Riikka Ahola

Gamified physical activation of young men – a Multidisciplinary Population-Based Randomized Controlled Trial (MOPO study)

BackgroundInactive and unhealthy lifestyles are common among adolescent men. The planned intervention examines the effectiveness of an interactive, gamified activation method, based on tailored health information, peer networks and participation, on physical activity, health and wellbeing in young men. We hypothesize that following the intervention the physical activation group will have an improved physical activity, as well as self-determined and measured health compared with the controls.Methods/designConscription-aged men (18 years) attending compulsory annual call-ups for military service in the city of Oulu in Finland (n = 1500) will be randomized to a 6-months intervention (n = 640) or a control group (n = 640) during the fall 2013. A questionnaire on health, health behaviour, diet and wellbeing is administered in the beginning and end of the intervention. In addition, anthropometric measures (height, weight and waist circumference), body composition, grip strength, heart rate variability and aerobic fitness will be measured. The activation group utilizes an online gamified activation method in combination with communal youth services, objective physical activity measurement, social networking, tailored health information and exercise programs according to baseline activity level and the readiness of changes of each individual. Daily physical activity of the participants is monitored in both the activation and control groups. The activation service rewards improvements in physical activity or reductions in sedentary behaviour. The performance and completion of the military service of the participants will also be followed.DiscussionThe study will provide new information of physical activity, health and health behaviour of young men. Furthermore, a novel model including methods for increasing physical activity among young people is developed and its effects tested through an intervention. This unique gamified service for activating young men can provide a translational model for community use. It can also be utilized as such or tailored to other selected populations or age groups.Trial registrationClinicalTrials.gov Identifier: NCT01376986

Effects of High‐Impact Training on Bone and Articular Cartilage: 12‐Month Randomized Controlled Quantitative MRI Study

Osteoarthritis and osteoporosis often coexist in postmenopausal women. The simultaneous effect of bone‐favorable high‐impact training on these diseases is not well understood and is a topic of controversy. We evaluated the effects of high‐impact exercise on bone mineral content (BMC) and the estimated biochemical composition of knee cartilage in postmenopausal women with mild knee osteoarthritis. Eighty women aged 50 to 66 years with mild knee osteoarthritis were randomly assigned to undergo supervised progressive exercise three times a week for 12 months (n = 40) or to a nonintervention control group (n = 40). BMC of the femoral neck, trochanter, and lumbar spine was measured by dual‐energy X‐ray absorptiometry (DXA). The biochemical composition of cartilage was estimated using delayed gadolinium‐enhanced magnetic resonance imaging (MRI) cartilage (dGEMRIC), sensitive to cartilage glycosaminoglycan content, and transverse relaxation time (T2) mapping that is sensitive to the properties of the collagen network. In addition, we evaluated clinically important symptoms and physical performance–related risk factors of falling: cardiorespiratory fitness, dynamic balance, maximal isometric knee extension and flexion forces, and leg power. Thirty‐six trainees and 40 controls completed the study. The mean gain in femoral neck BMC in the exercise group was 0.6% (95% CI, –0.2% to 1.4%) and the mean loss in the control group was –1.2% (95% CI, –2.1% to –0.4%). The change in baseline, body mass, and adjusted body mass change in BMC between the groups was significant (p = 0.005), whereas no changes occurred in the biochemical composition of the cartilage, as investigated by MRI. Balance, muscle force, and cardiorespiratory fitness improved significantly more (3% to 11%) in the exercise group than in the control group. Progressively implemented high‐impact training, which increased bone mass, did not affect the biochemical composition of cartilage and may be feasible in the prevention of osteoporosis and physical performance–related risk factors of falling in postmenopausal women.

Daily impact score in long-term acceleration measurements of exercise

Mechanical loading increases and maintains bone mass and strength. Daily stress stimulus and osteogenic index theories have been suggested to describe the osteogenic potential of exercise, using exponential or logarithmic relationships, respectively, between loading numbers and magnitude. Inspired by these theories, the aim of this study was to develop and test a daily impact score (DIS) using long-term continuous acceleration measurements of exercise. Acceleration data were collected during a previous exercise trial, in which the subjects (healthy women, 35-40 years, N=34 in the high-impact exercise group and N=30 in the control group) wore a body movement monitor on their waist during the 12-month study. DIS was calculated from the 12-month average daily acceleration distributions in two ways: DIS(Exp) adopted from the daily stress stimulus and DIS(Log) simplified from the osteogenic index. Areal bone mineral density (aBMD) at the proximal femur and cortical bone geometry at the mid-femur were measured at baseline and 12 months. DIS calculated in either of the ways was significantly higher in the exercise group than in the control group. DIS(Exp) and DIS(Log) were strongly correlated (R=0.982). Both DIS(Exp) and DIS(Log) were significantly associated with 12-month aBMD changes at the hip (R up to 0.550, p<0.01) and geometry changes at the mid-femur (R up to 0.472, p<0.05) in the exercise group. DIS calculated either from exponential or logarithmic relationship can be used in acceleration-based measurements of daily exercise. DIS was positively related with changes in hip aBMD and mid-femur bone geometry after 12 months of exercise.

Effects of Exercise on Patellar Cartilage in Women with Mild Knee Osteoarthritis.

PURPOSE This study aims to investigate the effects of exercise on patellar cartilage using T2 relaxation time mapping of magnetic resonance imaging in postmenopausal women with mild patellofemoral joint osteoarthritis (OA). METHODS Eighty postmenopausal women (mean age, 58 (SD, 4.2) yr) with mild knee OA were randomized to either a supervised progressive impact exercise program three times a week for 12 months (n = 40) or a nonintervention control group (n = 40). Biochemical properties of cartilage were estimated using T2 relaxation time mapping, a parameter sensitive to collagen integrity, collagen orientation, and tissue hydration. Leg muscle strength and power, aerobic capacity, and self-rated assessment with the Knee Injury and Osteoarthritis Outcome Score were also measured. RESULTS After intervention, full-thickness patellar cartilage T2 values had medium-size effect (d = 0.59; 95% confidence interval, 0.16 to 0.97; P = 0.018); the change difference was 7% greater in the exercise group compared with the control group. In the deep half of tissue, the significant exercise effect size was medium (d = 0.56; 95% confidence interval, 0.13 to 0.99; P = 0.013); the change difference was 8% greater in the exercise group compared with controls. Furthermore, significant medium-size T2 effects were found in the total lateral segment, lateral deep, and lateral superficial zones in favor of the exercise group. Extension force was 11% greater (d = 0.63, P = 0.006) and maximal aerobic capacity was 4% greater (d = 0.55, P = 0.028) in the exercise group than in controls. No changes in Knee Injury and Osteoarthritis Outcome Score emerged between the groups. CONCLUSIONS Progressively implemented high-impact and intensive exercise creates enough stimuli and exerts favorable effects on patellar cartilage quality and physical function in postmenopausal women with mild knee OA.

Effect of wrist-worn activity monitor feedback on physical activity behavior: A randomized controlled trial in Finnish young men

The purpose of this study is to evaluate whether the use of an activity monitor providing feedback has an effect on physical activity (PA) in young men. A population-based sample of 276 conscription-aged (mean = 17.9, SD = 0.7 years) men participated in a 3-month randomized controlled trial in Oulu in 2012. Participants were randomized to an intervention group (INT, N = 137) and a control group (CON, N = 139). INT received a wrist-worn monitor (Polar Active) showing daily activity, and CON received identical monitors without feedback. Main outcome was the change from baseline in objectively measured weekly time spent in moderate-to-vigorous PA (MVPA) and sedentary activity (SED), as assessed by generalized estimation equations (GEE). Other lifestyle factors were assessed by a questionnaire at baseline and at 3 months. Weekly physical activity data (≥ 4 days with ≥ 8 h each) were obtained from 72 (53%) and 90 (65%) men in the INT and CON, respectively. Based on GEE, time spent in MVPA increased (p = 0.012) and SED decreased (p = 0.032) in the INT compared with the CON. During the first 7 weeks, the INT spent on average 1 h less sedentary than the CON (t-test, p < 0.05). During the first week, the INT showed 12 minutes more MVPA compared to the CON (t-test, p = 0.034). Based on questionnaire data, the proportion of the most sedentary men decreased in the INT (Wilcoxon test, 28% vs. 10%, p = 0.029), with no change in the CON (20% vs. 19%, p = 0.546). To conclude, a wrist-worn activity monitor providing feedback had a short-term positive effect on PA and SED in young men. Trial registration This is a pilot study for a larger randomized controlled trial registered to the clinical trials register NCT01376986.

Measuring Physical Activity in Free-Living Conditions—Comparison of Three Accelerometry-Based Methods

We examined the agreement in time spent on different physical activity (PA) levels using (1) mean amplitude deviation (MAD) of raw acceleration from the hip, (2) wrist-worn Polar Active, and (3) hip-worn Actigraph counts using Freedsons cut-points among adults under free-living conditions. PA was measured in 41 volunteers (mean age 47.6 years) for 14 days. Two MET-based threshold sets were used for MAD and Polar Active for sedentary time (ST) and time spent in light (LPA), moderate (MPA), and vigorous (VPA) PA. Actigraph counts were divided into PA classes, ≤100 counts/min for ST and Freedsons cut-points for LPA, MPA, and VPA. Analysis criteria were simultaneous use of devices for at least 4 days of >500 min/d. The between-method differences were analyzed using a repeated measures analysis of variance test. Bland-Altman plots and ROC graphs were also employed. Valid data were available from 27 participants. Polar Active produced the highest amount of VPA with both thresholds (≥5 and ≥6 MET; mean difference 17.9–30.9 min/d, P < 0.001). With the threshold 3–6 MET for MPA, Polar Active indicated 19.2 min/d more than MAD (95% CI 5.8–32.6) and 51.0 min/d more than Actigraph (95% CI 36.7–65.2). The results did not differ with 3.5–5 MET for MPA [F(1.44, 37.43) = 1.92, P = 0.170]. MAD and Actigraph were closest to each other for ST with the threshold < 1.5 MET (mean difference 22.2 min/d, 95% CI 7.1–37.3). With the threshold <2 MET, Polar Active and Actigraph provided similar results (mean difference 7.0 min/d, 95% CI −17.8–31.7). Moderate to high agreement (area under the ROC curve 0.806–0.963) was found between the methods for the fulfillment of the recommendation for daily moderate-to-vigorous PA of 60 min. In free-living conditions the agreement between MAD, Polar Active, and Actigraph for measuring time spent on different activity levels in adults was dependent on the activity thresholds used and PA intensity. ROC analyses showed moderate to high agreement for the fulfillment of the recommendation for daily MVPA. Without additional statistical adjustment, these methods cannot be used interchangeably when measuring daily PA, but any of the methods can be used to identify persons with insufficient daily amount of MVPA.

Effect of tailored, gamified, mobile physical activity intervention on life satisfaction and self-rated health in young adolescent men

BackgroundOnline behavior-change programs may increase physical activity in adolescents, but their effects on subjective health and wellbeing are not well known. PurposeWe investigated the effects of a mobile physical activity intervention on life satisfaction and self-rated health among young adolescent men. MethodsIn this population-based study, 496 men (17.8y, SD 0.6y) participated in a 6-month trial. They were randomized into an intervention (n=250) and a control group (n=246). Only the intervention group had access to a tailored mobile service. Life satisfaction and self-rated health were inquired about at baseline and at the end of the trial. ResultsLife satisfaction improved in the intervention (p<0.001) and control group (p=0.01). Life satisfaction was most likely to improve among men with low baseline satisfaction (OR 13.8; 95% CI 3.751.8) and mood-related exercise motive (2.5 (1.15.6)). There were no statistically significant changes in self-rated health, but those who reported poor health at baseline (OR 9.6; 95% CI 3.724.9) and improved self-rated fitness during the trial (4.2 (1.511.9)) were more likely to gain improvements in self-rated health. ConclusionIn this mobile physical activity intervention, improvements in self-rated health and life satisfaction were associated with low life satisfaction and poor self-rated health at baseline within the intervention group. Trial registrationThis randomized controlled trial is registered to the clinical trials register NCT01376986. A population-based, large sample size and a randomized controlled design.Effectiveness of a novel intervention on subjective wellbeing among adolescent men.Life satisfaction increased similarly regardless of the group allocation.Low baseline subjective wellbeing was associated with positive changes.

Measurement of Osteogenic Exercise – How to Interpret Accelerometric Data?

Bone tissue adapts to its mechanical loading environment. We review here the accelerometric measurements with special emphasis on osteogenic exercise. The accelerometric method offers a unique opportunity to assess the intensity of mechanical loadings. We present methods to interpret accelerometric data, reducing it to the daily distributions of magnitude, slope, area, and energy of signal. These features represent the intensity level of physical activities, and were associated with the changes in bone density, bone geometry, physical performance, and metabolism in healthy premenopausal women. Bone adaptations presented a dose- and intensity dependent relationship with impact loading. Changes in hip were threshold dependent, indicating the importance of high-impacts exceeding acceleration of 4 g or slope of 100 g/s as an osteogenic stimulus. The number of impacts needed was 60/day. We also present the daily impact score to describe the osteogenic potential of daily mechanical loading with a single score. The methodology presented here can be used to study musculoskeletal adaptation to exercise in other target groups as well.

Detecting and profiling sedentary young men using machine learning algorithms

Many governments and institutions have guidelines for health-enhancing physical activity. Additionally, according to recent studies, the amount of time spent on sitting is a highly important determinant of health and wellbeing. In fact, sedentary lifestyle can lead to many diseases and, what is more, it is even found to be associated with increased mortality. In this study, a data set consisting of self-reported questionnaire, medical diagnoses and fitness tests was studied to detect sedentary young men from a large population and to create a profile of a sedentary person. The data set was collected from 595 young men and contained altogether 678 features. Most of these are answers to multi-choice close-ended questions. More precisely, features were mostly integers with a scale from 1 to 5 or from 1 to 2, and therefore, there was only a little variability in the values of features. In order to detect and profile a sedentary young man, machine learning algorithms were applied to the data set. The performance of five algorithms is compared (quadratic discriminant analysis (QDA), linear discriminant analysis (LDA), C4.5, random forests, and nearest neighbours (kNN)) to find the most accurate algorithm. The results of this study show that when the aim is to detect a sedentary person based on medical records and fitness tests, LDA performs better than the other algorithms, but still the accuracy is not high. In the second part of the study the differences between highly sedentary and non-sedentary young men are searched, recognition can be obtained with high accuracy with each algorithm.

Gamified Persuasion: User Experiences of Online Activation Service

The authors have empirically examined the persuasive properties of digital games from a multidisciplinary perspective. Besides the relevant cultural and psychological theories related to the game phenomenon, the authors have included a case study where a persuasive online activation service was tested among young men N=280, average 17.9 year old in the promotion of physical and social activity. The emphasis of the article is on qualitative material, which is based on in-depth interviews of 10 individuals, as well as participant observation considering the user experiences regarding the activation service and gaming in general. The authors have concluded that games contain persuasive characteristics based on human culture and psychology and that these characteristics could effectively be utilized in physically and socially activating games.