Seppo Miilunpalo

Exercise for health for early postmenopausal women: a systematic review of randomised controlled trials.

Women who pass menopause face many changes that may lead to loss of health-related fitness (HRF), especially if sedentary. Many exercise recommendations are also relevant for early postmenopausal women; however, these may not meet their specific needs because the recommendations are based mainly on studies on men. We conducted a systematic review for randomised, controlled exercise trials on postmenopausal women (aged 50 to 65 years) on components of HRF. HRF consists of morphological fitness (body composition and bone strength), musculoskeletal fitness (muscle strength and endurance, flexibility), motor fitness (postural control), cardiorespiratory fitness (maximal aerobic power, blood pressure) and metabolic fitness (lipid and carbohydrate metabolism). The outcome variables chosen were: bodyweight; proportion of body fat of total bodyweight (F%); bone mineral density (BMD); bone mineral content (BMC); various tests on muscle performance, flexibility, balance and coordination; maximal oxygen consumption (V̇O2max); resting blood pressure (BP); total cholesterol (TC); high-density lipoprotein-cholesterol; low-density lipoprotein-cholesterol; triglycerides; blood glucose and insulin.The feasibility of the exercise programme was assessed from drop-out, attendance and injury rates. Twenty-eight randomised controlled trials with 2646 participants were assessed. In total, 18 studies reported on the effects of exercise on bodyweight and F%, 16 on BMD or BMC, 11 on muscular strength or endurance, five on flexibility, six on balance or coordination, 18 on V̇O2max, seven on BP, nine on lipids and two studies on glucose an one on insulin. Based on these studies, early postmenopausal women could benefit from 30 minutes of daily moderate walking in one to three bouts combined with a resistance training programme twice a week. For a sedentary person, walking is feasible and can be incorporated into everyday life. A feasible way to start resistance training is to perform eight to ten repetitions of eight to ten exercises for major muscle groups starting with 40% of one repetition maximum. Resistance training initially requires professional instruction, but can thereafter be performed at home with little or no equipment as an alternative for a gym with weight machines. Warm-up and cool-down with stretching should be a part of every exercise session. The training described above is likely to preserve normal bodyweight, or combined with a weight-reducing diet, preserve BMD and increase muscle strength. Based on limited evidence, such exercise might also improve flexibility, balance and coordination, decrease hypertension and improve dyslipidaemia.

Health-related fitness test battery for adults: associations with perceived health, mobility, and back function and symptoms☆☆☆

OBJECTIVE To evaluate the health-related content validity of nine fitness tests by studying how low, mid, and high levels of fitness are associated with perceived health and musculoskeletal functioning. DESIGN Cross-sectional methodological study. SETTING A research institute for health promotion. PARTICIPANTS Middle-aged (37 to 57 years) men (n = 245) and women (n = 253), evenly selected from five age cohorts of a random population sample. MAIN OUTCOME MEASURES The odds ratios (ORs) of selected health outcomes for low (least fit 20%), mid (next 40%), and high (most fit 40%) fitness categories in the different tests adjusted for several possible confounders. RESULTS Cardiorespiratory fitness, as measured by 2-km walk test, was strongly and consistently associated with perceived health and mobility (stair climbing) in both genders (range of ORs, 2.4 to 17.6), and a somewhat weaker relationship was found with leg power and with leg strength (ORs, 2.5 to 7.2). Low fitness in back muscular endurance and upper-body strength were associated with mobility disability (ORs, 2.8 to 8.5) and with back dysfunction and pain (ORs, 2.9 to 6.1). High fitness in back endurance in men and in balance in women were related to positive back health (ORs, 2.5 to 3.7). Body mass index was associated with musculoskeletal disability in women (ORs, 2.4 to 5.3). Balance, leg strength, and leg flexibility in men; and leg power, trunk and leg flexibility in women were not associated with health outcomes. CONCLUSIONS Among a middle-aged population, the majority of the evaluated fitness tests demonstrated health-related validity by strong associations with perceived health and musculoskeletal functioning, and by weaker associations with back symptoms.

How can physical activity be changed—: Basic concepts and general principles in the promotion of health-related physical activity

Basic concepts and general principles in the promotion of health-related physical activity are presented based on selected behavioral science theories, research findings and conceptual analysis. The concepts and principles selected include (1) a realistic and flexible concept of physical activity, (2) a pragmatic use of the determinants of physical activity, (3) targeting promotion to specific stages of adoption at a time, (4) a systematic facilitation of the change process by health communications and environmental changes, and (5) a stepwise organization of the promotional activities while respecting the target peoples freedom of choice.

The process and methods of health counseling by primary health care personnel in Finland: a national survey.

A stratified random sample of 53 Finnish health centers was selected, and representative samples of their physicians, nurses and physiotherapists were surveyed by questionnaire on the frequency of their use of health education methods in health counseling and their perception of the ease vs. difficulty of implementing the stages of the process of lifestyle counseling. Overall, the assessment of the enabling and reinforcing factors in client health behavior (social relationships and physical environment), the translation of these factors into a behavior change program and the evaluation of such programs were seen as difficult by all three categories of health care professionals. The implementation stage of lifestyle counseling was, however, generally rated as easy, although quite a limited selection of education methods and self-evident motivational prompts were used. The physiotherapists regarded the process of lifestyle counseling in their specialty, exercise counseling, as easier to conduct and they used a more varied selection of methods than the other health care personnel groups. The findings indicate a need for further in-service education for Finnish health center professionals on health education methods as well as a need for the restructuring of the care system to allow better opportunities for the full realization of the process of health counseling.

The versatile nature of physical activity—on the psychological, behavioural and contextual characteristics of health-related physical activity

This paper presents a comprehensive characterisation of physical activity based on psychological, behavioural and contextual aspects. Based on the characterisation it suggests a promotional classification of physical activity into five categories. The categories are: 1, Occupational activity; 2, Lifestyle activity; 3, Recreation activity; 4, Fitness activity; and 5, Sport activity. Examples are given of activities in each category and of the related emotional aspects, outcome expectations, degree of personal choice and health benefits. The importance of the emotional component and the relevance of the outcome expectations are discussed and contextual considerations are presented on the basis of the promotional classification. The implications of the classification for the practice of health-enhancing physical activity promotion are discussed.

Health-related fitness tests as predictors of difficulties in long-distance walking among high-functioning older adults

Background and aims: Health-related fitness (HRF) tests are valid predictors of self-reported mobility difficulties among high-functioning older adults. The aim of the present study was to identify optimal cut-off values for HRF tests predicting self-reported difficulties in walking 2 km (WD). Methods: Subjects were 55- to 69-year-old men and women who were free of WD at baseline. The HRF assessment in 1996 included seven test items, and postal questionnaires were used to assess occurrence of new WD in 2002. Analysis of covariance and receiver-operating characteristic analysis were used as statistical methods. Results: In a 1-km walk, the sensitivity and specificity at the optimal cut-off 10:15 (min:s) for men were 63% and 75%, and at the cut-off 10:47 for women 70% and 71%. In dynamic back extension, the sensitivity and specificity at the optimal cut-off 16.5 (repetitions) were 67% and 65% in men and 82% and 59% at cut-off 13.5 in women. Correspondingly, in backward walking, the sensitivity and specificity at the optimal cut-off 27.7 (seconds) were 65% and 69% in men and 74% and 61% at cut-off 35.0 in women. Conclusions: The 1-km walk, dynamic back extension and backward walking tests had the best predictive value for WD. These tests, with identified cut-off values, can be used to screen individuals who are at increased risk of WD. Tests can also be used in physical activity counseling to target activity to those components of HRF that indicate poor fitness and are important for good walking ability.

Predictive value of health-related fitness tests for self-reported mobility difficulties among high-functioning elderly men and women

Background and aims: The functional independence of elderly populations deteriorates with age. Several tests of physical performance have been developed for screening elderly persons who are at risk of losing their functional independence. The purpose of the present study was to investigate whether several components of health-related fitness (HRF) are valid in predicting the occurrence of self-reported mobility difficulties (MD) among high-functioning older adults. Methods: Subjects were community-dwelling men and women, born 1917–1941, who participated in the assessment of HRF [6.1-m (20-ft) walk, one-leg stand, backwards walk, trunk side-bending, dynamic back extension, one-leg squat, 1-km walk] and who were free of MD in 1996 (no difficulties in walking 2km, n=788; no difficulties in climbing stairs, n=647). Postal questionnaires were used to assess the prevalence of MD in 1996 and the occurrence of new MD in 2002. Logistic regression analysis was used as the statistical method. Results: Both inability to perform the backwards walk and a poorer result in it were associated with risk of walking difficulties in the logistic model, with all the statistically significant single test items included. Results of 1-km walk time and one-leg squat strength test were also associated with risk, although the squat was statistically significant only in two older birth cohorts. Regarding stair-climbing difficulties, poorer results in the 1-km walk, dynamic back extension and one-leg squat tests were associated with increased risk of MD. Conclusions: The backwards walk, one-leg squat, dynamic back extension and 1-km walk tests were the best predictors of MD. These tests are recommended for use in screening high-functioning older people at risk of MD, as well as to target physical activity counseling to those components of HRF that are important for functional independence.

Is generic physical activity or specific exercise associated with motor abilities

PURPOSE Evidence of the effect of leisure time physical activity (LTPA) modes on the motor abilities of a mature population is scarce. The purpose of this study was to compare the motor abilities of physically active and inactive men and women and to examine the associations of different exercise modes and former and recent LTPA (R-LTPA) with motor ability and various physical tests. METHODS The LTPA of the participants (men n = 69, women n = 79; aged 41-47 yr) was ascertained by a modified Physical Activity Readiness Questionnaire, including questions on the frequency, duration, and intensity of R-LTPA and former LTPA and on exercise modes. Motor abilities in terms of balance, agility, and coordination were assessed with a battery of nine tests supplemented with five physical fitness tests. Multiple statistical methods were used in analyses that were conducted separately for men and women. RESULTS The MET-hours per week of R-LTPA correlated statistically significantly with the tests of agility and static balance (rs = -0.28, P = 0.022; rs = -0.25, P = 0.043, respectively) among men and with the static balance (rs = 0.41), 2-km walking (rs = 0.36), step squat (rs = 0.36) (P < or = 0.001, respectively), and static back endurance (rs = 0.25, P = 0.024) among women. In the stepwise regression among men, the most frequent statistically significant predictor was the playing of several games. For women, a history of LTPA for more than 3 yr was the strongest predictor for good results in almost all tests. CONCLUSIONS Participants with long-term and regular LTPA had better motor performance, and especially a variety of games improve components of motor ability. Diverse, regular, and long-term exercise including both specific training and general activity develops both motor abilities and physical fitness.