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