used to evaluate the effects of time, age, gender, cohort and chronic conditions on changes in mobility. Results At the baseline, “younger” old people, men and individuals in the cohorts for 2003 and 2007 had significantly better mobility compared with women, older individuals and individuals in the 2001 cohort. In addition, individuals with fewer chronic conditions had better mobility than those with more diseases. Mobility declined for most of the participants during the follow-up. The difference in the change in mobility over time for gender, age or chronic conditions was not statistically significant. The analyses were performed with a subgroup of participants aged 90–91 years at the baseline, and results did not differ substantially from the results for the entire study sample. However, the effect of chronic conditions on the change in mobility was statistically significant among participants aged 90-91years. Conclusions No differences were observed in the rate of mobility decline over time between age or gender. The effect of chronic conditions on the change in mobility was significant only among individuals aged 90–91 years. The prevention efforts are important and should focus even more, also among the oldest-old, on additional modifiable risk factors such as maintaining muscle strength.
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Affiliation(s)
- Kristina Tiainen
- School of Health Sciences and Gerontology Research Center, University of Tampere, 33014, Tampere, Finland.
| | - Jani Raitanen
- School of Health Sciences and Gerontology Research Center, University of Tampere, 33014, Tampere, Finland. .,UKK-Institute for Health Promotion Research, P.O. Box 30, 33501, Tampere, Finland.
| | - Elina Vaara
- School of Health Sciences and Gerontology Research Center, University of Tampere, 33014, Tampere, Finland. .,Department of Social Research, University of Helsinki, P.O. Box 54, 00014, Helsinki, Finland.
| | - Antti Hervonen
- School of Health Sciences and Gerontology Research Center, University of Tampere, 33014, Tampere, Finland.
| | - Marja Jylhä
- School of Health Sciences and Gerontology Research Center, University of Tampere, 33014, Tampere, Finland. .,Institute for Advanced Social Research, University of Tampere, 33014, Tampere, Finland.
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