Population aging increases the need for knowledge on positive aspects of aging, and contributions of older people to their own wellbeing and that of others. We defined active aging as an individual's striving for elements of wellbeing with activities as per their goals, abilities and opportunities. This study examines associations of health, health behaviors, health literacy and functional abilities, environmental and social support with active aging and wellbeing. We will develop and validate assessment methods for physical activity and physical resilience suitable for research on older people, and examine their associations with active aging and wellbeing. We will examine cohort effects on functional phenotypes underlying active aging and disability.
For this population-based study, we plan to recruit 1000 participants aged 75, 80 or 85 years living in central Finland, by drawing personal details from the population register. Participants are interviewed on active aging, wellbeing, disability, environmental and social support, mobility, health behavior and health literacy. Physical activity and heart rate are monitored for 7 days with wearable sensors. Functional tests include hearing, vision, muscle strength, reaction time, exercise tolerance, mobility, and cognitive performance. Clinical examination by a nurse and physician includes an electrocardiogram, tests of blood pressure, orthostatic regulation, arterial stiffness, and lung function, as well as a review of chronic and acute conditions and prescribed medications. C-reactive protein, small blood count, cholesterol and vitamin D are analyzed from blood samples. Associations of factors potentially underlying active aging and wellbeing will be studied using multivariate methods. Cohort effects will be studied by comparing test results of physical and cognitive functioning with results of a cohort examined in 1989-90.
The current study will renew research on positive gerontology through the novel approach to active aging and by suggesting new biomarkers of resilience and active aging. Therefore, high interdisciplinary impact is expected. This cross-sectional study will not provide knowledge on temporal order of events or causality, but an innovative cross-sectional dataset provides opportunities for emergence of novel creative hypotheses and theories.
The aim of this study was to investigate the associations of age and education with types of leisure-time physical activity in a population sample of Finnish adults.
The sample, part of the National FINRISK Study, comprised 1940 men and 2497 women age 25 to 64 years. Self-reported questionnaires were used to collect data on education and leisure-time physical activity. Overall leisure-time physical activity was further divided into conditioning and daily physical activity.
In men and women, age had an inverse association with conditioning physical activity but not with daily and overall leisure activity. Strong direct associations were found between education and conditioning and overall leisure activity.
All age groups report fairly similar levels of overall and daily levels of leisure-time physical activity, but the levels differ across educational groups. In health promotion, more emphasis should be targeted to the population groups with lower education.
To profile participants based on reported outdoor physical activity barriers using a data-driven approach, describe the profiles and study their association with unmet physical activity need.
Cross-sectional analyses of 848 community-dwelling men and women aged 75-90 living in Central Finland in 2012. Barriers to outdoor physical activity and unmet physical activity need were enquired with a questionnaire. The latent profiles were identified by profiling participants into latent groups using a mixture modeling technique on the multivariate set of indicators of outdoor physical activity barriers. A path model was used to study the associations of the profiles with unmet physical activity need.
Five barrier profiles were identified. Profile A was characterized with minor barriers, profile B with weather barriers, profile C with health and weather barriers, profile D with barriers concerning insecurity, health and weather; and profile E with mobility and health barriers. The participants in the profiles differed in the proportion of individual and environmental barriers. The risk for unmet physical activity need was highest among people whose severe mobility difficulties restricted their outdoor physical activity.
Outdoor physical activity barriers reflect the imbalance in person-environment fit among older people, manifested as unmet physical activity need.
The contribution of travel-related urban zones, cycling and pedestrian networks and green space to commuting physical activity among adults - a cross-sectional population-based study using geographical information systems.
The current political agenda aims to promote active environments and physical activity while commuting to work, but research on it has provided mixed results. This study examines whether the proximity of green space and people's residence in different travel-related urban zones contributes to commuting physical activity.
Population-based cross-sectional health examination survey, Health 2011 study, and geographical information system (GIS) data were utilized. The GIS data on green space and travel-related urban zones were linked to the individuals of the Health 2011 study, based on their home geocoordinates. Commuting physical activity was self-reported. Logistic regression models were applied, and age, gender, education, leisure-time and occupational physical activity were adjusted. Analyses were limited to those of working age, living in the core-urban areas of Finland and having completed information on commuting physical activity (n?=?2 098).
Home location in a pedestrian zone of a main centre (odds ratio?=?1.63; 95 % confidence interval?=?1.06-2.51) or a pedestrian zone of a sub-centre (2.03; 1.09-3.80) and higher proportion of cycling and pedestrian networks (3.28; 1.71-6.31) contributed to higher levels of commuting physical activity. The contribution remained after adjusting for all the environmental attributes and individuals. Based on interaction analyses, women living in a public transport zone were almost two times more likely to be physically active while commuting compared to men. A high proportion of recreational green space contributed negatively to the levels of commuting physical activity (0.73; 0.57-0.94) after adjusting for several background factors. Based on interaction analyses, individuals aged from 44 to 54 years and living in sub-centres, men living in pedestrian zones of sub-centres, and those individuals who are physically inactive during leisure-time were less likely to be physically active while commuting.
Good pedestrian and cycling infrastructure may play an important role in promoting commuting physical activity among the employed population, regardless of educational background, leisure-time and occupational physical activity. Close proximity to green space and a high proportion of green space near the home may not be sufficient to initiate commuting physical activity in Finland, where homes surrounded by green areas are often situated in car-oriented zones far from work places.
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The high educated live longer and healthier lives when compared to the low educated. Physical fitness as a health indicator reflects the level of physical activity along with other health-influencing factors such as obesity, smoking, chronic diseases and individual training effects. Studies support that self-rated physical fitness correlates with objectively measured physical fitness well. However, the educational differences in self-rated physical fitness are not known.
Our aim was to study educational differences in self-rated physical fitness in Finnish population. The data were collected in 2007 for a cross-sectional population based National FINRISK Study. The analyzed data included 2722 men and 3108 women aged 25 to 74 years. Statistical method was ordinal logistic regression.
Longer educational career was associated with better self-rated physical fitness. The educational differences in self-rated physical fitness were largely explained by health behavior. Leisure-time physical activity explained fully and body mass index partly the educational differences in self-rated physical fitness among men. The combination of body mass index, history of chronic diseases and smoking explained the differences fully among men and partly among women. Leisure-time, occupational and commuting physical activities, body mass index, history of chronic diseases and smoking together explained all educational differences in self-rated physical fitness among both genders.
Although educational differences in self-rated physical fitness were found, they were explained by health behavior related factors. Leisure-time physical activity offered the strongest single explanation for the educational differences in self-rated physical fitness. Thus, possibilities for leisure-time physical activity should be increased especially among the low educated.
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The aim of this study was to describe the underlying theory and the implementation of a 2-year individualized physical activity counseling intervention and to evaluate whether benefits persisted 1.5 years after the intervention. The sample included 632 sedentary 75- to 81-year-old participants. Data were collected in 2003-2005. The participants were randomly assigned to an intervention group and a control group. The intervention consisted of an individualized face-to-face meeting followed by telephone contacts every 4 months for 2 years, with the aim to increase participation in specific physical activities as well as to increase habitual physical activity. At the 2-year follow-up, the prevalence of physical activities in the intervention group vs. control group was as follows: supervised calisthenics training 20 vs. 16%, walking for fitness 69 vs. 62%, weight training 13 vs. 8% and water aerobics 19 vs. 7%. For water aerobics and walking for fitness, the treatment effect was significant [water aerobics odds ratio (OR) 2.49, 95% confidence interval (CI) 1.16-5.36, walking for fitness OR 1.58, 95% CI 1.05-2.40]. As to the other activities, the effect did not reach statistical significance. At the 1.5-year post-intervention, the follow-up results indicated that the intervention effect was still evident. The subgroup analyses suggested that physical activity counseling may be most efficacious among people with intact mobility, while those having manifest mobility limitations may not benefit from it. Older people who have manifest mobility limitations may need more face-to-face counseling.
The aim of this study was to investigate whether persistent leisure-time physical activity, adjusted for genetic liability and childhood experiences, protects against chronic diseases, early signs of disability, and loss of life satisfaction.
From 5663 healthy adult twin pairs, we identified 146 pairs who were discordant for both intensity and volume of leisure physical activity in 1975 and 1981. Of them, both members of 95 pairs were alive and participated in our follow-up study in 2005 when chronic diseases (such as diabetes, cardiovascular disease, and osteoarthritis), life satisfaction, and disability were assessed by a structured telephone interview. The mean age of the participants was 58 yr (range = 47-79 yr) in 2005. Paired tests were used in the analyses.
At the end of follow-up, the active cotwins had a decreased risk of reporting at least one chronic diseases, whereas active monozygotic (MZ) twins had two or more chronic diseases significantly less often than their inactive cotwins (odds ratio [OR] = 0.14, P = 0.031). Overall, the risk for type 2 diabetes or glucose intolerance (OR = 0.09, P = 0.022) and elevated blood pressure (OR = 0.46, P = 0.039) was decreased among the active cotwins. These effects were seen clearly among dizygotic twins but not always among small number of monozygotic twins. The active cotwins reported greater life satisfaction (P = 0.047) and tended to be less likely to be hospitalized (P = 0.065), although active cotwins had somewhat more sports-related injuries (OR = 1.9, P = 0.051) than inactive cotwins. Studied disability variables did not differ between the active and the inactive cotwins.
Physical activity reduces the risk for chronic diseases and helps in maintaining life satisfaction. However, genetic factors may play a role in this association because some findings emerged more clearly among dizygotic than monozygotic twins discordant for physical activity.
Our purpose was to assess the direct and indirect contribution of childhood socio-economic conditions to educational differences in leisure-time physical activity among women and men.
Population-based data were derived from a representative sample of Finns aged >or=30 years (N = 7112) as part of Health 2000 Survey. Multinomial logistic regression analysis was applied. Leisure-time physical activity was divided into inactivity, moderate and high activity.
Childhood socio-economic conditions had both a direct and indirect effect through adulthood socio-economic conditions on educational differences in leisure-time physical activity. The direct effect of childhood socio-economic conditions on educational differences in inactivity was stronger than its indirect effects through adulthood socio-economic conditions and other health behaviours and related factors. Adulthood socio-economic conditions had a considerable indirect effect on educational differences in leisure-time physical activity through other adulthood health behaviours and related factors among men.
In order to narrow educational differences in leisure-time physical activity, we should secure a childhood environment that enables a physically active lifestyle, support leisure-time physical activity in diverse occupational groups, guarantee equal physical activity possibilities across different educational careers and support those with insufficient material resources.
The role of forests in enhancing human health and well-being has been studied in Finland for more than a decade, and these benefits are increasingly recognized by the Finnish society. The national research has studied the associations of use and availability of nature with health using different research methods such as population surveys, on-site field experiments, and combining GIS-based data describing the provision of nature areas with use of the areas and health status of people. This article sums up research results from multidisciplinary research work in Finland. One of the main study areas has been restorative effects of nature areas using various psychological measures. These studies demonstrate that forests and other nature areas are important in reducing stress and add recovery from work. Moreover, field experiments have confirmed that visiting forests have beneficial psychological and physiological effects on human health. These effects can be explained by psychological stress relief with contribution from reduced air pollution and noise exposure during the visits. In addition, studies looking at long-term effects of nature exposure suggest that physical activity has a mediating role in perceived health benefits, particularly among suburban residents. Recent efforts include national policy-science discussions on how the research knowledge can be implemented within various sectors such as public health and land-use planning and forest management. This work has resulted a suggestion for a national program called Nature for Health and Well-Being in Finland consisting of an action plan and a multidisciplinary research program. More comprehensive research knowledge has contributed to and triggered series of practical experiments and pilots that are briefly discussed in the article.
essential aspects of independence in community mobility among older people concern the control over where, when and how to participate (perceived autonomy), and actual mobility (life-space mobility; frequency, distance and need of assistance). We studied relationships between frailty and life-space mobility and perceived autonomy in participation outdoors among community-dwelling 75-90 years old people.
longitudinal analyses of the 'Life-space mobility in old age' cohort study (n = 753). Life-space mobility (Life-Space Assessment, range 0-120) and perceived autonomy in participation outdoors (Impact on Participation and Autonomy subscale 'autonomy outdoors', range 0-20) were assessed at baseline and 2 years later. Baseline frailty indicators were unintentional weight loss (self-report), weakness (5 times chair rise), exhaustion (self-report), slowness (2.44 m walk) and low physical activity (self-report).
in total, 53% had no frailty, 43% pre-frailty (1-2 frailty indicators) and 4% frailty (=3 indicators). Generalised estimation equation models showed that life-space mobility was lower among those with frailty and pre-frailty compared with those without frailty and, in addition, declined at a faster pace. Perceived autonomy in participation outdoors was more restricted among those with frailty and pre-frailty compared with those without frailty, but the rate of decline did not differ.
frailty was associated with more restricted life-space mobility and poorer perceived autonomy in the decision-making concerning community mobility. Over the follow-up, frailty predicted a steeper decline in life-space mobility but not in perceived autonomy. Further study is warranted to determine whether compensation strategies or changes in the valuation of activities underlie this discrepancy.
'Let's Move It' - a school-based multilevel intervention to increase physical activity and reduce sedentary behaviour among older adolescents in vocational secondary schools: a study protocol for a cluster-randomised trial.
Physical activity (PA) has been shown to decline during adolescence, and those with lower education have lower levels of activity already at this age, calling for targeted efforts for them. No previous study has demonstrated lasting effects of school-based PA interventions among older adolescents. Furthermore, these interventions have rarely targeted sedentary behaviour (SB) despite its relevance to health. The Let's Move It trial aims to evaluate the effectiveness and the cost-effectiveness of a school-based, multi-level intervention, on PA and SB, among vocational school students. We hypothesise that the intervention is effective in increasing moderate-to-vigorous-intensity physical activity (MVPA), particularly among those with low or moderate baseline levels, and decreasing SB among all students.
The design is a cluster-randomised parallel group trial with an internal pilot study. The trial is conducted in six vocational schools in the Helsinki Metropolitan area, Finland. The intervention is carried out in 30 intervention classes, and 27 control classes retain the standard curriculum. The randomisation occurs at school-level to avoid contamination and to aid delivery. Three of the six schools, randomly allocated, receive the 'Let's Move It' intervention which consists of 1) group sessions and poster campaign targeting students' autonomous PA motivation and self-regulation skills, 2) sitting reduction in classrooms via alterations in choice architecture and teacher behaviour, and 3) enhancement of PA opportunities in school, home and community environments. At baseline, student participants are blind to group allocation. The trial is carried out in six batches in 2015-2017, with main measurements at pre-intervention baseline, and 2-month and 14-month follow-ups. Primary outcomes are for PA, MVPA measured by accelerometry and self-report, and for SB, sedentary time and breaks in sedentary time (accelerometry). Key secondary outcomes include measured body composition, self-reported well-being, and psychological variables. Process variables include measures of psychosocial determinants of PA (e.g. autonomous motivation) and use of behaviour change techniques. Process evaluation also includes qualitative interviews. Intervention fidelity is monitored.
The study will establish whether the Let's Move It intervention is effective in increasing PA and reducing SB in vocational school students, and identify key processes explaining the results.
ISRCTN10979479 . Registered: 31.12.2015.
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Our aim was to examine the contribution of past and current physical workload to occupational class differences in leisure-time physical inactivity.
Data were taken from the Finnish population-based Health 2000 Survey of employees aged >or=30 years (N=3355). We assessed physical activity during leisure time using a questionnaire and dichotomized responses to inactive versus active. Occupational class was classified into white- and blue-collar worker. Adjustments were made for current work-related factors, other measures of socioeconomic position, clinically diagnosed chronic diseases, other health behaviors, and history of physical workload. We applied sequential logistic regression to the analyses.
Inactivity during leisure time was more common in blue-collar employees than in their white-collar counterparts [women odds ratio (OR) 1.50, 95% confidence interval (95% CI) 1.12-2.00; men OR 1.66, 95% CI 1.30-2.12]. These occupational differences were not due to working hours, work schedule, or chronic diseases. Among women, current job strain decreased the occupational differences in leisure-time physical inactivity slightly (OR 1.37, 95% CI 0.99-1.04). Education and household income contributed to occupational differences for men (OR 1.45, 95% CI 1.02-2.07), but had no additional effect among women. The occupation differences in leisure-time physical inactivity disappeared after adjusting for smoking and body mass index in women (OR 1.33, 95% CI 0.97-1.83) and men (OR 1.27, 95% CI 0.88-1.82) and were further attenuated after adjusting for history of physical workload among men (OR 1.07, 95% CI 0.67-1.72).
Having a long history of exposure to physical work (among men) and a high current job strain (among women) contributed to occupational class differences in leisure-time physical inactivity.
This study investigated the associations of personal goals with exercise activity, as well as the relationships between exercise-related and other personal goals, among older women. Both cross-sectional and longitudinal designs were used with a sample of 308 women ages 66-79 at baseline. Women who reported exercise-related personal goals were 4 times as likely to report high exercise activity at baseline than those who did not report exercise-related goals. Longitudinal results were parallel. Goals related to cultural activities, as well as to busying oneself around the home, coincided with exercise-related goals, whereas goals related to own and other people's health and independent living lowered the odds of having exercise-related goals. Helping older adults to set realistic exercise-related goals that are compatible with their other life goals may yield an increase in their exercise activity, but this should be evaluated in a controlled trial.
Life-space mobility - the spatial extent of mobility in daily life - is associated with quality of life and physical functioning but may also be influenced by future orientation expressed in personal goals. The aim of this study was to explore how different personal goals predict changes in older people's life-space mobility.
This prospective cohort study with a 2-year follow-up included 824 community-dwelling people aged 75 to 90 years from the municipalities of Jyväskylä and Muurame in Central Finland. As part of the Life-Space Mobility in Old Age study (LISPE), which was conducted between 2012 and 2014, the participants responded to the Life-Space Assessment and Personal Project Analysis in addition to questions on socio-demographics and health. Data were analyzed using generalized estimation equation models.
The results showed that goals indicating a desire to be active in daily life, to stay mentally alert, and to exercise were associated with higher life-space mobility, and that the associations remained over the follow-up years. Goals related to maintaining functioning predicted higher life-space mobility at the 2-year follow-up. In contrast, goals reflecting improvement of poor physical functioning predicted lower life-space mobility. The results remained significant even when adjusted for indicators of health and functioning.
This study indicates that supporting older people in striving for relevant personal goals in their lives might contribute to a larger life-space and thus also to improved quality of life in old age.
The aim was to study objectively assessed walkability of the environment and participant perceived environmental facilitators for outdoor mobility as predictors of physical activity in older adults with and without physical limitations. 75-90-year-old adults living independently in Central Finland were interviewed (n = 839) and reassessed for self-reported physical activity one or two years later (n = 787). Lower-extremity physical limitations were defined as Short Physical Performance Battery score =9. Number of perceived environmental facilitators was calculated from a 16-item checklist. Walkability index (land use mix, street connectivity, population density) of the home environment was calculated from geographic information and categorized into tertiles. Accelerometer-based step counts were registered for one week (n = 174). Better walkability was associated with higher numbers of perceived environmental facilitators (p
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The aim was to study the associations of physical activity and socioeconomic status with overweight from 1978 to 2002 and to explore whether the trend in overweight was different across educational groups or leisure time and commuting physical activity groups.
The study population comprised 37,084 women and 34,191 men who participated in cross-sectional postal surveys carried out annually from 1978 to 2002. The surveys included independent nationally representative random samples of Finns aged 25 to 64 years. Information on weight, height, leisure time and commuting physical activity was self-reported. The level of education was obtained from national register data. Overweight was defined as a body mass index (kg/m2) of 25 or higher.
Overweight was more prevalent among the physically inactive and lower educated. The prevalence of overweight increased over time. Across the study years, those men and women who participated in leisure time or commuting physical activity had a lower prevalence of overweight in all educational groups. The increase in the prevalence of overweight followed a similar pattern in all physical activity and education groups.
Engagement in physical activity has not prevented an increase in the prevalence of overweight in any socioeconomic group among Finnish men and women from 1978 to 2002.
Designing evidence-based interventions to address socioeconomic disparities in health and health behaviours requires a better understanding of the specific explanatory mechanisms. We aimed to investigate a comprehensive range of potential theoretical mediators of physical activity (PA) and screen time in different socioeconomic status (SES) groups: a high SES group of high school students, and a low SES group of vocational school students. The COM-B system, including the Theoretical Domains Framework (TDF), was used as a heuristic framework to synthesise different theoretical determinants in this exploratory study.
Finnish vocational and high school students (N?=?659) aged 16-19, responded to a survey assessing psychological, social and environmental determinants of activity (PA and screen time). These determinants are mappable into the COM-B domains: capability, opportunity and motivation. The outcome measures were validated self-report measures for PA and screen time. The statistical analyses included a bootstrapping-based mediation procedure.
Regarding PA, there were SES differences in all of the COM-B domains. For example, vocational school students reported using less self-monitoring of PA, weaker injunctive norms to engage in regular PA, and fewer intentions than high school students. Mediation analyses identified potential mediators of the SES-PA relationship in all of three domains: The most important candidates included self-monitoring (CI95 for b: 0.19-0.47), identity (0.04-0.25) and material resources available (0.01-0.16). However, SES was not related to most determinants of screentime, where there were mainly gender differences. Most determinants were similarly related with both behaviours in both SES groups, indicating no major moderation effect of SES on these relationships.
This study revealed that already in the first years of educational differentiation, levels of key PA determinants differ, contributing to socioeconomic differences in PA. The analyses identified the strongest mediators of the SES-PA association, but additional investigation utilising longitudinal and experimental designs are needed. This study demonstrates the usefulness of combining constructs from various theoretical approaches to better understand the role of distinct mechanisms that underpin socioeconomic health behaviour disparities.