promotion of physical activity in finlandpromotion of physical activity in finland katja borodulin,...

21.3.2012 1

Promotion of physical activity in Finland

Katja Borodulin, Senior Researcher, Adj.Prof.

21.3.2012 2

Causal chain for ischaemic heart disease

WHO: Global Health Risks Report, 2009

21.3.2012 3

Risk of impaired glucose tolerance and type 2 diabetes in men and women (national FINRISK Study 2002)

4,51

2,89

1,00

6,17

3,95

1,37

0

1

2

3

4

5

6

7

1st 2nd 3rd

WHR tertiles

Ris

k o

f im

paired g

lucose t

ole

rance a

nd

type 2

dia

bete

s

Physically

active

Physically

inactive

(n=1276) Adjusted for age, family history of diabetes, systolic blood pressure,

alcohol consumption, and smoking. Borodulin et al. 2006,

Diabetic Medicine, 23:1025–28

21.3.2012 4

Risk of overweight or obesity (BMI >=25) in women aged 25-64 years

FINRISK 2002-study, adjusted for age and education

Borodulin ym. 2005

1 1,01

1,29

1,61

1,02

1,74

0,6

0,8

1

1,2

1,4

1,6

1,8

Low sitting Medium sitting High sitting

Ris

k o

f o

verw

eig

ht

or

ob

esit

y

Active

Inactive

21.3.2012 5

Aerobic fitness and waist-to-hip ratio associates with triglycerides in Finnish men

(National FINRISK 2002 Study, n=1787)

low middle high

1st tertile

2nd tertile

3rd tertile

0.5

0.8

1.1

1.4

1.7

2.0

2.3

2.6

Tri

gly

ce

rid

es

Fitness (p<0.001)

WHR (p<0.001)

Finnish men in National FINRISK 2002

Study (n=1713).

Controlled for age, smoking, and alcohol

use. P(interaction)=0.001

Borodulin et al. 2005,

Eur J Cardiovasc Prev Rehabil 12:126-131

21.3.2012 6

Aerobic fitness and waist-to-hip ratio associates with C-reactive protein levels

MatalaKeski

Korkea

1

2

3

0

0,2

0,4

0,6

0,8

1

CRP

Arvioitu aerobinen kunto

(p<0.001)

Vyötärö-lantio-

suhteen tertiilit

(p<0.001)

Finnish men in National FINRISK 2002

Study (n=1713).

Controlled for age, smoking, alcohol use.

p-value for interaction term=0.001

Borodulin et al. 2006,

Atherosclerosis, 185:381-7

21.3.2012 7

Associations of different types of PA with heart disease mortality

in Finnish women (National FINRISK Study 1972-2002)

Gang et al., Circulation, 2007,194:490–97

Adjusted for age, study year, education, alcohol consumption, smoking status, body mass index, systolic blood pressure, cholesterol, and history of diabetes, and separately for other types of physical activity.

21.3.2012 8

Time trends in leisure time, occupational, and commuting physical activity

1972-2002 (FINRISK Study)

Lähde: Borodulin et al. 2008, EurJPublicH

0

10

20

30

40

50

60

70

80

90

1972 1977 1982 1987 1992 1997 2002

Year

%

LTPA, men

LTPA, women

OPA, men

OPA, women

COMPA, men

COMPA, women

21.3.2012 9

Leisure time physical activity frequency, in men 1972-2002

0

5

10

15

20

25

30

35

40

45

50

1972 1977 1982 1987 1992 1997 2002

Daily

2-3x/wk

Once a week

Inactive

Borodulin 2005, unpublished

21.3.2012 10

Leisure time physical activity frequency, in women 1972-2002

0

10

20

30

40

50

60

1972 1977 1982 1987 1992 1997 2002

Daily

2-3x/wk

Once a week

Inactive

Borodulin 2005, unpublished

21.3.2012 11

What explains the changes in PA?

• Technological innovations, motorized transportation

• Washing machine, TV, internet, computer, elevator

• Urbanization

• Increased leisure time; exercise is fashionable, health club memberships etc.

• Daily PA and active transportation are decreasing

• Polarization of the society

21.3.2012 12

Prevalence of physical activity during leisure time in the European Union.

Martinez-Gonzalez et al. MSSE, 2001

medians (25th and 75th percentiles) of MET-h·wk-1 in leisure time

21.3.2012 13

Leisure-time physical activity among Finns

0

50

100

150

200

250

Kävely

työm

atk

alla

Pyörä

ily

työm

atk

alla

Juoksu

Hiihto

Kävely

Pyörä

ily

Uin

ti,

vesiv

oim

iste

lu

Aero

bic

Pallo-

ja m

ailapelit

Kunto

saliharjoitte

lu

Mets

ästy

s,

marjastu

s,

kala

stu

s

Pih

aty

öt

Rem

onto

inti

Mets

äty

öt,

halo

nhakkuu

Kotity

öt,

siivoam

inenLIIK

UN

NA

N M

ÄÄ

RÄ

(M

ET

h/v

)

mies

nainen

Lähde: Borodulin ym. 2006, L&T

Walking

Household chores, cleaning

Men

Women

Beneficial activities

(non-conditioning exercise)

Cross-country skiing

21.3.2012 14

PA Recommendations

• Based on scientific evidence on the dose-response relationship

• CDC, ACSM/AHA, WHO

• Separately for children, adults and older adults

ADULTS Moderate

(3-6 METs)

Vigorous

(over 6 METs)

Combination of Mod-Vig

Weight training

Frequency Most days of wk

3 per wk - 2 per wk

Duration 30 min/daily Min. 20 min.

- -

Energy expenditure

- - 450 MET min per wk

-

21.3.2012 15

Recommendation of PA in Finland

• “Current Care” guidelines by Finnish Medical Society Duodecim:

– weekly: moderate 2h 30 min OR vigorous 1h 15min AND weight training

• UKK institute for health promotion:

– ”PA pie”

21.3.2012 16

21.3.2012 17

Actors in health-enhancing PA in Finland

Central government

Ministry of Health

Other ministries

Local government

Municipalities (336)

NGOs

National sport & health/public

health organizations

Regional sport & health

organizations

Local sport & health

organizations

Private sector

Sport & exercise

services

Physical activity for

occupational

settings

Citizens

Ministry of education

and culture

21.3.2012 18

PA promotion ”playgrounds”

• Organized PA

• Non-organized PA

• Daily PA

Role of facilities & physical environment

Roles of local authorities, sport clubs, work places, schools, private companies

Role of personal motivation to PA

Difficult to make one PA program that fits all

21.3.2012 19

Examples of national initiatives and programs

• Fit for life program (adults 40+)

• Schools on move (children)

• Trip around the world (children)

• Strength to aging (older persons)

• Small daily decision (total population)

• the Adventures of a Finn-Man”, Meter-Man

(overweight men)

21.3.2012 20

Non-built environment

• Nature has a special meaning in Finland

• ”Every man’s right”

21.3.2012 21

Built environment and facilities

• Most facilities owned by local authorities (PA sector), but also increasingly by private sector

• Bike and pedestrian lanes (transport sector)

• Parks and recreational areas (park sector)

• Expensive to build and maintain

• Subsidized entrance fees if not free of charge

21.3.2012 22

Bike and pedestrian ways

• The most popular PA facility in

Finland

• An enabler to PA

• Maintained year around

• Safety, lights, cross-roads

21.3.2012 23

Summary

• Many Finns are not physically active enough

• Multisectorial collaboration is needed

• PA programs should be targeted and tailored in detail

• Infrastructure for PA makes a difference