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The adverse health effects of sedentary behavior and prolonged sedentary bouts are well-known. However, it is still unknown how physical activity can modify adverse health impacts related to sedentary behavior. The purpose of this study was to develop signal analysis methodology for sedentary behavior and physical activity classification from raw data of a hip-worn accelerometer and to investigate associations of patterns of sedentary behavior with lipid and glucose metabolism. A machine learning model was developed and validated using acceleration data, which included nine predefined and controlled typical daily activities ranging in intensity from sedentary to vigorous physical activity. Acceleration data was collected from 22 Finnish adults using a triaxial accelerometer attached to an elastic belt on a hip. The data were classified into five categories (lying down, sitting, and light, moderate, and vigorous physical activity). Thirty-six middle-aged Finnish adults wore an accelerometer for 14 days, and their sedentary behavior and sitting characteristics were determined. In addition, associations of sedentary behavior, sitting, and physical activity with glucose and lipid metabolism were investigated in the Northern Finland Birth Cohort 1966 46-year follow-up (n=5,832). Participants completed health and lifestyle questionnaires and attended clinical examinations and two weeks of sedentary behavior and physical activity measurements. Isotemporal substitution modeling was used for investigating time reallocations from sedentary to physical activities. The developed machine learning model provided acceptable accuracy for sedentary behavior and physical activity classifications. The method can be used for describing characteristics of sedentary behavior and sitting separately. Patterns of SB were more consistently associated with lipid metabolism than those of sitting. Associations between sedentary behavior and cardiometabolic health depended on moderate-t, Tiivistelmä Runsaan paikallaanolon ja pitkien paikallaanolojaksojen haitalliset vaikutukset terveyteen ovat hyvin tiedossa, mutta edelleen puuttuu tietoa, kuinka fyysinen aktiivisuus voi muokata paikallaanolon haitallisia vaikutuksia terveyteen. Työn tarkoituksena oli kehittää signaalinkäsittelymenetelmä paikallaanolon ja fyysisen aktiivisuuden luokittelemiseksi lantiolla pidettävän aktiivisuusmittarin raakakiihtyvyyksistä sekä tutkia paikallaanolon piirteiden yhteyksiä rasva- ja sokeriaineenvaihduntaan. Koneoppimismalli kehitettiin ja validoitiin käyttämällä kiihtyvyysdataa, joka sisälsi yhdeksän ennalta määriteltyä ja kontrolloitua tyypillistä arkiaktiviteettia, joiden intensiteetti vaihteli paikallaanolosta raskaaseen fyysiseen aktiivisuuteen. Kiihtyvyysdata kerättiin 22 suomalaisen aikuisen lantiolta elastiseen vyöhön kiinnitetyllä kolmiakselisella kiihtyvyysanturilla, jonka raakadata luokiteltiin viiteen eri luokkaan (makaaminen, istuminen sekä kevyt, keskiraskas ja raskas fyysinen aktiivisuus). Kolmekymmentäkuusi keski-ikäistä suomalaista käyttivät kiihtyvyysanturia 14 päivän ajan ja heidän paikallaanolonsa ja istumisensa piirteet määritettiin. Paikallaanolon, istumisen ja fyysisen aktiivisuuden yhteyksiä rasva- ja sokeriaineenvaihduntaan tutkittiin Pohjois-Suomen vuoden 1966 syntymäkohortin 46-vuotistutkimuksessa (n = 5832). Tutkittavat täyttivät terveys- ja elämäntapakyselyitä ja osallistuivat kliinisiin tutkimuksiin sekä kahden viikon mittaisiin paikallaanolon ja fyysisen aktiivisuuden mittauksiin. Isotemporaalisella korvausmallilla tutkittiin paikallaanoloajan korvaamista fyysisellä aktiivisuudella. Kehitetyllä koneoppimismenetelmällä voidaan riittävällä tarkkuudella luokitella paikallaanoloa ja fyysistä aktiivisuutta. Menetelmää voidaan käyttää paikallaanolon ja istumisen piirteiden kuvailussa erikseen. Paikallaanolon piirteet olivat selvemmin yhteydessä rasva-aineenvaihduntaan kuin istumisen piirteet. Paikallaanolon yhteydet rasva-aineenvaihduntaan oliva

Objectives: Up to 70% of women with polycystic ovary syndrome (PCOS) have pre-obesity or obesity. The aim of this study was to investigate whether women with PCOS have more weight-loss attempts than women without PCOS, regardless of BMI. Moreover, women's weight perceptions in relation to previous weight-loss attempts were evaluated. Methods: A population-based birth cohort study included women with (n = 278) and without PCOS (control individuals, n = 1560) who were examined at ages 31 and 46 years with questionnaires and clinical examinations. Results: Women with PCOS had more weight-loss attempts compared with control individuals at age 31 (47% vs. 34%, p <0.001) and 46 years (63% vs. 47%, p < 0.001). At age 46 years, PCOS was associated with multiple weight-loss attempts in the adjusted model (odds ratio: 1.43 [95% CI: 1.00‐2.03], p = 0.05). The perception of having overweight was more prevalent in those with PCOS, even among participants with normal weight, at age 31 (PCOS 47% vs. control 34%, p = 0.014) and 46 years (PCOS 60% vs. control 39%, p = 0.001). Conclusions: Women with PCOS were more likely to have experienced multiple weight-loss attempts and a perception of having overweight compared with control individuals, regardless of obesity status.

Purpose: This study estimated the long-term individual-level productivity costs of physical inactivity. Methods: The data were drawn from the Northern Finland Birth Cohort 1966, to which the productivity cost variables (sick leaves and disability pensions) from Finnish registries were linked. Individuals (N = 6261) were categorized into physical activity groups based on their level of physical activity, which was measured in three ways: 1) self-reported leisure-time moderate- to vigorous-intensity physical activity (MVPA) at 46 yr old, 2) longitudinal self-reported leisure-time MVPA at 31–46 yr old, and 3) accelerometer-measured overall MVPA at 46 yr old. The human capital approach was applied to calculate the observed costs (years 2012–2020) and the expected costs (years 2012–2031). Results: The results showed that the average individual-level productivity costs were higher among physically inactive compared with the costs among physically active. The results were consistent regardless of the measurement type of physical activity or the period used. On average, the observed long-term productivity costs among physically inactive individuals were €1900 higher based on self-reported MVPA, €1800 higher based on longitudinal MVPA, and €4300 higher based on accelerometer-measured MVPA compared with the corresponding productivity costs among physically active individuals. The corresponding difference in the expected costs was €2800, €1200, and €8700, respectively. Conclusions: The results provide evidence that productivity costs differ according to an individual’s level of physical activity. Therefore, investments in physical activity may decrease not only the direct healthcare costs but also the indirect productivity costs paid by the employee, the employer, and the government.

Low back pain (LBP) is the leading cause of disability worldwide and often associated with lifestyle factors. However, studies further examining the role of these lifestyle factors in non-specific low back pain in comparison with radicular pain are sparse. The aim of this cross sectional study was to investigate how diverse lifestyle factors are associated with LBP. The study population of 3385 middle aged adults with and without low back pain was drawn from a large Birth 1966 Cohort. Outcome measures were steps per day, abdominal obesity, physical activity and endurance of the back muscles. Back static muscular endurance, abdominal obesity and physical activity were measured by means of the Biering–Sørensen test, waist circumference and a wrist worn accelerometer, respectively. Logistic regression analysis was applied to estimate associations of back static muscular endurance, abdominal obesity and accelerometer-measured physical activity with non-specific low back pain and radicular pain. An additional 1000 steps per day were associated with 4% lower odds of having non-specific low back pain. Participants with abdominal obesity had 46% higher odds of having radicular pain, whereas increases of 10 s in back static muscular endurance and 10 min in daily vigorous physical activity were associated with 5% and 7% lower odds of having radicular pain, respectively. In this population-based study, non-specific low back pain and radicular pain were associated with different lifestyle and physical factors at midlife. Non-specific low back pain was associated only with the average daily number of steps, whereas abdominal obesity was the strongest determinant of radicular pain, followed by vigorous physical activity and back static muscular endurance. The findings of this study contribute to better understand the role of lifestyle factors in both non-specific low back pain and radicular pain. Future longitudinal studies are required to explore causality.

This study aimed to examine the associations of sedentary time, and substituting sedentary time with physical activity and sleep, with cardiometabolic health markers while accounting for a full 24 h of movement and non-movement behaviors, cardiorespiratory fitness (CRF), and other potential confounders. The participants were 4585 members of the Northern Finland Birth Cohort 1966, who wore a hip-worn accelerometer at the age of 46 years for 14 consecutive days. Time spent in sedentary behaviors, light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) were determined from the accelerometer and combined with self-reported sleep duration to obtain the 24-h time use. CRF was estimated from the peak heart rate in a submaximal step test. An isotemporal substitution paradigm was used to examine how sedentary time and substituting sedentary time with an equal amount of LPA, MVPA, or sleep were associated with adiposity markers, blood lipid levels, and fasting glucose and insulin. Sedentary time was independently and adversely associated with the markers of cardiometabolic health, even after adjustment for CRF, but not in partition models including LPA, MVPA, sleep, and CRF. Substituting 60, 45, 30, and 15 min/day of sedentary time with LPA or MVPA was associated with 0.2%–13.7% favorable differences in the cardiometabolic health markers after accounting for LPA, MVPA, sleep, CRF, and other confounders. After adjustment for movement and non-movement behaviors within the 24-h cycle, reallocating additional time to both LPA and MVPA was beneficially associated with markers of cardiometabolic health in middle-aged adults regardless of their CRF level.

Background: Insufficient physical activity is risk factor for morbidity and premature mortality. This population-based birth cohort study investigated the cross-sectional and longitudinal associations between self-reported temperament at age 31 and self-reported leisure-time moderate to vigorous physical activity (MVPA) levels and changes thereof from the age of 31 to the age of 46 years. Methods: The study population comprised 3,084 subjects (1,359 male and 1,725 female) from the Northern Finland Birth Cohort 1966. MVPA was self-reported at ages 31 and 46 years. Novelty seeking, harm avoidance, reward dependence, and persistence and their subscales were measured using Cloninger’s Temperament and Character Inventory at age 31. Four temperament clusters were used in the analyses: persistent, overactive, dependent, and passive. Logistic regression was used to evaluate the relationship between temperament and MVPA. Results: The persistent and overactive temperament profiles at age 31 were positively associated with higher MVPA levels both in young adulthood and in midlife, while the passive and dependent temperament profiles were associated with lower MVPA levels. The overactive temperament profile was associated with a decrease in MVPA levels from young adulthood to midlife among males. Conclusion: A passive temperament profile characterized by high harm avoidance is associated with a higher risk of low MVPA level than other temperament profiles over the life cycle in females. The results suggest that temperament may play a role in determining the level and sustainability of MVPA. Individual targeting and intervention tailoring for promoting physical activity should consider temperament traits.

This 36-month study aimed to determine whether exercise intervention added to weight loss treatment in the beginning or at 6 months is effective for weight loss and long-term weight maintenance. A total of 120 obese adults (body mass index >30) were randomly assigned to intensified behavioral modification (iBM), iBM+ additional exercise from 0 to 3 months (CWT1), iBM+ additional exercise from 6 to 9 months (CWT2), and a control group (CON). Questionnaires and measurements were collected at baseline, 3, 9, 24, and 36 months. The intervention consisted of an 12 months intensified weight-loss period followed by a 24 months weight-maintenance period. Eighty (67%) subjects (mean age 46.0 years, BMI 36.2) completed the trial. Compared with the control group, all three intervention groups had significant weight loss during the 36-month intervention period (p < 0.001). The achieved weight loss remained significant at 36 months in the iBM (−6.8%, p < 0.001), the CWT1 (−5.8%, p < 0.001), and the CWT2 group (−3.9%, p < 0.001). The CWT1 group showed significant reduction in waist circumference at 9 months (−11.3 cm, p < 0.001), at 24 months (−8.8 cm, p < 0.001), and at 36 months (−8.7 cm, p < 0.001). Intensified behavioral modification alone and with exercise resulted in clinically significant weight loss and long-term weight maintenance. The addition of exercise at the onset promoted greater reductions in waist circumference. In the treatment of obesity, including severe obesity, more intensive lifestyle interventions with exercise should be incorporated.

Cardiovascular disease (CVD) causes a high disease burden. Physical activity (PA) reduces CVD morbidity and mortality. We aimed to determine the relationship between the composition of moderate-to-vigorous PA (MVPA), light PA (LPA), sedentary behavior (SB), and sleep during midlife to the incidence of major adverse cardiac events (MACE) and all-cause mortality at a 7-year follow-up. The study population consisted of Northern Finland Birth Cohort 1966 members who participated in the 46-year follow-up in 2012 and were free of MACE (N = 4147). Time spent in MVPA, LPA, and SB was determined from accelerometer data. Sleep time was self-reported. Hospital visits and deaths were obtained from national registers. Participants were followed until December 31, 2019, or first MACE occurrence (acute myocardial infarction, unstable angina pectoris, stroke, hospitalization due to heart failure, or death due to CVD), death from another cause, or censoring. Cox proportional hazards model was used to estimate hazard ratios of MACE incidence and all-cause mortality. Isotemporal time reallocations were used to demonstrate the dose–response association between time spent in behaviors and outcome. The 24-h time composition was significantly associated with incident MACE and all-cause mortality. More time in MVPA relative to other behaviors was associated with a lower risk of events. Isotemporal time reallocations indicated that the greatest risk reduction occurred when MVPA replaced sleep. Higher MVPA associates with a reduced risk of incident MACE and all-cause mortality after accounting for the 24-h movement composition and confounders. Regular engagement in MVPA should be encouraged in midlife.

The prevalence of obesity is increasing worldwide despite a rise in therapeutic interventions to address this epidemic. However, there is a dearth of evidence-based non-surgical treatment guidelines for severe obesity. The aim of this three-year randomized, controlled trial was to elucidate the role of physical activity (PA) in the treatment of severe obesity. First, we studied the association of lifelong PA, aerobic fitness, and cardiac autonomic function by heart rate variability in severely obese adults. Secondly, we investigated the long-term effects of a three-month intensified behavioral modification (iBM) with exercise on glucose tolerance. Thirdly, we aimed to find out whether the timing of the exercise implemented at the weight loss phase of the intervention affects weight loss and waist circumference reduction (WC) from baseline. Finally, we evaluated whether a three-month exercise intervention combined with iBM has long-term effects on weight loss, weight maintenance, and reduction of WC over a three-year follow-up. 120 volunteers (mean BMI 36.8) were randomized into three intervention groups and a control group. All intervention groups were offered intensified behavioral weight loss guidance. According to previous studies, weight loss often stops and re-weighting begins after six months of intervention; we thus added exercise to the protocol of one group right at the beginning of the intervention and to another group after six months. Supervised three-month heart rate-controlled exercise training was implemented as circuit weight training. The weight loss period lasted 12 months, and the weight maintenance period lasted 24 months. Lifetime physical activity and aerobic fitness were positively associated with cardiac autonomic function. During the trial, iBM alone and combined with exercise led to clinically significant weight loss and long-term weight control. Increasing exercise right at the beginning of the weight loss period reduced abdominal, Tiivistelmä Lihavuus yleistyy huolimatta erilaisten hoitomuotojen kehittymisestä. Vaikean lihavuuden hoitamiseen on vain vähän tutkitusti vaikuttavia ei-leikkauksellisia vaihtoehtoja. Tämän tutkimuksen tavoitteena oli selvittää fyysisen aktiivisuuden roolia vaikean lihavuuden hoidossa. Ensimmäiseksi tutkimme elinaikaisen fyysisen aktiivisuuden ja aerobisen kunnon yhteyksiä sykevaihtelulla mitattuun sydämen autonomiseen säätelyyn vaikeasti lihavilla aikuisilla. Toisessa osatyössä selvitimme 3 kuukauden liikuntaharjoittelun ja tehostetun elintapaohjauksen pitkäaikaisia yhteisvaikutuksia sokeriaineenvaihduntaan. Kolmannessa osatyössä selvitimme, vaikuttaako painonpudotusvaiheessa toteutetun liikuntaharjoittelun ajoitus painonpudotukseen ja vyötärönympärykseen. Lopuksi tutkimme, vaikuttaako elintapaohjaukseen yhdistetty 3 kuukauden harjoittelu pitkällä aikavälillä painonpudotukseen, painonhallintaan ja vyötärönympärykseen kolmen vuoden seurannan aikana. 120 vapaaehtoista aikuista (keskimääräinen BMI 36,8) satunnaistettiin kolmeen interventioryhmään ja kontrolliryhmään. Kaikille interventioryhmien jäsenille tarjottiin tehostettua elintapaohjausta painonpudotukseen. Aiempien interventiotutkimusten perusteella painonlasku usein pysähtyy 6 kuukauden kohdalla. Tämän vuoksi sisällytimme interventioprotokollaan liikuntaharjoittelun yhdelle ryhmälle heti intervention alussa ja toiselle ryhmälle 6 kuukauden kohdalla aloittamisesta. Ohjattu 3 kuukauden liikuntaharjoittelu toteutettiin sykeohjattuna kiertoharjoitteluna. Painonpudotusvaihe kesti 12 kuukautta ja painonhallintavaihe 24 kuukautta. Elinikäinen fyysinen aktiivisuus ja aerobinen kunto olivat positiivisesti yhteydessä sydämen autonomiseen säätelyyn. Tehostettu elintapaohjaus yksin ja yhdessä liikuntaharjoittelun kanssa johti kliinisesti merkittävään painonpudotukseen ja pitkäaikaiseen painonhallintaan. Liikunnan lisääminen heti painonpudotuksen alussa pienensi keskivartalolihavuutta, edisti painonhallintaa ja paransi soke

With respect to physical fitness, activity and wellbeing, digital games are often considered as “screen-time”, which reduces healthy physical activities, often causing the player to sit down and eat unhealthily while playing. However, when recognising and identifying the persuasive properties in games, their “magic circle” can be used to activate and move the players instead of passivating them. Many Augmented Reality Games (ARGs), such as Ingress Prime and Pokémon GO, can increase the physical activity of the players. This multidisciplinary dissertation examines, identifies and categorises persuasive properties of several ARGs, studied in the arctic context. The findings of this study are based on qualitative material, such as participant observation, interviews, discussions and comments of the players as well as quantitative data. This study is an applied digital ethnography, comprising of both offline and online interactions, material and methods. The qualitative material was analysed applying content analysis and the statistical material was analysed using statistical software analysis. The findings were reflected in the light of several cultural and motivational theories, such as the flow and self-determination theories, as well as theories considering digital persuasion. Digital, as well as traditional, games are inherently persuasive; they lure the player to continue playing. Based on this study, the “digital magic circle” comprises multiple cultural and psychological factors, as well as several factors related specifically to digital media. Essentially, games offer the players purposeful activity with clear and achievable goals: the more successful the game design, the stronger the persuasive power. Playing such games may cause the optimal experience (flow) in player, often resulting in the player to play even more. Such persuasiveness could be implemented in “moving games” like ARGs, increasing the player’s physical activity, affecting health and w, Tiivistelmä Fyysisen kunnon, aktiivisuuden ja hyvinvoinnin kannalta digitaalisten pelien pelaaminen käsitetään usein ”ruutuajaksi”, joka istuttaa pelaajan sohvalle, ja usein myös syömään epäterveellisesti pelatessaan. Samalla pelaaminen vähentää terveyden kannalta tärkeän fyysisen aktiivisuuden määrää. Pelien suostuttelevien ominaisuuksien tiedostamisella ja tunnistamisella niiden ”taikapiiriä” voidaan kuitenkin hyödyntää pelaajien aktivoimisessa ja liikuttamisessa passivoinnin sijaan. Monien Lisätyn Todellisuuden Pelien (ARGs, Augmented Reality Games), kuten Ingress Prime ja Pokémon GO, ajatellaan lisäävän pelaajien fyysistä aktiivisuutta. Tässä monitieteisessä väitöstyössä tarkastellaan, tunnistetaan ja luokitellaan lisätyn todellisuuden pelien suostuttelevia ominaisuuksia arktisessa viitekehyksessä. Tutkimuksen tulokset perustuvat osallistuvaan havainnointiin, pelaajien haastatteluihin, keskusteluihin ja kommentteihin sekä tilastolliseen aineistoon. Kyseessä on soveltava etnografinen tutkimus, joka rakentuu niin verkossa kuin sen ulkopuolella tapahtuvaan toimintaan, tutkimusaineistoon ja menetelmiin. Laadullinen aineisto analysoitiin sisällönanalyysin menetelmin, ja määrällinen aineisto tilastoanalyysin menetelmin. Tuloksia reflektoitiin erinäisiin kulttuuri- ja motivaatioteorioihin, kuten Flow- ja itseohjautuvuus teorioihin, sekä digitaalista suostuttelevuutta koskeviin teorioihin. Digitaaliset, siinä missä perinteisetkin pelit, ovat itsessään suostuttelevia; ne houkuttelevat pelaajaa jatkamaan pelaamista. Tämän tutkimuksen perusteella ”Digitaalinen taikapiiri” muodostuu erinäisistä kulttuurisista ja psykologisista tekijöistä, sekä digitaalisiin medioihin liittyvistä erityispiirteistä. Pelit tarjoavat pelaajilleen tarkoituksenmukaista toimintaa, johon kuuluvat selkeät ja saavutettavissa olevat päämäärät. Mitä paremmin peli on suunniteltu, sitä tehokkaammin se myös suostuttelee. Tällaisten pelien pelaaminen voi aiheuttaa pelaajassa optimaalisen kokemuksen (Flow)

Objectives: Discriminating sleep period from accelerometer data remains a challenge despite many studies have adapted 24-h measurement protocols. We aimed to compare and examine the agreement among device-estimated and self-reported bedtime, wake-up time, and sleep periods in a sample of adults. Materials and methods: Participants (108 adults, 61 females) with an average age of 33.1 (SD 0.4) were asked to wear two wearable devices (Polar Active and Ōura ring) simultaneously and record their bedtime and wake up time using a sleep diary. Sleep periods from Polar Active were detected using an in-lab algorithm, which is openly available. Sleep periods from Ōura ring were generated by commercial Ōura system. Scatter plots, Bland–Altman plots, and intraclass correlation coefficients (ICCs) were used to evaluate the agreement between the methods. Results: Intraclass correlation coefficient values were above 0.81 for bedtimes and wake-up times between the three methods. In the estimation of sleep period, ICCs ranged from 0.67 (Polar Active vs. sleep diary) to 0.76 (Polar Active vs. Ōura ring). Average difference between Polar Active and Ōura ring was −1.8 min for bedtimes and −2.6 min for wake-up times. Corresponding values between Polar Active and sleep diary were −5.4 and −18.9 min, and between Ōura ring and sleep diary −3.6 min and −16.2 min, respectively. Conclusion: Results showed a high agreement between Polar Active activity monitor and Ōura ring for sleep period estimation. There was a moderate agreement between self-report and the two devices in estimating bedtime and wake-up time. These findings suggest that potentially wearable devices can be interchangeably used to detect sleep period, but their accuracy remains limited.

Objectives: To investigate the effects of 4 months of customised, home-based exergaming on physical function and pain after total knee replacement (TKR) compared with standard exercise protocol. Methods: In this non-blinded randomised controlled trial, 52 individuals aged 60–75 years undergoing TKR were randomised into an exergaming (intervention group, IG) or a standard exercising group (control group, CG). Primary outcomes were physical function and pain measured before and after (2 months and 4 months) surgery using the Oxford Knee Score (OKS) and Timed Up and Go (TUG) test. Secondary outcomes included measures of the Visual Analogue Scale, 10m walking, short physical performance battery, isometric knee extension and flexion force, knee range of movement and satisfaction with the operated knee. Results: Improvement in mobility measured by TUG was greater in the IG (n=21) at 2 (p=0.019) and 4 months (p=0.040) than in the CG (n=25). The TUG improved in the IG by −1.9 s (95% CI, −2.9 to −1.0), while it changed by −0.6 s (95% CI −1.4 to 0.3) in the CG. There were no differences between the groups in the OKS or secondary outcomes over 4 months. 100% of patients in the IG and 74% in the CG were satisfied with the operated knee. Conclusion: In patients who have undergone TKR, training at home with customised exergames was more effective in mobility and early satisfaction and as effective as standard exercise in pain and other physical functions. In both groups, knee-related function and pain improvement can be considered clinically meaningful. Trial registration number: NCT03717727.

This study investigated the association between physical activity (PA) and midlife income. The population-based data comprised employed members of the Northern Finland Birth Cohort 1966 (N = 2797). Using binned scatterplots and polynomial regressions, we evaluated the association between accelerometer-measured moderate PA (MPA), vigorous PA (VPA), and moderate-to-vigorous PA (MVPA) at 46 years old and register-based income at 50 years old. The models were adjusted for sex, marital status, number of children, education, adolescent PA, occupational physical strenuousness, and time preference. We found MPA (p < 0.001), VPA (p < 0.05), and MVPA (p < 0.001) to associate curvilinearly with income. In subgroup analyses, a curvilinear association was found between MPA (p < 0.01) and MVPA (p < 0.01) among those with physically strenuous work, VPA among all females (p < 0.01) and females with physically light work (p < 0.01), and MPA and MVPA among all males and males with physically strenuous work (p < 0.05; p < 0.01; p < 0.05; p < 0.05, respectively) and income. The highest income benefits occurred at PA volumes higher than current PA guidelines. Linear associations between PA and income were found among females for MPA (p < 0.05) and MVPA (p < 0.05), among those with physically light work for MPA (p < 0.05), VPA (p < 0.05), and MVPA (p < 0.05), and among females with physically strenuous work for VPA (p < 0.05). We conclude that PA up to the current recommended level is associated with income, but MPA exceeding 505.4 min/week, VPA exceeding 216.4 min/week, and MVPA exceeding 555.0 min/week might have a negative association with income.

Purpose: This study aimed to identify and characterize joint profiles of sedentary time and physical activity among adults and to investigate how these profiles are associated with markers of cardiometabolic health. Methods: The participants included 3702 of the Northern Finland Birth Cohort 1966 at age 46 yr, who wore a hip-worn accelerometer during waking hours and provided seven consecutive days of valid data. Sedentary time, light-intensity physical activity, and moderate- to vigorous-intensity physical activity on each valid day were obtained, and a data-driven clustering approach (“KmL3D”) was used to characterize distinct joint profiles of sedentary time and physical activity intensities. Participants self-reported their sleep duration and performed a submaximal step test with continuous heart rate measurement to estimate their cardiorespiratory fitness (peak heart rate). Linear regression was used to determine the association between joint profiles of sedentary time and physical activities with cardiometabolic health markers, including adiposity markers and blood lipid, glucose, and insulin levels. Results: Four distinct groups were identified: “active couch potatoes” (n = 1173), “sedentary light movers” (n = 1199), “sedentary exercisers” (n = 694), and “movers” (n = 636). Although sufficiently active, active couch potatoes had the highest daily sedentary time (>10 h) and lowest light-intensity physical activity. Compared with active couch potatoes, sedentary light movers, sedentary exercisers, and movers spent less time in sedentary by performing more physical activity at light-intensity upward and had favorable differences in their cardiometabolic health markers after accounting for potential confounders (1.1%–25.0% lower values depending on the health marker and profile). Conclusions: After accounting for sleep duration and cardiorespiratory fitness, waking activity profiles characterized by performing more physical activity at light-intensity up

Background: Regardless of competitive athletes’ body image pressures, only few studies have focused on adolescent sport participants’ body image and the findings are inconclusive. Furthermore, the role of competitive goals in sports on adolescents’ body size perception has not been studied. We examined the factors associated with adolescents’ competitive goals in sports and body size perception, and the associations between adolescents’ competitive goals in sports and body size perception. Methods: The cross-sectional study consisted of 475 goal-oriented sports club participants and 936 reference youths (aged 14–16 years). The study questionnaire included multiple choice items on health behaviours, motives to exercise, competitive goals in sports and body size perception. The multinomial logistic regression analysis was used to investigate the associations. Results: Adolescents with competitive goals in sports perceived their body size as about the right size more frequently than reference youths (68% vs 47%, p < 0.001 in girls; 74% vs 61%, p < 0.001 in boys). More than one-fourth of girls with competitive goals in sports perceived themselves as overweight, although only 7% of them were overweight. Adolescents with appearance/weight motives to exercise and poor perceived physical fitness had higher odds of perceived fatness. Additionally, BMI was positively associated with perceived fatness and negatively with perceived thinness. Having competitive goals in sports was not independently associated with perceived fatness or perceived thinness. Conclusions: Adolescents’ BMI, appearance/weight motives to exercise, and perceived physical fitness were more strongly associated with body size perception than their competitive goals in sports. However, perceived fatness among girls with competitive goals in sports should be considered in organized sports.

Introduction: There is limited understanding of how older adults can reach kinematic goals in rehabilitation while performing exergames and conventional exercises, and how similar or different the kinematics during exergaming are when compared with conventional therapeutic exercise with similar movement. The aim of this study was to describe the movement characteristics performed during exercise in custom-designed exergames and conventional therapeutic exercises among patients who have undergone unilateral total knee replacement (TKR). In addition, the secondary aim was to assess the relation of these exercise methods, and to assess participants’ perceived exertion and knee pain during exergaming and exercising. Materials and methods: Patients up to 4 months after the TKR surgery were invited in a single-visit exercise laboratory session. A 2D motion analysis and force plates were employed to evaluate movement characteristics as the volume, range, and intensity of movement performed during custom-designed knee extension-flexion and weight shifting exergames and conventional therapeutic exercises post TKR. The perceived exertion and knee pain were assessed using the Borg Rating of Perceived Exertion and Visual Analog Scale, respectively. Results: Evaluation of seven patients with TKR [age median (IQR), 65 (10) years] revealed that the volume and intensity of movement were mostly higher during exergames. Individual goniometer-measured knee range of motion were achieved either with exergames and conventional therapeutic exercises, especially in knee extension exercises. The perceived exertion and knee pain were similar after exergames and conventional therapeutic exercises. Conclusions: During custom-designed exergaming the patients with TKR achieve the movement characteristics appropriate for post-TKR rehabilitation without increasing the stress and pain experienced even though the movement characteristics might be partly different from conventional therapeut

Introduction : Physical inactivity, excessive total time spent in sedentary behavior (SB) and prolonged sedentary bouts have been proposed to be risk factors for chronic disease morbidity and mortality worldwide. However, which patterns and postures of SB have the most negative impacts on health outcomes is still unclear. This population-based study aimed to investigate the independent associations of the patterns of accelerometer-based overall SB and sitting with serum lipid biomarkers at different moderate- to vigorous-intensity physical activity (MVPA) levels. Methods: Physical activity and SB were measured in a birth cohort sample (N = 3272) at 46 yr using a triaxial hip-worn accelerometer in free-living conditions for 14 d. Raw acceleration data were classified into SB and PA using a machine learning–based model, and the bouts of overall SB and sitting were identified from the classified data. The participants also answered health-related questionnaires and participated in clinical examinations. Associations of overall SB (lying and sitting) and sitting patterns with serum lipid biomarkers were investigated using linear regression. Results: The overall SB patterns were more consistently associated with serum lipid biomarkers than the sitting patterns after adjustments. Among the participants with the least and the most MVPA, high total time spent in SB and SB bouts of 15–29.99 and ≥30 min were associated with impaired lipid metabolism. Among those with moderate amount of MVPA, higher time spent in SB and SB bouts of 15–29.99 min was unfavorably associated with serum lipid biomarkers. Conclusions: The associations between SB patterns and serum lipid biomarkers were dependent on MVPA level, which should be considered when planning evidence-based interventions to decrease SB in midlife.

Background: Articular surface size is traditionally considered to be a relatively stable trait throughout adulthood. Increased joint size reduces bone and cartilage tissue strains. Although physical activity (PA) has a clear association with diaphyseal morphology, the association between PA and articular surface size is yet to be confirmed. This cross-sectional study aimed to clarify the role of moderate-to-vigorous PA (MVPA) in knee morphology in terms of tibiofemoral joint size. Methods: A sample of 1508 individuals from the population-based Northern Finland Birth Cohort 1966 was used. At the age of 46, wrist-worn accelerometers were used to monitor MVPA (≥3.5 METs) during a period of two weeks, and knee radiographs were used to obtain three knee breadth measurements (femoral biepicondylar breadth, mediolateral breadth of femoral condyles, mediolateral breadth of the tibial plateau). The association between MVPA and knee breadth was analyzed using general linear models with adjustments for body mass index, smoking, education years, and accelerometer weartime. Results: Of the sample, 54.8% were women. Most individuals were non-smokers (54.6%) and had 9—12 years of education (69.6%). Mean body mass index was 26.2 (standard deviation 4.3) kg/m2. MVPA was uniformly associated with all three knee breadth measurements among both women and men. For each 60 minutes/day of MVPA, the knee breadth dimensions were 1.8—2.0% (or 1.26—1.42 mm) larger among women (p < 0.001) and 1.4—1.6% (or 1.21—1.28 mm) larger among men (p < 0.001). Conclusions: Higher MVPA is associated with larger tibiofemoral joint size. Our findings indicate that MVPA could potentially increase knee dimensions through similar biomechanical mechanisms it affects diaphyseal morphology, thus offering a potential target in reducing tissue strains and preventing knee problems. Further studies are needed to confirm and investigate the association between articulation area and musculoskeletal health

Summary Our existence on Earth is founded on a vital nature, which supports human physical and mental health. However, nature is often depicted only through biodiversity, whereas geodiversity—the diversity of non-living nature—has so far been neglected. Geodiversity consists of assemblages, structures, and systems of geological, geomorphological, soil, and hydrological components that fundamentally underlie biodiversity. Biodiversity can support overall human health only with the foundation of geodiversity. Landscape characteristics, such as varying topography or bodies of water, promote aesthetic and sensory experiences and are also a product of geodiversity. In this Personal View, we introduce the concept of geodiversity as a driver for planetary health, describe its functions and services, and outline the intricate relationships between geodiversity, biodiversity, and human health. We also propose an agenda for acknowledging the importance of geodiversity in health-related research and decision making. Geodiversity is an emerging topic with untapped potential for ensuring ecosystem functionality and good living conditions for people in a time of changing environments.

Background: Exergames can provide encouraging exercise options. Currently, there is limited evidence regarding home-based exergaming in the postoperative phase of total knee replacement (TKR). Objective: This study aimed to investigate the effects of a 4-month postoperative home-based exergame intervention with an 8-month follow-up on physical function and symptoms among older persons undergoing TKR compared with home exercise using a standard protocol. In addition, a concurrent embedded design of a mixed methods study was used by including a qualitative component within a quantitative study of exergame effects. Methods: This was a dual-center, nonblinded, two-arm, parallel group randomized controlled trial with an embedded qualitative approach. This study aimed to recruit 100 patients who underwent their first unilateral TKR (aged 60–75 years). Participants were randomized to the exergame or standard home exercise arms. Participants followed a custom-made exergame program independently at their homes daily for 4 months. The primary outcomes at 4 months were function and pain related to the knee using the Oxford Knee Score questionnaire and mobility using the Timed Up and Go test. Other outcomes, in addition to physical function, symptoms, and disability, were game user experience, exercise adherence, physical activity, and satisfaction with the operated knee. Assessments were performed at the preoperative baseline and at 2, 4, and 12 months postoperatively. Exergame adherence was followed from game computers and using a structured diary. Self-reported standard exercise was followed for 4 months of intervention and physical activity was followed for 12 months using a structured diary. Qualitative data on patients’ perspectives on rehabilitation and exergames were collected through laddering interviews at 4 and 12 months. Results: This study was funded in 2018. Data collection began in 2019 and was completed in January 2022. The COVID-19 pandemic caused an u

Land use and transportation policies have been recognized globally as major sources of physical inactivity, but there has been a gap between research and policy implementation. Our objective for this research was to produce an integrated view of community planning policies and the association between urban form characteristics and transportation mode choices in the city of Oulu from 1998 to 2016. Our findings showed that increasing density and diversity of the urban form, emphasizing active transportation, and developing the city center were highlighted in the community and transportation planning policies. In practice, urban form development focused on the inner city, but in the outer urban area and urban fringe, sprawl and car dependency increased. Overall, the active transportation mode share decreased by 2 percentage points during the follow-up, but increases in density, mix and access networks were associated with increased walking and cycling compared to car use. In conclusion, no consensus was established in Oulu to limit the dominance of private motor vehicles. Decreased active transportation mode share might have been due to inadequately assessed functional mix outside the inner city, increased urban sprawl and building more capacity for cars. In the future, stronger political leadership, increased density, better access to nearby services combined with investments in public transportation will be required to meet the policy goals.

Neighbourhood socioeconomic status and physical access to amenities and greenness are factors that have been associated with mental, physical and perceived health. However, associations between long-time exposure to these circumstances and changes in perceived health in the middle-age population have remained a relatively underexamined area. This study aimed to examine the association between residential environmental history and changes in perceived health in the Northern Finland Birth Cohort 1966 (N = 5973) population encompassing the two latest data collections at 31 and 46 years of age. Longitudinal time-varying geographical data on the residential environment’s economic dependency ratio, population density, distance to local services and presence of green areas were derived from various spatial registers and linked to cohort members’ exact residential history. According to a multivariable logistic regression analysis, having a residential history in municipalities with higher-than-average (poor) economic dependency ratios was associated with higher odds of poor perceived health changing to good. Among men, living farther than 2 km away from local services was associated with a higher risk of change from good perceived health to poor, and living farther than 300 m away from green areas was associated with a lower risk of change from good perceived health to poor. The residential environments’s urban/rural context may be one factor contributing to the findings. The results point to the importance of considering local residential area characteristics and residence duration in certain areas as potential determinants of health. Finally, having long-term residential history in areas with poor access to services and amenities has the potential to undermine health during one’s lifetime.

This paper studies the impact of long-term unemployment on physical activity. We examined the effects 6 and 15 years following a severe business cycle downturn in Finland over the period 1991–1994. The study sample comprised residents of Northern Finland. The unemployed individuals were 23–26 years old during the downturn. Physical activity, measured by MET minutes and meeting WHO guidelines, was higher 15 years later among those people who experienced the longest periods of unemployment in 1991–1994. Physical activity was somewhat lower among people with relatively shorter periods of unemployment.

The amount of physical activity decreases and sedentary time increases with aging, predisposing older adults to increased risk of type 2 diabetes and cardiovascular diseases. The aims of this study were to evaluate the associations between accelerometer-measured physical activity and sedentary time with glucose metabolism, cardiovascular risk and mortality in older adults. In 2013–2015, population-based sample of older adults (n = 714) participated in the Oulu45 cohort study at age of 67–70 years. Physical activity and sedentary time were measured with wrist-worn Polar Active accelerometer based activity monitor for two weeks. Participants’ underwent an oral glucose tolerance test and risk of cardiovascular diseases was estimated with Framingham risk score. The data for all-cause mortality were identified from the Digital and Population Data Services Agency, Finland after an average of 6.2 years follow-up. Four physical activity profiles were identified. In more active profiles, prevalence of glucose metabolism disorders, 120 min glucose and insulin values in oral glucose tolerance test were lower compared with the less active profiles. In older adults with central obesity, even light physical activity and avoiding sedentary time were associated with improved glucose metabolism and decreased insulin resistance. Both light and moderate to vigorous physical activity were associated with lower risk of cardiovascular diseases. High sedentary time was associated with increased cardiovascular risk. Low sedentary time and high time spent in light physical activity were associated with lower mortality. Based on these results, a higher amount of physical activity, at any intensity level, and avoidance of sedentary time were associated with reduced risk of type 2 diabetes, cardiovascular diseases and mortality in older adults. Especially overweight older adults should be encouraged to increase their physical activity and to avoid being sedentary., Tiivistelmä Vähäinen fyysisen aktiivisuuden määrä ja runsas paikallaanoloaika lisäävät riskiä sairastua tyypin 2 diabetekseen sekä sydän- ja verisuonisairauksiin. Tämän tutkimuksen tavoitteina oli selvittää kiihtyvyysanturilla mitatun kevyen, kohtuukuormitteisen ja raskaan fyysisen aktiivisuuden sekä paikallaanolon yhteyttä iäkkäiden henkilöiden sokeriaineenvaihduntaan sekä sydän- ja verisuonisairauksien ja kuoleman riskiin. Väestöpohjaisen Oulu45-kohorttitutkimuksen aineisto (n = 714) kerättiin vuosina 2013–2015, ja tutkittavat olivat iältään 67–70-vuotiaita. Tutkittavien fyysinen aktiivisuus ja paikallaanolo mitattiin kahden viikon ajan ranteessa pidettävällä kiihtyvyysanturiin perustuvalla Polar Active -aktiivisuusmittarilla. Tutkittaville tehtiin sokerirasituskoe ja heidän sydän- ja verisuonisairauksien riskiään arvioitiin Framinghamin riskipisteillä. Kuolleisuustiedot kerättiin Digi- ja väestötietovirastosta keskimäärin 6,2 vuoden seuranta-ajan jälkeen. Tutkimuksessa tunnistettiin iäkkäistä neljä liikkujaprofiilia. Profiililtaan fyysisesti aktiivisilla oli harvemmin sokeriaineenvaihdunnan häiriöitä ja matalammat 120 minuutin glukoosi- ja insuliiniarvot sokerirasituskokeessa. Kevyt fyysinen aktiivisuus ja vähäisempi paikallaanoloaika tehostivat etenkin keskivartalolihavien iäkkäiden sokeriaineenvaihduntaa ja vähensivät insuliiniresistenssiä. Sekä kevyt, että kohtuukuormitteinen ja raskas fyysinen aktiivisuus vähensivät sydän- ja verisuonisairauksien riskiä, kun taas runsas paikallaanoloaika lisäsi riskiä. Runsaampi kevyt fyysinen aktiivisuus ja vähäinen paikallaanoloaika pienensivät kuoleman riskiä. Tämän väitöskirjan tulosten perusteella vähäinenkin fyysinen aktiivisuus on paikallaanoloa parempi vaihtoehto iäkkäiden henkilöiden sokeriaineenvaihdunnan ja sydänterveyden edistämiseksi. Erityisesti keskivartalolihavia iäkkäitä tulisi rohkaista lisäämään liikkumista ja vähentämään paikallaanoloa.

Objective: To examine the role of physical activity (PA) and sedentary behavior (SED) for work engagement. Methods: We used data from Northern Finland Birth Cohort 1966 Study (n = 3046 to 4356) to analyze self-reported weekly leisure-time physical activity (LTPA), daily leisure-time sitting time (LTST) and work engagement. PA and SED 24-hour were also measured with accelerometer for 14 days. The data were analyzed using linear regression analyses. Results: High self-reported LTPA and sports participation were associated with higher work engagement and its subdimensions. High self-reported ST was associated with lower work engagement, vigor, and absorption. Accelerometer-measured light PA was associated with higher work engagement and vigor, and accelerometer-measured steps were linked to higher vigor. Accelerometer-measured SED was associated with lower work engagement, vigor, and dedication. Conclusions: Self-reported and accelerometer-measured PA and SED may play a role in people’s work engagement.

Background: The Beck Depression Inventory (BDI) and BDI-II (revised version) are some of the most widely used and comparable self-report scales for assessing the presence and severity of depressive symptoms in many countries. However, although the relative mean score of each symptom in different countries may vary, the cultural differences of BDI-II symptoms for each item have not been previously studied. Aims: To examine the overall picture of the magnitude of the symptoms in the Finnish population, and compare the relative mean score of each symptom between all published population-based samples from different countries fulfilling the search criteria. Method: We conducted a search for population-based studies reporting BDI-II item, using Scopus, PsycINFO and PubMed, and five population-based samples were identified. Relative average scores for each item of the scale were calculated for the Finnish population and five populations from other countries. Meta-regression methods were used to test the differences in the relative score of each symptom between each country separately, and results were then visually compared with spider charts. Results: We found significant differences in several BDI-II item scores between countries: lower indecisiveness, higher changes in sleep pattern and higher irritability in Finland; higher loss of pleasure in Norway; higher loss of interest in the Dominic Republic; higher self-criticalness and feelings of punishment in Mexico; and higher sadness in Japan. Conclusions: Based on the study fundings and including all currently published population-based samples with BDI-II scores, cultural differences in depressive symptoms should be considered when interpreting BDI-II item scores.

Aims: To examine the association of physical activity (PA) and sedentary time (ST) with glucose metabolism according to waist circumference (WC) in older people. Methods: A population-based sample of 702 individuals (aged 67–70 years) wore wrist-worn accelerometers for two weeks and underwent an oral glucose tolerance test. The associations between moderate-to-vigorous (MVPA) and light (LPA) PA, ST, and glucose metabolism across the tertiles of WC were analysed using general linear regression. Results: Among highest WC tertile, LPA negatively associated with fasting insulin (β = − 0.047, 95% CI − 0.082 to − 0.012), HOMA-IR (β = − 0.098, 95% CI − 0.184 to − 0.012), and HOMA-β (β = − 3.367, CI − 6.570 to − 0.783). ST associated with 120 min glucose (β = 0.140, CI 0.021 to 0.260). Among lowest WC tertile, MVPA negatively associated with 30 min insulin (β = − 0.086, 95% CI − 0.168 to − 0.004) and 120 min insulin (β = − 0.160, 95% CI − 0.257 to − 0.063) and positively associated with Matsuda index (β = 0.076, 95% CI 0.014 to 0.139). Light PA negatively associated with 120 min insulin (β = − 0.054, 95% CI − 0.104 to − 0.005). Conclusion: With the limitation of the cross-sectional study, reducing ST and increasing LPA may be beneficial for glucose metabolism among abdominally obese older adults. Lean older adults could benefit more from increasing MVPA.

For adolescent athletes, data on nutrition behaviors are limited. The present study aimed to evaluate the dietary habits of adolescent sports club participants (SPs) compared with those of non-participants (NPs). The cross-sectional study of 1917 adolescents aged 14–16 was based on data from the Finnish Health Promoting Sports Club (FHPSC) study. The health behavior surveys were conducted among SPs (n = 1093) and NPs (n = 824). Logistic regression was used to test statistical significance of the differences in dietary habits between SPs and NPs. SPs were more likely than NPs to eat breakfast on weekends [89% vs 79%, odds ratio (OR) 1.46, 95% confidence interval (CI) 1.07–2.01] and to report daily consumption of vegetables (46% vs 32%, OR 1.33, 95% CI 1.04–1.69) and fat-free or semi-skimmed milk (72% vs 55%, OR 1.33, 95% CI 1.04–1.68). Dietary habits regarded as unhealthy, such as sugared soft drink consumption, were similar between the groups. The aforementioned healthy dietary habits are more frequent in SPs than NPs, and unhealthy dietary habits are equally frequent in the groups. Both adolescent SPs’ and NPs’ dietary habits have deficiencies, like inadequate vegetable and fruit consumption. Sports clubs’ opportunities for adolescents’ healthy eating promotion should be examined.

Physical activity (PA) influences bone tissue throughout the lifespan and is believed to have a positive effect on vertebral size also during adulthood, thus potentially improving vertebral strength and reducing fracture risk. Modic changes (MC), divided in three subgroups (MC1, MC2, MC3), are vertebral bone marrow changes visible in magnetic resonance imaging (MRI) that are associated with non-specific low back pain (LBP). This thesis includes three population-based cohort studies (I, II, III) which aim was to investigate the association between device-measured moderate to vigorous intensity PA (MVPA, ≥ 3.5 METs), vertebral cross-sectional area (CSA) (I), and lumbar MC (II), and to determine the relationship between vertebral dimensions and lumbar MC (III), using a subsample (n = 1202–1374) of the Northern Finland Birth Cohort 1966. Participants aged 46 to 48 underwent lumbar MRI from which vertebral dimensions and lumbar MC were assessed, and their daily MVPA was determined by a wrist-worn activity monitor. The results showed that MVPA was positively associated with vertebral CSA among both sexes. Among men, a higher amount of MVPA was associated with increased odds of any lumbar MC, particularly MC2, whereas among women no such association was found. Exploration of the relationship between vertebral dimensions and lumbar MC revealed that vertebral height was positively associated with the presence of lumbar MC2, whereas vertebral CSA and volume were not associated with MC. The results of this thesis propose that MVPA has a positive impact on vertebral size among both sexes at midlife, thus lifelong MVPA might be a preventive action for reducing future vertebral fractures. Lumbar MC seem to be associated with higher vertebrae. MVPA seems to be associated with an increased likelihood of lumbar MC, but only among men and especially with MC2, strengthening the hypothesis that changed mechanical conditions due to hyperloading are connected to MC2. Further stu, Tiivistelmä Alaselkäkipu on yleisin työikäisten toimintakykyä heikentävä sairaus, ja nikamamurtumat ovat merkittävä ikääntyvän väestön liikuntakykyä ja elämänlaatua heikentävä tekijä maailmanlaajuisesti. Fyysinen aktiivisuus vaikuttaa luustoon läpi elämän, ja sillä on mahdollisesti positiivinen vaikutus nikaman kokoon vielä aikuisiässäkin vahvistaen nikamaa ja ennaltaehkäisten murtumia. Modic-muutokset (MC:t, alaryhmät MC1, MC2, MC3) ovat magneettikuvauksessa nähtäviä selkänikamien luuydinmuutoksia, jotka ovat yhteydessä pitkittyneeseen alaselkäkipuun. Väitöstutkimuksen (osatyöt I, II, III) tavoitteena oli selvittää kiihtyvyysanturiin perustuvalla ranteessa pidettävällä aktiivisuusmittarilla mitatun vähintään kohtuullisesti kuormittavan fyysisen aktiivisuuden (≥ 3.5 METs) yhteyttä nikaman poikkipinta-alaan (I) ja lannerangan MC:n riskiin (II). Lisäksi selvitettiin nikaman koon ja MC:n välistä yhteyttä (III). Tutkimusaineistona oli väestöpohjainen Pohjois-Suomen syntymäkohortti 1966. Tutkittavien (n = 1202–1374) ollessa 46–48-vuotiaita, he osallistuivat fyysisen aktiivisuuden mittauksiin ja lannerangan magneettikuvaukseen. Tulokset osoittivat, että vähintään kohtuullisesti kuormittava fyysinen aktiivisuus oli positiivisesti yhteydessä nikaman poikkipinta-alaan molemmilla sukupuolilla. Miehillä suurempi määrä päivittäistä vähintään kohtuukuormitteista fyysistä aktiivisuutta oli positiivisesti yhteydessä lannerangan MC:n, erityisesti MC2:n, naisilla yhteyttä ei havaittu. Nikaman korkeus oli positiivisesti yhteydessä lannerangan MC2:n, nikaman poikkipinta-ala ja tilavuus eivät sen sijaan olleet yhteydessä MC:n. Tutkimustulosten perusteella voidaan todeta, että vähintään kohtuukuormitteisella fyysisellä aktiivisuudella on positiivinen vaikutus nikaman kokoon keski-iässä molemmilla sukupuolilla ja sitä voidaan pitää yhtenä varteenotettavana nikamamurtumien ennaltaehkäisykeinona. Lannerangan MC:t saattavat olla yhteydessä korkeampaan nikamaan, ja miehillä vähintään kohtuuk

Introduction: Physical inactivity is a global concern, especially among adolescent men. Little research has been done on the association between parental factors and young adults’ physical activity in the context of residential environment. We aimed to reveal what parental factors are associated with physical activity among adolescent men living in built and natural environments. Methods: A population-based sample of 1,904 men (mean age = 17.9, SD = 0.7 years) completed a questionnaire regarding physical activity, parental factors, and lifestyle in Northern Finland in 2012 and 2013. Geographical information system methods and dominant land-use type were used to define the residential environment in a 1-kilometer radius buffer zone surrounding each participant’s home address. If the residential area included more artificial surfaces, it was defined as a built environment, and areas including more nature were defined as natural environments. Results: According to multivariable analyses, a mother’s physical activity (OR = 1.9; 95% CI: 1.3–2.8) was positively associated with the physical activity of adolescent men living in built environments, and the father’s physical activity was positively associated with the physical activity of adolescent men living in natural environments (2.8; 1.7–4.8). Self-rated health (built 5.9 [4.0–8.7]; natural 5.2 [3.0–9.0]) was positively associated with physical activity level. Those with symptoms of depression were more likely to be physically inactive (built 0.5 [0.3–0.8]; natural 0.3 [0.1–0.6]). Adolescent men were equally physically active regardless of the living environment. Conclusions: The level of physical activity of parents, self-rated health, and depressive symptoms should be considered when designing physical activity promotions for adolescent men according to their residential environments.

The popularity of accelerometer-based activity monitors has been associated with several analytical challenges, including how to quantify accelerometer outputs in terms of sedentary behavior, light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Recently, machine learning (ML) approaches have been coupled with raw accelerometry to classify activities by intensity, but the generalizability of ML models outside of the development datasets remains poorly understood. Currently, the health benefits of meeting the recommended amounts of sleep and MVPA in adults are well documented, but the cardiometabolic health implications of sedentary time and LPA are still unclear. The present study reviewed studies calibrating and validating wearable accelerometers using ML approaches and preformed cross-dataset tests to evaluate the generalization performance of ML models for classifying activity intensities from raw acceleration data. Additionally, the latest follow-up in the Northern Finland Birth Cohort 1966 study (n = 5,840) at age 46 years included measurement of daily activities for two weeks with two accelerometers. This data was used to examine how the levels and patterns of accelerometer-estimated activity intensities (sedentary behavior, LPA, and MVPA) are associated with cardiometabolic health in this large sample of middle-aged adults, and to create a data-driven hierarchy predicting their activity behaviors. Based on the study, ML techniques can classify activities in terms of type, category, or intensity with acceptable accuracy irrespective of accelerometer placement. However, ML models developed with raw acceleration data for classifying activity intensities (sedentary behavior, LPA, and MVPA) are not generalizable to other populations monitored with different accelerometers, suggesting that further strategies are needed to enhance their generalizability. The study suggests that adults, in addition to MVPA, may also gain, Tiivistelmä Nykyään hyvin suosittujen kiihtyvyysanturiin perustuvien aktiivisuusmittareiden keräämän datan analysointiin liittyy monia haasteita, kuten paikallaanolon, kevyen liikunnan sekä keskiraskaan ja raskaan liikunnan tarkan määrän määrittäminen. Viime aikoina on otettu käyttöön koneoppimismenetelmiä kiihtyvyysanturin tuottaman raakasignaalin analysoinnissa luokittelemaan liikettä sen intensiteetin perusteella, mutta toistaiseksi näiden menetelmien yleistettävyys on huonosti tiedossa. Nykyisin tiedetään aika hyvin ne terveyshyödyt, joita saadaan, jos noudatetaan unen sekä keskiraskaan ja raskaan liikunnan suosituksia. Paikallaanolon ja kevyen liikunnan vaikutukset sydän- ja verisuoniterveyteen ovat kuitenkin heikommin tiedossa. Tässä tutkimuksessa tehtiin systemaattinen kirjallisuuskatsaus koneoppimismenetelmien käytöstä kannettavien kiihtyvyysanturien kalibroinnissa ja validoinnissa. Työssä testattiin koneoppimismenetelmien yleistettävyyttä fyysisen aktiivisuuden intensiteetin luokitteluun kiihtyvyysanturin antaman raakadatan perusteella yhdistäen useita toisistaan riippumattomia mittausaineistoja. Pohjois-Suomen vuoden 1966 syntymäkohortin 46-vuotisaineistonkeruussa (n = 5,840) oli mitattu liikunta-aktiivisuutta kahdella kiihtyvyysanturilla. Tämän mittaustiedon avulla tutkittiin sitä, kuinka kiihtyvyysanturilla mitattu fyysisen aktiivisuuden intensiteetti (paikallaanolo, kevyt liikunta sekä keskiraskas ja raskas liikunta) ja eri intensiteetillä toteutetun aktiivisuuden jakautuminen vuorokauden sisällä ovat yhteydessä keski-ikäisten sydänterveyteen. Lisäksi luotiin aineiston perusteella hierarkinen malli ennustamaan liikuntakäyttäytymistä. Tutkimuksen perusteella koneoppimistekniikoiden avulla voidaan riittävällä tarkkuudella luokitella fyysistä aktiivisuutta liikuntamuodon, intensiteetin ja eri intensiteettien jakautumisen perusteella riippumatta kiihtyvyysanturin sijainnista. Kiihtyvyysanturin tuottamaan raakadataan perustuvat fyysisen aktiivisuuden intensi

Breaking up sedentary time with physical activity (PA) could modify the detrimental cardiometabolic health effects of sedentary time. Our aim was to identify profiles according to distinct accumulation patterns of sedentary time and breaks in adults, and to investigate how these profiles are associated with cardiometabolic outcomes. Participants (n = 4439) of the Northern Finland Birth Cohort 1966 at age 46 years wore a hip-worn accelerometer for 7 consecutive days during waking hours. Uninterrupted ≥1-min sedentary bouts were identified, and non-sedentary bouts in between two consecutive sedentary bouts were considered as sedentary breaks. K-means clustering was performed with 65 variables characterizing how sedentary time was accumulated and interrupted. Linear regression was used to determine the association of accumulation patterns with cardiometabolic health markers. Four distinct groups were formed as follows: “Couch potatoes” (n = 1222), “Prolonged sitters” (n = 1179), “Shortened sitters” (n = 1529), and “Breakers” (n = 509). Couch potatoes had the highest level of sedentariness and the shortest sedentary breaks. Prolonged sitters, accumulating sedentary time in bouts of ≥15–30 min, had no differences in cardiometabolic outcomes compared with Couch potatoes. Shortened sitters accumulated sedentary time in bouts lasting <15 min and performed more light-intensity PA in their sedentary breaks, and Breakers performed more light-intensity and moderate-to-vigorous PA. These latter two profiles had lower levels of adiposity, blood lipids, and insulin sensitivity, compared with Couch potatoes (1.1–25.0% lower values depending on the cardiometabolic health outcome, group, and adjustments for potential confounders). Avoiding uninterrupted sedentary time with any active behavior from light-intensity upwards could be beneficial for cardiometabolic health in adults.

The health benefits of physical activity (PA) are indisputable, but physical inactivity remains a global public health concern. There is a need to design cities that support active transportation because the built environment (BE) is a possible major contributor to physical inactivity. The present study aimed to examine the BE as a determinant of PA with a specific focus on longitudinal associations, residential relocation, and producing policy-relevant knowledge of land use and transportation policies, and urban form and transportation modal share development. First, previous longitudinal studies were reviewed using the narrative synthesis analysis method. Second, population-based prospective Northern Finland Birth Cohort 1966 data were used to assess the longitudinal associations between residential relocation and changes in regular walking and cycling behavior. Finally, a longitudinal mixed methods approach focused on the interconnection between qualitative document analysis of local land use and transportation policies and quantitative analysis of urban form development and its association with transportation modal share development. Increases in urban form density, mixed land use, and access networks (DMA) were associated with increased walking and cycling and decreased car use. Residential relocation trajectories were mostly stable. Relocation focused more often to less dense and diverse neighborhoods, but relocating to the most urban neighborhoods increased the odds of starting both regular cycling and walking, as compared to the opposite relocation trajectory. In the city of Oulu, urban form did not develop entirely according to related policies, and goals to increase active transportation modal share were not achieved, possibly due to an inadequate functional mix outside the city center, increased urban sprawl, and building more capacity for cars. Changing how community structures are developed seems a promising strategy for increasing population P, Tiivistelmä Näyttö fyysisen aktiivisuuden terveysvaikutuksista on kiistaton. Tästä huolimatta fyysinen inaktiivisuus on maailmanlaajuinen kansanterveydellinen ongelma. Rakennettu ympäristö on keskeinen väestön liikkumattomuutta selittävä tekijä, joten aktiivisten kulkutapojen, kuten kävelyn ja pyöräilyn, edistäminen kaupunkisuunnittelussa tulisi huomioida nykyistä paremmin. Tässä tutkimuksessa selvitettiin asuinympäristön muutosten yhteyttä liikkumisen muutoksiin ja toimintapoliittisten tekijöiden yhteyttä kuntalaisten kulkutapavalintoihin pitkällä aikavälillä Oulussa. Tutkimuksen systemaattisessa kirjallisuuskatsauksessa seulottiin aiemmat pitkittäistutkimukset, ja tulokset analysoitiin käyttäen narratiivisen synteesin metodia. Asuinympäristön muutosten yhteyttä säännöllisen kävelyn ja pyöräilyn muutoksiin tutkittiin hyödyntäen Pohjois-Suomen syntymäkohortti 1966 -aineistoa. Maankäytön ja liikenteen toimintapolitiikan kehitystä ja sen yhteyttä yhdyskuntarakenteen ja liikenteen kulkutapaosuuksien kehitykseen analysoitiin sekamenetelmin. Yhdyskuntarakenteen tiiviyden, toimintojen sekoittumisen ja katuverkoston risteystiheyden lisääntyminen olivat yhteydessä lisääntyneeseen kävelyyn ja pyöräilyyn ja autoilun vähenemiseen. Suurin osa tutkittavista asui samankaltaisessa ympäristössä koko seuranta-ajan. Tutkittavat olivat muuttaneet useammin harvemmin asuttuun, toiminnoiltaan yksipuolisempaan ympäristöön. Muuttaminen hyvin urbaaniin ympäristöön oli yhteydessä todennäköisempään säännöllisen kävelyn ja pyöräilyn aloittamiseen. Yhdyskuntarakenne ei kehittynyt Oulussa täysin toimintapolitiikan mukaisesti eikä tavoite aktiivisen liikenteen kulkumuoto-osuuden kasvattamiseksi täyttynyt. Tämä saattoi olla seurausta liian vähäisestä toimintojen sekoittumisesta keskustan ulkopuolella, kaupunkirakenteen hajautumisesta ja autoilun olosuhteiden kehittämisestä. Tutkimuksen tulosten perusteella yhdyskuntarakenteen kehittäminen aktiivisia kulkutapoja suosivaksi vaikuttaa lupaavalta stra

Valid and useful dietary assessment methods for adolescents with type 1 diabetes (T1D) are needed. In this study, we compared an image-based method with a written food diary for dietary intake estimation among adolescents with T1D and evaluated the adolescents’ experiences of the methods. Adolescents with T1D aged 13 to 18 years (n = 13) photographed their meals (n = 264) with a mobile phone camera and simultaneously kept a written food diary for four consecutive days. The participants filled out electronic background and feedback questionnaires. The agreement between the methods was evaluated using intraclass correlation coefficients (ICCs) and Bland–Altman plot analyses. The agreement between the methods was moderate to excellent for the energy intake (ICC = 0.91, 95% confidence interval (CI): 0.66 to 0.97, p < 0.001) and good to excellent for total carbohydrate intake (ICC = 0.95, 95% CI: 0.84 to 0.99, p < 0.001). The adolescents considered photographing easier and faster than keeping a food diary. In conclusion, the image-based method appeared comparable to the food diary for dietary intake estimation among adolescents with T1D. The photographing of meals may become a useful dietary assessment tool for adolescents with T1D, but must be further developed and validated.

Although the health benefits of physical activity (PA) are well known, the majority of adolescents are not sufficiently physically active. New innovative ways to promote active lifestyles are needed. This study aimed to evaluate the effectiveness of a wrist-worn activity monitor (Polar Active) and a gamified web-based mobile service in promoting PA in young men. The study also examined the convergent validity between three different accelerometer-based PA measurement methods. In this study, two randomized controlled trials (RCT) were conducted in Oulu, Finland among 18-year-old men. The three-month RCT (n=276) was conducted in fall 2012 and the six-month population-based RCT (n=496) between September 2013 and March 2014. In both trials, participants were randomized to an intervention and a control group. The intervention group was given the wrist-worn Polar Active monitor with PA feedback. In the six-month trial, the intervention group also got access to a mobile service developed in this study. During both trials, PA was continuously measured in both study groups. In the control group, PA was measured with an otherwise similar monitor but which provided only the time of day and no feedback. The convergent validity was examined between the agreement in time spent at different PA levels using Polar Active, mean amplitude deviation (MAD) of raw acceleration, and Actigraph with the Freedson thresholds. In the validation study, all three activity monitors were continuously used for two weeks by 41 volunteers. The three-month trial had a short-term positive effect on daily moderate-to-vigorous PA (MVPA) and sedentary time in the intervention group. The positive change in sedentary time was sustained for longer. During the six-month trial, a positive trend in favor of the intervention group was observed in daily MVPA. Low amount of daily vigorous PA at baseline was associated with the increase in MVPA. The functionalities of the mobile service related to PA were, Tiivistelmä Vaikka fyysisen aktiivisuuden terveysvaikutukset ovat hyvin tiedossa, valtaosa nuorista ei liiku riittävästi. Tarvitaan uusia menetelmiä edistämään nuorten aktiivista elämäntapaa. Tämän tutkimuksen tarkoituksena oli selvittää ranteessa pidettävän aktiivisuusmittarin ja pelillistetyn mobiilipalvelun vaikutus nuorten miesten fyysiseen aktiivisuuteen. Lisäksi tutkittiin kolmen eri kiihtyvyysmittaukseen perustuvan aktiivisuusmittausmenetelmän yhtenevyyttä. Tutkimuksessa toteutettiin kaksi satunnaistettua, kontrolloitua interventiota, oululaisilla 18-vuotiailla miehillä. Kolmen kuukauden interventio (n=276) toteutettiin syksyllä 2012 ja 6 kuukauden väestöpohjainen interventio (n=496) syyskuun 2013 ja maaliskuun 2014 välillä. Molemmissa interventioissa osallistujat satunnaistettiin interventio- ja kontrolliryhmään. Interventioryhmä sai käyttöönsä aktiivisuusmittarin, joka antoi palautetta aktiivisuudesta. Lisäksi 6 kuukauden interventiossa interventioryhmä sai käyttöönsä tutkimuksessa kehitetyn mobiilipalvelun. Molemmissa interventioissa kaikkien tutkittavien fyysistä aktiivisuutta mitattiin jatkuvasti. Kontrolliryhmä ei saanut aktiivisuuspalautetta. Aktiivisuusmittausmenetelmien yhtenevyyttä fyysisen aktiivisuuden eri tasoilla vietetyn ajan mittaamisessa tutkittiin vertaamalla Polar Active -mittaria, kiihtyvyyssignaalin perustuvaa menetelmää (mean amplitude deviation, MAD) ja Actigraph-mittaria Freedsonin raja-arvoilla. Neljäkymmentäyksi vapaaehtoista käytti kaikkia kolmea mittaria samanaikaisesti kahden viikon ajan. Kolmen kuukauden interventiolla oli lyhytaikainen positiivinen vaikutus kohtuukuormitteisen tai raskaan fyysisen aktiivisuuden ja paikallaanolon määrään. Paikallaanolon muutos säilyi pidempään. Kuuden kuukauden interventiossa havaittiin interventioryhmässä pieni, ei-merkitsevä nousu kohtuukuormitteisessa tai raskaassa aktiivisuudessa. Aktiivisuus lisääntyi intervention aikana niillä miehillä, joilla alussa oli vähän raskasta fyysistä aktiivisuutt

Purpose: This study aimed to examine how compositions of 24-h time use and time reallocations between movement behaviors are associated with cardiometabolic health in a population-based sample of middle-age Finnish adults. Methods: Participants were 3443 adults 46 yr of age from the Northern Finland Birth Cohort 1966 study. Participants wore a hip-worn accelerometer for 14 d from which time spent in sedentary behavior (SB), light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were determined. These data were combined with self-reported sleep to obtain the 24-h time-use composition. Cardiometabolic outcomes included adiposity markers, blood lipid levels, and markers of glucose control and insulin sensitivity. Multivariable-adjusted regression analysis, using a compositional data analysis approach based on isometric log-ratio transformation, was used to examine associations between movement behaviors with cardiometabolic outcomes. Results: More daily time in MVPA and LPA, relative to other movement behaviors, was consistently favorably associated with all cardiometabolic outcomes. For example, relative to time spent in other behaviors, 30 min·d−1 more MVPA and LPA were both associated with lower 2-h post–glucose load insulin level (−11.8% and −2.7%, respectively). Relative to other movement behaviors, more daily time in SB was adversely associated with adiposity measures, lipid levels, and markers of insulin sensitivity, and more daily time asleep was adversely associated with adiposity measures, blood lipid, fasting plasma glucose, and 2-h insulin. For example, 60 min·d−1 more SB and sleep relative to the remaining behaviors were both associated with higher 2-h insulin (3.5% and 5.7%, respectively). Conclusions: Altering daily movement behavior compositions to incorporate more MVPA at the expense of any other movement behavior, or more LPA at the expense of SB or sleep, could help to improve cardiometabolic he

Disordered eating behavior (DEB) is associated with psychological distress. It increases the risk of weight gain and complicates weight loss and maintenance. Disordered eating behavior may be under-recognized in young men and in treating obesity. This study aimed to increase knowledge of DEB and its associations with weight and physical activity in young men. Moreover, it aimed to clarify the effects of intensive lifestyle intervention on eating behavior traits and weight in adults. Population-based data on young men (n = 2,491) was collected from the Finnish Defence Forces’ call-ups in 2010, 2011, and 2013 in the Oulu area, Finland. Behaviors related to disordered eating, weight, and exercise were investigated using a questionnaire. Anthropometric and physical fitness measurements and medical examinations were performed. A second dataset was obtained from 120 working-age adults (BMI > 30) who participated in intensive lifestyle intervention. Questions related to eating behavior traits were asked at the beginning of the study and thrice during a three-year intervention. Heights and weights were measured. Disordered eating behavior occurred in 11.1% of young men and was more common among overweight men. General symptoms of DEB and compulsive desire to lose weight occurred more frequently in overweight young men, while bulimic behavior occurred with all weights. Four DEB profiles were recognized: compulsive thinking of dieting, eating in secret, being concerned about eating control, and mild disordered eating. Disordered eating behavior was associated with less physical activity, higher sedentary leisure time, and especially body-related motives to exercise. Among working-aged people, binge eating occurred in one in four women but was rare in men. During the intensive lifestyle intervention, impulsive eating decreased and emotional eating was lower at the end of the intervention among those who lost and maintained at least 5% of their weight. Cognitive restra, Tiivistelmä Häiriintynyt syömiskäyttäytyminen on yhteydessä psyykkiseen pahoinvointiin sekä altistaa painonnousulle ja vaikeuttaa laihtumista ja painonhallintaa. Nuorilla miehillä ja etenkin lihavuuden hoidossa syömishäiriöoireet voivat jäädä huomioimatta. Tämän väitöskirjatyön tavoitteena oli lisätä tietoa nuorten miesten häiriintyneestä syömiskäyttäytymisestä ja sen yhteydestä painoon ja liikuntakäyttäytymiseen. Tavoitteena oli myös selvittää tehostetun elintapaohjauksen vaikutusta työikäisten syömiskäyttäytymispiirteisiin ja painon muutokseen. Nuorten miesten väestöpohjainen aineisto (n = 2491) kerättiin Oulun alueen kutsunnoissa vuosina 2010, 2011 ja 2013. Miesten syömis-, paino- ja liikuntakäyttäytymistä kartoitettiin kyselyllä ja heille tehtiin antropometrian ja fyysisen kunnon mittaukset sekä terveystarkastus. Toinen aineisto koostui elintapaohjausinterventioon osallistuneista 120 työikäisestä (BMI > 30). Tutkittavat täyttivät tutkimuksen alussa ja kolmevuotisen intervention eri vaiheissa kyselyn, jolla selvitettiin heidän syömiskäyttäytymistään. Heidän pituutensa ja painonsa mitattiin. Häiriintynyttä syömiskäyttäytymistä esiintyi 11,1 prosentilla nuorista miehistä, ja se oli yleisempää ylipainoisilla. Yleisiä syömishäiriöoireita ja pakonomaista laihtumisen halua esiintyi enemmän ylipainoisilla, kun taas ahmimisen oireita esiintyi kaiken painoisilla. Tutkimuksessa tunnistettiin neljä syömishäiriöoireilun profiilia: laihtumista tavoittelevat, salaa ahmivat, syömisen hallinnastaan huolestuneet ja lievästi syömisellään oireilevat. Häiriintynyt syömiskäyttäytyminen oli yhteydessä vähäisempään fyysiseen aktiivisuuteen, runsaampaan istumiseen ja etenkin kehokeskeisiin liikkumismotiiveihin. Työikäisten aineistossa joka neljännellä naisella esiintyi ahmimista, miehillä ei juurikaan. Elintapaohjauksen myötä pysyvästi vähintään viisi prosenttia laihtuneilla impulsiivinen syöminen väheni ja tunnesyöminen oli intervention lopussa vähäisempää kuin heillä, joiden paino ei

Background: Recently, the importance of light physical activity (LPA) for health has been emphasized, and residential greenness has been positively linked to the level of LPA and a variety of positive health outcomes. However, people spend less time in green environments because of urbanization and modern sedentary leisure activities. Aims: In this population-based study, we investigated the association between objectively measured residential greenness and accelerometry measured physical activity (PA), with a special interest in LPA and gender differences. Methods: The study was based on the Northern Finland Birth Cohort 1966 (5433 members). Participants filled in a postal questionnaire and underwent clinical examinations and wore a continuous measurement of PA with wrist-worn Polar Active Activity Monitor accelerometers for two weeks. The volume of PA (metabolic equivalent of task or MET) was used to describe the participant’s total daily activity (light: 2–3.49 MET; moderate: 3.5–4.99 MET; vigorous: 5–7.99 MET; very vigorous: ≥8 MET). A geographic information system (GIS) was used to assess the features of each individual’s residential environment. The normalized difference vegetation index (NDVI) was used for the objective quantification of residential greenness. Multiple linear regression and a generalized additive model (GAM) were used to analyze the association between residential greenness and the amount of PA at different intensity levels. Results: Residential greenness (NDVI) was independently associated with LPA (unadjusted β = 174; CI = 140, 209) and moderate physical activity (MPA) (unadjusted β = 75; CI = 48, 101). In the adjusted model, residential greenness was positively and significantly associated with LPA (adjusted β = 70; CI = 26, 114). In men, residential greenness was positively and significantly associated with LPA (unadjusted β = 224; CI = 173, 275), MPA (unadjusted β = 75; CI = 48, 101), and moderate to vigorous physical activity (

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiov