Liv Berit Augestad

Physical activity and fertility in women: the North-Trøndelag Health Study

BACKGROUND Changes in the state of energy balance owing to changes in physical activity may affect the reproductive system. We evaluated the association between physical activity (PA) and fertility and parity in healthy women. METHODS A population-based health survey (HUNT 1) was conducted during 1984-1986 in Nord-Trøndelag county, Norway, with follow-up from 1995 to 1997 (HUNT 2). The study included 3887 women, <45 years old in HUNT 2. PA was assessed by baseline questionnaire, and fertility and parity by questionnaire at follow-up. Data focused on overall occurrence of infertility in the population (without biological confirmation). RESULTS Increased frequency, duration and intensity of PA were associated with increased subfertility, and frequency of PA was associated with voluntary childlessness (P < 0.01). After adjusting for age, parity, smoking, and marital status, women who were active on most days were 3.2 times more likely to have fertility problems than inactive women. Exercising to exhaustion was associated with 2.3 times the odds of fertility problems versus low intensity. Women with highest intensity of PA at baseline had the lowest frequency of continuing nulliparity and highest frequency of having three or more children during follow-up (P < 0.05). Sensitivity analysis including body mass index as confounder did not alter the results. No associations were found between lower activity levels and fertility or parity. CONCLUSION Increased risk of infertility was only found for the small group of women reporting the highest levels of intensity and frequency of PA. Awareness of the possible risks of infertility should be highlighted among non-athletic women who exercise vigorously.

Isokinetic muscle strength after anterior cruciate ligament reconstruction

The purpose of the present study was to investigate the isokinetic muscle strength 6 months after reconstruction of the anterior cruciate ligament (ACL). In order to recommend full‐load come‐back in sport, sufficient muscle strength may be important. Ninety female elite team handball players (mean 24.1 years) were postoperatively tested with Biodex. The operated limb was compared with the contralateral limb: 82.2% had a hamstring strength of a minimum of 49.6 Nm, corresponding to at least 90% of the non‐operated limb, while only 12.2% fulfilled the recommended strength of 117.7 Nm for quadriceps femoris. Patients over 26 years showed significantly lower muscle strength in the operated limb than their younger counterparts. Increased focus on quadriceps femoris muscle strength during rehabilitation may improve the knee function faster after ACL reconstruction.

Physical Activity and Depressive Symptoms Among Norwegian Adults Aged 20-50

INTRODUCTION To analyze the association between physical activity (PA) and occurrence of depressive symptoms in The Nord-Trøndelag Health Survey (HUNT 1 1984-1986, HUNT 2 1995-1997). METHODS In this prospective follow-up study, we studied men and women who were 21-40 years old in HUNT 1, and participated in HUNT 2. The sample consisted of 3,353 women and 3,308 men. We used logistic regression and calculated odds ratios (OR) to assess the association between physical activity and depression (Hospital Anxiety and Depression Scale depression subscale [HADS-D]). Confounding was addressed by excluding those with relevant health conditions and adjustment. RESULTS Among women 272 (8.1%) and among men 293 (8.9%) scored higher than 8 on the HADS-D scale. We found a higher mean on HADS-D in men and women who were inactive. Men participating in low PA had significantly lower scores on depression (OR=0.63, confidence interval [CI]=0.43-0.93, p=.02) than inactive men. Women participating in medium PA had significantly lower scores on depression (OR=0.69, CI=0.49-0.97, p=.03) than inactive women. CONCLUSIONS Young men and women who exercised were less likely to have a high depression score, compared with inactive people. Our prospective, observational study included a large population and indicated some significant associations between physical activity and depression.

Gender, eating behavior, and personality characteristics in physically active students.

The aim of this paper was to examine associations between personality traits, eating disorder (ED) behavior, exercise, and gender. The participants (n=1482: 905 women and 577 men) were students from four universities in Norway. The subjects filled out a compound questionnaire including demographics, weekly hours of exercise, type of sport, Karolinska Scales of Personality (KSP), and the Eating Disorder Inventory (EDI). Because of the data collection procedure, it is difficult to provide a clear‐cut response rate in this study. The results showed that the risk ratio for women who scored 40 or higher on the EDI was three times higher compared with men. ED behavior did not seem to be associated with high weekly hours of physical activity in general. There were significant gender differences in personality traits. However, women and men with high scores on the EDI showed no differences on the KSP scales, except on “detachment” and “indirect aggression”. The most important predictors for weekly hours of physical activity were the EDI scales “drive for thinness” and “body dissatisfaction”, and the personality variables “extraversion” and “neuroticism”. The factors that contributed most to the differences between students who scored 40 or higher on the EDI and those who scored below 40 on the EDI were neuroticism, BMI, gender, and age.

Eating disorder behavior in physically active Norwegian women.

Competitive female athletes may have higher risk of eating disorders (ED) than recreational athletes, in part because low body fat may be advantageous in sports. However, women who participate in sports or physical activities might also do this for weight reduction, altering body shape, and for other food related reasons. This study was conducted to evaluate the association between hours of leisure time physical activity (PA) and prevalence of ED, and whether the association between the Eating Disorders Inventory (EDI) scales and ED, as classified by the Survey of Eating Disorders (SED), was the same among women with high vs. low physical activity levels. The community‐based study sample consisted of 898 female students aged 18–50 years. Subjects filled out the EDI, the SED, and a questionnaire concerning physical activity and demographic data. Physical activity was not associated with increased risk of having a SED‐defined diagnosis of an ED or of having an EDI score greater than 40, which is sometimes used to define women at risk for having an eating disorder. Women with a SED‐defined ED had higher scores on all subscales of the EDI, but did not differ with respect to age, BMI or hours of weekly activity. The strongest predictors of having a SED‐defined ED were body mass index (BMI), two EDI scales, drive of thinness and Bulimia Nervosa, with no differences between the two PA groups. Among women with a SED‐defined ED, those with more than 5 h weekly PA did not differ from others with respect to scoring on the EDI or BMI. Results suggest that hours of physical activity may not increase risk of developing ED. Effective interventions are needed to help the growing numbers of persons with body‐image and eating difficulties. For some, moderate physical training might be helpful.

Physical activity, physical fitness, and body composition among children and young adults with visual impairments: A systematic review

The aim of the review was to evaluate current evidence-based knowledge about physical activity, physical fitness, and body composition among children and young adults with visual impairments. A systematic literature review of articles published between January 1984 and April 2014 inclusive was conducted. The participants were in the age range of 5–22 years. A total of 29 publications met the inclusion criteria. In general, the findings revealed lower levels of participation in physical activity, poorer physical fitness, and higher prevalence of overweight and obesity among children with visual impairments compared to children with no reported visual impairments. Lack of longitudinal observational studies and randomized clinical trials reduced the possibilities to draw cause–effect conclusions. However, the 23 cross-sectional studies confirmed that young adults with visual impairment may need more physical activity to become fitter and have a healthier body composition. Furthermore, low physical activity may influence higher prevalence of overweight and obesity among children and young adults with vision loss.

The relationship between eating disorders and personality in physically active women

The aim of the study was to examine the relationship between personality factors, self‐reported eating disorders, type of physical activity, level of sport competition and hours spent on physical activity each week among physically active non‐athletes and athletes. A total of 591 high school women participated in the study. The mean age was 19 during the data collection. Scores were obtained on the Karolinska Scales of Personality (KSP) and a questionnaire concerning eating disorders (1) and physical activity. All diagnoses were based upon the DSM‐IV criteria for anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS). The prevalence of AN was 1.5%, BN 2.0%. AN + BN 0.3% and EDNOS 12.9%. The prevalence of eating disorders (ED) was highest among physically active non‐athletes who were members of fitness clubs (odds ratio (OR)=1.86. 95% CI: 1.08–2.79). However, there was no relationship between the prevalence of eating disorders and the level of sport competition or time spent on physical activity. The results showed that women with eating disorders scored higher in anxiety, hostility and detachment, and lower in socialisation than the women without eating disorders. The results indicated that individuals with certain personality characteristics had a higher risk for being classified with ED, but it does not seem to be related to whether they are physically active or not. The findings in this study may support the hypothesis that participating in physical activity can have some positive psychological effects, but this does not necessarily apply to patients with AN and BN. ED may have a biological/genetic explanation according to Eysencks personality theory.

The Association between Physical Activity and Forearm Bone Mineral Density in Healthy Premenopausal Women

PURPOSE To analyze the association between recreational and occupational physical activity and forearm bone mineral density (BMD) in healthy premenopausal women. METHODS During 1984-1986, a population-based health survey (HUNT 1) was conducted among women and men aged >19 years in Nord-Trøndelag county in Norway. The second, follow-up survey (HUNT 2) was conducted during 1995-1997. The subjects in this study consist of healthy premenopausal women (n = 1396) < 45 years old in the year of participation of HUNT 2 who had undergone distal and ultradistal radius densitometry in 1995-1997, performed with single-energy x-ray absorptiometry. RESULTS Women with the highest scores of estimated combined recreational and occupational physical activity (PA) in 1984 and 1995 had significantly higher BMD in the distal radius (mean BMD 0.487 compared with mean BMD 0.480 among those with a low combined PA score) (p for trend = 0.04). At the ultradistal site of the radius, women with a high combined PA score had mean a BMD = 0.403 compared with women with low PA scores (mean BMD = 0.384) (p for trend = 0.017). After adjusting for age, marital status, smoking, amenorrhea, body mass index (BMI), and daily milk consumption, the associations remained the same or got even stronger. CONCLUSIONS The small group of women in the highest category of PA had a significantly higher forearm BMD and the smallest risk of low BMD. Important unanswered questions remain about the optimal relationship between intensity, amount and type of PA, and BMD and later risk of osteoporosis. Further research on BMD as a surrogate measure of structural and architectural bone quality and the sensitivity of different measuring sites for estimation of the effect of PA on bone is warranted.

Occurrence of and Mortality From Childhood Neuronal Ceroid Lipofuscinoses in Norway

The aim of this study was to estimate the prevalence of, incidence of, and survival from childhood neuronal lipofuscinoses in Norway. All children with neuronal ceroid lipofuscinoses living in Norway are referred to the Tambartun National Resource Centre for the Visually Impaired. We based the data collection on the medical records at Tambartun. We identified 70 children with neuronal ceroid lipofuscinoses who were born in Norway from 1957 to 1998. Seven had a diagnosis of late infantile neuronal ceroid lipofuscinoses, and 63 had the juvenile form of neuronal ceroid lipofuscinoses. In 2005, the prevalence of childhood neuronal ceroid lipofuscinoses was 8.3 per million inhabitants in Norway, and all children were diagnosed with the juvenile form. The average annual incidence rate of childhood neuronal ceroid lipofuscinoses was 1.8 per 100,000 live births using the years from 1957 to 1978 and 3.9 using the years from 1978 to 1999. The trend in incidence increased at an annual rate of about 3.3% per year (P = .001), averaged over this period. Restricted to the most recent period (1967—1998), the trend was much weaker (1.4% increase per year; P = .3), and confidence intervals included the possibility of no trend. The median age at death of children diagnosed with late infantile neuronal ceroid lipofuscinoses was 12 years (95% confidence interval 9—14) and 26 years (95% confidence interval 25—30) for children diagnosed with the juvenile form. The results did not support the hypothesis that children with neuronal ceroid lipofuscinoses born in 1975 or later lived longer than those born from 1957 to 1975 (relative risk 1.0, 95% confidence interval 0.36—2.8). Mortality was similar for both genders (hazard ratio 0.97, 95% confidence interval 0.4— 2.2). (J Child Neurol 2006;21:917—922; DOI 10.2310/7010.2006.00215).

Menstrual dysfunction in Norwegian top athletes.

Abstract. Of 301 Norwegian female top athletes, all members of the national team in 27 different sports, who were approached with a questionnaire about menstrual function, 278 (92.4%) responded. Ninety‐nine of the respondents who used oral contraceptives were excluded. Of the remaining 179, 18 (10.1%) reported secondary amenorrhea (>4 months since the last period) and were chosen for further studies. Blood samples were drawn for hormonal analyses between 10 and 12 a.m. and at least 12 hours after the last training session. Their mean age was 20.8 years (range 18‐27), mean height 169.8 cm (160‐180), mean weight 58.5 kg (51‐67), and their mean age at menarche 14.6 years (13—16.5), significantly older than that of the other top athletes: 13.5 years (p <0.05). Their mean number of training hours per week was 16.1 (12—24). Hormonal changes were consistent with simple normoprolactinemic hypotha‐lamic suppression, characterized by low values of FSH, es‐tradiol—17β and prolactin. The androgen hormones demonstrated high levels of dihydrotestosterone. Testosterone levels were within normal limits, but in the upper part of the range, whereas sex hormone‐binding globulin was in the lower normal range.