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Khan H.,Emory University | Kella D.,Emory University | Rauramaa R.,Kuopio Research Institute of Exercise Medicine | Savonen K.,Kuopio Research Institute of Exercise Medicine | And 2 more authors.
Heart Rhythm | Year: 2015

Background Atrial fibrillation (AF) is the most common arrhythmia worldwide and has a complex association with physical fitness. The relationship of cardiorespiratory fitness (CRF) with the risk for AF has not been previously investigated in population-based studies. Objective The purpose of this study was to determine the relationship of CRF with incident AF. Methods CRF, as assessed by maximal oxygen uptake (VO2max) during exercise testing, was measured at baseline in 1950 middle-aged men (mean age 52.6 years, SD 5.1) from the Kuopio Ischaemic Heart Disease (KIHD) study. Results During average follow-up of 19.5 years, there were 305 incident AF cases (annual AF rate of 65.1/1000 person-years, 95% confidence interval [CI] 58.2-72.8). Overall, a nonlinear association was observed between CRF and incident AF. The rate of incident AF varied from 11.5 (95% CI 9.4-14.0) for the first quartile of CRF, to 9.1 (95% CI 7.4-11.2) for the second quartile, 5.7 (95% CI 4.4-7.4) for the third quartile, and 6.3 (95% CI 5.0-8.0) for the fourth quartile. Age-adjusted hazard ratio comparing top vs bottom fourth of usual CRF levels was 0.67 (95% CI 0.48-0.95), attenuated to 0.98 (95% CI 0.66-1.43) upon further adjustment for risk factors. These findings were comparable across age, body mass index, history of smoking, diabetes, and cardiovascular disease status at baseline. Conclusion Improved fitness as indicated by higher levels of CRF is protective of AF within a certain range, beyond which the risk of AF rises again. These findings warrant further replication. © 2015 Heart Rhythm Society.

Bakhoya V.N.,University of Eastern Finland | Kurl S.,University of Eastern Finland | Laukkanen J.A.,University of Eastern Finland | Laukkanen J.A.,Kuopio Research Institute of Exercise Medicine
European Journal of Preventive Cardiology | Year: 2014

Background: T-wave inversion (TWI) is a frequently encountered electrocardiographic (ECG) finding during routine medical examination of asymptomatic individuals, and of patients with various clinical conditions. However, the role of isolated TWI in the prediction of acute coronary syndrome (ACS) in the community has not been extensively studied. We investigated the relationship between TWI in routine ECG and the risk for ACS in the general population.Methods: This study is based on a random sample of 1997 men aged 42-60 years in Eastern Finland. Electrocardiograms recorded at rest were classified using the Minnesota codes. The association between isolated TWI and ACS was determined using a multivariable adjusted Cox proportional hazard model.Results: Negative T-waves were present in 3.6% of the participants. During an average follow-up of 20 years, a total of 493 ACS events were registered. After adjusting for age, TWI was associated with a 3.10-fold (95% confidence interval (CI) 2.21-4.32) risk for ACS. After additional adjustment for previously known coronary risk factors, TWI remained statistically significant in predicting ACS (relative risk 2.23; 95% CI 1.57-3.15). Negative T-waves was one of the strongest risk markers for ACS compared with other ECG-based variables such as left ventricular hypertrophy, previous Q-wave and prolonged QRS duration.Conclusion: TWI has a strong and independent predictive value for ACS in the general population. © The European Society of Cardiology 2012.

Ngandu T.,Karolinska Institutet | Lehtisalo J.,Karolinska Institutet | Solomon A.,Karolinska Institutet | Solomon A.,Institute of Clinical Medicine Neurology | And 27 more authors.
The Lancet | Year: 2015

Background Modifiable vascular and lifestyle-related risk factors have been associated with dementia risk in observational studies. In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), a proof-of-concept randomised controlled trial, we aimed to assess a multidomain approach to prevent cognitive decline in at-risk elderly people from the general population. Methods In a double-blind randomised controlled trial we enrolled individuals aged 60-77 years recruited from previous national surveys. Inclusion criteria were CAIDE (Cardiovascular Risk Factors, Aging and Dementia) Dementia Risk Score of at least 6 points and cognition at mean level or slightly lower than expected for age. We randomly assigned participants in a 1:1 ratio to a 2 year multidomain intervention (diet, exercise, cognitive training, vascular risk monitoring), or a control group (general health advice). Computer-generated allocation was done in blocks of four (two individuals randomly allocated to each group) at each site. Group allocation was not actively disclosed to participants and outcome assessors were masked to group allocation. The primary outcome was change in cognition as measured through comprehensive neuropsychological test battery (NTB) Z score. Analysis was by modified intention to treat (all participants with at least one post-baseline observation). This trial is registered at ClinicalTrials.gov, number NCT01041989. Findings Between Sept 7, 2009, and Nov 24, 2011, we screened 2654 individuals and randomly assigned 1260 to the intervention group (n=631) or control group (n=629). 591 (94%) participants in the intervention group and 599 (95%) in the control group had at least one post-baseline assessment and were included in the modified intention-to-treat analysis. Estimated mean change in NTB total Z score at 2 years was 0·20 (SE 0·02, SD 0·51) in the intervention group and 0·16 (0·01, 0·51) in the control group. Between-group difference in the change of NTB total score per year was 0·022 (95% CI 0·002-0·042, p=0·030). 153 (12%) individuals dropped out overall. Adverse events occurred in 46 (7%) participants in the intervention group compared with six (1%) participants in the control group; the most common adverse event was musculoskeletal pain (32 [5%] individuals for intervention vs no individuals for control). Interpretation Findings from this large, long-term, randomised controlled trial suggest that a multidomain intervention could improve or maintain cognitive functioning in at-risk elderly people from the general population. Funding Academy of Finland, La Carita Foundation, Alzheimer Association, Alzheimer's Research and Prevention Foundation, Juho Vainio Foundation, Novo Nordisk Foundation, Finnish Social Insurance Institution, Ministry of Education and Culture, Salama bint Hamdan Al Nahyan Foundation, Axa Research Fund, EVO funding for University Hospitals of Kuopio, Oulu, and Turku and for Seinäjoki Central Hospital and Oulu City Hospital, Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare, and af Jochnick Foundation. © 2015 Elsevier Ltd.

Haapala E.A.,University of Eastern Finland | Poikkeus A.-M.,University of Jyvaskyla | Tompuri T.,University of Eastern Finland | Tompuri T.,Kuopio University Hospital | And 6 more authors.
Medicine and Science in Sports and Exercise | Year: 2014

PURPOSE: We investigated the associations of cardiovascular and motor performance in grade 1 with academic skills in grades 1-3. METHODS: The participants were 6-to 8-yr-old children with complete data in grades 1-2 for 174 children and in grade 3 for 167 children. Maximal workload during exercise test was used as a measure of cardiovascular performance. The shuttle run test (SRT) time, the errors in balance test, and the number of cubes moved in box and block test (BBT) were measures of motor performance. Academic skills were assessed using reading fluency, reading comprehension, and arithmetic skill tests. RESULTS: Among boys, longer SRT time was associated with poorer reading fluency in grades 1-3 (β =-0.29 to-0.39, P < 0.01), reading comprehension in grades 1-2 (β =-0.25 to-0.29, P < 0.05), and arithmetic skills in grades 1-3 (β =-0.33 to-0.40, P < 0.003). Poorer balance was related to poorer reading comprehension (β =-0.20, P = 0.042). The smaller number of cubes moved in BBT was related to poorer reading fluency in grades 1-2 (β = 0.23-0.28, P < 0.03), reading comprehension in grade 3 (β = 0.23, P = 0.037), and arithmetic skills in grades 1-2 (β = 0.21-0.23, P < 0.043). Among girls, longer SRT time was related to poorer reading fluency in grade 3 (β =-0.27, P = 0.027) and arithmetic skills in grade 2 (β =-0.25, P = 0.040). The smaller number of cubes moved in BBT was associated with worse reading fluency in grade 2 (β = 0.26, P = 0.030). Cardiovascular performance was not related to academic skills. CONCLUSIONS: Poorer motor performance was associated with worse academic skills in children, especially among boys. These findings emphasize early identification of children with poor motor performance and actions to improve these children's motor performance and academic skills during the first school years. © 2014 by the American college of Sports Medicine.

Eloranta A.-M.,University of Eastern Finland | Lindi V.,University of Eastern Finland | Schwab U.,Kuopio University Hospital | Schwab U.,University of Eastern Finland | And 7 more authors.
International Journal of Obesity | Year: 2012

Objectives:To investigate the associations of dietary factors with overweight, body fat percentage (BF%), waist circumference (WC) and hip circumference (HC) among children. Design: Cross-sectional analysis of the Physical Activity and Nutrition in Children (PANIC) Study among 510 children (263 boys, 247 girls) aged 6-8 years from Kuopio, Finland. Methods: The childrens weight, height, WC and HC were measured. Overweight was defined by International Obesity Task Force body mass index cutoffs. The BF% was measured by dual-energy X-ray absorptiometry, nutrient intakes and meal frequency by 4-day food records and eating behaviour by Childrens Eating Behaviour Questionnaire. Results: Daily consumption of all the three main meals was inversely associated with overweight (odds ratio (OR) 0.37, 95% confidence interval (CI) 0.18-0.75), BF% (Β 0.12, P=0.012), WC (Β 0.16, P=0.002) and HC (Β 0.15, P=0.002). Enjoyment of food, food responsiveness and emotional overeating were directly associated with overweight (OR 1.57, 95% CI 1.04-2.35; OR 4.68, 95% CI 2.90-7.54; OR 2.60, 95% CI 1.52-4.45, respectively), BF% (Β 0.13, P=0.004; Β 0.30, P<0.001; Β 0.09, P=0.035, respectively), WC (Β 0.14, P=0.003; Β 0.40, P<0.001; Β 0.19, P<0.001, respectively) and HC (Β 0.15, P=0.001; Β 0.38, P<0.001; Β 0.15, P=0.001, respectively). Satiety responsiveness was inversely associated with overweight (OR 0.42, 95% CI 0.26-0.67), BF% (Β 0.20, P<0.001), WC (Β 0.26, P<0.001) and HC (Β 0.26, P<0.001). Slowness in eating was inversely associated with overweight (OR 0.61, 95% CI 0.41-0.92), WC (Β 0.16, P=0.001) and HC (Β 0.17, P=0.001). Protein intake was directly associated with BF% (Β 0.11, P=0.017), WC (Β 0.11, P=0.020) and HC (Β 0.13, P=0.008). Conclusions: Promoting regular consumption of main meals and healthy eating behaviours should be emphasized in the prevention of overweight among children. More research is needed on the association of protein-rich foods with body adiposity in children. © 2012 Macmillan Publishers Limited All rights reserved.

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