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1.  Physical activity, body mass index and heart rate variability-based stress and recovery in 16 275 Finnish employees: a cross-sectional study 
BMC Public Health  2016;16:701.
Background
Physical inactivity, overweight, and work-related stress are major concerns today. Psychological stress causes physiological responses such as reduced heart rate variability (HRV), owing to attenuated parasympathetic and/or increased sympathetic activity in cardiac autonomic control. This study’s purpose was to investigate the relationships between physical activity (PA), body mass index (BMI), and HRV-based stress and recovery on workdays, among Finnish employees.
Methods
The participants in this cross-sectional study were 16 275 individuals (6863 men and 9412 women; age 18–65 years; BMI 18.5–40.0 kg/m2). Assessments of stress, recovery and PA were based on HRV data from beat-to-beat R-R interval recording (mainly over 3 days). The validated HRV-derived variables took into account the dynamics and individuality of HRV. Stress percentage (the proportion of stress reactions, workday and working hours), and stress balance (ratio between recovery and stress reactions, sleep) describe the amount of physiological stress and recovery, respectively. Variables describing the intensity (i.e. magnitude of recognized reactions) of physiological stress and recovery were stress index (workday) and recovery index (sleep), respectively. Moderate to vigorous PA was measured and participants divided into the following groups, based on calculated weekly PA: inactive (0 min), low (0 < 150 min), medium (150–300 min), and high (>300 min). BMI was calculated from self-reported weight and height. Linear models were employed in the main analyses.
Results
High PA was associated with lower stress percentages (during workdays and working hours) and stress balance. Higher BMI was associated with higher stress index, and lower stress balance and recovery index. These results were similar for men and women (P < 0.001 for all).
Conclusion
Independent of age and sex, high PA was associated with a lower amount of stress on workdays. Additionally, lower BMI was associated with better recovery during sleep, expressed by a greater amount and magnitude of recovery reactions, which suggests that PA in the long term resulting in improved fitness has a positive effect on recovery, even though high PA may disturb recovery during the following night. Obviously, several factors outside of the study could also affect HRV-based stress.
Electronic supplementary material
The online version of this article (doi:10.1186/s12889-016-3391-4) contains supplementary material, which is available to authorized users.
doi:10.1186/s12889-016-3391-4
PMCID: PMC4971625  PMID: 27484470
Body mass index; Heart rate variability; Physical activity; Physiological stress; Stress; Stress assessment
2.  Objectively measured physical activity in Finnish employees: a cross-sectional study 
BMJ Open  2014;4(12):e005927.
Objectives
To objectively measure the amount of intensity-specific physical activity by gender and age with respect to body mass index (BMI) during workdays and days off among Finnish employees.
Design
A cross-sectional study.
Setting
Primary care occupational healthcare units.
Participants
A sample of 9554 Finnish employees (4221 men and 5333 women; age range 18–65 years; BMI range 18.5–40 kg/m2) who participated in health assessments related to occupational health promotion.
Main outcome measurements
The amount of moderate-to-vigorous (MVPA) and vigorous (VPA) physical activity (≥3 and ≥6 metabolic equivalents, respectively) was assessed by estimating the minute-to-minute oxygen consumption from the recorded beat-to-beat R-R interval data. The estimation method used heart rate, respiration rate and on/off response information from R-R interval data calibrated by age, gender, height, weight and self-reported physical activity class. The proportion of participants fulfilling the aerobic physical activity recommendation of ≥150 min/week was calculated on the basis of ≥10 min bouts, by multiplying the VPA minutes by 2.
Results
Both MVPA and VPA were higher among men and during days off, and decreased with increasing age and BMI (p<0.001 for all). Similar results were observed when the probability of having a bout of MVPA or VPA lasting continuously for ≥10 min per measurement day was studied. The total amount of VPA was low among overweight (mean ≤2.6 min/day), obese (mean ≤0.6 min/day) and all women in the age group 51–65 years (mean ≤2.5 min/day) during both types of days. The proportion of participants fulfilling the aerobic physical activity recommendation was highest for normal weight men (65%; 95% CI 62% to 67%) and lowest for obese women (10%; 95% CI 8% to 12%).
Conclusions
Objectively measured physical activity is higher among men and during days off, and decreases with increasing age and BMI. The amount of VPA is very low among obese, overweight and older women.
doi:10.1136/bmjopen-2014-005927
PMCID: PMC4265094  PMID: 25500160
Physical activity; Obesity; Exercise intensity; Heart rate variability; Objective monitoring
3.  Factors behind Leisure-Time Physical Activity Behavior Based on Finnish Twin Studies: The Role of Genetic and Environmental Influences and the Role of Motives 
BioMed Research International  2014;2014:931820.
Different approaches are being taken to clarify the role of various factors in the development of physical activity behaviors. Genetic studies are a new area of physical activity research and also the motives for physical activity have been widely studied. The purpose of this paper is to review the findings emerging from the longitudinal genetic studies on leisure-time physical activity and to evaluate the associations between motivational factors and leisure-time physical activity. The focus is to review recent findings of longitudinal Finnish twin studies. The results of the latest longitudinal Finnish twin studies point to the existence of age-specific genetic and environmental influences on leisure-time physical activity. Variations in environmental factors seem to explain the observed deterioration in leisure-time physical activity levels. A decline in genetic influences is seen first from adolescence to young adulthood and again from the age of thirty to the mid-thirties. In the Finnish twin participants, mastery, physical fitness, and psychological state were the major motivation factors associated with consistent leisure-time physical activity behavior. The results also indicate that intrinsic motivation factors may be important for engagement in leisure-time physical activity.
doi:10.1155/2014/931820
PMCID: PMC3997869  PMID: 24809061
4.  Increase in physical activity and cardiometabolic risk profile change during lifestyle intervention in primary healthcare: 1-year follow-up study among individuals at high risk for type 2 diabetes 
BMJ Open  2011;1(2):e000292.
Objectives
To investigate the association between increase in physical activity and changes in cardiometabolic risk factors during a lifestyle intervention programme in routine clinical settings.
Design
Prospective follow-up.
Setting
400 primary healthcare centres and occupational healthcare outpatient clinics in Finland.
Participants
Individuals at high risk for type 2 diabetes identified in the implementation project of the national diabetes prevention programme (FIN-D2D) and participating in baseline and 1-year follow-up visits. Final study group comprised the 1871 non-diabetic participants who responded at follow-up visit to a question on stability versus increase of physical activity.
Interventions
Lifestyle intervention.
Primary outcome measures
Cardiometabolic risk factors (body composition, blood pressure and those measured from fasting venous blood samples) measured at baseline and follow-up visits.
Results
Of the participants, 310 (16.6% of all responders) reported at follow-up having clearly increased their physical activity during the past year, while 1380 (73.8%) had been unable to increase their physical activity. Those who increased their activity decreased their weight by 3.6 kg (95% CI 2.9 to 4.3, age and sex adjusted, p<0.001) and waist circumference by 3.6 cm (95% CI 2.9 to 4.3, p<0.001) more than those who did not increase their activity. Similarly, those who increased their physical activity had greater reductions in total cholesterol (group difference in reduction 0.17 mmol/l, 95% CI 0.06 to 0.28, p=0.002), low-density lipoprotein cholesterol (0.16 mmol/l, 95% CI 0.06 to 0.26, p=0.001), low-density lipoprotein/high-density lipoprotein ratio (0.17, 95% CI 0.08 to 0.25, p<0.001) as well as fasting glucose (0.09 mmol/l, 95% CI 0.03 to 0.15, p=0.004) and 2 h glucose levels (0.36 mmol/l, 95% CI 0.17 to 0.55, p=0.023) than those who did not increase their physical activity.
Conclusion
Increasing physical activity seems to be an important feature of cardiometabolic risk reduction among individuals at high risk for type 2 diabetes participating in preventive interventions in routine clinical settings.
Article summary
Article focus
There is evidence from randomised controlled trials that supervised exercise interventions improve cardiometabolic risk factor levels.
It is not known how knowledge from intensive interventions of randomised clinical trials can be applied in various real-life clinical settings with limited resources.
In this paper, we report the results of an analysis of physical activity changes and their association to cardiometabolic risk factors among individual at high risk for type 2 diabetes and participating in preventive lifestyle intervention in routine clinical settings of primary healthcare.
Key messages
Less than one-fifth of the participants reported at ‘1-year’ follow-up having clearly increased their physical activity during the past year.
Those who increased their activity improved clearly their cardiometabolic risk profile including reductions of waist circumference and fasting low-density lipoprotein cholesterol and glucose levels, which result persisted after the adjustment for dietary change.
Increasing physical activity seems to be an important feature of cardiometabolic risk reduction among individuals at high risk for type 2 diabetes participating in preventive interventions in routine clinical settings.
Strengths and limitations
FIN-D2D is the first national effort to implement the prevention of diabetes in a primary healthcare setting.
Follow-up data on the changes in physical activity are available from a subgroup of participants.
The limitations of this report include that physical activity changes are documented by a questionnaire.
doi:10.1136/bmjopen-2011-000292
PMCID: PMC3244658  PMID: 22184585
5.  Association between education and future leisure-time physical inactivity: a study of Finnish twins over a 35-year follow-up 
BMC Public Health  2016;16:720.
Background
Education is associated with health related lifestyle choices including leisure-time physical inactivity. However, the longitudinal associations between education and inactivity merit further studies. We investigated the association between education and leisure-time physical inactivity over a 35-year follow-up with four time points controlling for multiple covariates including familial confounding.
Methods
This study of the population-based Finnish Twin Cohort consisted of 5254 twin individuals born in 1945–1957 (59 % women), of which 1604 were complete same-sexed twin pairs. Data on leisure-time physical activity and multiple covariates was available from four surveys conducted in 1975, 1981, 1990 and 2011 (response rates 72 to 89 %). The association between years of education and leisure-time physical inactivity (<1.5 metabolic equivalent hours/day) was first analysed for each survey. Then, the role of education was investigated for 15-year and 35-year inactivity periods in the longitudinal analyses. The co-twin control design was used to analyse the potential familial confounding of the effects. All analyses were conducted with and without multiple covariates. Odds Ratios (OR) with 95 % Confidence Intervals (CI) were calculated using logistic and conditional (fixed-effects) regression models.
Results
Each additional year of education was associated with less inactivity (OR 0.94 to 0.95, 95 % CI 0.92, 0.99) in the cross-sectional age- and sex-adjusted analyses. The associations of education with inactivity in the 15- and 35-year follow-ups showed a similar trend: OR 0.97 (95 % CI 0.93, 1.00) and OR 0.94 (95 % CI 0.91, 0.98), respectively. In all co-twin control analyses, each year of higher education was associated with a reduced likelihood of inactivity suggesting direct effect (i.e. independent from familial confounding) of education on inactivity. However, the point estimates were lower than in the individual-level analyses. Adjustment for multiple covariates did not change these associations.
Conclusions
Higher education is associated with lower odds of leisure-time physical inactivity during the three-decade follow-up. The association was found after adjusting for several confounders, including familial factors. Hence, the results point to the conclusion that education has an independent role in the development of long-term physical inactivity and tailored efforts to promote physical activity among lower educated people would be needed throughout adulthood.
doi:10.1186/s12889-016-3410-5
PMCID: PMC4973543  PMID: 27492437
Adult; Behavioral genetics; Cohort studies; Educational status; Exercise; Follow-Up studies; Twins
6.  Effect of Intensive Exercise in Early Adult Life on Telomere Length in Later Life in Men 
A career as an elite-class male athlete seems to improve metabolic heath in later life and is also associated with longer life expectancy. Telomere length is a biomarker of biological cellular ageing and could thus predict morbidity and mortality. The main aim of this study was to assess the association between vigorous elite-class physical activity during young adulthood on later life leukocyte telomere length (LTL). The study participants consist of former male Finnish elite athletes (n = 392) and their age-matched controls (n = 207). Relative telomere length was determined from peripheral blood leukocytes by quantitative real-time polymerase chain reaction. Volume of leisure-time physical activity (LTPA) was self-reported and expressed in metabolic equivalent hours. No significant difference in mean age-adjusted LTL in late life (p = 0.845) was observed when comparing former male elite athletes and their age-matched controls. Current volume of LTPA had no marked influence on mean age-adjusted LTL (p for trend 0.788). LTL was inversely associated with age (p = 0.004).Our study findings suggest that a former elite athlete career is not associated with LTL later in life.
Key pointsA career as an elite-class athlete is associated with improved metabolic health in late life and is associated with longer life expectancy.A career as an elite-class athlete during young adulthood was not associated with leukocyte telomere length in later life.Current volume of leisure-time physical activity did not influence telomere length in later life.
PMCID: PMC4424450  PMID: 25983570
Aging; athlete; DNA repeats; physical activity
7.  The effectiveness and applicability of different lifestyle interventions for enhancing wellbeing: the study design for a randomized controlled trial for persons with metabolic syndrome risk factors and psychological distress 
BMC Public Health  2014;14:310.
Background
Obesity and stress are among the most common lifestyle-related health problems. Most of the current disease prevention and management models are not satisfactorily cost-effective and hardly reach those who need them the most. Therefore, novel evidence-based controlled interventions are necessary to evaluate models for prevention and treatment based on self-management. This randomized controlled trial examines the effectiveness, applicability, and acceptability of different lifestyle interventions with individuals having symptoms of metabolic syndrome and psychological distress. The offered interventions are based on cognitive behavioral approaches, and are designed for enhancing general well-being and supporting personalized lifestyle changes.
Methods/Design
339 obese individuals reporting stress symptoms were recruited and randomized to either (1) a minimal contact web-guided Cognitive Behavioral Therapy-based (CBT) intervention including an approach of health assessment and coaching methods, (2) a mobile-guided intervention comprising of mindfulness, acceptance and value-based exercises, (3) a face-to-face group intervention using mindfulness, acceptance and value-based approach, or (4) a control group. The participants were measured three times during the study (pre = week 0, post = week 10, and follow-up = week 36). Psychological well-being, lifestyles and habits, eating behaviors, and user experiences were measured using online surveys. Laboratory measurements for physical well-being and general health were performed including e.g. liver function, thyroid glands, kidney function, blood lipids and glucose levels and body composition analysis. In addition, a 3-day ambulatory heart rate and 7-day movement data were collected for analyzing stress, recovery, physical activity, and sleep patterns. Food intake data were collected with a 48 -hour diet recall interview via telephone. Differences in the effects of the interventions would be examined using multiple-group modeling techniques, and effect-size calculations.
Discussion
This study will provide additional knowledge about the effects of three low intensity interventions for improving general well-being among individuals with obesity and stress symptoms. The study will show effects of two technology guided self-help interventions as well as effect of an acceptance and value–based brief group intervention. Those who might benefit from the aforesaid interventions will increase knowledge base to better understand what mechanisms facilitate effects of the interventions.
Trial registration
Current Clinical Trials NCT01738256, Registered 17 August, 2012.
doi:10.1186/1471-2458-14-310
PMCID: PMC4006637  PMID: 24708617
Lifestyle; Well-being; Obesity; Stress; Acceptance and Commitment Therapy; Cognitive behavioral therapy; Mobile application; Web-based intervention; Technology-aided interventions
8.  Leisure-Time Physical Activity and Academic Performance: Cross-Lagged Associations from Adolescence to Young Adulthood 
Scientific Reports  2016;6:39215.
Physical activity and academic performance are positively associated, but the direction of the association is poorly understood. This longitudinal study examined the direction and magnitude of the associations between leisure-time physical activity and academic performance throughout adolescence and young adulthood. The participants were Finnish twins (from 2,859 to 4,190 individuals/study wave) and their families. In a cross-lagged path model, higher academic performance at ages 12, 14 and 17 predicted higher leisure-time physical activity at subsequent time-points (standardized path coefficient at age 14: 0.07 (p < 0.001), age 17: 0.12 (p < 0.001) and age 24: 0.06 (p < 0.05)), whereas physical activity did not predict future academic performance. A cross-lagged model of co-twin differences suggested that academic performance and subsequent physical activity were not associated due to the environmental factors shared by co-twins. Our findings suggest that better academic performance in adolescence modestly predicts more frequent leisure-time physical activity in late adolescence and young adulthood.
doi:10.1038/srep39215
PMCID: PMC5156951  PMID: 27976699
9.  Effects of a progressive aquatic resistance exercise program on the biochemical composition and morphology of cartilage in women with mild knee osteoarthritis: protocol for a randomised controlled trial 
Background
Symptoms associated with osteoarthritis of the knee result in decreased function, loss of working capacity and extensive social and medical costs. There is a need to investigate and develop effective interventions to minimise the impact of and even prevent the progression of osteoarthritis. Aquatic exercise has been shown to be effective at reducing the impact of osteoarthritis. The purpose of this article is to describe the rationale, design and intervention of a study investigating the effect of an aquatic resistance exercise intervention on cartilage in postmenopausal women with mild knee osteoarthritis.
Methods
A minimum of 80 volunteers who meet the inclusion criteria will be recruited from the local population through newspaper advertisements. Following initial assessment volunteers will be randomised into two groups. The intervention group will participate in a progressive aquatic resistance exercise program of 1-hour duration 3 times a week for four months. The control group will be asked to maintain normal care during this period. Primary outcome measure for this study is the biochemical composition of knee cartilage measured using quantitative magnetic resonance imaging; T2 relaxation time and delayed gadolinium-enhanced magnetic resonance imaging techniques. In addition, knee cartilage morphology as regional cartilage thickness will be studied. Secondary outcomes include measures of body composition and bone traits using dual energy x-ray absorptiometry and peripheral quantitative computed tomography, pain, function using questionnaires and physical performance tests and quality of life. Measurements will be performed at baseline, after the 4-month intervention period and at one year follow up.
Discussion
This randomised controlled trial will investigate the effect a progressive aquatic resistance exercise program has on the biochemical composition of cartilage in post-menopausal women with mild knee osteoarthritis. This is the first study to investigate what impact aquatic exercise has on human articular cartilage. In addition it will investigate the effect aquatic exercise has on physical function, pain, bone and body composition and quality of life. The results of this study will help optimise the prescription of aquatic exercise to persons with mild knee osteoarthritis.
Trial Registration
ISRCTN65346593
doi:10.1186/1471-2474-14-82
PMCID: PMC3599473  PMID: 23497162
Osteoarthritis; Quantitative MRI; T2 relaxation time; dGEMRIC; Bone; Aquatic exercise
10.  Perceived need to increase physical activity levels among adults at high risk of type 2 diabetes. A cross-sectional analysis within a community-based diabetes prevention project FIN-D2D 
BMC Public Health  2012;12:514.
Background
Increased physical activity is a cornerstone of type 2 diabetes prevention. The perception of a need to change is considered essential in behaviour change processes. However, the existing literature on individuals’ perceived need to change health behaviour is limited. In order to improve understanding of diabetes prevention through increased physical activity levels (PAL), we assessed factors associated with perceiving a need to increase PAL among adults at high risk of diabetes.
Methods
Opportunistic screening was used within a primary-care based lifestyle intervention covering 10 149 men and women at high risk of type 2 diabetes. Data were obtained at baseline visits. The explored determinants were demographic, anthropometric/clinical, behavioural and psychosocial characteristics, along with four categories of PAL awareness. Logistic regression was used in the analysis.
Results
74% of men (n = 2 577) and 76% of women (n = 4 551) perceived a need to increase their PAL. The participants most likely to perceive this need were inactive, had a larger waist circumference, rated their PAL as insufficient, and were at the contemplation stage of change. Smoking, elevated blood pressure, dyslipidaemia, and a family history of diabetes were not associated with this perception. The likelihood was also greater among women with less perceived fitness and less education. Demographic factors other than education did not determine participants’ perceived need to increase PAL. PAL overestimators were less likely to perceive the need to increase their PAL than realistic inactive participants.
Conclusions
Subjective rather than objective health factors appear to determine the perception of a need to increase PAL among adults at high risk of diabetes. Client perceptions need to be evaluated in health counselling in order to facilitate a change in PAL. Practical descriptions of the associations between metabolic risk factors, PAL, and diabetes are needed in order to make the risk factors concrete for at-risk individuals.
doi:10.1186/1471-2458-12-514
PMCID: PMC3506518  PMID: 22781026
Physical activity; Exercise; Behaviour change; Perception; Awareness; Type 2 diabetes; Prevention; FIN-D2D; Lifestyle intervention
11.  Branched-Chain Amino Acid Levels Are Related with Surrogates of Disturbed Lipid Metabolism among Older Men 
Aims/hypothesis
Existing studies suggest that decreased branched-chain amino acid (BCAA) catabolism and thus elevated levels in blood are associated with metabolic disturbances. Based on such information, we have developed a hypothesis how BCAA degradation mechanistically connects to tricarboxylic acid cycle, intramyocellular lipid storage, and oxidation, thus allowing more efficient mitochondrial energy production from lipids as well as providing better metabolic health. We analyzed whether data from aged Finnish men are in line with our mechanistic hypothesis linking BCAA catabolism and metabolic disturbances.
Methods
Older Finnish men enriched with individuals having been athletes in young adulthood (n = 593; mean age 72.6 ± 5.9 years) responded to questionnaires, participated in a clinical examination including assessment of body composition with bioimpedance and gave fasting blood samples for various analytes as well as participated in a 2-h 75 g oral glucose tolerance test. Metabolomics measurements from serum included BCAAs (isoleucine, leucine, and valine).
Results
Out of the 593 participants, 59 had previously known type 2 diabetes, further 67 had screen-detected type 2 diabetes, 127 impaired glucose tolerance, and 125 impaired fasting glucose, while 214 had normal glucose regulation and one had missing glucose tolerance information. There were group differences in all of the BCAA concentrations (p ≤ 0.005 for all BCAAs), such that those with normal glucose tolerance had the lowest and those with diabetes mellitus had the highest BCAA concentrations. All BCAA levels correlated positively with body fat percentage (r = 0.29–0.34, p < 0.0001 for all). Expected associations with high BCAA concentrations and unfavorable metabolic profile indicators from metabolomics analysis were found. Except for glucose concentrations, the associations were stronger with isoleucine and leucine than with valine.
Conclusion/interpretation
The findings provided further support for our hypothesis by strengthening the idea that the efficiency of BCAA catabolism may be mechanistically involved in the regulation of fat oxidation, thus affecting the levels of metabolic disease risk factors.
doi:10.3389/fmed.2016.00057
PMCID: PMC5122573  PMID: 27933294
branched-chain amino acids; metabolic disease; tricarboxylic acid cycle; lipid oxidation; mitochondria; energy metabolism
12.  Effects of diet-induced obesity and voluntary wheel running on the microstructure of the murine distal femur 
Background
Obesity and osteoporosis, two possibly related conditions, are rapidly expanding health concerns in modern society. Both of them are associated with sedentary life style and nutrition. To investigate the effects of diet-induced obesity and voluntary physical activity we used high resolution micro-computed tomography (μCT) together with peripheral quantitative computed tomography (pQCT) to examine the microstructure of the distal femoral metaphysis in mice.
Methods
Forty 7-week-old male C57BL/6J mice were assigned to 4 groups: control (C), control + running (CR), high-fat diet (HF), and high-fat diet + running (HFR). After a 21-week intervention, all the mice were sacrificed and the left femur dissected for pQCT and μCT measurements.
Results
The mice fed the high-fat diet showed a significant weight gain (over 70% for HF and 60% for HFR), with increased epididymal fat pad mass and impaired insulin sensitivity. These obese mice had significantly higher trabecular connectivity density, volume, number, thickness, area and mass, and smaller trabecular separation. At the whole bone level, they had larger bone circumference and cross-sectional area and higher density-weighted maximal, minimal, and polar moments of inertia. Voluntary wheel running decreased all the cortical bone parameters, but increased the trabecular mineral density, and decreased the pattern factor and structure model index towards a more plate-like structure.
Conclusions
The results suggest that in mice the femur adapts to obesity by improving bone strength both at the whole bone and micro-structural level. Adaptation to running exercise manifests itself in increased trabecular density and improved 3D structure, but in a limited overall bone growth
doi:10.1186/1743-7075-8-1
PMCID: PMC3034661  PMID: 21241467
13.  Differences in Muscle and Adipose Tissue Gene Expression and Cardio-Metabolic Risk Factors in the Members of Physical Activity Discordant Twin Pairs 
PLoS ONE  2010;5(9):e12609.
High physical activity/aerobic fitness predicts low morbidity and mortality. Our aim was to identify the most up-regulated gene sets related to long-term physical activity vs. inactivity in skeletal muscle and adipose tissues and to obtain further information about their link with cardio-metabolic risk factors. We studied ten same-sex twin pairs (age range 50–74 years) who had been discordant for leisure-time physical activity for 30 years. The examinations included biopsies from m. vastus lateralis and abdominal subcutaneous adipose tissue. RNA was analyzed with the genome-wide Illumina Human WG-6 v3.0 Expression BeadChip. For pathway analysis we used Gene Set Enrichment Analysis utilizing active vs. inactive co-twin gene expression ratios. Our findings showed that among the physically active members of twin pairs, as compared to their inactive co-twins, gene expression in the muscle tissue samples was chronically up-regulated for the central pathways related to energy metabolism, including oxidative phosphorylation, lipid metabolism and supportive metabolic pathways. Up-regulation of these pathways was associated in particular with aerobic fitness and high HDL cholesterol levels. In fat tissue we found physical activity-associated increases in the expression of polyunsaturated fatty acid metabolism and branched-chain amino acid degradation gene sets both of which associated with decreased ‘high-risk’ ectopic body fat and plasma glucose levels. Consistent with other findings, plasma lipidomics analysis showed up-regulation of the triacylglycerols containing the polyunsaturated fatty acids. Our findings identified skeletal muscle and fat tissue pathways which are associated with the long-term physical activity and reduced cardio-metabolic disease risk, including increased aerobic fitness. In particular, improved skeletal muscle oxidative energy and lipid metabolism as well as changes in adipocyte function and redistribution of body fat are associated with reduced cardio-metabolic risk.
doi:10.1371/journal.pone.0012609
PMCID: PMC2940764  PMID: 20862330
14.  Gender Differences in Sport Injury Risk and Types of Inju-Ries: A Retrospective Twelve-Month Study on Cross-Country Skiers, Swimmers, Long-Distance Runners and Soccer Players 
This twelve months survey compared injury risk and injury types by genders (312 females, 262 males) in 15- to 35-year-old cross-country skiers, swimmers, long- distance runners and soccer players. More male than female athletes reported at least one acute injury (44% vs. 35%, p < 0.05), and more male than female runners reported at least one overuse injury (69% vs. 51%, p < 0.05). When the incidence of acute and overuse injuries both separately and combined was calculated per 1000 training hours, per 1000 competition hours and all exposure hours combined we found no gender differences in either of these comparisons. After adjustment for sport event males were at increased risk for posterior thigh overuse injuries compared to females (relative risk (RR) 5.8, 95% confidence interval (CI) 1.3 to 26.4, p < 0.05) while females were at increased risk for overuse injuries in the ankle compared to males (RR 3.1, 95% CI 1.0 to 9.3, p < 0.05). After adjustment for exposure time (injuries/1000 exposure hours) significance of the difference between the sexes in overuse injury to the ankle persisted (female 0.11 vs. male 0.02 injuries/1000 exposure hours, p < 0.05). Six athletes had an anterior cruciate ligament (ACL) injury, of whom four were female soccer players. After combining all reported acute and overuse ankle and knee injuries, the proportion of athletes with such injury was higher in the female compared to male soccer players (75% and 54% respectively; p < 0.05), but no difference was found in such injuries when calculated per 1000 exposure hours. In conclusion, we found some gender differences in sport-related injuries, but most of these differences seemed to be explained at least in part by differences in the amount of training.
Key pointsOnly a few sport injury studies have compared in-jury rates between the sexesOverall gender-related risk for acute and overuse injuries in top-level athletes between the sexes was smallSome gender differences in the specific anatomical locations of injuries as well as in specific injuries in sports were foundSome of these differences seem to be explained by the differences in the amount of training
PMCID: PMC3763291  PMID: 24150009
Male; female; athletic injuries; acute injury; over-use injury
15.  MOTOR DEVELOPMENT AND PHYSICAL ACTIVITY: A LONGITUDINAL DISCORDANT TWIN-PAIR STUDY 
Introduction
Previous longitudinal research suggests that motor proficiency in early life predicts physical activity in adulthood. Familial effects including genetic and environmental factors could explain the association, but no long-term follow-up studies have taken into account potential confounding by genetic and social family background. The present twin study investigated whether childhood motor skill development is associated with leisure-time physical activity levels in adulthood independent of family background.
Methods
Altogether, 1 550 twin pairs from the FinnTwin12 study and 1 752 twin pairs from the FinnTwin16 study were included in the analysis. Childhood motor development was assessed by the parents’ report of whether one of the co-twins had been ahead of the other in different indicators of motor skill development in childhood. Leisure-time physical activity (MET hours/day) was self-reported by the twins in young adulthood and adulthood. Statistical analyses included conditional and ordinary linear regression models within twin pairs.
Results
Using all activity-discordant twin pairs, the within-pair difference in a sum score of motor development in childhood predicted the within-pair difference in the leisure-time physical activity level in young adulthood (p<0.001). Within specific motor development indicators, learning to stand unaided earlier in infancy predicted higher leisure-time MET values in young adulthood statistically significantly in both samples (FinnTwin12 p=0.02, FinnTwin16 p=0.001) and also in the pooled dataset of the FinnTwin12 and FinnTwin16 studies (p<0.001). Having been more agile than the co-twin as a child predicted higher leisure-time MET values up to adulthood (p=0.03).
Conclusions
More advanced childhood motor development is associated with higher leisure-time MET values in young adulthood at least partly independent of family background, in both men and women.
doi:10.1249/MSS.0000000000000650
PMCID: PMC4576714  PMID: 26378945
ADOLESCENCE; EXERCISE; MOTOR SKILLS; PHYSICAL ACTIVITY; TWINS
16.  iGEMS: an integrated model for identification of alternative exon usage events 
Nucleic Acids Research  2016;44(11):e109.
DNA microarrays and RNAseq are complementary methods for studying RNA molecules. Current computational methods to determine alternative exon usage (AEU) using such data require impractical visual inspection and still yield high false-positive rates. Integrated Gene and Exon Model of Splicing (iGEMS) adapts a gene-level residuals model with a gene size adjusted false discovery rate and exon-level analysis to circumvent these limitations. iGEMS was applied to two new DNA microarray datasets, including the high coverage Human Transcriptome Arrays 2.0 and performance was validated using RT-qPCR. First, AEU was studied in adipocytes treated with (n = 9) or without (n = 8) the anti-diabetes drug, rosiglitazone. iGEMS identified 555 genes with AEU, and robust verification by RT-qPCR (∼90%). Second, in a three-way human tissue comparison (muscle, adipose and blood, n = 41) iGEMS identified 4421 genes with at least one AEU event, with excellent RT-qPCR verification (95%, n = 22). Importantly, iGEMS identified a variety of AEU events, including 3′UTR extension, as well as exon inclusion/exclusion impacting on protein kinase and extracellular matrix domains. In conclusion, iGEMS is a robust method for identification of AEU while the variety of exon usage between human tissues is 5–10 times more prevalent than reported by the Genotype-Tissue Expression consortium using RNA sequencing.
doi:10.1093/nar/gkw263
PMCID: PMC4914109  PMID: 27095197
17.  Physical activity in adulthood: genes and mortality 
Scientific Reports  2015;5:18259.
Observational studies report a strong inverse relationship between leisure-time physical activity and all-cause mortality. Despite suggestive evidence from population-based associations, scientists have not been able to show a beneficial effect of physical activity on the risk of death in controlled intervention studies among individuals who have been healthy at baseline. On the other hand, high cardiorespiratory fitness is known to be a strong predictor of reduced mortality, even more robust than physical activity level itself. Here, in both animals and/or human twins, we show that the same genetic factors influence physical activity levels, cardiorespiratory fitness, and risk of death. Previous observational follow-up studies in humans suggest that increasing fitness through physical activity levels could prolong life; however, our controlled interventional study with laboratory rats bred for low and high intrinsic fitness contrast with these findings. Also, we find no evidence for the suggested association using pairwise analysis among monozygotic twin pairs who are discordant in their physical activity levels. Based on both our animal and human findings, we propose that genetic pleiotropy might partly explain the frequently observed associations between high baseline physical activity and later reduced mortality in humans.
doi:10.1038/srep18259
PMCID: PMC4678877  PMID: 26666586
18.  Predictors of lower extremity injuries in team sports (PROFITS-study): a study protocol 
Introduction
Several intrinsic risk factors for lower extremity injuries have been proposed, including lack of proper knee and body control during landings and cutting manoeuvres, low muscular strength, reduced balance and increased ligament laxity, but there are still many unanswered questions. The overall aim of this research project is to investigate anatomical, biomechanical, neuromuscular, genetic and demographic risk factors for traumatic non-contact lower extremity injuries in young team sport athletes. Furthermore, the research project aims to develop clinically oriented screening tools for predicting future injury risk.
Methods
Young female and male players (n=508) from nine basketball teams, nine floorball teams, three ice hockey teams, and one volleyball team accepted the invitation to participate in this four-and-half-year prospective follow-up study. The players entered the study either in 2011, 2012 or 2013, and gave blood samples, performed physical tests and completed the baseline questionnaires. Following the start of screening tests, the players will be followed for sports injuries through December 2015. The primary outcome is a traumatic non-contact lower extremity injury. The secondary outcomes are other sports-related injuries. Injury risk is examined on the basis of anatomical, biomechanical, neuromuscular, genetic and other baseline factors. Univariate and multivariate regression models will be used to investigate association between investigated parameters and injury risk.
doi:10.1136/bmjsem-2015-000076
PMCID: PMC5117034  PMID: 27900143
Sporting injuries; Risk factor; Adolescent; Lowever extremity; ACL
19.  Subjective stress, objective heart rate variability-based stress, and recovery on workdays among overweight and psychologically distressed individuals: a cross-sectional study 
Background
The present study aimed to investigate how subjective self-reported stress is associated with objective heart rate variability (HRV)-based stress and recovery on workdays. Another aim was to investigate how physical activity (PA), body composition, and age are associated with subjective stress, objective stress, and recovery.
Methods
Working-age participants (n = 221; 185 women, 36 men) in this cross-sectional study were overweight (body mass index, 25.3–40.1 kg/m2) and psychologically distressed (≥3/12 points on the General Health Questionnaire). Objective stress and recovery were based on HRV recordings over 1–3 workdays. Subjective stress was assessed by the Perceived Stress Scale. PA level was determined by questionnaire, and body fat percentage was assessed by bioelectrical impedance analysis.
Results
Subjective stress was directly associated with objective stress (P = 0.047) and inversely with objective recovery (P = 0.046). These associations persisted after adjustments for sex, age, PA, and body fat percentage. Higher PA was associated with lower subjective stress (P = 0.037). Older age was associated with higher objective stress (P < 0.001). After further adjustment for alcohol consumption and regular medication, older age was associated with lower subjective stress (P = 0.043).
Conclusions
The present results suggest that subjective self-reported stress is associated with objective physiological stress, but they are also apparently affected by different factors. However, some of the found associations among these overweight and psychologically distressed participants with low inter-individual variation in PA are rather weak and the clinical value of the present findings should be studied further among participants with greater heterogeneity of stress, PA and body composition. However, these findings suggest that objective stress assessment provides an additional aspect to stress evaluation. Furthermore, the results provide valuable information for developing stress assessment methods.
doi:10.1186/s12995-015-0081-6
PMCID: PMC4620623  PMID: 26504485
Heart rate variability; Objective stress; Perceived stress scale; Physiological stress; Physical activity; Psychological stress; Recovery; Stress assessment; Subjective stress; Work-related stress
20.  Health promotion activities of sports clubs and coaches, and health and health behaviours in youth participating in sports clubs: the Health Promoting Sports Club study 
Introduction
Sports clubs form a potential setting for health promotion, but the research is limited. The aim of the Health Promoting Sports Club (HPSC) study was to elucidate the current health promotion activities of youth sports clubs and coaches, and to investigate the health behaviours and health status of youth participating in sports clubs compared to non-participants.
Methods and analysis
The study design employs cross-sectional multilevel and multimethod research with aspirations to a prospective cohort study in the next phase. The setting-based variables at sports clubs and coaching levels, and health behaviour variables at the individual level, are investigated using surveys; and total levels of physical activity are assessed using objective accelerometer measurements. Health status variables will be measured by preparticipation screening. The health promotion activity of sports clubs (n=154) is evaluated by club officials (n=313) and coaches (n=281). Coaches and young athletes aged 14–16 (n=759) years evaluate the coaches’ health promotion activity. The survey of the adolescents’ health behaviours consist of two data sets—the first is on their health behaviours and the second is on musculoskeletal complaints and injuries. Data are collected via sports clubs (759 participants) and schools 1650 (665 participants and 983 non-participants). 591 (418 athletes and 173 non-athletes) youth, have already participated in preparticipation screening. Screening consists of detailed personal medical history, electrocardiography, flow-volume spirometry, basic laboratory analyses and health status screening, including posture, muscle balance, and static and dynamic postural control tests, conducted by sports and exercise medicine specialists.
Ethics and dissemination
The HPSC study is carried out conforming with the declaration of Helsinki. Ethical approval was received from the Ethics Committee of Health Care District of Central Finland. The HPSC study is close-to-practice, which generates foundations for development work within youth sports clubs.
doi:10.1136/bmjsem-2015-000034
PMCID: PMC5117060  PMID: 27900129
Athlete; Health promotion; Sports medicine; Sport
21.  Motives for Physical Activity among Active and Inactive Persons in Their Mid-Thirties 
The purpose of this study was to examine the motives for leisure time physical activity among active and inactive men and women in their mid-thirties. We used both cross-sectional and longitudinal designs. Altogether, 2308 participants (mean age 33.9 years, 53.4 % women) were identified from the population-based FinnTwin16 Cohort. Physically active and inactive individuals were identified on the basis of their leisure time MET hours/day. We evaluated participants’ physical activity motivation with a modified version of the Recreational Exercise Motivation Measure. Comparisons between active and inactive individuals were analysed using the Wald test for equality of means, and effect sizes were calculated as Cohen’s d. Motives related to mastery, physical fitness, social aspect of physical activity, psychological state, enjoyment, willingness to be fitter/look better than others and appearance were significantly more important for the active than inactive participants. Conforming to others’ expectations was the only item on which the inactive persons scored higher than active persons. The longitudinal results for physical activity were parallel to the cross-sectional results. This study supports to the view that motivation factors differ between active and inactive persons, and that intrinsic motives are associated with consistent leisure time physical activity.
doi:10.1111/sms.12040
PMCID: PMC3646077  PMID: 23331765
intrinsic motivation; extrinsic motivation; exercise; leisure time physical activity; leisure time physical inactivity
22.  Overuse injuries in youth basketball and floorball 
Background
The popularity of team sports is growing among young people. High training volume and intensity may predispose young athletes to overuse injuries. Research to date has tended to focus on acute injuries rather than overuse injuries. The purpose of this study was to examine the occurrence, nature, and severity of overuse injuries in youth basketball and floorball, with the hypothesis that overuse injuries are frequent in youth team sports.
Methods
The study comprised a total of 401 Finnish team sports athletes (207 basketball and 194 floorball players). The data were collected using a detailed questionnaire. The participants (mean age 15.8±1.9 years) responded to the questionnaire covering information on overuse injuries during the previous 12 months.
Results
A total of 190 overuse injuries was reported (97 in basketball and 93 in floorball). In both sports, most of the injuries involved the lower extremities (66% and 55% of all injuries in basketball and floorball, respectively). In basketball, the most commonly injured site was the knee (44 cases, 45%). In floorball, the most commonly injured sites were the lower back/pelvis (36 cases, 39%) and knee (32 cases, 34%). Overuse injuries caused an average time loss from full participation of 26±50 (median 7) days in basketball and 16±37 (median 5) days in floorball.
Conclusion
Overuse injuries are a common problem in youth team sports, and often cause long-term absence from full participation. The findings suggest that injury reduction and training load monitoring strategies are needed in the field. More research using explicit prospective data collection is needed to better understand the problem.
doi:10.2147/OAJSM.S82305
PMCID: PMC4447174  PMID: 26045679
overuse injuries; sports injuries; epidemiology; adolescence; team sports
23.  The prevalence of musculoskeletal pain and use of painkillers among adolescent male ice hockey players in Finland 
Participating in competitive sport increases the risk for injuries and musculoskeletal pain among adolescent athletes. There is also evidence that the use of prescription drugs has increased among sport club athletes. The purpose of this study was to evaluate the use of painkillers among young male ice hockey players (IHP) in comparison to schoolboys (controls) and its relation to the prevalence of musculoskeletal pain and problems during activities and sleeping. Information was gathered through a questionnaire, completed by 121 IHP and compared to the responses of 618 age-matched controls. Results showed that monthly existing pain was at 82% for IHP, and 72% for controls, though IHP had statistically more musculoskeletal pain in their lower limbs (56% vs. 44%), lower back (54% vs. 35%), and buttocks (26% vs. 11%). There were no group differences in the neck, upper back, upper limb, or chest areas. The disability index was statistically similar for both groups, as musculoskeletal pain causing difficulties in daily activities and sleeping was reported by a minority of subjects. Despite this similarity, IHP used more painkillers than controls (18% vs. 10%). Further nuanced research is encouraged to compare athletes and non-athletes in relation to painkillers.
doi:10.1080/21642850.2014.884463
PMCID: PMC4345898  PMID: 25750794
musculoskeletal pain; painkillers; adolescent athletes; injury and prevention
24.  Persistence or Change in Leisure-Time Physical Activity Habits and Waist Gain During Early Adulthood: A Twin-Study 
Obesity (Silver Spring, Md.)  2014;22(9):2061-2070.
Objective
To determine the relationship between persistence or change in leisure-time physical activity habits and waist gain among young adults.
Design and Methods
Population-based cohort study among 3383 Finnish twin individuals (1578 men) from five birth cohorts (1975–1979), who answered questionnaires at mean ages of 24.4 y (SD 0.9) and 33.9 y (SD 1.2), with reported self-measured waist circumference. Persistence or change in leisure-time physical activity habits was defined based on thirds of activity metabolic equivalent h/day during follow-up (mean 9.5 y; SD 0.7).
Results
Decreased activity was linked to greater waist gain compared to increased activity (3.6 cm, P<0.001 for men; 3.1 cm, P<0.001 for women). Among same-sex activity discordant twin pairs, twins who decreased activity gained an average 2.8 cm (95%CI 0.4 to 5.1, P=0.009) more waist than their co-twins who increased activity (n=85 pairs); among MZ twin pairs (n=43), the difference was 4.2 cm (95%CI 1.2 to 7.2, P=0.008).
Conclusions
Among young adults, an increase in leisure-time physical activity or staying active during a decade of follow-up was associated with less waist gain, but any decrease in activity level, regardless baseline activity, led to waist gain that was similar to that associated with being persistently inactive.
doi:10.1002/oby.20788
PMCID: PMC4149596  PMID: 24839266
Physical activity; waist circumference; twins; longitudinal studies
25.  Hormone replacement therapy enhances IGF-1 signaling in skeletal muscle by diminishing miR-182 and miR-223 expressions: a study on postmenopausal monozygotic twin pairs 
Aging Cell  2014;13(5):850-861.
MiRNAs are fine-tuning modifiers of skeletal muscle regulation, but knowledge of their hormonal control is lacking. We used a co-twin case–control study design, that is, monozygotic postmenopausal twin pairs discordant for estrogen-based hormone replacement therapy (HRT) to explore estrogen-dependent skeletal muscle regulation via miRNAs. MiRNA profiles were determined from vastus lateralis muscle of nine healthy 54–62-years-old monozygotic female twin pairs discordant for HRT (median 7 years). MCF-7 cells, human myoblast cultures and mouse muscle experiments were used to confirm estrogen’s causal role on the expression of specific miRNAs, their target mRNAs and proteins and finally the activation of related signaling pathway. Of the 230 miRNAs expressed at detectable levels in muscle samples, qPCR confirmed significantly lower miR-182, miR-223 and miR-142-3p expressions in HRT using than in their nonusing co-twins. Insulin/IGF-1 signaling emerged one common pathway targeted by these miRNAs. IGF-1R and FOXO3A mRNA and protein were more abundantly expressed in muscle samples of HRT users than nonusers. In vitro assays confirmed effective targeting of miR-182 and miR-223 on IGF-1R and FOXO3A mRNA as well as a dose-dependent miR-182 and miR-223 down-regulations concomitantly with up-regulation of FOXO3A and IGF-1R expression. Novel finding is the postmenopausal HRT-reduced miRs-182, miR-223 and miR-142-3p expression in female skeletal muscle. The observed miRNA-mediated enhancement of the target genes’ IGF-1R and FOXO3A expression as well as the activation of insulin/IGF-1 pathway signaling via phosphorylation of AKT and mTOR is an important mechanism for positive estrogen impact on skeletal muscle of postmenopausal women.
doi:10.1111/acel.12245
PMCID: PMC4331762  PMID: 25040542
aging; AKT; FOXO3A; IGF-1 signaling; IGF-1R; menopause; miR-142-3p; miR-182; miR-223; mTOR; phosphorylation

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