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The purpose of this descriptive cross-sectional study is to describe the amount and intensity of physical activity (PA) measured by accelerometry among adolescents participating in organized sports (SCP) and age-matched non-participating peers (NP). SCPs (332) and NPs (139) wore an accelerometer on the hip for seven days. PA was reported using the 1-min exponential moving average. The current moderate-to-vigorous physical activity (MVPA) recommendation of at least an average of 60 min of MVPA daily was reached by 85% of SCPs and 45% of NPs (p <.001). During training days, the MVPA times among SCPs ranged from 153 ± 39 min in males and 109 ± 35 min in females participating in basketball to 113 ± 33 min in males participating in floorball and 83 ± 32 min in females participating in gymnastics. Sports participation contributes rather strongly to the accumulation of the recommended amount of MVPA. During training days, SCPs, except for females participating in gymnastics, accumulated more MVPA than NPs. During non-training days, only males participating in cross-country skiing and females participating in track and field accumulated more MVPA than NPs. HIGHLIGHTS PA of Finnish adolescents participating in nine different organized sports and age-matched non-participating peers was measured by accelerometry for one week and the results are reported using the 1-min exponential moving average. Adolescents participating in many organized sports accumulated more PA than non-participants; this was observed in meeting the PA recommendations, total amount of PA at different intensities, and step count. The current PA recommendation of at least an average of 60 min of MVPA per day was reached by 85% of SCPs and 45% of non-participating peers. Vigorous physical activity at least three times per week was incorporated by 96% of SCPs and 81% of NPs. During training days, males participating in soccer, basketball, and cross-country skiing spent more time in MVPA than females participating in the same sports. During non-training days, the time spent in MVPA was similar between males and females participating in sports clubs. [ABSTRACT FROM AUTHOR]

Background: Cardiorespiratory fitness is linked to various health outcomes. This study aimed to establish cut-off values for estimated cardiorespiratory fitness associated with poor physical functioning in middle-aged to older adults., Methods: A total of 2638 participants (1083 males), aged 40-69 years, performed a 6-min walking test (6MWT) to estimate cardiorespiratory fitness (VO2max) and completed a health-related questionnaire. Physical functioning was assessed using four outcomes: perceived health, perceived fitness, difficulties in 2-km walking, and difficulties in climbing several stairs. Receiver operator characteristics (ROC) curves were used to determine cut-off values for estimated VO2max and 6MWT distance linked to poor physical functioning based on the four outcomes. Analyses were done separately for males and females, and for 40- to 49-, 50- to 59-, and 60- to 69-year-old groups. Multinomial regression was used to analyze differences between fitness thirds in outcome variables., Results: ROC analyses were significant for all outcomes (AUC 0.686-0.834, P<0.001). In the total group, cut-off values for estimated VO2max were 29.9-30.2 mL/kg/min, and for walking distance, 588.0-599.5 m. Cut-off values decreased with age, and mean differences between males and females were 3.3 mL/kg/min and 33 m. All cut-off values were within ±1.3 mL/kg/min of the lower fitness tertile. The odds ratios of having poor physical functioning in the middle and high fitness thirds were less than 0.50 compared to low fitness third., Conclusions: VO2max of 30 mL/kg/min and 600-m walking distance seemed reasonable cut-off values for poor physical functioning. Exceeding the currently proposed thresholds is a desirable goal to avoid consequences of insufficient fitness.

Whole-body vibration training (WBV) training has shown positive effects on bone strength, muscle strength, and balance, but the evidence on fall prevention is not yet persuasive. This study aimed to evaluate the effectiveness of WBV training in preventing falls and improving physical performance among older adults at fall risk. The study was an assessor- and participant-blinded, randomized, and controlled 10-week training trial with a 10-month follow-up. One hundred and thirty older adults (mean age 78.5 years, 75% women) were randomly allocated into the WBV group ( n = 68) and the low-intensity wellness group ( n = 62). Falls were prospectively collected using monthly returned and verified diaries. Physical performance was evaluated at baseline before randomization, after the intervention, and follow-up with established methods. The data were analyzed on an intention-to-treat basis. Negative binomial regression was used to estimate the incidence rate ratios for falls, and Cox regression models were used to calculate the hazard ratios for fallers. Between-group differences in physical performance were estimated by generalized linear mixed models. The retention rate was 93%, and the mean adherence to the WBV training was 88% and 86% to the wellness training. Sixty-eight participants fell at least once, and there were 156 falls in total. In the WBV group, the incidence rate of falls was 1.5 (95% confidence interval 0.9 to 2.5) compared to the wellness group ( p = 0.11). The hazard ratio for fallers in the WBV group was 1.29 (0.78 to 2.15) ( p = 0.32). There was no between-group difference in physical performance after the training period, but by the end of the follow-up, WBV-related benefits appeared. The chair-rising capacity was maintained in the WBV group, while the benefit disappeared in the wellness group ( p = 0.004). Also, the 0.5-point difference in short physical performance battery (SPPB) score favored WBV training ( p = 0.009). In conclusion, progressive side-alternating WBV training was feasible and well-tolerated among fall-prone older adults. During the one-year follow-up, WBV training was associated with improved physical performance but did not prevent falls compared to chair-based group exercises.

Objective: This study aims to investigate the efficacy of two exercise interventions in reducing lower extremity (LE) injuries in novice recreational runners., Methods: Novice runners (245 female, 80 male) were randomised into hip and core (n=108), ankle and foot (n=111) or control (n=106) groups. Interventions were completed before running and included exercise programmes focusing on either (1) hip and core or (2) ankle and foot muscles. The control group performed static stretching exercises. All groups were supervised by a physiotherapist and performed the same running programme. Injuries and running exposure were registered using weekly questionnaires during the 24-week study. Primary outcome was running-related LE injury., Results: The incidence of LE injuries was lower in the hip and core group compared with the control group (HR 0.66; 95% CI 0.45 to 0.97). The average weekly prevalence of overuse injuries was 39% lower (prevalence rate ratio, PRR 0.61, 95% CI 0.39 to 0.96), and the prevalence of substantial overuse injuries was 52% lower (PRR 0.48, 95% CI 0.27 to 0.90) in the hip and core group compared with the control group. No significant difference was observed between the ankle and foot group and control group in the prevalence of overuse injuries. A higher incidence of acute injuries was observed in the ankle and foot group compared with the control group (HR 3.60, 95% CI 1.20 to 10.86)., Conclusion: A physiotherapist-guided hip and core-focused exercise programme was effective in preventing LE injuries in novice recreational runners. The ankle and foot programme did not reduce LE injuries and did not protect against acute LE injuries when compared with static stretching., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Reliable and valid data on physical activity (PA) and sedentary behavior (SB) are needed for implementing evidence-based interventions and policies. Monitoring of these behaviors is based on PA questionnaires (PAQs) and device-based measurements, but their comparability is challenging. The present study aimed to investigate the test-retest reliability and concurrent validity of Finnish versions of the widely used PAQs (IPAQ-SF, EHIS-PAQ, GPAQ, Eurobarometer) and to compare their data with accelerometer data. This study is based on the Finnish data of the European Union Physical Activity and Sport Monitoring project (EUPASMOS). Participants ( n = 62 adults, 62% women) answered the PAQs twice, one week apart, and wore an accelerometer for these seven consecutive days. Intraclass correlations, Spearman's rank correlations, t -tests, and Cohen's kappa with bootstrap confidence intervals were used to analyze the data. The PAQs had typically moderate-to-good test-retest reliability (ICC 0.22-0.78), GPAQ, EHIS-PAQ, and Eurobarometer showing the highest reliability. The PAQs correlated with each other when assessing sitting and vigorous PA (R = 0.70-0.97) and had a fair-to-substantial agreement when analyzing adherence to the PA recommendations (74-97%, Cohen's kappa 0.25-0.73). All the PAQs had a poor criterion validity against the accelerometry data. The Finnish versions of the PAQs are moderately reliable and valid for assessing PA, adherence to PA recommendations and sitting among adult participants. However, the poor criterion validity against accelerometer data indicates that PAQs assess different aspects of PA constructs compared to accelerometry.

Background: Varying trends in children's and adolescents' physical activity (PA) have been reported during the last 10-20 years. Trends in sedentary behavior (SB) have been studied only rarely. The purpose of the present study was to describe population-based trends in accelerometer-measured PA, standing and SB, among Finnish 7-15-year-old children and adolescents, and to evaluate the potential influence of the COVID-19 pandemic on these behaviors., Method: A cross-sectional population-based Finnish school-aged physical activity Study (FSPA) measured daily steps, vigorous (VPA), moderate (MPA), moderate-to-vigorous (MVPA), light physical activity (LPA), standing, and SB by an accelerometer for seven consecutive days in 2016, 2018, and 2022 (n = 7.080, 57% girls). The data was analyzed by multivariate regression analysis., Results: In 2016, participants took on average 10.305 steps per day, and spent 0:15 (h: min) in VPA, 1:37 in MPA, 1:52 in MVPA, 3:48 in LPA, 0:55 in standing and 7:52 in SB. From 2016 to 2018, daily steps, MPA, LPA, and standing increased [229 steps (95% Confidence Interval, CI 70-387), 0:03 (CI 0:01 - 0:04), 0:11 (CI 0:09 - 0:14), and 0:07 (CI 0:05 - 0:08), respectively], while VPA and SB decreased [0:01 (CI 0:00-0:02) and 0:20 (CI 0:16 - 0:24), respectively]. From 2018 to 2022, daily PA and standing declined [751 steps (CI 562-939), VPA 0:02 (CI 0:01 - 0:03), MPA 0:09 (CI 0:07 - 0:11), MVPA 0:11 (CI 0:09 - 0:14), LPA 0:08 (CI 0:05 - 0:11), and standing 0:01 (CI 0:01 - 0:03)] while SB increased 0:21 (CI 0:16 - 0:25) indicating potential influence of the pandemic., Conclusions: Children and adolescents became physically less active from 2016 to 2022. The potential effects of the COVID-19 were seen as declined PA and increased sedentariness from 2018 to 2022., (© 2024. The Author(s).)

Preoperative cardiorespiratory fitness may influence the recovery after cardiac procedure. The aim of this study was to investigate the cardiorespiratory fitness of patients scheduled for elective cardiac procedures, using a six-minute walk test, and compare the results with a population-based sample of Finnish adults. Patients (n=234) awaiting percutaneous coronary intervention or coronary angiography, coronary artery bypass grafting, aortic valve replacement or mitral valve surgery performed the six-minute walk test. VO 2 max was calculated based on the walk test. The patients were compared to a population-based sample of 60-69-year-old Finnish adults from the FinFit2017 study. The mean six-minute walk test distances (meters) and VO 2 max (ml/kg/min) of the patient groups were: 452±73 and 24.3±6.9 (coronary artery bypass grafting), 499±84 and 27.6±7.2 (aortic valve replacement), 496±85 and 27.4±7.3 (mitral valve surgery), and 519±90 and 27.3±6.9 (percutaneous coronary intervention or coronary angiography). The population-based sample had significantly greater walk test distance (623±81) and VO 2 max (31.7±6.1) than the four patient groups (all p-values<0.001). All patient groups had lower cardiorespiratory fitness than the reference population of 60-69-year-old Finnish adults. Particularly the coronary artery bypass grafting group had a low cardiorespiratory fitness, and therefore might be prone to complications and challenging rehabilitation after the operation., Competing Interests: The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Background: Female healthcare workers have a high prevalence of low back pain (LBP)-related sickness absence. Here, we report findings of a 24-month follow-up of a previously published 6-month randomized controlled trial (RCT)., Methods: By adopting an RCT with 6 months of intervention and follow-up at 6, 12, and 24 months, we assessed the maintenance of changes in the effectiveness (LBP and fear of pain) of the interventions (neuromuscular exercise [NME], back-care counseling, both combined) using a generalized linear mixed model adjusted for baseline covariates. The incremental cost-effectiveness ratio was calculated in terms of quality-adjusted life years (QALY). A bootstrap technique was used to estimate the uncertainty around a cost-effectiveness acceptability curve., Results: Of the 219 females, 71% had data at 24 months. Between 6 and 24 months, LBP intensity (primary outcome) remained low in all intervention arms (-20% to -48%) compared to the control (-10% to -16%). Pain interfering with work remained low in the combined and exercise arms for up to 24 months. At 24 months, the total costs were lowest in the combined arm (€484 vs. €613-948, p < 0.001), as were the number of back-related sickness absence days (0.16 vs. 1.14-3.26, p = 0.003). The analysis indicated a 95% probability of the combined arm to be cost-effective per QALY gained at €1120., Conclusions: Six months of weekly NME combined with four counseling sessions was cost-effective for treating LBP and the effect was maintained over 24 months., Trial Registration: ClinicalTrials.gov, NCT01465698, 7/11/2011, prospective., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

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.

Work ability (WA) reflects an individual's resources, work demands, and related environment. Self-reports have shown that higher physical activity (PA) is associated with better WA. This study investigated associations of accelerometer-measured (24/7) physical behavior and cardiorespiratory fitness (CRF) with WA. In the FinFit2017-population-based study, the physical behavior of 20-69-year-old working Finns was measured in terms of PA, standing, and sedentariness using validated MAD-APE algorithms based on raw triaxial accelerometer data. During waking hours, the accelerometer was hip-worn, while during the time in bed (TIB), it was worn on the non-dominant wrist. CRF was measured with a 6 min walk test. WA was assessed by four questions excerpted from the Work Ability Index (WAI), called the short WAI (sWAI). Participants ( n = 1668, mean age 46.6, SD = 10.9, 57% women) scored on average 23.3 on the sWAI (range 6-27), with a higher value indicating a better WA. More minutes in standing ( p = 0.001) and in moderate ( p = 0.004) and vigorous PA ( p < 0.001) as well as a higher step number ( p < 0.001) and better CRF ( p < 0.001) were associated with a higher sWAI value. More time spent lying down ( p < 0.001) and in high-movement ( p < 0.001) and total TIB ( p = 0.001) was associated with a lower sWAI. Detailed analysis of 24/7 physical behavior can be utilized in identifying individual-related indicators of WA.

The aim of this study was to examine the associations of spinal kinematics and physical activity (PA) with bodily pain, physical functioning, and work ability among health care workers with low back pain (LBP). Spinal kinematics and PA were measured with a wireless Inertial Measurement Unit system (ValedoMotion®) and a waist-worn tri-axial accelerometer (Hookie AM20), respectively. Their association was assessed in relation to Work Ability Index (WAI), bodily pain and physical functioning (RAND-36) in 210 health care workers with recurrent LBP. Greater lumbar movement variability/less deterministic lumbar movement (in angular velocity) during a "Pick Up a Box" functional task was correlated with higher amounts of step counts (r = -0.29, p = 0.01) and moderate PA (r = -0.24, p = 0.03). A higher amount of PA (p = 0.03) as well as less movement control impairment (p = 0.04) and movement variability (p = 0.03) were associated with greater work ability, whilst greater vigorous PA was the only parameter to explain higher physical functioning (p = 0.02). PA and movement variability were relative to each other to explain bodily pain (p = 0.01). These findings show the importance of considering the interaction between lumbar kinematics and physical activity while planning strategies to improve bodily pain, physical functioning and work ability among health care workers with LBP., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The aim of this study was to investigate physical fitness, football-specific skills, and their association with injury risk in youth football. Altogether 447 male and female players aged 9-14 years (median 12 years) participated in performance tests and prospective follow-up. The physical fitness tests included five-jump test for distance, 30-m sprint, football-specific figure of eight agility, countermovement jump, and Yo-Yo intermittent endurance test level 1. The football-specific skill tests included dribbling and passing tests. Injuries and exposure were registered during the 20-week follow-up. Our candidate risk factors were low/high level of physical fitness measured with a composite score of physical fitness tests and low/high level of football-specific skills measured with a composite score of dribbling and passing tests. Secondarily, we investigated performance in individual tests and their association with injury risk. During the follow-up, players reported 565 injuries (264 acute and 301 overuse injuries). High level of physical fitness was associated with increased rate of all injuries (age-, sex-, and mean team exposure-adjusted IRR: 1.28, 95% CI: 1.04-1.58). The level of football-specific skills had no influence on the overall injury rate. Burden of overuse injuries, but not acute injuries was significantly higher in most fit players compared with the players in the reference group (IRR: 2.09, 95% CI: 1.04-4.24). In conclusion, most fit players were at greater risk of sustaining injuries in youth competitive football., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Military training programmes are often similar for male and female recruits despite sex differences in physical performance that may influence training adaptations during military service. The present study aimed to compare changes in physical fitness and anthropometrics between Finnish female and male recruits during military service., Methods: A total of 234 690 male and 3549 female recruits participated in fitness tests at the beginning and end of military service between 2005 and 2015. Anthropometric measurements were body mass, height, body mass index (BMI) and waist circumference (WC). Fitness tests consisted 12 min running, standing long jump, and sit-ups and push-ups., Results: No changes were observed in anthropometrics, while both sexes improved most of the fitness test results. After adjustment for service time, branch, age, initial fitness test results, BMI and WC, improvement in running test performance was 158 m (95% CI 142 to 173, p≤0.001) greater in male than female recruits. Similarly, improvements were larger in male recruits for push-ups (5 reps/min, 95% CI 5 to 6, p≤0.001), sit-ups (2 reps/min, 95% CI 2 to 3, p≤0.001) and standing long jump (12 cm, 95% CI 11 to 13, p≤0.001) when compared with women., Conclusions: The study revealed sex differences in adaptations to the standardised military training. Both male and female recruits improved their physical fitness, but smaller gains were observed in women using the same training programme. The mechanisms explaining sex differences in adaptations to military training, and whether tailored training programmes are needed specifically for female recruits to reduce sex differences during military service, warrants further studies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This study investigates the association between depressive symptoms and multisite pain and health-related quality of life and work ability in currently employed health care workers with recurrent low back pain (LBP)., Methods: Multisite pain, depressive symptoms, quality of life, and work ability were assessed by validated questionnaires. A generalized linear model was used for statistical analysis., Results: Notably, 28% of female health care workers with LBP had at least moderate levels of depressive symptoms. Depressive symptoms were significantly associated with decreased health-related quality of life and work ability. Multisite pain was not significantly associated with work ability., Conclusions: Depressive symptoms are relatively common in female health care workers with LBP, and treatment of these symptoms may be crucial to improve their work ability., Competing Interests: Conflict of Interest: None Declared., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Occupational and Environmental Medicine.)

Background: The aerobic part of the recently updated physical activity (PA) guidelines for adults recommends at least 150 min of moderate or at least 75 of vigorous-intensity PA or an equivalent combination of both. PA can be accumulated of any bout duration. On an absolute scale, moderate-intensity threshold is 3 metabolic equivalents (METs) and vigorous 6 METs. On a scale relative to individual's personal capacity, moderate-intensity threshold is 40% and vigorous 60% of the oxygen uptake reserve. In this study, the adherence to the new guidelines was evaluated using both absolute and relative thresholds., Methods: Totally, 1645 adults aged 20-64 years, participated in this population-based study and their cardiorespiratory fitness (CRF) was estimated with 6-min walking test. The participants with estimated maximal oxygen uptake <7.9 MET were categorized as low CRF group and the others as adequate CRF group. The participants were instructed to wear a triaxial hip-worn accelerometer for 1 week and their adherence to PA guidelines was assessed from the accelerometer data., Results: The adequate CRF group had higher adherence to PA guidelines with the absolute thresholds, but the use of relative thresholds inverted the results. The adherence varied from 20% to 99% in the total sample depending on the analysis parameters of accelerometer data., Conclusions: The absolute thresholds provide a more appropriate basis to assess the adherence to PA guidelines in population-based samples and interventions. The use of individually determined relative thresholds may be more useful for individual exercise prescriptions in PA counseling., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Public Health Association.)

Background: We investigated preoperative physical activity (PA) and sedentary behaviour (SB) in patients scheduled for elective cardiac procedures and compared them with population-based sample of Finnish adults., Methods: Cardiac patients (n = 139) undergoing cardiac operations carried a triaxial accelerometer for seven days during the month before the procedure. Patients were categorised into four groups according to the procedure: percutaneous coronary intervention or coronary angiography (PCI-CA), coronary artery bypass grafting (CABG), aortic valve replacement (AVR) and mitral valve surgery (MVS). The raw accelerometer data was analyzed with dedicated algorithms to determine metabolic equivalents (METs, 3.5 mL/kg/min of oxygen consumption) of PA. The intensity of PA was divided into two categories: light (LPA, 1.5-2.9 METs) and moderate-to-vigorous (MVPA, ≥ 3.0 METs), while SB represented intensity < 1.5 MET without movements. SB and PA were described as daily means and accumulation from different bout lengths. Daily standing, steps and mean and peak MET-values were calculated. The results were compared between the patient groups and against the reference group from a population-based study FinFit2017., Results: Cardiac patients had fewer daily steps than the FinFit population (p = 0.01), and less SB accumulating from < 20 min bouts (p = 0.002) but more from 20 to 60 min bouts (p = 0.002). Particularly, CABG group had less daily MVPA (p = 0.002) and MVPA accumulating from > 10 min bouts (p < 0.001) than the FinFit population., Conclusions: We found large differences in PA and SB between the patient groups and the FitFit population, CABG group having the worst activity profile. Also, the variation within the patient groups was wide, which should be considered to individualise the rehabilitation programs postoperatively. Trial registration clinicaltrials.gov (NCT03470246). Registered 19 March 2018, https://clinicaltrials.gov/ct2/show/NCT03470246., (© 2022. The Author(s).)

Background: Low physical activity and high sedentary behaviour are unquestionably relevant for public health while also increasing direct and indirect costs., Methods: The authors examined the direct and indirect costs attributable to low physical activity and high sedentary behaviour in Finland in 2017. Costs related to major non-communicable diseases drawn from Finnish registries covered direct costs (outpatient visits, days of inpatient care, medication and institutional eldercare) and indirect costs (sickness-related absences, disability pensions, unemployment benefits, all-cause mortality and losses of income tax revenue). Prevalences of low physical activity and high sedentary behaviour (≥8 hours per 16 waking hours) were based on self-reports among adolescents or accelerometer data among adults and the elderly from three Finnish population studies: FINFIT 2017, Health 2011 and the Cardiovascular Risk in Young Finns Study. Cost calculations used adjusted population attributable fractions (PAF) and regression models. Total annual costs were obtained by multiplying PAF by the total costs of the given disease., Results: The total costs of low physical activity in Finland in 2017 came to approximately €3.2 billion, of which direct costs accounted for €683 million and indirect ones for €2.5 billion. Costs attributable to high sedentary behaviour totalled roughly €1.5 billion., Conclusion: The findings suggest that low physical activity and high sedentary behaviour levels create substantial societal costs. Therefore, actions intended to increase physical activity and reduce excessive sedentary behaviour throughout life may yield not only better health but also considerable savings to society., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The purpose of this study was to measure physical activity (PA), sedentary behavior (SB), and hour-by-hour PA patterns with an accelerometer in a population-based sample of Finnish children and adolescents., Methods: A total of 3274 participants (3rd, 5th, 7th, 9th graders) from 176 schools wore a hip-worn triaxial accelerometer for seven days during waking hours. Mean amplitude deviation of the acceleration data was used to assess PA intensity that was converted to metabolic equivalents and categorized into light, moderate, and vigorous PA. Angle for posture estimation was used to measure SB and standing., Results: The majority of participants' PA consisted of light PA, and they were sedentary for more than half of their waking hours. Children were more active than adolescents, and boys were more active than girls. Participants took, on average, 9890 steps daily, and one third met the PA recommendation. The participants were divided into tertiles based on daily steps to investigate the variation in PA patterns. Compared to the least active tertile, the most active tertile took twice as many steps on weekdays and nearly three times as many steps on the weekend., Conclusions: The majority of the participants were not active enough, and there was a great variation in PA levels and patterns, especially among the adolescents and on weekends.

Background: Population studies gathering measured data on fitness and physical behavior, covering physical activity, standing, sedentary behavior, and time in bed, are scarce. This article describes the protocol of the FINFIT 2021 study that measures fitness and physical behavior in a population-based sample of adults and analyzes their associations and dose-response relationships with several health indicators., Methods: The study comprises a stratified random sample of 20-69-year-old men and women ( n = 16,500) from seven city-centered regions in Finland. Physical behavior is measured 24/7 by tri-axial accelerometry and analyzed with validated MAD-APE algorithms. Health and fitness examinations include fasting blood samples, measurements of blood pressure, anthropometry, and health-related fitness. Domains of health, functioning, well-being, and socio-demographics are assessed by a questionnaire. The data are being collected between September 2021 and February 2022., Discussion: The study provides population data on physical fitness and physical behavior 24/7. Physical behavior patterns by intensity and duration on an hour-by-hour basis will be provided. In the future, the baseline data will be assessed against prospective register-based data on incident diseases, healthcare utilization, sickness absence, premature retirement, and death. A similar study will be conducted every fourth year with a new random population sample.

Depending on their cardiorespiratory fitness (CRF), people may perceive the exertion of incident physical activity (PA) differently. Therefore, the use of relative intensity thresholds based on individual fitness have been proposed to evaluate the accumulation of PA at different intensity levels. A subsample of the FinFit2017-study, 1952 adults (803 men and 1149 women) aged 20-69 years, participated in this study. Their maximal oxygen uptake (VO 2 max) was predicted with a 6 min walk test, and they were instructed to wear a triaxial hip-worn accelerometer for one week. The participants were divided into CRF tertiles by five age groups and sex. Raw acceleration data were analyzed with the mean amplitude deviation method in 6 s epochs. Additionally, the data were smoothed with 1 min and 6 min exponential moving averages. The absolute intensity threshold for moderate activity was 3.0 metabolic equivalent (MET) and for vigorous 6.0 MET. Correspondingly, the relative thresholds were 40% and 60% of the oxygen uptake reserve. Participants in the lowest CRF tertile were the most active with relative thresholds, and participants in the highest CRF tertile were the most active with absolute thresholds. High-fit people easily reached the absolute thresholds, while people in the lowest CRF tertile had to utilize most of their aerobic capacity on a daily basis simply to keep up with their daily chores or peers.

Objectives: The purpose of the present study was to investigate how aerobic fitness, muscle fitness and body mass index (BMI) change in relation to their baseline levels during 6-12 months of military service., Design: Retrospective longitudinal follow-up study., Methods: The study group consisted of 249279 healthy young male conscripts (age 19.1±0.4 yrs.) who completed their military service between the years 2005-2015. Anthropometrics (body mass, height, BMI), aerobic fitness (12-min running test) and muscle fitness (sit-ups, push-ups, standing long jump) were measured., Results: A 12-min running test improved by 5% (107±292m), standing long jump 1% (2.1±16.2cm), 1-min sit-ups 19% (4±8 repetitions/min) and 1-min push-ups 33% (5±10 repetitions/min) (p<0.001 for all). Baseline fitness and baseline BMI levels were inversely associated with their changes (r=-0.37 to -0.47, p<0.001). Performance improved in conscripts in the lowest two baseline fitness quartiles in all tests, while it decreased in conscripts in the highest fitness quartiles. In addition, in conscripts who were obese at baseline, body mass decreased on average by 4.9±7.0kg (p<0.001)., Conclusions: On average, the physical fitness of conscripts improved during their compulsory military service. In particular, conscripts with a lower baseline fitness level or higher BMI showed the largest improvements, which may be significant findings from both a military readiness and national health perspective. However, the decline in physical performance of high-fit conscripts highlights the importance of individualization of physical training and military training load during military service., (Copyright © 2020 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: Exercise is recommended for the treatment and management of low back pain (LBP) and the prevention of chronicity. Exercise adherence has been only modest in intervention studies among people with musculoskeletal pain. Fear-avoidance beliefs (FABs) are known to affect exercise adherence. The purpose was twofold: to examine which bio-psycho-social factors contributed to exercise adherence during a 6-month neuromuscular exercise intervention among female healthcare workers with recurrent LBP, and to investigate how exercising affects FABs at 6 and 12 months' follow-up., Methods: Some 219 healthcare workers aged 30-55 years with mild-to-moderate re-current non-specific LBP were originally allocated into: 1) exercise, 2) counselling, 3) combined exercise and counselling, and 4) control groups. In the present secondary analysis, groups 1 and 3 (exercise only and exercise+counselling) were merged to be exercisers and groups 2 and 4 were merged to be non-exercisers. Baseline variables of the exercise compliers (≥24 times over 24 weeks; n  = 58) were compared to those of the non-compliers (< 1 time/week, 0-23 times; n  = 52). The effects of the exercise programme on FABs were analysed by a generalised linear mixed model according to the intention-to-treat principle (exercisers; n  = 110 vs non-exercisers; n  = 109) at three measurement points (baseline, 6, and 12 months). A per-protocol analysis compared the more exercised to the less exercised and non-exercisers., Results: A low education level ( p  = 0.026), shift work ( p  = 0.023), low aerobic (p  = 0.048) and musculoskeletal ( p  = 0.043) fitness, and high baseline physical activity-related FABs ( p  = 0.019) were related to low exercise adherence. The exercise programme reduced levels of both physical activity- and work-related FABs, and there was a dose response: FABs reduced more in persons who exercised ≥24 times compared to those who exercised 0-23 times., Conclusion: Healthcare workers who had lower education and fitness levels, worked shifts, and had high physical activity-related FABs had a lower adherence to the 6-month neuromuscular exercise programme. Exercising with good adherence reduced levels of FABs, which have been shown to be linked with prolonged LBP. Motivational strategies should be targeted at persons with low education and fitness levels and high FABs in order to achieve better exercise adherence., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Background: Exercise interventions focusing on balance and strength training have been shown to be effective for falls prevention. The aim of this 20-year register-based follow-up was to examine whether long-term participation in recreational female gymnastics is associated with a lower risk of medically-attended injurious falls., Methods: Health care register data of 187 women (103 recreational gymnasts and 84 sedentary controls) from the original cohort of 243 women were assessed. The mean age (sd) at baseline was 62.8 (5.4) years and the mean follow-up time was 19.4 (2.7) years (range from 5.6 to 21.0 years). Injurious falls were scrutinized from medical records. An injurious fall was defined as an event in which falling was mentioned as a reason for making contact with health-care professionals. Negative binomial regression was used to estimate incidence rate ratios (IRR) for injurious falls, and Cox-regression models for calculating hazard ratios (HR) for injured fallers with the control group as reference., Results: Recreational gymnasts had about 30% less injurious falls compared to controls, the mean IRR (95% CI) being 0.71 (0.51 to 0.96). The HR for injured fallers was 0.73 (0.52 to 1.02) favoring the recreational gymnasts. There were no statistically significant between-group differences for fractures., Conclusions: Long-term recreational gymnastics appears to reduce the risk of injurious falls in old age.

Introduction: Low bone mineral density is a risk factor for fractures. The aim of this follow-up study was to assess the association of various bone properties with fall-related fractures., Materials and Methods: 187 healthy women aged 55 to 83 years at baseline who were either physically active or inactive were followed for 20 years. They were divided into two groups by whether or not they sustained fall-related fractures: fracture group (F) and nonfracture group (NF). At baseline, several bone properties were measured with DXA and pQCT, and their physical performance was also assessed., Results: During the follow-up, 120 women had no fall-related fractures, while 67 (38%) sustained at least one fall with fracture. NF group had about 4 to 11% greater BMD at the femoral neck and distal radius; the mean differences (95% CI) were 4.5 (0.3 to 8.6) % and 11.1 (6.3 to 16.1) %, respectively. NF group also had stronger bone structure at the tibia, the mean difference in BMC at the distal tibia was 6.0 (2.2 to 9.7) %, and at the tibial shaft 3.6 (0.4 to 6.8) %. However, there was no mean difference in physical performance., Conclusions: Low bone properties contribute to the risk of fracture if a person falls. Therefore, in the prevention of fragility fractures, it is essential to focus on improving bone mass, density, and strength during the lifetime. Reduction of falls by improving physical performance, balance, mobility, and muscle power is equally important., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2019 Kirsti Uusi-Rasi et al.)

This cross-sectional study analysed the association of sedentary behaviour (SB) and standing with waist circumference. Finnish adults aged 30-75 years from a sub-sample of population-based Health 2011 Study used a hip-worn tri-axial accelerometer (Hookie AM20, Traxmeet, Ltd, Espoo, Finland) for seven days. Those 1405 participants (57% women) who used accelerometer at least four days, minimum of 10 hours/day, were included. SB and standing were analysed in 6s epochs using validated algorithm. Daily total time, daily number and accumulated time from bouts (30s-5min,30s-10min,30s-15min,30s 30min,>5min,>10min,>15min, >30min) as well as daily number of sit-to-stand transitions were determined. Waist circumference (cm) was measured in standardized way. Participants' mean age was 52 years (SD 12.2). Mean waist circumference was 97cm (SD 12.3) in men and 87cm (SD 12.7) in women. According to multivariable stepwise linear regression analysis, sit-to-stand transitions [standardised regression coefficient (β)= -0.14, 95%CI -0.20 to -0.09], standing bouts of 30s-5min (β= -0.21, 95%CI -0.26 to -0.15) and number of 30s-30min SB bouts (β=0.12, 95%CI 0.06 to 0.17) were most strongly associated with waist circumference. Besides assessing total SB time, future studies should assess also different bout lengths of SB and sit-to-stand transitions and standing times should be assessed separately.

Background: Low back pain (LBP) is common among healthcare workers, whose work is physically strenuous and thus demands certain levels of physical fitness and spinal control. Exercise is the most frequently recommended treatment for LBP. However, exercise interventions targeted at sub-acute or recurrent patients are scarce compared to those targeted at chronic LBP patients. Our objective was to examine the effects of 6 months of neuromuscular exercise on pain, lumbar movement control, fitness, and work-related factors at 6- and 12-months' follow-up among female healthcare personnel with sub-acute or recurrent low back pain (LBP) and physically demanding work., Methods: A total of 219 healthcare workers aged 30-55 years with non-specific LBP were originally allocated to four groups (exercise, counselling, combined exercise and counselling, control). The present study is a secondary analysis comparing exercisers (n = 110) vs non-exercisers (n = 109). Exercise was performed twice a week (60 min) in three progressive stages focusing on controlling the neutral spine posture. The primary outcome was intensity of LBP. Secondary outcomes included pain interfering with work, lumbar movement control, fitness components, and work-related measurements. Between-group differences were analysed with a generalised linear mixed model according to the intention-to-treat principle. Per-protocol analysis compared the more exercised to the less exercised and non-exercisers., Results: The mean exercise attendance was 26.3 (SD 12.2) of targeted 48 sessions over 24 weeks, 53% exercising 1-2 times a week, with 80% (n = 176) and 72% (n = 157) participating in 6- and in 12-month follow-up measurements, respectively. The exercise intervention reduced pain (p = 0.047), and pain interfering with work (p = 0.046); improved lumbar movement control (p = 0.042), abdominal strength (p = 0.033) and physical functioning in heavy nursing duties (p = 0.007); but had no effect on other fitness and work-related measurements when compared to not exercising. High exercise compliance resulted in less pain and better lumbar movement control and walking test results., Conclusion: Neuromuscular exercise was effective in reducing pain and improving lumbar movement control, abdominal strength, and physical functioning in nursing duties compared to not exercising.

Introduction: Personalized intervention to increase physical Activity and reduce sedentary behaviour in rehabilitation after Cardiac Operations (PACO) is a smartphone-based and accelerometer-based eHealth intervention to increase physical activity (PA) and reduce sedentary behaviour (SB) among patients recovering from cardiac surgery., Design: Prospective randomised controlled trial., Methods and Analysis: The present protocol describes a randomised controlled clinical trial to be conducted in the Heart Centres of Kuopio and Turku university hospitals. The trial comprises 540 patients scheduled for elective coronary artery bypass grafting, aortic valve replacement or mitral valve repair. The patients will be randomised into two groups. The control group will receive standard postsurgical rehabilitation guidance. The eHealth intervention group will be given the same guidance together with personalised PA guidance during 90 days after discharge. These patients will receive personalised daily goals to increase PA and reduce SB via the ExSedapplication. Triaxial accelerometers will be exploited to record patients' daily accumulated PA and SB, and transmit them to the application. Using the accelerometer data, the application will provide online guidance to the patients and feedback of accomplishing their activity goals. The data will also be transmitted to the cloud, where a physiotherapist can monitor individual activity profiles and customise the subsequent PA and SB goals online. The postoperative improvement in patients' step count, PA, exercise capacity, quality of sleep, laboratory markers, transthoracic echocardiography (TTE) parameters and quality of life, and reduction in SB and incidence of major cardiac events are investigated as outcomes., Conclusions: The PACO intervention aims to build a personalised eHealth tool for the online tutoring of cardiac surgery patients., Trial Registration Number: NCT03470246., Competing Interests: Competing interests: None declared.

Active commuting to work (ACW) has beneficial effects on health, traffic, and climate. However, more robust evidence is needed on how to promote ACW. This paper reports the findings of a multilevel natural experiment with a randomized controlled trial in 16 Finnish workplaces. In Phase 1, 11 workplaces (1823 employees) from Area 1 were exposed to environmental improvements in walking and cycling paths. In Phase 2, five more workplaces (826 employees) were recruited from Area 2 and all workplaces were randomized into experimental group (EXP) promoting ACW with social and behavioral strategies and comparison group (COM) participating only in data collection. Process and impact evaluation with questionnaires, travel diaries, accelerometers, traffic calculations, and auditing were conducted. Statistics included Wilcoxon Signed Ranks Test, Mann-Whitney U -test, and after-before differences with 95% confidence intervals (95% CI). After Phase 1, positive change was seen in the self-reported number of days, which the employees intended to cycle part of their journey to work in the following week ( p = 0.001). After Phase 2, intervention effect was observed in the proportion of employees, who reported willingness to increase walking (8.7%; 95% CI 1.8 to 15.6) and cycling (5.5%; 2.2 to 8.8) and opportunity to cycle part of their journey to work (5.9%; 2.1 to 9.7). To conclude, the intervention facilitated employees' motivation for ACW, which is the first step towards behavior change., Competing Interests: The authors declare no conflict of interest.