Urho Kaleva Kekkonen Institute

Physical activity (PA) has an important role in the prevention and treatment of type 2 diabetes (T2D). Interventions with mobile-based technology (mobile health [mHealth]) seem promising in PA promotion, but their behavioral framework is often vague, and the implementation is seldom reported. This paper examines perceived behavior change needs and implementation of an mHealth approach in increasing nonexercise PA in patients with T2D. A 3-arm mHealth intervention was conducted in primary care. Information on perceived behavior change needs was collected with a modified capability, opportunity, motivation-behavior (COM-B) questionnaire before the intervention from a separate sample of patients with T2D (n=25) and at the intervention baseline (n=119). Implementation evaluation focused on the fidelity and acceptability of the main arm of the intervention (n=39), which included 24-hour accelerometer use, a smartphone app with personal feedback, a PA leaflet, a YouTube video on walking, and individual counseling with 3 face-to-face sessions and 4 telephone contacts. Data on fidelity were accumulated during the intervention through counseling cards and cloud computing. Data on acceptability were collected with a questionnaire at the end of the intervention (Likert scale from 1 to 5). Data analysis was mainly descriptive. The participants' responses revealed 3 items in capability and 2 in motivation, which stood out as perceived behavior change needs. Moreover, the main intervention arm showed good fidelity (eg, face-to-face sessions: 112/117, 96% and telephone contacts completed: 145/156, 93%; mean weekly accelerometer use 54%; ranging from 80% to 17% during the intervention) and acceptability (mean score ranging from 3.8 to 4.8), although some challenges were also experienced, especially in cloud-computed feedback and accelerometer-app use. The findings on behavior change needs call for additional research since no comparable studies were found. In addition, the explanatory value of the COM-B model and the psychometric properties of the COM-B questionnaire deserve further attention. The main intervention arm seemed applicable to clinical practice. However, the challenges discovered underscore the importance of pretesting technology-based approaches in patients with T2D.

Purpose: Loyalty to behaviour can be defined as a consistent preference for a specific way of acting, maintained over time. Physical activity (PA) and inactivity behaviours established in childhood and adolescence may persist in adulthood and affect health throughout the life cycle. The purpose of the present study is to monitor behavioural loyalty among children and adolescents. Methods: Data were collected from three Finnish School-Age Physical Activity studies (2016, 2018, and 2022) involving 4,631 students in 1st, 3rd, 5th, 7th, and 9th grades, aged 7–15 years. Participants wore hip-worn accelerometers for seven consecutive days. Moderate-to-vigorous physical activity (MVPA) was analysed using the mean amplitude deviation, smoothed with a 1 minute exponential moving average. Each school or non-school day was classified as active if it included at least 60 minutes of MVPA, and inactive otherwise. The analysis was done in two independent categories, loyalty to physical activity (LtPA) and loyalty to physical inactivity (LtPI). The day was classified as LtPA if an active day was followed by another active day and as LtPI if an inactive day was followed by another inactive day. Active-inactive and inactive-active pairs are not reported here. Results: On school days, LtPA showed a decreasing pattern with an increasing grade. The proportion of days classified as LtPA was 97%, 94%, 92%, 79%, and 70% for grades from 1st to 9th. A similar downwards pattern was observed on non-school days, although the proportions were lower: 88%, 79%, 70%, 62%, and 49%. In contrast, LtPI increased with an increasing grade level. On school days, the proportion of days LtPI were 21%, 26%, 24%, 46%, and 51%. The proportions were higher on non-school days with values of 41%, 43%, 56%, 63%, and 76%. Conclusion: On school days, there is a large drop in LtPA and a corresponding increase in LtPI between 5th and 7th grade. On non-school days, the harmful trend was observed across all grade levels. These findings suggest that PA promotion efforts during school days should be especially targeted at 7th grade students. On non-school days, the PA promotion should begin already for 1st grade students.

Examine potentially modifiable risk factors (MRFs) for female/woman/girl athletes' lower-extremity injuries. Systematic review with meta- or semiquantitative analyses and Grading of Recommendations, Assessment, Development and Evaluation. MEDLINE, CINAHL, APA PsycINFO, Cochrane Systematic Review Database, CENTRAL, SPORTDiscus, EMBASE, ERIC searched 30 October or 23 November 2023. Primary data studies with comparison group(s) assessing the association of MRFs for sport-related lower-extremity injury(s) with ≥1 female/woman/girl per study group. Across 195 studies (n=115; 58.9% female/woman/girl-specific estimates) including 1 525 662 participants (2.4% females/women/girls), eight injury outcomes were assessed (n=75 general lower-extremity, n=3 groin, n=6 hip, n=17 thigh, n=88 knee, n=17 lower-leg, n=27 ankle, n=9 foot). Sixty-six MRF categories were identified. Substantial heterogeneity in MRFs and injury outcomes exists, with high risk of bias present in 37.4% of studies. Considering female/woman/girl specific estimates, we performed meta-analyses for 10 MRFs (body mass, x (BMI), weekly training distance, muscle strength, artificial turf, off-season plyometric training, readiness to return-to-sport, single-leg hop asymmetry, vertical drop jump peak knee flexion angle and ground reaction force) and semiquantitative analyses for 26 MRFs for a variety of injuries. Meta-analyses suggest no association between any lower-extremity strength outcome (g=0.01, 95% CI -0.11 to 0.14; I2=37.3%; very low certainty evidence) or artificial turf (Incidence Rate Ratio=0.97, 95% CI 0.88 to 1.07; I2=2.4%; low certainty evidence) and various lower-extremity injuries. Higher body mass (g=0.19, 95% CI 0.00 to 0.38; I2=71.7%) and/or BMI (g=0.22, 95% CI 0.09 to 0.36; I2=37.0%) are associated with several lower-extremity injuries (very low certainty evidence). This review synthesises a large body of exploratory research, exposes important knowledge gaps and provides a foundation for understanding MRFs for female/woman/girl athlete lower-extremity injuries. PROSPERO CRD42024486715.

This paper provides an overview of the most recent assessment, collected in early midlife, of the FinnTwin12 cohort, a population-based study of Finnish twins born in 1983–1987. The twins were invited to complete an online survey assessing a range of variables, including physical and mental health, alcohol use and problems, other substance use, and early midlife environments (e.g., parenthood). In total, 2,085 individuals (~ 40% of the original sample) completed the survey (551 complete twin pairs, 58.7% female, 37.3% monozygotic, Mage = 37.2 years, SD = 1.47 years, age range = 34–39 years). Individuals who participated were more likely to be female, monozygotic, and have higher parental education and less hyperactivity/impulsivity and aggression at age 12 when compared to individuals who were invited but did not participate. Parental alcohol misuse and the twins’ alcohol use and misuse at age 14 were not related to study retention. Alcohol misuse in early midlife was positively associated with nicotine dependence, lifetime use of cannabis and other drugs, trauma exposure, and depressive symptoms, and negatively associated with physical health and having biological children. These new data expand upon the wealth of measures collected as part of previous assessments, expanding the scope of work on the etiology and correlates of alcohol misuse within a longitudinal, genetically-informed framework. In addition to these new survey measures, we are planning an in-person assessment to collect physiological measurements and conduct additional in-depth phenotyping on a subset of twins who have been more intensively studied over the years.

Musculoskeletal (MSK) disorders represent a significant burden to society and can be unpleasant for the affected individuals. Physical activity (PA) can prevent MSK disorders while conferring other health benefits. The present study aimed to investigate associations between device-measured PA and perceived MSK disorders among young adult men. PA at different intensity levels, standing, and sedentary behavior were measured with a hip-worn accelerometer in a cohort of 422 young adult Finnish men aged 26 years on average. The incidences of three common MSK disorders (viz., knee pain, lumbar radicular pain, and lumbago pain) during the last month were inquired by a questionnaire. Binary logistic regression was used to examine the associations between the MSK outcomes and explanatory PA variables (PA times at different intensity levels, standing, and sedentary times). The models were controlled for age, education, smoking, BMI, and maximal oxygen uptake. PA, standing, and sedentary times were not significantly associated with the incidence of perceived MSK pain during the last month, except for lumbago pain. Lumbago pain was slightly more probable if the time spent in light PA increased, even after controlling for potential confounding factors, including moderate-to-vigorous PA, with an odds ratio (OR) of 1.07 (95% CI: 1.02-1.14). Sedentary time showed an opposite association, with an OR of 0.98 (95% CI: 0.96-1.00). There were neither positive nor negative clinically meaningful associations between PA and recent MSK disorders among young adult men. The result is surprising and requires further confirmation.

The aim of this study was to evaluate the effect of an Argentine Tango (AT) program on total physical activity (PA) time in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). Prospective randomized controlled pilot study with two parallel groups. Participants were randomized 1:1 to attend a 24-week AT program from baseline to month6 for the immediate tango group (ITG) and a 12-week AT program from month3 to month6 for the wait-list control group (WLCG). Total PA time was measured at baseline, month3, and month6 using the Global Physical Activity Questionnaire-ONAPS and an accelerometer. Twenty-seven participants (15 RA and 12 SpA) were enrolled in the study. Thirteen participants in the WLCG and 14 in the ITG. At month3, there was no significant difference in the total PA time between the two groups. Longitudinal analyses revealed no significant difference between the two groups regarding PA, sedentary, fatigue, anxiety, depression, balance, physical performance, pain, and stress. However, body appreciation improved significantly in the ITG compared with the WLCG. Both groups showed improved physical abilities at 6month, including improvements in the 6-min walk test and timed up and go test. The ITG also reported reduced pain at months 3 and 6, while the WLCG exhibited improved balance at month 6. Although the AT program did not significantly increase total PA time in patients with CIR, it positively impacted body appreciation and physical abilities suggesting its potential as a complementary therapy. Key Points • Body appreciation significantly improved after a 24-week AT program, emphasizing the positive impact of dance on self-perception. • Both groups exhibited improved physical abilities at month 6, indicating a positive influence on participants' overall mobility and functional capacity. • The 24-week AT group reported reduced pain at months 3 and 6, and the 12-week AT group exhibited improved balance at month 6.

Objectives This study focused on how adolescents’ perceptions of coaches’ health promotion activity predict maintained participation and dropout in organized sports in emerging adulthood. In addition, differences in lifestyle habits between maintainers, dropouts, and nonparticipants in organized sports were explored. Materials and Methods Overall, 616 adolescents reported organized sports participation in the Finnish Health Promoting Sports Club (FHPSC) study at ages 15 and 19. Of these, 323 reported coach’s health promotion activity on health topics at the age of 15. An index of a coach’s general health promotion activity was formed. At age 19, all study participants reported their lifestyle habits. Results Among males, those who had perceived coaches’ general health promotion activity as frequent were more likely to be maintainers than dropouts (48.6% vs. 20.0%) (p = .002). Among females, there was no significant difference (32.0% vs. 28.4%). Logistic regression analysis adjusted for gender showed that perceiving coach’s general health promotion activity as frequent increased the odds of being a maintainer rather than a dropout. Moreover, maintainers had higher odds of having healthy lifestyle habits when compared to nonparticipants (related to physical activity; sleep; fruit and vegetable consumption; and cigarette use) or dropouts (related to physical activity; and cigarette use). In addition, dropouts had higher odds of having healthy lifestyle habits than nonparticipants (related to sleep; and cigarette use). Conclusions Perceiving coaches’ health promotion activity as frequent was related to maintained participation in organized sports among males. Maintainers were more likely to have more healthy lifestyle habits than nonparticipants and dropouts. There is a need to invest in coaches’ health promotion activity when it is infrequent. A more detailed understanding is needed of coaches’ health promotion activity that supports both maintained participation in sports, especially among females, and healthy lifestyle habits in emerging adulthood.

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To describe long-term care (LTC) use in Finland and Sweden in 2020, by reporting residential entry and exit patterns including hospital admissions and mortality, compared with the 2018-2019 period and community-living individuals. From national registers in Finland and Sweden, all individuals 70+ were included. Using the Finnish and Swedish study populations in January 2018 as the standard population, we reported changes in sex- and age-standardized monthly rates of entry into and exit from LTC facilities, mortality and hospital admission among LTC residents and community-living individuals in 2020. Around 850,000 Finns and 1.4 million Swedes 70+ were included. LTC use decreased in both countries from 2018 to 2020. In the first wave (March/April 2020), Finland experienced a decrease in LTC entry rates and an increase in LTC exit rates, both more marked than Sweden. This was largely due to short-term movements. Mortality rates peaked in April and December 2020 for LTC residents in Finland, while mortality peaked for both community-living individuals and LTC residents in Sweden. A decrease in hospital admissions from LTC facilities occurred in April 2020 and was less marked in Finland versus Sweden. During the first wave of the pandemic mortality was consistently higher in Sweden. We also found a larger decrease in LTC use and, among LTC residents, a smaller decrease in hospital admissions in Finland than in Sweden. This study calls for assessing the health consequences of the differences observed between these two Scandinavian countries as part of the lessons from the COVID-19 pandemic.