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To investigate the effects of a 12-month home-based exercise program on functioning and falls among persons with signs of frailty.A randomized controlled trial with a 1:1 allocation.Home-based.Home-dwelling persons aged 65 years or older meeting at least 1 frailty phenotype criteria (N=300). The mean age of the participants was 82.2±6.3 years, 75% were women, 61% met 1-2 frailty criteria, and 39% met ≥3 criteria.A 12-month, individually tailored, progressive, and physiotherapist-supervised physical exercise twice a week (n=150) vs usual care (n=149).FIM, Short Physical Performance Battery (SPPB), handgrip strength, instrumental activities of daily living (IADL), and self-reported falls and physical activity (other than intervention). Assessed 4 times at home over 12 months.FIM deteriorated in both groups over 12 months, -4.1 points (95% confidence interval [CI], -5.6 to -2.5) in the exercise group and -6.9 (95% CI, -8.4 to -2.3) in the usual care group (group P=.014, time P.001, interaction P=.56). The mean improvement in SPPB was significantly greater in the exercise group (1.6 [95% CI, 1.3-2.0]) than in the usual care group (0.01 [95% CI, -0.3 to 0.3]) (group P.001, time P=.11, interaction P=.027). The exercise group reported significantly fewer falls per person-year than the usual care group (incidence rate ratio, 0.47 [95% CI, 0.40-0.55]; P.001). There was no significant difference between the groups over 12 months in terms of handgrip strength, IADL function, or self-reported physical activity.One year of physical exercise improved physical performance and decreased the number of falls among people with signs of frailty. FIM differed between the groups at 12 months, but exercise did not prevent deterioration of FIM, IADL, or handgrip strength.

Objectives We investigated whether a specific exercise program for the neck–shoulder region reduces headache intensity, frequency, and duration, and how it influences neck disability among women with chronic headache compared to a control group. Design Two-center randomized controlled trial. Subjects 116 working-age women. Intervention The exercise group (n = 57) performed a home-based program with six progressive exercise modules, over 6 months. The control group (n = 59) underwent six placebo-dosed transcutaneous electrical nerve stimulation sessions. Both groups performed stretching exercises. Main measures The primary outcome was pain intensity of headache, assessed using the Numeric Pain Rating Scale. Secondary outcomes were frequency and duration of weekly headaches, and neck disability assessed using the Neck Disability Index. Generalized linear mixed models were used. Results Mean pain intensity at baseline was 4.7 (95% CI 4.4 to 5.0) in the exercise group and 4.8 (4.5 to 5.1) in the control group. After 6 months the decrease was slight with no between-group difference. Headache frequency decreased from 4.5 (3.9 to 5.1) to 2.4 (1.8 to 3.0) days/week in the exercise group, and from 4.4 (3.6 to 5.1) to 3.0 (2.4 to 3.6) in the control group (between-group p = 0.017). Headache duration decreased in both groups, with no between-group difference. Greater improvement in the Neck Disability Index was found in the exercise group (between-group change −1.6 [95% CI −3.1 to −0.2] points). Conclusion The progressive exercise program almost halved headache frequency. The exercise program could be recommended as one treatment option for women with chronic headache.

Purpose: To examine the associations between muscular fitness (MF) and body composition. Method: MF was assessed with three tests of FitnessGram test battery. Total body fat percentage (BF%), abdominal fat percentage (AF%) and fat-free mass (FFM) were measured by dual-energy X-ray absorptiometry (DXA). The IOTF body mass index (BMI) cut-offs were used to define healthy weight, overweight, and obesity. Results: MF was inversely associated with BF% and AF%. The children in the moderate and high MF groups had significantly lower BF% and AF% compared with the children in the low MF group within the same BMI category. After adjusting for cardiorespiratory fitness (CRF), BMI and sex, the differences between the MF groups were significant for BF% but not for AF%. Conclusion: There were significant inverse associations between MF and DXA -measured adiposity. Within the same BMI category, total and abdominal adiposity were lower in children with moderate or high MF than in children with low MF.

To investigate the effects of 12 months of physiotherapist-supervised, home-based physical exercise on the severity of frailty and on the prevalence of the 5 frailty phenotype criteria, using secondary analyses.Randomized clinical trial, with 1:1 allocation into 12-month home-based physical exercise, or usual care. The multicomponent exercise sessions (60 minutes) were supervised by the physiotherapist and included strength, balance, functional, and flexibility exercises twice a week at participants' homes.Home-dwelling older adults aged ≥65 years who were frail (meeting 3-5 criteria) or prefrail (1-2 criteria) according to frailty phenotype criteria.The severity of frailty (nonfrail, prefrail, or frail) was assessed using frailty phenotype criteria, and the prevalence of each frailty criterion (weight loss, low physical activity, exhaustion, weakness, and slowness) were assessed at baseline and at 12 months.Two hundred ninety-nine persons were included in the analyses, of whom 184 were prefrail and 115 were frail at baseline. Their mean age was 82.5 (SD 6.3) years, and 75% were women. There was a significant difference between the exercise and usual care groups' transitions to different frailty states from baseline to 12 months among those who at baseline were prefrail (P = .032) and frail (P = .009). At 12 months, the mean number of frailty criteria had decreased in the exercise group (-0.27, 95% CI -0.47, -0.08) and remained unchanged in the usual care group (0.01, 95% CI -0.16, 0.18; P = .042). The prevalence of the exhaustion (P = .009) and the low physical activity (P.001) criteria were lower at 12 months in the exercise group than in the usual care group.The severity of frailty can be reduced through 12-month supervised home-based exercise training. Exercise should be included in the care of older adults with signs of frailty.

Objective To evaluate the effects of a physical exercise program on days lived at home, the use and costs of health care and social services, mortality, and functional independence among patients with hip fractures. Design Randomized controlled trial with a parallel 2-group design consisting of a 12-month intervention and 12-month registry follow-up. Setting Home-based intervention. Participants Patients aged ≥60 years (N=121) with operated hip fracture and who were living at home were randomized into physical exercise (n=61) and usual care (n=60) groups. Interventions Supervised physical exercise twice a week. Main Outcome Measures The primary outcome was the number of days lived at home over 24 months. Secondary outcomes were the use and costs of health care and social services, mortality over 24 months, and Functional Independence Measure (FIM) over 12 months. Results Over 24 months, there was no significant difference between the groups in terms of days lived at home (incidence rate ratio, 1.01; 95% confidence interval [CI], 0.90-1.14) or mortality (hazard ratio, 1.01; 95% CI, 0.42-2.43). The mean total costs of health care and social services did not differ between the groups. The costs per person-year were 1.26-fold (95% CI, 0.87-1.86) greater in the physical exercise group than in the usual care group over 12 months and 1.08-fold (95% CI, 0.77-1.70) over 24 months. The mean difference between the change in FIM of the groups over 12 months was 4.5 points (95% CI, 0.5-8.5; P=.029) in favor of the physical exercise group. Conclusions Long-term home-based physical exercise had no effect on the number of days lived at home over 24 months among patients with hip fractures. The intervention was cost neutral over these 24 months. The FIM scores improved in both groups over 12 months, but the improvement was significantly greater in the physical exercise group than in the usual care group.

Objectives: Frailty increases the risks of hospitalization, institutionalization, and death. Our objective was to study the effects of home-based physical exercise on the number of days spent at home among pre frail and frail persons, versus usual care. In addition, utilization and costs of health care and social services, cost-effectiveness, and health-related quality-of-life (HRQoL) were explored. Design: Randomized controlled trial, with year-long supervised exercise for 60 minutes twice a week versus usual care. Follow-up for 24 months after randomization. Setting and Participants: A sample of 299 home-dwelling persons in South Karelia, Finland. Main inclusion criteria: >65 years, meeting at least 1 of the frailty phenotype criteria, Mini-Mental State Examination score >17. Methods: Primary outcome, days spent at home over 24 months, was calculated deducting days in inpatient care, in nursing homes, and days after death. HRQoL was assessed (15D questionnaire) at baseline and at 3, 6, and 12 months. Utilization data were retrieved from medical records. Results: The participants' mean age was 82.5 (SD 6.3), 75% were women, 61% were pre-frail and 39% frail. After 24 months, there was no difference between groups in days spent at home [incidence rate ratio 1.03; 95% confidence interval (CI) 0.98-1.09]. After 12 months, the costs per person-year were 1.60-fold in the exercise group (95% CI 1.23-1.98), and after 24 months, 1.23-fold (95% CI 0.95-1.50) versus usual care. Over 12 months, the exercise group gained 0.04 quality-adjusted life-years and maintained the baseline 15D level, while the score in the usual care group deteriorated (P for group Conclusions and Implications: Physical exercise did not increase the number of days spent at home. Exercise prevented deterioration of HRQoL, and in the frail subgroup, all intervention costs were compensated with decreased utilization of other health care and social services over 24 months. (c) 2020 AMDA The Society for Post-Acute and Long-Term Care Medicine.

Background Obesity has become a major health challenge in children. Fundamental movement skills (FMS) are suggested to have an important role for being physically active and decreasing the risk of obesity. This systematic review aimed to give an overview of studies providing evidence for a relationship between FMS and the weight status in children. Material/Methods A systematic search of five electronic databases (MEDLINE (PubMed), SportDiscus, ERIC, PsycInfo and SCOPUS) was conducted in January 2015. Studies examining associations between FMS and weight status in children aged 3–12 years were included. Results The final sample included 12 cross-sectional studies. Seven studies found statistically significant inverse association between FMS and body mass index (BMI). Three studies used waist circumference (WC), and significant inverse associations were found in two of these. Dual-energy X-ray absorptiometry (DXA) was used in one study and significant association was found between FMS and abdominal and total body fat percentage. One study, using skinfolds, found no association. Conclusions Based on the findings of the 12 studies, the relationship between FMS and weight status in children aged 3–12 years remains unclear. Developing competency in FMS may have important health consequences, and more studies are needed in which body composition is objectively measured with DXA. peerReviewed

We studied differences in physical activity (PA), sedentary behaviour (SB), and the types of PA and SB between Finnish girls and boys and children from different socioeconomic backgrounds (SES). We assessed PA, SB, parental education, and household income using detailed questionnaires in a representative population sample of 486 children (238 girls, 248 boys) aged 6-8 years. Girls spent on average 1.7 h/day and boys 2.0 h/day in total PA (p = 0.002). Altogether 66% of girls and 54% of boys had less than 2 h of total PA per day (p = 0.012). Girls had lower levels of unsupervised PA (45 vs. 54 min/day, p = 0.001), supervised PA (1.5 vs. 1.9 h/week, p = 0.009), and PA during school recess (1.8 vs. 1.9 h/week, p = 0.032) than boys. Girls had higher levels of total SB (3.8 vs. 3.4 h/day, p = 0.015) but lower levels of screen-based SB (1.5 vs. 1.9 h/day, p 0.001) than boys. Lower parental education and household income were associated with lower levels of supervised PA in girls (p = 0.011 and p = 0.008, respectively) and in boys (p = 0.006 and p = 0.003, respectively). Lower parental education and household income were also related to higher levels of screen-based SB in boys (p = 0.005 and p 0.001, respectively) but not in girls. Girls have lower levels of total, unsupervised, and supervised PA, PA during recess, and screen-based SB but higher levels of total SB than boys. Lower parental education and household income are associated with lower levels of supervised PA in both genders and higher levels of screen-based SB in boys.

Background Increasing the level of physical activity among persons with signs of frailty improves physical functioning. There is a lack of long-term supervised physical exercise intervention studies including a validated definition of frailty. Aims To present baseline characteristics of persons with signs of frailty participating in a randomized long-term home-based physical exercise trial (HIPFRA), and to study associations between the severity of frailty, functional independence and health-related quality-of-life (HRQoL). Methods Three hundred persons, ≥ 65 years old and with signs of frailty (assessed by Fried´s phenotype criteria) were recruited from South Karelia, Finland and randomized to a 12-month physiotherapist-supervised home-based physical exercise program (n = 150), and usual care (n = 150). Assessments at the participants’ homes at baseline, and after 3, 6 and 12 months included the Short Physical Performance Battery (SPPB), the Functional Independence Measure (FIM), HRQoL (15D) and the Mini-Mental State Examination (MMSE). Results Eligibility was screened among 520 persons; 300 met the inclusion criteria and were randomized. One person withdrew consent after randomization. A majority (75%) were women, 182 were pre-frail and 117 frail. The mean age was 82.5 (SD 6.3) years, SPPB 6.2 (2.6), FIM 108.8 (10.6) and MMSE 24.4 (3.1) points, with no significant differences between the study groups. Inverse associations between the severity of frailty vs. FIM scores and HRQoL (p

Objective: Rehabilitation is often neglected in clinical practice guidelines, even when there is evidence for its effectiveness. The Current Rehabilitation development project, documented in this article, aimed to develop processes and structures to incorporate evidence and good practice on rehabilitation and functional capacity into the Finnish national Current Care Guidelines. Design: Descriptive assessment. Methods: The 3-year Current Rehabilitation development project was launched in 2012. It began with an assessment of existing rehabilitation evidence on the Current Care Guideline database and a query to Finnish rehabilitation experts. The project group developed and compiled tools for Current Care editors and guideline panels. The editorial team continued to monitor changes in rehabilitation evidence in the guidelines. Results: During the years 2012-2014, a total of 54 guidelines were published, and rehabilitation was incorporated into 31 of them. The number of rehabilitation-related evidence summaries increased from 49 to 164. During the next 3 years an additional 41 guidelines were published. Rehabilitation was incorporated to 24 of them, and the number of rehabilitation-related evidence summaries increased from 78 to 136. Conclusion: The level of evidence criteria used for rehabilitative interventions were the same as for symptomatic or curative interventions. Evidence showing the effectiveness of rehabilitation increased substantially during the project.

The aim of this follow-up study was to explore the long-term effects of a 6-month trial of exercise training on hot flushes. The follow-up was 4 years after the exercise intervention ended.A cohort study after a randomised controlled trial. Ninety-five of the 159 randomised women (60%) participated in anthropometric measurements and performed a 2-km walk test. Participants completed a questionnaire and kept a one-week diary on physical activity, menopause symptoms and sleep quality. The frequency of 24-h hot flushes was multiplied by severity and the total sum for one week was defined as the Hot Flush Score (HFScore). Multilevel mixed regression models were analysed to compare the exercise and control groups.Hot Flush Score (HFScore) as assessed with the one-week symptom diary.The women in the exercise group had a higher probability of improved HFScore, i.e. a decrease in HFScore points, adjusted for hormone therapy (OR 0.95; 95% CI 0.90-1.00) than women in the control group at the 4-year follow-up. After additional adjustment for sleep quality, the result approached statistical significance at HFScore≥13 with women in the exercise group. Women who had the least amount of hot flushes, HFScore13, benefited most from exercise during the 4-year follow-up when compared with women in the control group.Women in the exercise group had positive effects on their HFScore 4 years after a 6-month exercise intervention.

Health concerns, such as frailty and osteoporotic fractures decrease functional capacity and increase use of health and social care services in the aging population. The ability to continue living at home is dependent on functional capacity, which can be enhanced by rehabilitation. We study the effects of a 12-month home-based physiotherapy program with 12-month follow-up on duration of living at home, functional capacity, and the use of social and health care services among older persons with signs of frailty, or with a recently operated hip fracture. This is a non-blinded, parallel group, randomized controlled trial performed in South Karelia Social and Health Care District, Finland (population 131,000). Three hundred community-dwelling older persons with signs of frailty (age ≥ 65) and 300 persons with a recent hip fracture (age ≥ 60) will be recruited. Frailty is screened by FRAIL questionnaire and verified by modified Fried’s frailty criteria. Both patient groups will be randomized separately to a physiotherapy and a usual care arm. Individualized, structured and progressive physiotherapy will be carried out for 60 min, twice a week for 12 months at the participant’s home. The primary outcome at 24 months is duration of living at home. Our hypothesis is that persons assigned to the physiotherapy arm will live at home for six months longer than those in the usual care arm. Secondary outcomes are functional capacity, frailty status, health-related quality-of-life, falls, use and costs of social and health care services, and mortality. Assessments, among others Short Physical Performance Battery, Functional Independence Measure, Mini Nutritional Assessment, and Mini-Mental State Examination will be performed at the participant’s home at baseline, 3, 6, and 12 months. Register data on the use and costs of social and health care services, and mortality will be monitored for 24 months. Our trial will provide new knowledge on the potential of intensive, long-term home-based physiotherapy among older persons at risk for disabilities, to enhance functional capacity and thereby to postpone the need for institutional care, and diminish the use of social and health care services. ClinicalTrials.gov Identifier: NCT02305433 , Registered Nov 28, 2014.

Sauna bathing has a long tradition, especially in the northern circumpolar countries, and it has become popular in Europe and the United States.1,2 In Finland, with a population of 5.5 million, for example, 1 million saunas are in use. Most Finns take 1 or more sauna baths a week, starting in childhood. A number of reports about sauna bathing focus on its health benefits.1–3 The public accept regular sauna bathing as a method of “hardening,” which means enhancing the body's resistance. Increased blood supply to the skin and mucosa improves regulation of body temperature, stabilization of the autonomic nervous system with decreased sympathetic activity, and the support of antioxidative protection potentials with improved defense against free radicals.3 The purported positive effects of sauna bathing for prevention of and therapy for cardiovascular diseases, such as coronary heart disease, and post myocardial infarction, congestive heart failure, and hypertension, remain unchallenged.1 Positive effects are reported for glucose metabolism, whereby sauna bathing should work comparably to physical activity by sensitizing the tissue for the insulin-dependent glucose uptake.3 Through hyperthermia and elevated blood supply to the periphery of the body, diabetic complications such as macroangiopathy and microangiopathy can be counteracted.3 Regular sauna bathing may also lower serum cholesterol and its proportion in low-density lipoprotein.3 All these factors contribute to vascular health. Furthermore, in common disorders of the musculoskeletal system, sauna bathing contributes to pain relief and prevention of the transition of acute to chronic pain.3 In depression, chronic fatigue syndrome, and anorexia nervosa, sauna bathing may reduce symptoms.3 In addition, sauna bathing brings wellness, pleasure, and a certain type of hedonia; socializing can create camaraderie or friendship (figure).

Insulin metabolism has been previously linked to oxidized low-density lipoproteins (ox-LDL), but corroborating intervention studies are lacking. We investigated whether changes in ox-LDL levels are accompanied by changes in insulin sensitivity in a 32-month life-style intervention study.A 2-month weight reduction was followed by 6-month diet and exercise counselling and a 2-year follow-up period. Men of 35-50 years of age, BMI ≥ 30 kg/m(2), and waist circumference100 cm were recruited via newspapers in the city of Tampere, Finland. Of the 90 men meeting the inclusion criteria, 67 (76%) completed the study. Ox-LDL was estimated as the presence of oxidized lipids in LDL. Homeostasis model assessment of insulin resistance (HOMA-IR), ox-LDL, and ratio of ox-LDL and high-density lipoprotein cholesterol (ox-LDL/HDL-c) were used as the main outcome measures.The detected changes in HOMA-IR were strikingly similar to those in ox-LDL and ox-LDL/HDL-c. Compared to the first HOMA-IR quartile, the fourth quartile had 23%-51% higher concentrations in ox-LDL and ox-LDL/HDL-c at all time points (P0.05 for all).This weight reduction intervention study adds evidence to support the connection between insulin metabolism and oxidized LDL, possibly contributing to the higher incidence of atherosclerotic cardiovascular diseases among diabetic patients.

Background Few community-based lifestyle interventions have examined subjective well-being. We examined the effects of health counseling and exercise training on self-rated health (SRH), self-rated well-being (SRW) and depressive symptoms in middle-aged men at increased risk for cardiovascular disease (CVD) in a randomized controlled trial. Methods Men (N.=168) with at least two CVD risk factors engaging in leisure-time physical activity less than three times/week were randomized into: A) a group receiving single-session health counseling; B) a group receiving single-session health counseling and three months of weekly structured group exercise training; or C) a control group. We assessed SRH and SRW using visual analogue scales and depressive symptoms using a brief depression screener (the Patient Health Questionnaire-2, PHQ-2). Results Generalized estimating equation (GEE) models showed that, after 3 and 12 months, SRH (P=0.024) and SRW (P=0.014) improved across all groups. We found no differences between the groups (group by time effect, P=0.44 and P=0.80). The proportion of men with PHQ-2 scores ≥3 (positive depression screen) decreased in groups A (from 27% to 13%) and B (from 34% to 18%), but increased among controls (from 26% to 31%) (group by time effect, P=0.078). Conclusions We found improvements in SRH and SRW, with a diminishing proportion of men screening positive for depression one year after a single health counseling session and a three-month exercise-training program. We detected, however, no statistically significant differences when comparing men who received health counseling or health counseling combined with exercise training to controls.

This study examined the associations of cardiorespiratory fitness (CRF) and leisure-time physical activity (LTPA) with health-related quality of life (HRQoL) in women at risk for gestational diabetes mellitus (GDM). The participants were 39 women planning pregnancy with a history of GDM and/or BMI >29 kg/m2 . We assessed CRF by measuring maximal oxygen consumption (VO2max ) during incremental cycle ergometer exercise until voluntary fatigue. LTPA was self-reported, and HRQoL assessed with the SF-36 Health Survey (SF-36). The mean (SD) VO2max was 27 (6) mL·kg-1 ·min-1 , and the mean LTPA was 2.6 (1.7) h/wk. After controlling for BMI, VO2max was positively associated with the SF-36 General Health scale (β 1.27, 95% CI: 0.09, 2.44, P=.035) and the Physical Component Summary (β 0.48, 95% CI: 0.14, 0.82, P=.007). The General Health scale (P=.023) and the Physical Component Summary (P=.011) differed even between those with very poor and poor CRF. After controlling for BMI, LTPA was positively associated with the SF-36 Physical Functioning scale (rs =.34, P=.039), the General Health scale (β 3.74, 95% CI: 0.64, 6.84, P=.020), and the Physical Component Summary (β 1.13 95% CI: 0.19, 2.06, P=.020). To conclude, CRF and LTPA were positively associated with perceived general health and physical well-being in women planning pregnancy and at risk for GDM. Even a slightly better CRF would be beneficial for well-being among women with low levels of CRF.

Background Many adults are insufficiently physically active for health. Counselling is the main method to promote physical activity (PA) in primary care but often implemented inadequately. The aim of this study was to increase health professionals’ i) know-how about health-related PA and PA counselling, ii) implementation and quality of PA counselling, iii) familiarity with and use of Physical Activity Prescription (PAP), iv) internal and external collaboration and v) use of electronic patient record system in PA counselling. Methods Four Finnish health centres participated. Each nominated a working group for reaching the goals through a 6-month development work, which was supported with monthly tutorials by the research group. The outcome evaluation of the development work included 19 variables, which reflected the five goals and were assessed before (baseline) and after the development work (follow-up). Variable-specific differences in proportions (%) and their 95 % confidence intervals (CI) between the time points indicated change. The measures were questionnaires to the health professionals (N = 75 at baseline and N = 80 at follow-up) and patients (N = 441 and N = 431), professionals’ record sheets on patient visits (N = 1008 and N = 1000), and telephone interviews to external partners (N = 48 and N = 28). The process was evaluated with the extent the working group members participated in the development work and with the implementation of development actions. Assessment was based on meeting minutes of tutorials and working group meetings. Results Health professionals’ familiarity with PAP (questionnaire, change 39 %-points; 95 % CI 26.5 to 52.5) and use of PAP (questionnaire, 32 %-points; 95 % CI 18.9 to 45.1 and record sheet, 4 %-points; 95 % CI 2.7 to 5.3) increased. A greater proportion of professionals had agreed in their working unit on using PAP (questionnaire, 32 %-points; 95 % CI 20.3 to 43.7) and used PAP as a referral to other health professionals (record sheet, 1 %-point; 95 % CI 0.3 to 1.7). Also the know-how of PA and PA counselling showed improvement but not statistically significantly. The working group members participated unevenly in the development work and had difficulties in allocating time for the work. This was seen in limited number of actions implemented. Conclusions The study was able to achieve some improvements in the familiarity with and use of PAP and to lesser extent in the know-how of health-related PA and PA counselling. To observe changes in other goals, which targeted more at organisational, inter-professional and multi-sectorial level, may have required more long-term actions. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0540-x) contains supplementary material, which is available to authorized users.

The purpose of the guideline is to promote physical activity in the prevention, treatment and rehabilitation of diseases. Physical activity plays a key role in the management of several chronic noncommunicable diseases. In this guideline, the following diseases are discussed: endocrinological, cardiovascular, musculoskeletal and respiratory diseases, as well as depression and cancer. In addition, physical activity during pregnancy and in senior citizens is reviewed. Exercise counseling should be included as part of disease management and lifestyle guidance.

Insomnia symptoms must be differentiated from insomnia disorder. The correct aiagnosis or insomnia aisoraer is important, as insomnia may also be a symptom of many other diseases. Cognitive behavioral methods are recommended as first-line treatment options. Treatment of acute insomnia with hypnotics should not exceed two weeks. In elderly persons adverse effects of hypnotics may exceed their beneficial effects in long-term use. Antidepressive medications acting on the histamine-1 system may be used in very small doses. The new guideline includes e.g. insomnia in pregnant and menopausal women and in cancer patients, and driving issues.

We studied dietary patterns, physical activity (PA), and monthly goal setting in a weight reduction intervention in long-distance professional drivers. The study was conducted in Finland in 2009–2012. Male drivers with waist circumference > 100 cm were randomized to a lifestyle counseling (LIFE, N = 55) and a reference (REF, N = 58) group. During 12 months, LIFE participated in 6 face-to-face and 7 telephone counseling sessions on diet and PA. Dietary patterns were assessed using an index combining food diary and counselor interview, and PA with the number of daily steps using a pedometer. Monthly lifestyle goals, perceived facilitators and barriers, and adverse effects of PA in the LIFE participants were monitored using counselors' log books. Forty-seven (85%) LIFE participants completed the 12-month program. After 12 months, the mean dietary index score improved by 12% (p = 0.002, N = 24), and the number of daily steps increased by 1811 steps (median; p = 0.01, N = 22). The most frequent dietary goals dealt with meal frequency, plate model, and intake of vegetables, fruits, and berries. The most common PA mode was walking. Typical facilitators to reach monthly lifestyle goals were support from family and friends and ailment prevention; typical barriers were working schedules and ailments. Adverse effects, most commonly musculoskeletal pain, occurred among 83% of the LIFE participants. Positive changes in lifestyle habits were observed during counseling. Monthly lifestyle counseling combining face-to-face and phone contacts seemed appropriate to long-distance drivers. Barriers for reaching lifestyle changes, and adverse effects of PA were common and need to be addressed when planning counseling. Trial registration: Clinical Trials NCT00893646, Highlights • Our study is one of the few lifestyle counseling RCTs in truck and bus drivers. • Dietary habits improved during 12-month program. • Habitual walking and daily step count increased during 12-month program. • Improved dietary habits were associated with weight reduction. • Perceived barriers related to working schedules and ailments were common.

Background and purpose: Metabolic syndrome has been associated with increased carotid intima-media thickness (CIMT) and cardiovascular disease (CVD). The objective of this study was to examine metabolic syndrome as a determinant of CIMT in men and women and to compare the Framingham risk score (FRS) and metabolic syndrome as risk factors for increased carotid atherosclerosis. Methods: The study population consisted of 1353 Finnish men and women aged 45 years and above who participated in Finnish population-based Health 2000 Survey. CIMT was used as a marker of subclinical atherosclerosis. The National Cholesterol Education Program Adult Treatment Panel III criterion was used to define the presence of metabolic syndrome. Results: In multivariable models, metabolic syndrome was an independent determinant of CIMT in both sexes (p ≤ 0.001 for both). When metabolic syndrome was included in the regression models along with its components, it was an independent determinant of CIMT in women but not in men. After dividing the population into risk categories according to FRS and the presence of metabolic syndrome, FRS predominantly determined CIMT regardless of the presence of metabolic syndrome in men. In women, however, CIMT was significantly higher in subjects with metabolic syndrome than in those without it, independently of the FRS. Conclusions: Metabolic syndrome is an independent determinant of CIMT in both sexes. In women but not in men, metabolic syndrome is associated with CIMT independently of its components. Metabolic syndrome provides additional information on a person’s risk for early atherosclerosis beyond FRS in women but not in men. © 2008 Elsevier Ireland Ltd. All rights reserved.

Valkeinen H, Alen M, Hakkinen A, Hannonen P, Kukkonen-Harjula K, Hakkinen K. Effects of concurrent strength and endurance training on physical fitness and symptoms in postmenopausal women with fibromyalgia: a randomized controlled trial. Objective To examine the effectiveness of concurrent strength and endurance training on muscle strength, aerobic and functional performance, and symptoms in postmenopausal women with fibromyalgia (FM). Design Randomized controlled trial. Setting Local gym and university research laboratory. Participants Twenty-six women with FM. Intervention Progressive and supervised 21-week concurrent strength and endurance training. Main Outcome Measures Muscle strength of leg extensors, upper extremities, and trunk; peak oxygen uptake (Vo 2 peak), maximal workload (Wmax), and work time; 10-m walking and 10-step stair-climbing time and self-reported functional capacity (Health Assessment Questionnaire); and symptoms of FM. Results After concurrent strength and endurance training, the groups differed significantly in Wmax ( P =.001), work time ( P =.001), concentric leg extension force ( P =.043), walking ( P =.001) and stair-climbing ( P P =.038). The training led to an increase of 10% ( P =.004) in Wmax and 13% ( P =.004) in work time on the bicycle but no change in Vo 2 peak. Conclusions Concurrent strength and endurance training in low to moderate volume improves the muscle strength of leg extensors, Wmax, work time, and functional performance as well as perceived symptoms, fatigue in particular. Concurrent strength and endurance training is beneficial to postmenopausal women with FM without adversities, but more extensive studies are needed to confirm the results.

The purpose of this study was to compare physical fitness and health-related quality-of-life between twenty-three postmenopausal women with fibromyalgia (age 58 +/- 3 years) and eleven healthy women (58 +/- 5 years). Aerobic fitness and isometric force of different muscle groups were measured. Functional performance was assessed by walking and stair-climbing times. Symptoms were assessed by visual analog scale and quality-of-life by RAND-36 questionnaire. Women with fibromyalgia had significantly lower isometric force in bilateral leg extensors (1285 vs. 1898 N), unilateral knee extensors (414 vs. 502 N) and flexors (197 vs. 235 N) than healthy women, but no differences were observed in forces of the trunk and upper extremities. Maximal workload in the aerobic test (130 vs. 151 W), functional performance and quality-of-life were lower in women with fibromyalgia and they reported more symptoms than healthy subjects, while maximal oxygen uptake did not differ between the groups. A lower maximal load in the aerobic test suggests the patients' unsatisfactory ability to stand physical loading and resist overall fatigue. Moreover, fatigue rather than pain was the main factor to decrease the quality-of-life in women with fibromyalgia. Additional efforts should be addressed to strength training, when planning health promotion and rehabilitation programs in fibromyalgia.

Sterol regulatory element-binding protein cleavage-activating protein (SCAP) and apolipoprotein E (apo E) regulate cellular and plasma lipid metabolism. Therefore, variations in the corresponding genes might influence weight reduction and obesity-associated metabolic changes. We investigated the relationships of SCAP (Ile796Val) and apo E polymorphisms on metabolic changes during weight reduction by using a 12-week very low-energy diet. Body composition, serum lipids, plasma glucose, and insulin were assessed in 78 healthy premenopausal women (initial body mass index, 34 +/- 4 kg/m(2); age, 40 +/- 4 years) before and after the intervention. The SCAP genotype groups did not differ in the responses of any parameters measured during weight reduction. Apo E did not differentiate the weight loss, but the changes in total and low-density lipoprotein cholesterol for the genotype groups apo E epsilon2/3, epsilon3/3, as well as epsilon3/4 and epsilon4/4 combined were -0.94 +/- 0.56 and -0.59 +/- 0.32, -0.71 +/- 0.49 and -0.49 +/- 0.45, and -0.55 +/- 0.47 and -0.37 +/- 0.39 mmol/L, respectively (P < .05 for both). In conclusion, neither the SCAP Ile796Val nor the apo E polymorphism was associated with weight loss in obese premenopausal women. However, the apo E-but not SCAP genotype-seems to be one of the modifying factors for serum cholesterol concentrations during very low-energy diet in obese premenopausal women.

To study relationships between obesity, physical inactivity and sleep-related disturbances (obstructive sleep apnea (OSA), sleep duration, sleep disturbances concomitant with daytime tiredness) in adults (or =30 years).Cross-sectional study with a random population sample.A total of 3377 men (mean age 52.3, s.d. 14.8, years) and 4264 women (56.4, s.d. 17.2, years).Dependent variables, measured: Waist circumference (WC) and body mass index (BMI). Independent variables, from a detailed interview/questionnaire: probable OSA, other sleep-related disturbances, sleep duration, type and frequency of leisure physical activity. Age, mental health, smoking and education were included in analyses as potential confounders.In men, OSA and physical inactivity increased likelihood for abdominal obesity (WCor =102 cm). Physical inactivity also increased, but long (or =9 h/day) sleep decreased likelihood for abdominal overweight (WC: 94-101 cm) in men. In women, abdominal obesity (WCor =88 cm) was associated positively with OSA, moderate sleep-related disturbances, and physical inactivity. Education modulated the influence of age on abdominal obesity in both genders. Using BMI as the dependent variable did not change the general information obtained by the model. In addition, abdominal obesity was found to be an independent risk factor also in multivariable models predicting categories of a combined sleep duration and sleep disturbances.Sleep duration and sleep-related disturbances are associated with obesity, even after controlling for OSA and physical inactivity. The results support the hypothesis of vicious circle between sleep and obesity.

Metabolic syndrome and its components have been associated with arterial stiffness and cardiovascular disease. The objective of this study was to examine the independent influences of metabolic syndrome, its components, and other cardiovascular risk factors on arterial stiffness as well as to compare 2 definitions for metabolic syndrome (National Cholesterol Education Program [NCEP] and International Diabetes Federation [IDF]) in their ability to identify subjects with arterial stiffness. The study population consisted of 401 Finnish men and women aged 45 years and older who participated in a substudy of the Finnish population-based Health 2000 Survey. Pulse wave velocity (PWV) measured by whole-body impedance cardiography was used as a marker of elevated arterial stiffness. In multivariate models, systolic blood pressure, age, waist circumference, and fasting blood glucose (P < or = .001 for all) were independent determinants for PWV. In the models including metabolic syndrome instead of its components, the NCEP and IDF definitions were similarly associated with PWV (P < or = .01 for both), the other independent determinants being age, sex (P < .001 for both) and plasma C-reactive protein concentration (P = .016 and P = .005 in models containing the NCEP and IDF definitions, respectively). Systolic blood pressure, age, waist circumference, and fasting blood glucose level were independently associated with increased arterial stiffness. Metabolic syndrome determined increased arterial stiffness independently of other known cardiovascular risk factors. The NCEP and IDF definitions did not differ in their ability to identify subjects with increased arterial stiffness.

A suitable amount of properly conducted and performed physical activity improves the functional capacity and quality of life of persons having a chronic disease. Regular endurance exercise and muscular strength training can also alleviate central risk factors of atherosclerotic disease. Exercise-based rehabilitation reduces mortality among patients with coronary artery disease or cardiac failure. In practice, exercise counseling and guidance is included as part of disease management and lifestyle guidance. This requires knowledge, competence and time resources from the physician. In addition, a clinical pathway involving health and exercise professionals is needed to support the implementation of exercise programs.

Background Cervicogenic headache and migraine are common causes of visits to physicians and physical therapists. Few randomized trials utilizing active physical therapy and progressive therapeutic exercise have been previously published. The existing evidence on active treatment methods supports a moderate effect on cervicogenic headache. Objective The aim of this study is to investigate whether a progressive, group-based therapeutic exercise program decreases the intensity and frequency of chronic headache among women compared with a control group receiving a sham dose of transcutaneous electrical nerve stimulation (TENS) and stretching exercises. Design A randomized controlled trial with 6-month intervention and follow-up was developed. The participants were randomly assigned to either a treatment group or a control group. Setting The study is being conducted at 2 study centers. Patients The participants are women aged 18 to 60 years with chronic cervicogenic headache or migraine. Intervention The treatment group's exercise program consisted of 6 progressive therapeutic exercise modules, including proprioceptive low-load progressive craniocervical and cervical exercises and high-load exercises for the neck muscles. The participants in the control group received 6 individually performed sham TENS treatment sessions. Measurements The primary outcome is the intensity of headache. The secondary outcomes are changes in frequency and duration of headache, neck muscle strength, neck and shoulder flexibility, impact of headache on daily life, neck disability, fear-avoidance beliefs, work ability, and quality of life. Between-group differences will be analyzed separately at 6, 12, and 24 months with generalized linear mixed models. In the case of count data (eg, frequency of headache), Poisson or negative binomial regression will be used. Limitations The therapists are not blinded. Conclusions The effects of specific therapeutic exercises on frequency, intensity, and duration of chronic headache and migraine will be reported.

In 2001, a collaborative Physical Activity Prescription Programme (PAPP) was started in Finland to increase physical activity (PA) counselling among physicians, especially in primary care. This article describes the initiation, implementation and evaluation of PAPP. Five actions were implemented to reach the programme goal: (i) developing a counselling approach for physicians; (ii) providing easy and open access to counselling material; (iii) facilitating physicians' uptake and adoption of the counselling approach; (iv) disseminating information about the counselling approach to physicians, health and exercise professionals and decision-makers and (v) raising financial resources to cover programme expenses. Evaluation was based on the dimensions of the RE-AIM framework: reach, effectiveness, adoption, implementation and maintenance. Effectiveness and adoption were evaluated with two questions added to the annual survey of the Finnish Medical Association to all practising physicians in the year 2002 (n = 16 692) and 2004 (n = 17 170). The 4-year PAPP was successful in reaching health care units (Reach), accomplishing most of the implementation actions (Implementation) and initiating local projects for institutionalizing the prescription-based counselling approach, 'Prex' (Maintenance). However, at the national level, the programme was not effective in increasing the frequency of asking about patients' PA habits (Effectiveness) or the frequency of using 'Prex' or other written material in PA counselling among physicians (Adoption). To improve the latter two, the duration of the programme would have had to be extended with more effort at strengthening physicians' confidence in PA counselling and knowledge about its effectiveness. Also, a more systematic approach would have been necessary to facilitate inter-sectoral network for adopting 'Prex' as a counselling tool at the local level.

We studied the association between weight maintenance, oxidized low-density lipoprotein (ox-LDL) and other lipoproteins in obese men.A 2-month weight reduction phase (WRP) with a very-low-energy diet was followed by a 6-month weight maintenance period and an unsupervised 2-year follow-up. Ninety men entered and 68 (76%) completed the study. Subjects were analyzed as one group and after division into two subgroups: 20 most successful men in maintaining the lost weight (subgroup 1) and the remaining (n=48) men (subgroup 2). Ox-LDL was measured by quantifying the amount of conjugated dienes in LDL particles.The mean (+/-s.d.) weight reduction at the end of the WRP (n=68) was 14% (confidence interval (CI) 12.9-14.7%, 14.5+/-4.2 kg, P0.001). Ox-LDL decreased by 22% (CI 16.9-28.1, 12.3+/-15.4 micromol/l, P0.001). At the end of the 2-year follow-up, the regain in weight from the end of the WRP was 11% (CI 9.0-12.4, 9.6+/-6.2 kg, P0.001). The regain in ox-LDL was 30% (CI 18.7-41.2, 8.2+/-15.4 micromol/l, P0.001). In subgroup 1 vs 2, the respective regains were 3% (CI 0.9-4.2, 2.2+/-3.0 kg, P=0.006) vs 14% (CI 12.7-15.6, 12.9+/-4.0 kg, P0.001) regarding weight and 9% (2.0+/-6.9 micromol/l, P=NS) vs 39% (CI 23.7-53.9, 11.2+/-17.2 micromol/l, P/=0.001) in ox-LDL.The favorable changes seen in ox-LDL particles and serum lipids during weight reduction could be maintained by keeping the weight reduced, which may indicate decreased risk of atherosclerosis. But weight regain causes a resurge of ox-LDL.

Objectives To examine the effectiveness of prescription-based counseling and self-monitoring in the promotion of physical activity in primary health care. Methods The study was conducted in Finland during 2003–2004. Physicians from 24 health care units (N = 67) were randomized to a prescription or a non-prescription group. The patients (N = 265) were assigned to the groups according to their physician. Every other patient of the non-prescription physicians received a pedometer and a physical activity log (MON) and feedback about their 5-day-recordings, the rest served as controls (CON). PA was assessed prior and 2 and 6 months after the physician's appointment with a questionnaire. Results The mean increase in weekly overall physical activity at 2 months was 1.0 (95% CI 0.0 to 2.0) session more in the prescription group than in controls. In at least moderate-intensity physical activity, the mean difference in changes was 0.8 (95% CI 0.1 to 1.5) sessions at 2 months and 0.9 (95% CI 0.2 to 1.5) sessions at 6 months for the favor of the prescription group. Compared to controls, self-monitoring increased the weekly duration of overall PA at 2 months on average by 217 min (95% CI 23 to 411). Conclusions Prescription can be recommended as a tool for primary health care physicians to promote physical activity. Self-monitoring with an expert feedback can be useful in increasing especially the weekly duration of overall physical activity in the short term.

OBJECTIVE: The aim was to assess long-term changes in food consumption and eating behaviour during and 2 y after dietary counselling in weight-reduced obese men. DESIGN: Observational study from a randomised controlled trial. SETTING: Outpatient clinic of a research institute. SUBJECTS: A total of 36 subjects with complete data on food intake during the study. Subjects were obese (mean body mass index (BMI) 32.8 kg/m2) men aged 35–50 y, recruited by media advertising. INTERVENTIONS: Dietary counselling was included in 2 months weight reduction with very-low-energy-diet and in 6 months weight maintenance programme, which also included physical activity counselling. This was followed by a 23 months unsupervised follow-up with yearly assessments. Food intake was assessed six times during the study by 4-day food records. Eating behaviour was assessed by Three-Factor Eating Questionnaire (TFEQ). RESULTS: Increased consumption of low-fat cheese, low-fat margarine, vegetables and high-fibre bread, and decreased consumption of sugar, sausage, high-fat cheese, high-fat margarine, fat products and sweets were observed during dietary counselling. Most of these changes returned later to prestudy consumption level. The relapse in dietary changes was partly associated with scoring low in restraint and high in disinhibition and hunger. CONCLUSION: In obese men, long-term maintenance of dietary changes was difficult. New ways to ease self-monitoring and increase self-efficacy might be necessary to improve maintenance of dietary changes.

Aims: We examined the associations of physical activity (PA) frequency with self-rated health (SRH), self-rated well-being (SRW) and depressive symptoms, in middle-aged men in Finland. Methods: The cross-sectional study comprised 665 men (mean age 41 ± 3 SD years; body mass index (BMI) 26.8 ± 4.2 SD kg/m2), who had completed the screening questionnaire of an intervention for men with cardiovascular risk factors. Their weekly frequency of PA was assessed by a questionnaire, SRH and SRW by visual analog scales (VAS), and depressive symptoms by the Patient Health Questionnaire-2 (PHQ-2). Results: The mean SRH ± SD (range of scale 0–100) by PA frequency categories was 56.2 ± 18.5 for PA sometimes or never, 63.8 ± 16.2 for PA about 1–2 times/week, and 71.1 ± 15.5 for PA at least 3 times/week. The mean SRW ± SD (range of scale 0–100) was 59.0 ± 20.4, 65.6 ± 17.6, and 68.9 ± 17.1, respectively. The mean PHQ-2 score ± SD (range of scale 0–6) by PA categories was 1.83 ± 1.40 for PA sometimes or never, 1.68 ± 1.28 for PA about 1–2 times/week, and 1.60 ± 1.31 for the PA at least 3 times/week group. SRH and SRW improved linearly with increasing PA frequency (both p < 0.001), and the results remained similar after adjustment for BMI, education and smoking status. No association existed between PA frequency and PHQ-2. Conclusions: More frequent PA was linearly associated with better SRH and SRW, but not with depressive symptoms that were measured by a brief depression screening tool.

BACKGROUND: Several studies support the hypothesis that oxidation of low-density lipoprotein (LDL) promotes atherogenesis. Obesity is one of the risk factors of atherosclerosis, but it is not known whether obesity is related to LDL oxidation. OBJECTIVE AND DESIGN: We investigated the effect of weight reduction and subsequent weight maintenance program on LDL oxidation in 77 obese premenopausal women (BMI 29–46 kg/m2). Another group of seven obese women served as a control group. Oxidized LDL was measured as baseline concentration of conjugated dienes in LDL lipids (ox-LDL). The weight reduction was performed in 12 weeks, using a very-low-energy diet. RESULTS: The mean weight loss was 13 kg (92 vs 79 kg). During weight reduction, the concentration of LDL cholesterol decreased by 11%, the concentration of ox-LDL decreased by 40%, and the ratio of ox-LDL to LDL by 33%. The concentration of LDL antioxidant capacity (LDL-TRAP) decreased by 8%, but the decrease was caused by the decrease in LDL. The concentration of LDL, ox-LDL or LDL-TRAP did not change in the control group. The weight reduction correlated with the decrease of ox-LDL. During the subsequent 9 month weight maintenance programme, the concentrations of serum LDL (10%), ox-LDL (11%), LDL-TRAP (29%), and the ratio of LDL-TRAP to LDL (21%) decreased. CONCLUSION: This study strengthens the evidence that the risk of atherogenesis is influenced favourably by weight reduction in obese women. This risk reduction is associated with a reduced oxidation of LDL.

Summary This paper is a systematic review of research data on associations between physical activity and weight gain, with or without prior weight reduction. The selected studies were restricted to Caucasian (white) adults. Most studies with data on physical activity collected at follow-up, found an inverse association between physical activity and long-term weight gain. This finding was present in studies both with and without prior weight reduction. Prospective studies with physical activity measured at baseline, and randomized weight reduction interventions, gave inconsistent results regarding the effects of increased physical activity on weight change. The weighted mean weight regain in randomized studies with or without exercise training was 0.28 and 0.33 kg/month, respectively. Based on observational studies, it seemed that an actual increase in energy expenditure of physical activity of approximately 6300‐8400 kJ/week (1500‐2000 kcal/week) is associated with improved weight maintenance. This is more than was prescribed in most randomized trials, and certainly more than the participants actually achieved. Adherence to a prescribed exercise programme remains a big challenge. Before new methods to improve exercise adherence are found, the role of prescribed physical activity in prevention of weight gain remains modest.

This study examined whether the Trp64Arg mutation in theβ 3-adrenergic receptor (β3AR) and the A→G mutation in the uncoupling protein-1 (UCP-1) genes have associations with weight loss and subsequent weight maintenance. Seventy-seven obese (body mass index range, 29–46 kg/m2), clinically healthy, premenopausal women were studied. A 12-wk weight reduction by very low calorie diet (VLCD) was followed by a 40-wk weight maintenance phase. The subjects were divided into four groups according to theirβ 3AR and UCP-1 genotype: no mutation (control; n = 37), only Trp64Arg mutation in the β3AR gene (n = 12), only A→G mutation in the UCP-1 gene (n = 23), and both mutations (n = 5). Subjects with both mutations had a lower weight reduction during VLCD than the controls [−10.5 ± 0.6 (±sem) vs. −14.0 ± 0.5 kg; P = 0.051, by ANOVA]. During the maintenance phase, weight in subjects with both mutations increased by 5.8 ± 1.5 kg, but remained unchanged in the controls (−0.5 ± 0.8 kg; P = 0.041). The changes in weight in s...

Background. Women with a history of gestational diabetes mellitus (GDM) are at increased risk for metabolic syndrome (MeS) after delivery. We studied the prevalence of MeS at one year postpartum among Finnish women who in early pregnancy were at increased risk of developing GDM.Methods. This follow-up study is a part of a GDM prevention trial. At one year postpartum, 150 women (mean age 33.1 years, BMI 27.2 kg/m2) were evaluated for MeS.Results. The prevalence of MeS was 18% according tothe International Diabetes Federation(IDF) criteria and 16% according toNational Cholestrol Education Program(NCEP) criteria. Of MeS components, 74% of participants had an increased waist circumference (≥80 cm). Twenty-seven percent had elevated fasting plasma glucose (≥5.6 mmol/L), and 29% had reduced HDL cholesterol (≤1.3 mmol/L). The odds ratio for the occurrence of MeS at one year postpartum was 3.0 (95% CI 1.0–9.2) in those who were overweight before pregnancy compared to normal weight women.Conclusions. Nearly one-fifth of the women with an increased risk of GDM in early pregnancy fulfilled the criteria of MeS at one year postpartum. The most important factor associated with MeS was prepregnancy overweight. Weight management before and during pregnancy is important for preventing MeS after delivery.

Immunotherapy involves the specific treatment of IgE-mediated allergic diseases, indicated for allergic rhinitis and conjunctivitis, allergic asthma, insect sting (bee and wasp) allergy, and food allergy (especially cow's milk, egg and wheat). Subcutaneous injection immunotherapy with pollens (both trees and grass), animal danders, insect venoms and house dust mite preparations for allergic rhinitis and asthma is effective for both adults and children. Sublingual immunotherapy indicated for allergic rhinitis caused by grass pollens (especially timothy), is effective and appears to be a safe route of administration. Specific oral tolerance induction is used in children over five years of age with severe food allergy.

Diagnosis is based on body mass index and waist circumference. The aim of treatment is to prevent and alleviate obesity comorbidities (e.g. type 2 diabetes, cardiovascular diseases, sleep apnoea and osteoarthritis) through a permanent weight reduction of at least 5%. The core element in management is lifestyle counselling on eating and exercise behaviours. This should be organised in primary care. Modalities supporting lifestyle changes include very-low-energy diets and orlistat drug therapy. Obesity surgery is indicated in cases of morbid obesity, if the appropriate conservative therapies do not lead to substantial weight loss. A flowchart presenting treatment options at different levels of health care is introduced.

Weight loss is claimed to cause bone loss. This prospective 12-month study evaluated effects of 3-month group-based weight loss with VLED on body composition, bone mass and strength (DXA and pQCT), muscle performance and biomarkers of bone turnover. The assessments were done at baseline and at 3 and 12 months. Sixty-two women of the recruited 75 obese (BMI>30) premenopausal women who completed the study were divided into 3 groups based on the tertiles of weight loss at 3 months. The group means of weight losses were 15.5% (Large), 10.5% (Medium) and 5.9% (Low). Statistical analyses were based on analysis of covariance. Bone turnover increased during the weight reduction period in all groups but practically returned to baseline during the weight maintenance phase. In general, mean bone changes remained marginal (approximately +/-1%) and the amount of weight reduction was not associated with bone loss. The only notable change was the 4% decline in bending strength at the distal radius. These results indicate that in obese premenopausal women, 3-month weight reduction resulted in increased bone turnover but was not deleterious for bone mass or strength at 3 months or after 9-month weight maintenance.

Objective To update the evidence of the efficacy and safety of the Essure system. Female sterilization has undergone changes in the last decade. Besides laparoscopic tubal occlusion, the Essure system is now a viable option, with about 200,000 women sterilized using this method. Design The review is based on the report of the Alberta Heritage Foundation for Medical Research and completed with systematic literature searches up to April 8, 2008. Setting The Managed Uptake of Medical Methods program of the Finnish National Research and Development Center for Health and Welfare. Patient(s) Women over 30 years, who had been sterilized by the Essure method. Intervention(s) Hysteroscopic tubal sterilization using Essure system. Main Outcome Measure(s) Efficacy/effectiveness, adverse events, costs. Result(s) Sterilization by Essure can be performed under local anesthesia or with oral analgesics in ambulatory settings. However, sterilization is not immediate and women must use additional contraception for 3 months until permanent tubal occlusion is verified by transvaginal ultrasound, hysterosalpingosonography, hysterosalpingography, or pelvic radiography. The evidence on efficacy and safety is mainly available from short follow-up case series but shows good efficacy and safety of the Essure system. Only a few small risks are associated with the procedure. Two economic studies, one of which implemented Essure as an in-office procedure, suggest that Essure could be more cost-effective than laparoscopic sterilization, but more information on the total cost is needed. Conclusion(s) The Essure system appears to be safe, permanent, irreversible, and a less invasive method of contraception compared with laparoscopic sterilization.

1) To examine whether cardiorespiratory fitness (CRF) is associated with waist circumference (WC) and overall and abdominal fatness in eight-year-old girls and boys. 2) To determine whether children with high CRF have lower WC, overall and abdominal fatness within the same body mass index (BMI) category compared with those with low CRF.A cross-sectional study of 304 eight-year-old children in Tampere, Finland whose parents responded to a postal invitation and participated in measurements.Total body fat percentage (BF%), abdominal region fat percentage (AF%), and fat-free mass (FFM) were assessed by dual-energy X-ray absorptiometry (DXA). WC, height and weight were measured. International BMI sex- and age-specific cut-off points were used for overweight and obesity definition, and participants were divided into two categories: normal weight or overweight/obese. CRF was assessed with a maximal multistage 20-m shuttle run test (20-mSRT).Of the children, 81% were normal weight and 19% were overweight/obese. CRF was inversely associated with WC (p0.011), BF% (p0.001) and AF% (p0.001) independent of age, sex and BMI. Within the same BMI category, children with high CRF had significantly lower WC (p=0.001), BF% (p0.001) and AF% (p0.001) compared with children with low CRF.Eight-year-old children with high CRF had lower overall and abdominal fatness compared with children with low CRF, independent of age, sex and BMI. CRF should be an important target already at a young age in preventing overall and abdominal obesity.