Tiina M. Ikäheimo

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

Central Aortic Blood Pressure of Hypertensive Men During Short-Term Cold Exposure

BACKGROUND Short- and long-term exposures to cold increase blood pressure and may explain the higher wintertime cardiovascular morbidity and mortality. Hypertensive subjects may be more susceptible to adverse cold-related cardiovascular health effects. The aim of our study was to assess the effect of short-term cold exposure on central aortic blood pressure among untreated hypertensive men. METHODS We conducted a population-based recruitment of 41 hypertensive men and a control group of 20 men without hypertension (aged 55-65 years) who underwent whole-body cold exposure (15-minute exposure to temperature -10 °C, wind 3 m/s, winter clothes). Central aortic blood pressure, augmentation index, and subendocardial viability ratio were measured by radial artery applanation tonometry. RESULTS Short-term cold exposure increased the central aortic blood pressure similarly both in both hypertensive men, from 130/93 to 162/107 mm Hg (P < 0.001) and men in the control group, from 114/81 to 142/91 mmHg (P < 0.001). Augmentation index increased by 12% (from 10% to 22%, P < 0.001; and from 16% to 28%, P < 0.001, respectively), whereas subendocardial viability ratio decreased 10% (from 188% to 177%, P = 0.001; and from 203% to 193%, P = 0.01, respectively) during cold exposure in both hypertensive men and control subjects. CONCLUSIONS Short-term cold exposure increases central aortic blood pressure and cardiac workload, and myocardial oxygen demand slightly increases in relation to blood supply in untreated hypertensive middle-aged men. Because of the higher baseline blood pressure among hypertensive subjects, the cold-induced rise in central aortic blood pressure may increase the risk of adverse cardiovascular health effects.

Exercise during military training improves cardiovascular risk factors in young men

OBJECTIVE Physical activity is a key component of lifestyle intervention but its independent contribution to weight loss and prevention of cardiovascular disease (CVD) remains unclear. We conducted a population-level follow-up study among young healthy Finnish men undergoing an intensive exercise intervention to examine the independent contribution of exercise to common CVD risk factors. METHODS A prospective study of 1112 young men with mean age of 19.3 years (range 19-28) undergoing military service with structured exercise training program. Endurance (12-min running test) and muscle fitness performance (MFI), body composition, blood pressure and biochemical measurements were obtained at baseline and follow-up (range 6-12 months). RESULTS Both endurance performance and MFI improved during follow-up (+170 m (SD 269) and 1.5 points (2.3), respectively, p<0.001 for both). Both improvement in endurance and MFI performance correlated with a reduction in weight, body mass index, waist circumference, fat mass and percentage, visceral fat area (VFA) and diastolic blood pressure (p<0.001 for all). Improvement in endurance performance also correlated with reduction in systolic blood pressure (p=0.042), total and LDL cholesterol (p=0.024 and p<0.0001, respectively) and improvement in MFI with a reduction in triglyceride levels (p=0.012). The 12-min running test correlated with changes in CVD risk factors better than did MFI. Associations between improved exercise performance and reduction in blood pressure, and changes in lipid levels were attributable to reduced weight and VFA. CONCLUSION We observed that an isolated, intensive exercise intervention, especially endurance training, significantly improved CVD risk factor levels, attributable to weight loss and reduced visceral fat area.

Frostbites in circumpolar areas.

Circumpolar areas are associated with prolonged cold exposure where wind, precipitation, and darkness further aggravate the environmental conditions and the associated risks. Despite the climate warming, cold climatic conditions will prevail in circumpolar areas and contribute to adverse health effects. Frostbite is a freezing injury where localized damage affects the skin and other tissues. It occurs during occupational or leisure-time activities and is common in the general population among men and women of various ages. Industries of the circumpolar areas where frostbite occurs frequently include transportation, mining, oil, and gas industry, construction, agriculture, and military operations. Cold injuries may also occur during leisure-time activities involving substantial cold exposure, such as mountaineering, skiing, and snowmobiling. Accidental situations (occupational, leisure time) often contribute to adverse cooling and cold injuries. Several environmental (temperature, wind, wetness, cold objects, and altitude) and individual (behavior, health, and physiology) predisposing factors are connected with frostbite injuries. Vulnerable populations include those having a chronic disease (cardiovascular, diabetes, and depression), children and the elderly, or homeless people. Frostbite results in sequelae causing different types of discomfort and functional limitations that may persist for years. A frostbite injury is preventable, and hence, unacceptable from a public health perspective. Appropriate cold risk management includes awareness of the adverse effects of cold, individual adjustment of cold exposure and clothing, or in occupational context different organizational and technical measures. In addition, vulnerable population groups need customized information and care for proper prevention of frostbites.

Cold-related symptoms among the healthy and sick of the general population: National FINRISK Study data, 2002

OBJECTIVE To determine the prevalence of cold-related symptoms among the general population, especially people with pre-existing diseases. STUDY DESIGN Six thousand nine hundred and fifty-one men and women aged 25-74 years, who had participated in the National FINRISK 2002 Study, filled in a questionnaire on cold-related symptoms. METHODS Age-specific and age-adjusted prevalence figures for cold-related symptoms were calculated. The symptoms were regressed for gender, age, region of residence, industry, self-reported disease and smoking. RESULTS Five percent of the subjects reported chest pain or arrhythmia in the cold, and higher prevalence figures were found for respiratory (men 26%/women 31%) and musculoskeletal symptoms (31%/28%). The prevalence of cold-related cardiovascular symptoms was particularly high among subjects with coronary heart disease (33%/46%) or cardiac insufficiency (25%/40%), as was the prevalence of respiratory symptoms among asthmatics (69%/78%) and subjects with chronic bronchitis (66%/77%). The symptoms increased with age, were more common in colder areas than milder areas, and were more common in those engaged in agricultural work than those engaged in industry or services. Cold-related cardiovascular and respiratory symptoms were more common among women than men. The regression-adjusted contributions (percentage points) to various cold-related symptoms were 2-45% for lung disease, 7-9% for cardiovascular disease, 3-15% for joint or back disease and 6-13% for mental disease. CONCLUSIONS Large proportions of people living in the north, particularly those with pre-existing medical conditions, experience cardiovascular, respiratory or musculoskeletal symptoms in the cold. Since the symptoms may predict future morbidity and mortality, a strategy is needed to reduce the cold-related health risks of the entire population.

Aerobic performance and body composition changes during military service

Abstract Objective. To examine the association between aerobic performance and body composition changes by body mass index (BMI). Design. 6–12 months’ follow-up during military service. Setting. Conscripts entering military service in 2005 in Sodankylä Jaeger Brigade (Finland). Subjects. 945 men (19 years, SD 1 years). Main outcome measures. Height, weight, waist circumference, BMI, and aerobic performance (Cooper test) were recorded. Body composition was measured by bioelectrical impedance analysis (BIA). The measured parameters were fat mass (FM), fat free mass (FFM), and visceral fat area (VFA). All the measurements were performed at the beginning and end of service. Results. On average, the military training period improved the running distance by 6.8% (169 m, p < 0.001) and the improvements were more pronounced in overweight (223.9 m/9.5%, p < 0.001) and obese (273.3 m/13.6 %, p < 0.001) conscripts. A strong inverse correlation between aerobic performance and body composition changes was observed, especially for weight (r = –0.305, p < 0.001) and VFA (r = –0.465, p < 0.001). A significant association between aerobic performance and changes in weight (p < 0.001), waist circumference (p < 0.001), FM (p < 0.001), and VFA (p < 0.001) by BMI was detected. The associated decrease in weight, waist circumference, FM, and VFA with improved aerobic performance was more substantial between overweight and obese compared with normal-weight subjects. Conclusions. Favourable changes in body composition are associated with improved aerobic performance during a physical training period such as military service. These findings are pronounced among overweight and obese men and can be applied at the population level in reducing obesity and co-morbidities.

Heat-related thermal sensation, comfort and symptoms in a northern population: the National FINRISK 2007 study.

BACKGROUND The occurrence of subjective symptoms related to heat strain in the general population is unknown. The present study aimed to describe the temperatures considered to be comfortable or hot and the prevalence of heat-related complaints and symptoms in the Finnish population. METHODS Four thousand and seven men and women aged 25-74 years, participants of the National FINRISK 2007 study, answered a questionnaire inquiring about the ambient temperatures considered to be hot and the upper limit of comfortable and about heat-related complaints and symptoms. The age trends in threshold temperatures and symptom prevalence were examined in 1-year groups by gender after smoothing with loess regression. The prevalence estimates were also adjusted for age. RESULTS The temperature considered as hot averaged 26°C and the upper limit for thermal comfort was 22°C. Both temperatures declined with age (from 25 to 74 years) by 1-5°C. Approximately 80% of the subjects reported signs or symptoms of heat strain in warm weather, mostly thirst (68%), drying of mouth (43%), impaired endurance (43%) and sleep disturbances (32%). Cardiac and respiratory symptoms were reported by 6 and 7%, respectively, and their prevalence increased up to the age of 75 years. The exception was thirst, whose prevalence declined with age. Most symptoms and complaints were more prevalent in women than men. CONCLUSIONS A large percentage of this northern European population suffers from heat-related complaints. Information on these is an aid in assessing the burden of summer heat on population health and is a prerequisite for any rational planning of pre-emptive measures.

Exercise capacity and mortality – a follow-up study of 3033 subjects referred to clinical exercise testing

Abstract Background: Exercise stress testing is used as a diagnostic and prognostic tool. We determined the prognostic significance of exercise test findings for cardiovascular (CVD) and all-cause mortality in men and women. Material and methods: 3033 subjects underwent a symptom-limited bicycle exercise test. Exercise capacity was defined as the mean of last four minutes of exercise workload. Results: During an average follow-up of 19 years, 186 (11.6%) CVD and 370 (20.6%) all-cause deaths in men and 57 (5.0%) CVD and 155 (12.5%) all-cause deaths in women occurred. Among exercise test variables (workload, ECG, BP, HR), exercise capacity was the strongest predictor of mortality. Low exercise capacity (1st quartile) was associated with a hazard ratio of 4.2 (95% CI: 1.7, 10.8) for CVD and 4.0 (95% CI: 2.5, 6.4) for all-cause mortality compared with high exercise capacity (4th quartile) among men and in women with a 5.4-fold (95% CI: 1.2, 24.0) risk for CVD and 2.3-fold (95% CI: 1.2, 4.3) risk for all-cause mortality, respectively. The relationship between other exercise test variables and mortality was much weaker. Conclusions: Among exercise test variables exercise capacity was the strongest predictor of CVD and all-cause mortality in both genders, and especially CVD deaths in women. Key Messages Exercise capacity was the most powerful predictor of CVD and all-cause mortality in both men and women. Low exercise capacity is a strong predictor of CVD death, especially among women.

Cardiac Repolarization and Autonomic Regulation during Short-Term Cold Exposure in Hypertensive Men: An Experimental Study

Objectives The aim of our study was to assess the effect of short-term cold exposure, typical in subarctic climate, on cardiac electrical function among untreated middle-aged hypertensive men. Methods We conducted a population-based recruitment of 51 hypertensive men and a control group of 32 men without hypertension (age 55–65 years) who underwent whole-body cold exposure (15 min exposure to temperature −10°C, wind 3 m/s, winter clothes). Conduction times and amplitudes, vectorcardiography, arrhythmias, and heart rate variability (autonomic nervous function) were assessed. Results Short-term cold exposure increased T-peak to T-end interval from 67 to 72 ms (p<0.001) and 71 to 75 ms (p<0.001) and T-wave amplitude from 0.12 to 0.14 mV (p<0.001) and from 0.17 to 0.21 mV (p<0.001), while QTc interval was shortened from 408 to 398 ms (p<0.001) and from 410 to 401 ms (p<0.001) among hypertensive men and controls, respectively. Cold exposure increased both low (from 390 to 630 ms2 (p<0.001) and 380 to 700 ms2 (p<0.001), respectively) and high frequency heart rate variability (from 90 to 190 ms2 (p<0.001) and 150 to 300 ms2 (p<0.001), respectively), while low-to-high frequency-ratio was reduced. In addition, the frequency of ventricular ectopic beats increased slightly during cold exposure. The cold induced changes were similar between untreated hypertensive men and controls. Conclusions Short-term cold exposure with moderate facial and mild whole body cooling resulted in prolongation of T-peak to T-end interval and higher T-wave amplitude while QTc interval was shortened. These changes of ventricular repolarization may have resulted from altered cardiac autonomic regulation and were unaffected by untreated hypertension. Trial Registration ClinicalTrials.gov NCT02007031

Cold-related cardiorespiratory symptoms among subjects with and without hypertension: the National FINRISK Study 2002

BACKGROUND Exposure to cold weather increases blood pressure (BP) and may aggravate the symptoms and influence the prognosis of subjects with a diagnosis of hypertension. We tested the hypothesis that subjects with hypertension alone or in combination with another cardiovascular disease (CVD) experience cold-related cardiorespiratory symptoms more commonly than persons without hypertension. This information is relevant for proper treatment and could serve as an indicator for predicting wintertime morbidity and mortality. METHODS A self-administered questionnaire inquiring of cold-related symptoms was obtained from 6591 men and women aged 25-74 yrs of the FINRISK Study 2002 population. BP was measured in association with clinical examinations. Symptom prevalence was compared between subjects with diagnosed hypertensive disease with (n = 395) or without (n = 764) another CVD, untreated diagnosed hypertension (n = 1308), measured high BP (n = 1070) and a reference group (n = 2728) with normal BP. RESULTS Hypertension in combination with another CVD was associated with increased cold-related dyspnoea (men: adjusted odds ratio 3.94, 95% confidence interval 2.57-6.02)/women: 4.41, 2.84-6.86), cough (2.64, 1.62-4.32/4.26, 2.60-6.99), wheezing (2.51, 1.42-4.43/;3.73, 2.08-6.69), mucus excretion (1.90, 1.24-2.91/2.53, 1.54-4.16), chest pain (22.5, 9.81-51.7/17.7, 8.37-37.5) and arrhythmias (43.4, 8.91-211/8.99, 3.99-20.2), compared with the reference group. Both diagnosed treated hypertension and untreated hypertension and measured high BP resulted in increased cardiorespiratory symptoms during the cold season. CONCLUSION Hypertension alone and together with another CVD is strongly associated with cold-related cardiorespiratory symptoms. As these symptoms may predict adverse health events, hypertensive patients need customized care and advice on how to cope with cold weather.