Physical activity (PA) at leisure by the elderly, and its relationship to cardiovascular (CV) and non-CV mortality, with and without competing risk, has been scarcely described. We determined the ...relationships between PA, smoking and 12-year CV, non-CV and all-cause mortality in elderly Oslo men screened for CV disease in 1972-1973 and 2000.
Among 14,846 men born during 1923-1932 and participating in 1972-1973, there were 5738 participants in 2000. During the 12 years follow-up 2154 died. Cox regression modelling of mortality endpoints, with and without competing risk, was applied analysing PA variables hours per week of light or vigorous PA intensity and degree of PA at leisure. Comparisons of predictive ability between PA and smoking were done by receiver operating characteristics.
Thirty minutes of PA per 6 days a week was associated with about 40% mortality risk reduction. There was a 5 years increased lifetime when comparing sedentary and moderate to vigorous physically active men. Associations to CV or non-CV mortality were slightly weakened, allowing competing risk. Conditional on the prevalence of smoking and PA, the degree of PA at leisure was almost as predictive as smoking with regard to the effects on mortality. Increase in PA was as beneficial as smoking cessation in reducing mortality.
Even at the age of 73 years, PA is associated highly with mortality between groups of sedentary and active persons. Allowing for competing risk did not weaken these associations markedly. Public health strategies in elderly men should include efforts to increase PA in line with efforts to reduce smoking behaviour.
The purpose was to test the effect of eccentric strength training and flexibility training on the incidence of hamstring strains in soccer. Hamstring strains and player exposure were registered ...prospectively during four consecutive soccer seasons (1999–2002) for 17–30 elite soccer teams from Iceland and Norway. The first two seasons were used as baseline, while intervention programs consisting of warm‐up stretching, flexibility and/or eccentric strength training were introduced during the 2001 and 2002 seasons. During the intervention seasons, 48% of the teams selected to use the intervention programs. There was no difference in the incidence of hamstring strains between teams that used the flexibility training program and those who did not relative risk (RR)=1.53, P=0.22, nor was there a difference compared with the baseline data (RR=0.89, P=0.75). The incidence of hamstring strains was lower in teams who used the eccentric training program compared with teams that did not use the program (RR=0.43, P=0.01), as well as compared with baseline data for the same intervention teams (RR=0.42, P=0.009). Eccentric strength training with Nordic hamstring lowers combined with warm‐up stretching appears to reduce the risk of hamstring strains, while no effect was detected from flexibility training alone. These results should be verified in randomized clinical trials.
A set of exercises – the “11”– have been selected to prevent football injuries. The purpose of this cluster‐randomized controlled trial was to investigate the effect of the “11” on injury risk in ...female youth football. Teams were randomized to an intervention (n=59 teams, 1091 players) or a control group (n=54 teams, 1001 players). The intervention group was taught the “11,” exercises for core stability, lower extremity strength, neuromuscular control and agility, to be used as a 15‐min warm‐up program for football training over an 8‐month season. A total of 396 players (20%) sustained 483 injuries. No difference was observed in the overall injury rate between the intervention (3.6 injuries/1000 h, confidence interval (CI) 3.2–4.1) and control group (3.7, CI 3.2–4.1; RR=1.0, CI 0.8–1.2; P=0.94) nor in the incidence for any type of injury. During the first 4 months of the season, the training program was used during 60% of the football training sessions, but only 14 out of 58 intervention teams completed more than 20 prevention training sessions. In conclusion, we observed no effect of the injury prevention program on the injury rate, most likely because the compliance with the program was low.
The methodology for studies designed to investigate potential risk factors for sports injury is reviewed, using the case of hamstring strains as an example. Injuries result from a complex interaction ...of multiple risk factors and events. Therefore, a multivariate statistical approach should be used. In addition, the sample size of the study needs to be considered carefully. Sample size mainly depends on the expected effect of the risk factor on injury risk, and to detect moderate to strong associations 20–50 injury cases are needed, whereas small to moderate associations would need about 200 injured subjects. Studies published to date on the risk factors for hamstring strains have methodological limitations, and are too small to detect small to moderate associations.
Many patients with lung cancer are deconditioned with poor physical fitness. Lung resection reduces physical fitness further, impairing the patient's ability to function in daily life.
We conducted a ...single-blind randomised controlled trial of high-intensity endurance and strength training (60 min, three times a week, 20 weeks), starting 5-7 weeks after surgery. The control group received standard postoperative care. The primary outcome was the change in peak oxygen uptake measured directly during walking until exhaustion. Other outcomes included changes in pulmonary function, muscular strength by one-repetition maximum (1RM), total muscle mass measured by dual energy X-ray absorptiometry, daily physical functioning and quality of life (QoL).
The intention-to-treat analysis of the 61 randomised patients showed that the exercise group had a greater increase in peak oxygen uptake (3.4 mL/kg/min between-group difference, p=0.002), carbon monoxide transfer factor (Tlco) (5.2% predicted, p=0.007), 1RM leg press (29.5 kg, p<0.001), chair stand (2.1 times p<0.001), stair run (4.3 steps, p=0.002) and total muscle mass (1.36 kg, p=0.012) compared with the controls. The mean±SD QoL (SF-36) physical component summary score was 51.8±5.5 and 43.3±11.3 (p=0.006), and the mental component summary score was 55.5±5.3 and 46.6±14.0 (p=0.015) in the exercise and control groups, respectively.
In patients recently operated for lung cancer, high-intensity endurance and strength training was well tolerated and induced clinically significant improvements in peak oxygen uptake, Tlco, muscular strength, total muscle mass, functional fitness and QoL. This study may provide a basis for exercise therapy after lung cancer surgery.
NCT01748981.
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Objectives. Few studies have simultaneously analysed the influence of elevated serum uric acid (UA) on acute myocardial infarction (AMI), ischaemic and haemorrhagic stroke (IS, HS) and congestive ...heart failure (CHF) in large healthy populations. We, here, examine UA as a risk factor for AMI, stroke and CHF by age and gender in the Apolipoprotein MOrtality RISk (AMORIS) Study.
Design. Prospective study (11.8 years, range 7–17) of fatal and nonfatal acute myocardial infarction, stroke and CHF through linkage with Swedish hospital discharge and mortality registers.
Settings. Measurements of uric acid in 417 734 men and women from health check‐ups in Stockholm area.
Results. There was a gradual increase in risk of AMI, stroke and CHF by increasing UA levels. Women had a stronger relationship between UA and both AMI and IS than men. Predictions of AMI were at least as powerful in the elderly as in the young, but not so for IS. Associations were markedly attenuated when adjusted for total cholesterol, triglycerides, hospital hypertension and diabetes status. The association between UA and HS was U‐shaped in both genders. CHF was more strongly related to UA than AMI and stroke and less affected by the adjustment factors.
Conclusions. Already moderate levels of UA appear to be associated with an increased incidence of AMI, stroke and CHF in middle‐aged subjects without prior cardiovascular disease. These associations seem to increase gradually from lower to higher levels of UA. UA may be an important complementary indicator of cardiovascular risk in the general population.
Objective To investigate the risk factors for pelvic organ prolapse (POP), including physical activity, clinically measured joint mobility and pelvic floor muscle (PFM) function.
Design One‐to‐one ...age‐ and parity‐matched case–control study.
Setting Akershus university hospital and one outpatient physiotherapy clinic in Norway.
Population Forty‐nine women with POP (POP quantification, stage ≥II) and 49 controls (stages 0 and I) were recruited from community gynaecologists and advertisements in newspapers.
Methods Validated questionnaires, interview and clinical examination, including Beighton’s scoring system (joint hypermobility) and vaginal pressure transducer measurements (PFM function), were used. Univariate and multivariate conditional logistic regression analyses for one‐to‐one matched case–control studies were used, and odds ratios with 95% CIs are reported.
Main outcome measures Pelvic floor muscle function (strength, endurance and resting pressure), socioeconomic status, body mass index, heavy occupational work, physical activity, family history, obstetric factors and markers of connective tissue weakness (striae, varicose veins, bruising, diastasis recti abdominis, joint hypermobility).
Results No significant differences were found between groups with regard to postmenopausal status, current smoking, current low‐intensity exercise, type of birth (caesarean, forceps, vacuum), birth weight, presence of striae, diastasis recti abdominis and joint hypermobility. Body mass index (OR 5.0; 95% CI 1.1–23.0), socioeconomic status (OR 10.5; 95% CI 2.2–50.1), heavy occupational work (OR 9.6; 95% CI 1.3–70.3), anal sphincter lacerations (OR 4.5; 95% CI 1.0–20.0), PFM strength (OR 7.5; 95% CI 1.5–36.4) and endurance (OR 11.5; 95% CI 2.0–66.9) were independently related to POP.
Conclusions Body mass index, socioeconomic status, heavy occupational work, anal sphincter lacerations and PFM function were independently associated with POP, whereas joint mobility and physical activity were not.
We examined the single and combined effects of a 1‐year diet and exercise intervention on the International Diabetes Federation (IDF) metabolic syndrome among middle‐aged males. The study was a ...randomized, controlled, 2 × 2 factorial intervention study. Participants included 137 men with metabolic syndrome according to the IDF criteria aged 40–49 years randomly allocated to four intervention groups: diet alone (n=34), exercise alone (n=34), the combination of the diet and exercise intervention (n=43) or control (n=26). The main outcome measure was metabolic syndrome as defined by IDF criteria (2005). In the combined diet and exercise group, 14 participants (32.6%) (P<0.0001 as compared with control) had the metabolic syndrome after 1‐year intervention. In the diet‐only group, 22 participants (64.7%) (P=0.023 vs control) and in the exercise‐only group 26 participants (76.5%) (P=0.23 vs control) had the metabolic syndrome following the intervention. Utilizing the factorial design, both dietary and exercise intervention had significant effects (P<0.005) on the resolution of the metabolic syndrome. Both exercise and dietary intervention reduced metabolic syndrome prevalence compared with control after 1 year of intervention. However, the combined diet and exercise intervention was significantly more effective than diet or exercise alone in the treatment of the metabolic syndrome.
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Objectives. To compare lipoprotein components associated with ischaemic and haemorrhagic stroke by age and gender in the Apolipoprotein MOrtality RISk (AMORIS) Study (n = 148 600).
Design. ...Prospective follow‐up study (11.8, range 7–17 years) of fatal and nonfatal ischaemic and haemorrhagic stroke through linkage with Swedish hospital discharge and mortality registers.
Setting. Measurements of lipoprotein components from health check‐ups in the larger Stockholm area.
Results. Ischaemic stroke was more common than haemorrhagic stroke (5 :1), but case fatality was higher in haemorrhagic stroke. An elevated apoB/apoA‐1 ratio and triglycerides, non‐HDL cholesterol, low HDL cholesterol, and the total cholesterol to high‐density cholesterol (TC/HDL‐C) ratio were associated with increased incidence of nonfatal and fatal ischaemic stroke as well as all cerebrovascular events (n = 7480) in both genders. The associations were somewhat stronger for nonfatal than fatal events. In ischaemic stroke the apoB/apoA‐1 ratio was a stronger predictor than the TC/HDL‐C ratio in all subjects, in those below 65 years of age and in those with LDL‐C below 3 mmol L−1. Haemorrhagic stroke was not associated with elevated atherogenic lipoproteins except for increased risk of fatal haemorrhagic stroke in women with a high apoB/apoA‐I ratio.
Conclusions. Dyslipidaemia is associated with an increased risk of ischaemic stroke but few relations were seen in haemorrhagic stroke. Use of the apoB/apoA‐I ratio as a marker of dyslipidaemia is at least as efficient as conventional lipids, for the identification of subjects at increased risk of stroke, especially ischaemic stroke. Practical advantages, fasting is not needed, speak in favour of using apoB and apoA‐1 in stroke risk prediction.
The aim of the study was to establish whether metabolic syndrome predicts the incidence of prostate cancer. The hypothesis was tested using the 27-year follow-up of the prospective cohort of 16,209 ...men aged 40–49 years who participated in the Oslo Study in 1972–1973. Men with established diabetes and men with cancer diagnosed before screening were excluded, leaving 15,933 for analyses. Metabolic syndrome is here composed of body mass index, nonfasting glucose, triglycerides, and blood pressure or drug-treated hypertension. Two analytical approaches were compared, namely, predefined (adjusted from National Cholesterol Education Program) and quartile values of risk factors. Age, body mass index, and sedentary versus intermediate physical activity at work were significant predictors in univariate proportional hazards regression analyses. Combinations of any two (relative risk = 1.23; p = 0.04) or any three (relative risk = 1.56; p = 0.00) factors of the metabolic syndrome using quartile values of risk factors were predictive of prostate cancer. The number of cases for four factors was too small for analyses. Predefined values of the risk factors were not found to be predictive. In conclusion, metabolic syndrome was found to predict prostate cancer during 27 years of follow-up, indicating an association between insulin resistance and the incidence of prostate cancer.
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